The last issue for 2001 of our journal is closing a successful period of activity for Romanian Society for Radiation Oncology but unfortunately darkened by the premature loss of our active president, that who was and headed the Cancer Clinic Hospital from Oradea, Dr. Vasile Pacurar. The destiny choose this year to be under the sign of Dr. Pacurar whose activity as teacher, physician and leader of the RSRO has reached a real climax, to mention only a few accomplishments as nomination as professor at the Medical School Oradea, president of RSRO which under his mandate became the Romanian Society for Radiotherapy and Medical Oncology, president of the first congress of our Society and not the least, the initiation of an award program to honor the merits and the achievements of his colleagues from which with modesty and discretion, he has excluded himself. The consideration and the moral debt we have for his achievements and the energy with which he fought for the interests of the Romanian oncology and of the RSRO, are making us to dedicate this issue of our journal to professor Păcurar, whose personality is remember with deep sorrow In memoriam.
The first congress of RSRO that marks 10 years of existence for our society, was held in Baile Felix Oradea, on October 4-6, 2001 with a very actual and close to the president, professor V. Pacurar: The role of cancer care network in Romania. The main objective of the congress was to identify the problems and their solutions to improve the quality of cancer care in Romania and approaching not only the therapeutic aspects but also those related to the strategy and organization, prevention, economics and professional education. The whole content of this issue, is an invitation to meditation on the present status in Romania and on our obliga- tions as professional society committed to a confused and often hesitant health reform but all hoping, to be still perfectible.
Stelian Pop, in his paper Governmental and non governamental initiatives for cancer control makes some incisive assertions as: „we can no more to continue to do what we have done and to expect different
results II which invites us to think upon and to take action but he tells us also how we must proceed and most
important is to get political support and the government commitment to fight for health, the role of the profes- sionals being to present viable programs with measurable results for the community. Also telling us how to proceed, is Mihaela Beuran whose initiative and commitment of family physicians are already known but now she points to the obstacles she had to confront with. The family physicians’ experience is singular for our country and we should insist to be disseminated in many other counties. For the cancer of the cervix, the practice demonstrated that there could be a solution but the breast cancer screening is still a problem to be solved and its opportunity should be appreciated on medical and economical considerations which are re- viewed by N. Ghilezan.
The session dedicated to Cancer Registries, chaired by V. Pacurar, opened with a well-documented plea on the role and the objectives of cancer registration presented by Ofelia Şuteu. Extremely interesting was the confrontation between the national (V. Păcurar for Bihor county, Daniela Coza and N. Todor for Cancer In- stitute Cluj Registry) and international experience. No doubts, the only territorial registries that really are exist- ing, are those from Bihor and Arad which demonstrate that this is possible even if they are still at the beginning. The registration only is not enough without quality assurance and quality control of the data (V. V. Pacurar, Ofelia Şuteu) and more important, without to make the so necessary step forward which is the permanent inquiry of cancer i.e. the registration of different therapies and their results as well the analyses and the results publication to be available for the policy makers and the community as a whole. The solution for the so contro- versial, for Romania, problem of registration was found since long time, tells us Adela Raţiu who has introduced the CANREG program of the IARC in Oradea and is inviting the other centers to join the ENCR. We acknowledge with pleasure that the affiliation of the Territorial Registry of Bihor County to ENCR is a national first due to Professor V. Păcurar. Cristina Vitoc et al. supports the practical significance of the epidemiological studies based on the cancer registries, with the RSRO experience regarding the breast, cervix and head & neck cancer and the radiotherapy organization.
Romanţa Lupşa is presenting the WHO recommendations for the palliative treatments and ,more important, is estimating the needs for founding such specialized services for Romania.
Evidence based medicine and continuous medical education gives to T. E. Ciuleanu the opportunity to make an insight in the moral values of the physician from today and his new responsibilities he got due to the extraordinary progress of medical sciences, therapeutic possibilities, economical constraints and the liberty of decision in relation with the options and the rights of the patient but also with the society as a whole. He is well assisted by Alex Eniu who comments 0 beneficial personal experience at the European Institute of Oncology from Milan relating the quality of medical performance and the continuous medical education. In the same context, Viorica Nagy presents the therapeutic guides, the RSRO activity in this domain and the need to update them in relation with the general progress and the tricky problem of what should be the standards for Romania.
The Oncological Life in Romania signals through Cristina Vitoc, the celebration of two years since the opening of the Breast Cancer Center at the Cancer Institute of Cluj, with a many successful activities but also with many other objectives to be realized. V. Cernea et al. is announcing another first for the Romanian
oncology by presenting the Research Center for Radiation Oncology – RCRO, ajoint venture under the frame
of the Education and Research Ministry, sponsored by the World Bank and as partners University ,,I. Haţieganu” Cluj / Radiation Oncology Department, Cancer Institute Cluj, Babeş-Bolyai University and Romanian Society for Radiation Oncology. RCRO is a research base with multiple users open to students, pre- and postdoctoral fellows from the country or abroad. We wish a long and successful life to this center and especially the results that shall foster the progress of our specialties. Finally, the Declaration of the RSRO Congress 200 I, accepted by all the participants is published.
The tribute which this valuable issue brings to our most regretted friend and colleague, is one of highly appreciation and his image will last for ever in our memory as professor Dr. Vasile Pacurar, president of first RSRO congress and the enthusiastic soul of our biennial Baile Felix meetings.
Department of Oncology, Satu-Mare County Hospital
We are in a prolonged Reform, with many convulsions and dominated by half of measures. In our country Health occupies through tradition one of the last 2 or 3 places in the politics agenda and in the Budget Law. Some people consider that if they could avoid Oncology services they could avoid cancer, too. There still exist physicians as well politicians who consider the practice of oncology in Romania almost useless.
