HPA Magazine 6
Cancer starts with a group of cells that have lost their normal control mechanisms and therefore acquire an uncontrolled growth. A multiplicity of factors, both genetic and environmental, can increase the risk of developing cancer. The proven increase in oncological diseases is due not only to better diagnostics, but also to an effective increase in the incidence of certain types of cancer, namely those related to excessive consumption of alcoholic beverages, tobacco, certain types of food, as well as occupational cancer, pollution in all its forms and the increase in life expectancy at birth. The Gambelas Chemotherapy Day Hospital celebrated its fifth year in July. This was made possible by the service and support we offer to oncology patients and their families, with a team that is steadily growing and structured, now offering all necessary means for chemotherapy, distinguished by their technical competence as well as their compassion.
Oncology is the medical speciality that treats cancer and Oncologists are the professionals who fight the disease. Cancer is a disturbing health problem for the Portuguese, as justified by its growing morbidity and mortality. In Portugal, 37 thousand new cases of cancer are detected each year. In the region of the Algarve, there were 2,281 new cases in 2011, with breast cancer being the most frequent for women and prostate cancer having the highest incidence for men, followed by lung cancer.
Nowadays Oncology is a synthesis of multiple know-
ledge and experiences, which requires the presence of a multidisciplinary team of professionals with appropriate education and training. This team must work in coordination and it is led by member of the team with the most extensive training, namely the Oncology Doctor.
Oncological diseases are addressed by diagnoses, treatment and follow-up of the patients by a multidisciplinary team, in which specialists of the various areas of medical knowledge such as Medical Oncology, Surgery, Radiotherapy, Anatomic Pathology, Clinical Pathology and, depending on the malignant neoplasm, of other specialities such as breast cancer, Haematology (leukaemia, lymphoma), Gastroenterology (cancers of the stomach, colon and rectum, pancreas, gallbladder), Endocrinology (cancer of the oral cavity), Gynaecology (cancer of the uterus, ovary, vulva), Urology (cancer of the kidney, bladder, prostate, testicles), Neurosurgery (cancer of the central nervous system); Anaesthesiology (treatment of acute and chronic pain), Clinical Psychology and Psychiatry (psychological and psychiatric monitoring of patients).
Evaluation of the cancer begins with a clinical history and physical exam. Patients often complain of lack of appetite, weight loss, changes to the sense of taste and smell, fatigue, psychological disturbances and pain.
Both of these help the doctor to assess the risk of cancer that a person has and to determine the exams necessary to detect it. Oncology diagnosis is histological, and requires a biopsy. When cancer is detected, other exams help to find its exact location and to see if it has spread to other organs (metastases). Once established, appropriate treatment is planned and the prognosis is determined.
The Chemotherapy Day Hospital of the Hospital Particular do Algarve is a modern unit providing semi-inpatient care, which allows the patients to remain within their family, professional and cultural environment. The Day Hospital as a private plan offers some advantages such as easier and nearly immediate access to cytostatic chemotherapy in its various protocols, oral and intravenous, as well as a practically minimum waiting time to begin treatment, accompanied by a specialised medical and nursing team, 24 hours a day. Another advantage is the possibility of getting treatments through any health subsystem, such as ADSE, ADM, national and foreign health insurance.
From 2011, when the Day Hospital was created, to 2015, there has been a nearly 300% increase in the number of treatments. The age group is mainly those over 65, which accounts for 42.3% of the total number of our patients.
The cancers most often treated are breast cancer (38%), colorectal tumours (26%), prostate cancer (10%) and bladder (8%). The majority of our patients are Portuguese, who make up 71% of the total, followed by 13% from the United Kingdom, 5% from Portuguese-speaking countries, 3% from Germany and 1% from France, Switzerland, Russia and Morocco.
Patients undergoing treatment are always accompanied in medical oncology consultations, in order to assess how they are responding to the therapy and determine the most efficient treatment to provide a cure.
A cure is defined as complete remission, in which all signs of the cancer are gone. Nowadays, 65% of patients diagnosed with cancer live another 5 years. Many of these survivors are elderly and have other associated pathologies, which must be addressed in order to optimise the functional state and longevity. Family doctors have a fundamental role to play in the prevention of diseases and in the treatment of complications and associated pathological situations.
As a way of responding to the focuses and recommendations the National Oncology Plan has defined strategies and means of intervention in the fight against cancer, emphasising the need to intensify the fight against smoking, reduce occupational exposure and environmental pollution of the air, soil and water, promote education for healthy eating, such as the Mediterranean diet and inform the population about sun protection. Besides this, screenings have a fundamental role to play in wiping out cancer: breast cancer screenings by mammograms, in women between 50-69 years of age, cervical cancer by cervical cytology (Papanicolau), for women between 30-60 years of age, increase in the capacity for early diagnosis of colorectal cancer by Faecal Occult Blood Testing and colonoscopy for those in the 50-74 age group.