Availability and outcomes of radiotherapy in Central Poland during the 2005-2012 period - an observational studyby Justyna Chalubinska-Fendler, Wojciech Fendler, Michal Spych, Jolanta Luniewska-Bury, Wojciech Mlynarski, Jacek Fijuth

BMC Cancer


Oncology / Cancer Research / Genetics



Availability and outcomes e l S of assessments of healthcare system efficacy [1]. The

EUROCARE network collects survival data of patients nearly impossible. However, an opportunity to perform such analyses arose owing to the highly centralised

Chalubinska-Fendler et al. BMC Cancer (2015) 15:214

DOI 10.1186/s12885-015-1236-7framework for nationwide integrative database construction and present the methodology and efficiency of a

Street, 93-509 Lodz, Poland

Full list of author information is available at the end of the articlewith malignancies from European countries, thus allowing unbiased comparisons amongst countries and continents [2]. However, despite recent advances in computer use in clinical practice, Poland is still struggling with digitization of its healthcare registries, distribution of radiotherapeutic equipment and staff limiting the scope of epidemiological analyses of the Polish population [3]. network of radiation oncology departments which exists in the publicly funded oncological treatment system of

Poland. Within the 16 administrative regions of Poland (voivodeships) there are only 23 radiation oncology centres, which thus constitute foci for epidemiological analyses in oncology. In the Lodzkie Voivodeship, a single, large centre oversees radiotherapy (RTx) for all eligible patients with cancer, and has been running a computerised medical database since January 2005. We have used this resource to demonstrate the development of a * Correspondence: justyna.chalubinska-fendler@e.umed.lodz.pl †Equal contributors 1Department of Radiotherapy, Medical University of Lodz, 4 PaderewskiegoBackground: Using a cross-database integrative approach, we performed an epidemiological analysis in a representative region of central Poland to evaluate the availability of radiotherapy (RTx) and overall survival of adult patients undergoing

RTx for cancer.

Methods: Epidemiological data on cancer incidence in the 2005–2012 period were obtained from the Nationwide

Cancer Registry. Using data from the Ministry of Internal Affairs, we collected survival information of all patients treated in the only centre providing RTx for a region inhabited by approximately 2.6 million people.

Results: After filtering out individuals on the basis of exclusion criteria, the final dataset covered 17,736 patients.

Availability of RTx increased marginally, from 23.5% (2005) to 24.4% (2011, R = 0.39, p = 0.38), with the highest values noted in patients with cervical (78.5%), prostate (70.6%) and breast cancer (62.7%). However, due to the decreasing population of the region, we noted increasing disparity in the likelihood of receiving RTx depending on the patient’s area of residence, with rural areas becoming progressively more neglected. The best prognosis was noted among patients with breast or prostate cancer with 5-year OS rates reaching 81.2% and 83.3%, respectively. Multivariate analysis controlling for type of diagnosis and patient age showed a time-dependent improvement in outcomes (HR(95% CI): 0.96 (0.94-0.98); p < 0.0001).

Conclusions: Availability of RTx in Poland is still below that reported by developed European centres. Survival of patients undergoing radical RTx has gradually improved, although it is still below that of leading RTx departments, potentially due to delayed diagnosis or organisational barriers, necessitating further investigations.


Population-based survival studies are a cornerstone

This makes it extremely difficult to perform comparative analyses of prevalence, whilst estimation of survival isCentral Poland during th observational study

Justyna Chalubinska-Fendler1*†, Wojciech Fendler2†, Micha and Jacek Fijuth1

Abstract© 2015 Chalubinska-Fendler et al.; licensee Bio

Creative Commons Attribution License (http:/ distribution, and reproduction in any medium

Domain Dedication waiver (http://creativecom article, unless otherwise stated.Open Access of radiotherapy in 2005-2012 period - an pych1, Jolanta Luniewska-Bury1, Wojciech Mlynarski2Med Central. This is an Open Access article distributed under the terms of the /creativecommons.org/licenses/by/4.0), which permits unrestricted use, , provided the original work is properly credited. The Creative Commons Public mons.org/publicdomain/zero/1.0/) applies to the data made available in this

Chalubinska-Fendler et al. BMC Cancer (2015) 15:214 Page 2 of 11cross-registry search, focused on evaluation of RTx availability and survival of cancer patients.


The study aimed to synthesise oncological data from regional and national levels, integrate it with place of residence information and provide an epidemiological reference on radiotherapy accessibility and survivorship in the Lodzkie Voivodeship. Epidemiological data on the number of newly diagnosed cancer cases in the Lodzkie

Region were obtained from the nationwide cancer registry (data available for 2005–2012). This dataset is collated using reports from oncology centres and financial data of the National Health Fund. The registry is overseen by the National Centre of Oncology (NCO). The

NCO dataset was previously used for epidemiological reports [4,5], and we used it here as the reference for evaluation of RTx availability.

To analyse RTx-related data collected at department level, we used the computer-based dataset of all patients treated in the Department of Radiotherapy of the Medical

University of Lodz During the study period, this department was the only specialist radiation oncology centre for the Lodzkie Voivodeship, a region inhabited by 2.53-2.58 million people according to Central Statistical Office data (http://www.stat.gov.pl/bdlen/app/strona.html?p_name= indeks). The department’s database was installed in

October 2004 and became the principal data storage resource for the department in January 2005. The database was constructed using Microsoft Access architecture (Microsoft, Redmond, WA, USA). It is continuously updated on a daily basis and manually curated. Data entry is performed by a team of three dedicated medical secretaries, and correctness of the medical records is verified by each patient’s attending doctor before the patient’s discharge. Data on diagnosis is coded using the ICD-10 classification as legally required by the National Health Fund.