According to the legislative framework, all patients with suspected neoplasms must be registered and registered without fail. Using dispensary observation, it is possible to detect pathology in a timely manner and prescribe the correct treatment, prevent complications, relapses and the spread of metastases. For the convenience of clinical examination, 4 clinical groups of cancer patients were developed, thanks to which it is possible to distribute the correct management of patients.
What is a tumor
Everyone knows that the human body consists of cells that perform different functions. However, under the influence of certain factors, they can cease to function correctly and begin to divide endlessly, thereby forming tumors. At the same time, such formations consume the hidden and main reserves of the body and release toxic metabolic products. Byas they grow, cells can “detach” and, along with the movement of blood or lymph, are redirected to the nearest organs or lymph nodes. Thus, the "metastasis" of the tumor occurs.
The concept of clinical groups of cancer patients
There are 4 specially designed groups for accounting, as well as tracking the timing and rules of clinical examination of patients. They are created to closely monitor the implementation of therapeutic measures and their effectiveness. Also, such accounting helps to conduct a timely examination of patients, detect the presence of metastases and relapses, and monitor newly ill, cured and deceased patients.
Clinical groups of cancer patients help to systematize lists for an adequate assessment of the situation for each individual patient. Thanks to such a division, oncological territorial departments monitor and notify the patient in time about the need for re-examination or additional measures. A similar distribution is required in oncology to obtain information about each patient and his condition. It is thanks to this classification that it is possible to compile truthful statistical information that helps to determine the big picture and take preventive measures.
It should be noted that the rules for dispensary observation are slightly different. There are such forms of pathology in which lifelong registration is required, in other cases such observation lasts 5 years after completecure and absence of metastases, and then the data is transferred to the archive.
Monitoring of patients is carried out according to the following scheme:
- for a year after therapy - once every few months;
- for the second year - once every six months;
- for the third or more - once a year.
Below we present a description of the clinical groups for registering cancer patients. This technique was created to facilitate the registration of cases. The patient's belonging to different groups is based on the results of treatment or examination. Depending on the dynamics and therapy, the patient may be redirected from one group to another.
Description and features of the first group
The first clinical group of cancer patients includes patients with suspected precancerous diseases or tumors.
Group a - it includes patients with an unspecified diagnosis and unclear signs of the disease. There are pre-established follow-up periods for such patients, which are equal to 10 days. After such a period, doctors are required to make an accurate diagnosis. Then the patient is either removed from the register or transferred to another oncology clinical group.
Group b - it includes patients with precancerous diseases:
- Optional precancer is a pathology that develops into cancer, but the likelihood of this is very small. Patients of this type are registered with different specialists.
- Obligate precancer is an ailment that most likely develops intomalignant neoplasm. Patients of this type are required to be registered with an oncologist.
People in the first clinical group of cancer patients are actively followed up for 2 years after treatment. Then they are removed from the register, and if complications are observed, they are transferred to other groups.
The usual dispensary card 030-6/y is started for such patients. All cards of patients who have been removed from the register are stored until the beginning of the reporting period, and then sent for computer processing and archive. If a patient needs to be re-entered into this group, a new card is created for the patient.
Description and features of the second group
The division of cancer patients into clinical groups is very important. For example, the second group includes patients in whom a malignant neoplasm has been confirmed and who require special therapy to achieve a stable remission or complete recovery.
This group includes all patients who have the opportunity to perform therapy to eliminate the source of inflammation and fully restore lost functions to improve the quality of life.
And also experts distinguish a separate group of cancer - 2a. This clinical group of cancer patients includes all patients requiring radical therapy. Often, patients in 2a are at stages 1–2 of the tumor process, in which it is possible to recover completely. There are also patients with a strictly localized or limited condition. After dispensary observation, such patients can be redirected to group 3 or 4.
Certain registration documents are drawn up for the 2nd clinical group of cancer patients. After the diagnosis is established, a form 090 / y is formed for each patient, which indicates that the patient went for the first time. It is compiled for everyone who sought medical help on their own or the problem was identified during the examination. Further, within 3 days, the document is transferred to an oncological institution and stored for at least 3 years.
After the end of therapy, form 027-1 / y is filled out. It is issued on the day of inpatient discharge, and then transferred to the territorial oncological institution located at the place of residence. And also a form 030-6 / y is issued, in which all information about the course of the patient's illness is located. It is filled in for the formation and registration of statistics.
