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Lung cancer in the foreground: the IEO of Milan at the top in Italy
Lung cancer in the foreground: the IEO of Milan at the top in Italy
Alone 1 hospital Italian out of 4 meets the minimum standard for the volume of interventions. On https: //www.d oveecomemicuro.it/ the ranking of the most performing centers by number of pulmonary malignancy operations (source: PNE 2017). First, the European Institute of Oncology of Milan (IEO), followed by the National Cancer Institute of Milan, the Humanitas Clinical Institute of Rozzano, Spedaliero Hospital Spedali Civili of Brescia and San Raffaele Hospital. from Milan. 97.5% of residents choose to be treated in the Region
Too many hospitals still do excessively low volumes
Too many hospitals still have excessively busy volumes low in terms of lung cancer. Only 27% reach the 100 annual interventions set as the minimum national reference standard: threshold, however, revised in the 2017 edition of the NCP (National Agenas Results Program) and increased from 150 operations to 100. " The volume of interventions is a measurable parameter that can have a significant impact on the outcomes of care, "says Elena Azzolini, specialist in public health and member of the scientific committee of https: //www.doveecomemicuro .it /." Agenas – l & National Agency for Regional Health Services – monitors it on behalf of the Ministry of Health, along with other indicators such as mortality at 30 days of operation: the data confirm that there is an badociation between a high number of interventions and favorable outcomes. "" The accumulated experience is particularly important in the case of complex surgical operations, "says Erino Angelo Rendin. a, Ordinary of Thoracic Surgery at the Sapienza University of Rome and Director of Thoracic Surgery at the University Hospital Sant? Andrea di Roma, who comments: "Hospitals that make excessively low volumes should be discouraged ". How many and how are the structures treating this carcinoma distributed in our country?
Photograph of the Italian reality
Italian public or private accredited structures that perform the intervention for lung cancer are 147: 54% in the north, 19% in the center and 27% in the south . Of all the interventions, 56% were carried out in the north, 27% in the center and 18% in the south
Very few meet the standards
The minimum ministerial reference value of 100 interventions per year is reached 27% of centers: 59% in the north, 33% in the center and 8% in the south. For mortality 30 days after surgery, the maximum threshold established is 0.5%. The structures that meet the two reference values are 7, equal to 5%
Diffusion data
In the male bad, lung cancer is the most common carcinoma on the planet. In women, however, it is 2 ° in incidence after bad cancer.
According to Aiom-Airtum data every year in our country about 33 thousand people die from this neoplasm and 110 new diagnoses are made on average per day. "Statistics show a steady increase in incidence over the past two decades.But the increase in recent years has affected more women than men." There is no doubt On the basis of this push, there is a smoking habit, which is developing in the female population.Its responsibility has been known for many years, as well as the impact of the pollution of the environment. air in industrialized western cities.It is more difficult to scientifically demonstrate the cause-effect relationship between pbadive smoking and the occurrence of carcinoma, due to the discontinuity of exposure. " , explains Erino Rendina
Possible Prevention: Who Should Have A Checking And When? 19659003] "With the Big Killer, lung cancer owes its bad reputation to the fact that, being asymptomatic in the initial stages, it is usually discovered late Rendina explains, 60% of diagnoses occur when the disease is in an advanced stage and the path of radical surgery is no longer an option. To date, in Italy, there are no screening tests covered by the national health system that counteract this tumor. The most effective instrument is low-dose thoracic computed tomography, a test that is offered free to all major smokers and ex-smokers in the United States
"The recommendation for those most at risk of developing Neoplasm – that is, more than 40 years old – is to perform TC checks every six months or every year. This test, even repeated, entails no risk to health and can identify carcinomas when they are still operable and healed, "says the expert.
How to get there Diagnosis
"The path usually begins with a first visit to the general practitioner and then continue with a consultation with the specialist (pulmonologist, oncologist or radiologist). To diagnose and understand the stage of the disease, you can use various tests: in addition to CT, bronchoscopy, biopsy badociated with histological examination, chest x-ray, pulmonary scintigraphy and Magnetic resonance ", explains Erino Rendina
What treatments are indicated
" Surgery, in the absence of metastasis or excessive operational risk to the patient, is still the treatment of first choice. However, chemotherapy, radiotherapy, biological therapy and targeted therapy can be used before surgery – as a neoadjuvant treatment – to reduce the tumor mbad and make carcinoma functional, or later – as adjunctive therapy – to prevent the risk of recurrence. , the expert explains.
Immunotherapy is the new frontier for the treatment of unresectable lung cancer. "It occurs in the presence of a molecule called PDL1 .In some clinical studies that have reached the final phase of experimentation, it is also used as neoadjuvant or adjuvant therapy, before or after surgery." [19659002] How to choose the hospital?
To make a comparison between the structures is enough to insert in the "research" the chosen key word, for example "lung" or "malignant lung cancer" and to select the item which interests among those suggested. At the top of the results page appear the centers sorted by number of interventions, by proximity or according to other selectable criteria.
The green light indicates the respect of the ministerial threshold while a scroll bar shows the positioning of the individual structures in the national panorama. The evaluation is done considering institutional quality indicators such as activity volumes (data validated and disseminated by the NPP). It is also possible to insert in the "search" a specific visit or examination (chest CT scan, pulmonary scintigraphy, etc …) or a specific intervention (segmental resection of the lung, ie removal of one pulmonary segment, pulmonary lobectomy, ie the removal of an entire lung lobe, etc.), and then restrict the field to the region or city to which it belongs. To better filter the results, simply check the boxes in the lower left that relate, for example, to the certifications
REGIONAL CLASSIFICATION (Source PNE 2017)
Accredited public or private structures that carry out this type of certification. Intervention are 33. The 5 structures that, in Lombardy, carry out a greater number of interventions are:
IEO – European Institute of Oncology of Milan (Number d & # 39; interventions: 449) FIRST IN ITALY
National Institute of Tumors of Milan (No. of interventions: 398) THIRD IN ITALY
Humanitas Clinical Institute of Rozzano (MI) (Number of 39: interventions: 306) FIFTH IN ITALY
Hospital Ospedaliero Spedali of Brescia (n Interventions: 230)
Hospital San Raffaele – Hospital San Donato Group of Milan (Number of interventions : 181)
27% of the structures respect the reference value of at least 100 interventions per year. 19659027] The Hospital Osp San Raffaele – San Donato Hospital of Milan and Hospital San Gerardo de Monza (No. of interventions: 101) in addition to having high volumes interventions respect the reference values in terms of mortality rate 30 days after admission (which must remain less than 0.5%), respectively 0.48% and 0.5%
Ce are the only two structures that, in Lombardy, respect both reference values in terms of volume of interventions and low mortality, equal to 6% of the total structures performing this type of intervention
2.5% of residents choose to be treated in other regions
97.5% of residents choose to seek treatment in their own region
29.1% of interventions of Non-Residents
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