Description and features of the third group
This category consists of patients who are practically he althy and simply under observation after the therapy. The 3rd clinical group is distinguished by the fact that in case of relapses, patients are transferred to the 2nd or 4th group. There are certain terms of the dispensary, and they depend on the form of cancer. Certain patients are forced to be observed by an oncologist for life, while others are enough for 5 years. If there are no recurrences, they are completely removed from the register. Special documentation is also maintained for this group, and after deregistration it is stored for 3 years and redirected toarchive.
Description and features of the fourth group
This category includes patients with advanced forms of the disease or in advanced stages, in which it is not possible to perform radical therapy, as in other clinical groups of oncological diseases. Category 4 includes persons who have had a relapse that is not subject to therapy. Patients of the 2nd group who refused therapy, or when the treatment is ineffective, are also included here. All such people are observed by a specialist at the place of residence.
It is possible that patients are brought here even after the initial examination, this often occurs in case of late seeking help. Many doctors refuse medical care to patients in this category, but this is strictly forbidden, as they need help to normalize the quality of life to a more comfortable level.
In addition to all the above documents, protocol 027-2/y is drawn up for this group, when a malignant formation is detected for the first time in the final stages. And also a similar document is drawn up posthumously if the disease has led to death.
The doctor's first steps
After establishing a malignant tumor, the doctor sends the patient to an oncological institution, as there specialists, in accordance with the classification of oncological diseases by clinical groups, will assign the patient to the required group. All required documents are also prepared, after which the person is redirected to the oncologicaloffice or dispensary. The patient is required to have an extract from the medical card with him. If the tumor was detected in an advanced stage, then, in addition to all the paperwork, a protocol is sent to the dispensary to detect advanced cancer.
Diagnosis
Everyone knows that with early recognition of any disease, there is a much greater chance for successful therapy, especially for oncology. All doctors know that a feature of any malignant neoplasm is the presence of local symptoms associated with the location of the tumor, as well as general signs, regardless of the affected organ.
Despite modern technologies, it is important for oncological practice to interview the patient and describe his complaints, according to which specialists make a diagnosis.
Anamnesis and complaints
The main reason that patients seek medical help late is that at the initial stages the tumor process does not manifest itself in any way. Further, such general symptoms are formed, which A. I. Savitsky called the "syndrome of small signs." Patients most often present with increased fatigue and decreased performance. Constant drowsiness appears, and interest in what is happening decreases. Then the appetite goes away, quite often for meat dishes, and the satisfaction from food disappears. Unusual and new sensations are formed. There may be a feeling of heaviness and tightness.
Quite often, the first sign is a simple feeling of discomfort, which the patient tries to explain with anything but the disease.
The presence of vomiting and nausea without visible symptoms, bloating, difficulty swallowing, the presence of blood in the urine and feces, or bloody discharge from the vagina are very often signs of cancer.
Treatment methods
Knowing the clinical groups of cancer patients and their characteristics, doctors apply different methods of therapy for each patient:
- 1a group. At the first suspicion of a disease, the doctor is obliged to examine the patient as soon as possible, up to 10 days. If there are no conditions for examination, then in order to make a diagnosis, it is required to redirect the patient to a dispensary or to an oncology room, providing him with an extract with the results of the studies. After 5-7 days, the doctor is obliged to check whether he got to the consultation. In this group, hospitalization is justified only if a special examination is required.
- 1in group. Patients who have facultative or obligate precancers require special therapy (radiation, surgery), so such people are referred to an oncologist. With facultative precancer, patients require special treatment, and they must be under dispensary supervision in the general medical network. There they take conservative therapy and undergo all examinations within the time limits established for such a disease.
- 2 and 2a groups. If a malignant neoplasm is detected in a patient, the doctor sends the patient with a similar statement to the oncology office of a district or city clinic. And also possibleredirection of patients of the general network immediately to the oncology dispensary or to another special institution where special treatment will be provided. After 7-10 days, the local therapist is obliged to find out if the patient went to therapy. Immediately, the doctor fills out and redirects the notification to the oncology office, while indicating to which center the patient was redirected.
- 3 group. As prescribed by the doctor, the local therapist provides the patient with a follow-up examination in the oncology room. If there is no oncologist, then the doctor independently performs the examination and examination of the patient and decides on the absence of metastases and relapse. Further, the revealed information is transferred to the oncological institution.
- 4 group. When a satisfactory condition is present, the doctor redirects the patient to an oncologist to develop a symptomatic treatment regimen. In case of serious illness, all consultations and procedures are performed at home under the guidance of an oncologist. For patients in whom the pathology was detected for the first time at an advanced stage, a special protocol is filled out and redirected to the oncology room.
All clinical cancer registration groups have been established to facilitate monitoring of patients and their condition.