All these have a direct effect on the level of supporting the prophylactic, preventive and curative activities from the domain of Oncology. We confront with the disease that in this century will become the number one cause of mortality. We cannot wait for others to do something that we can do better. We cannot continue to do the same thing we did before but expecting different results. With an economy which is struggling to grow, with the money collected for the heath, but used for the black
holes in the economy, with a poor population, all we have left to do is to focus on a better use of the few we have. This could lead to better results and higher earnings for the specialists. The alternative is to complain and act to little and too late. How do we face the situation now? How prepared are we for what is next? What price does the priceless life for the healthy, sick, physicians and managers? How could we better allocate and manage the financial, human resources, the equipment, etc? At these questions and many others we have to find an answer, to have an opinion. Or we will follow someone else’s. The article debates about some strategic challenges: the need for health services integration, managerial performance increase, the institutionalization of continuous learning and the new role of the bureaucracy.
It is a process of continuous search. But it helps us grow the perfonnances and the solidarity of the Oncology community in Romania.
Key words: Health reform, evaluation, quality control
Radioterapie & On cologie Medicală. 2001. 4:326-331
Cluj Association of Family Physicians
In 1999-2000 the Association of Family Physicians Cluj designed and implemented in collaboration with the Romanian Cancer Society a „Pilot Project for Integrated Early Detection of Cervical Cancer” with the financial support of the Open Society Foundation.
The Objectives of the Project aimed at: achieving improved access and coverage to Pap testing for women belonging to underprivileged social segments by using Primary Care facilities as the site for project implementation, insuring adequate quality for sampling and interpretation of the smears and improved follow-up of abnormal test results.
The Results recorded at the end of2000, demonstrated an excellent capacity of Primary Care based programs to ensure improved coverage and access for women with inadequate prior testing as well as an increased attendance of women belonging to underprivileged socio-economic categories. The Pilot documented the capacity of Primary care providers to ensure an optimal quality of sampling techniques as well as the viability of the introduction of quality assurance mechanisms at the level of the Cytology Laboratory.
Less promising results were obtained regarding specialty follow-up of abnormal tests emphasizing the need for improvement in the area of interdisciplinary collaboration as well as in the design and functioning of the information system
Key words: Cervical cancer, Primary Care, early detection, coverage, quality assurance
Radioterapie & Oncologie MedicaIă, 2001, 4: 332-340
UMPh „luliu Haţieganu „, Cancer Institute „Prof I.Chiricuţă”, Cluj-Napoca
The breast cancer is an important public health problem and many countries developed mamographic screening programs that have diminished the mortality but mostly for the women of 49-69 years. The efficiency of these programs depend on the target population, the infrastructure and logistic of the screening units, the performances of the professionals, quality assurance and the management of the program. In Romania, due to a relatively small number of new cases, the organisation of a specialized network for screening, is not justifiable for the time being due to high costs and low efficiency. An acceptable alternative would be to improve in a first step, the conditions for the diagnosis and treatment in each county with the initiation of small pilot screening programs in the areas with higher incidence of breast cancer and enough resources for work-up, treatment and follow-up. The next step, depending the experience to be accumulated, a national plan for the whole country could be envisaged.
Key words: breast cancer, mammographic screening, cost-efficiency
Radioterapie & Oncologie Medicală, 2001, 4:341-346
Cancer Hospital, Faculty of Medicine and Pharmacie, Oradea
Population-based registries, a well-recognized method of epidemiological surveillance of neoplasical diseases are considered by WHO as mandatory elements for a national cancer control program. The present article offers a description of a population-based cancer registry, using the experience of Territorial Cancer Registry of Bihor County and the recommendations of the International Agency for Research on Cancer. The importance of a legal and financial basis for the cancer registries is out lined in the article. Continuing the health reform in our country is an important premise of improving the cancer control in our country.
Key words: cancer registries, epidemiology, cancer control.
Radioterapie & Oncologie Medicală, 2001, 4:347-353
Department of Epidemiology, UMPh „Iuliu Haţieganu” Cluj-Napoca
The cancer registry is an essential part of any programme of cancer control, providing the only opportunity for a proper assessment of the cancer burden from a population. Its data can be used in a wide variety of areas of cancer control ranging from etiological research, through primary, secondary and tertiary prevention to health-care planning, so benefiting both the individual and society. Two main issues should be considered when evaluating the quality of the data in a cancer registry: its completeness and its validity, with emphasis on the standards under which to operate, for quality assurance. Comparability is a key issue in cancer statistics; the uniform collecting and analysis of data are absolutely necessary to allow easy comparisons with results from other registries.
Key words: Cancer registry, Cancer surveillance.
Radioterapie & Oncologie Medicală, 2001. 4:354-359
Cancer Registry of Bihor County
The cancer registry has an important role in cancer control, by planning the cancer control programs and their evaluation and so they need standardized methods and principles of functioning. The best ones are the international principles as recommended by the International Agency for Research on Cancer. The presentation is focused on these recommendations, so that every registry could rise to the international standards. The present paper is closing with a brief presentation of the CANREG Program.
Key words: cancer registry, international principles, legal basis, data base
Radioterapie & Oncologie Medicală. 2001. 4;360-364
Cristina Vitocl, V. Pacurar2, Viorica Nagy1,3, N. Ghilezan1,3
1 Cancer Institute „Prof I.Chiricuţă”, Cluj-Napoca
2 Faculty of Medicine and Pharmacie, Oradea
3UMPh „Iuliu Haţieganu „, Cluj-Napoca
Consequently the unacceptable epidemiological data, for the period 1960- 1990 RSRO, decided to act for identify challenges and solutions for improvement cancer care in our country. We have completed three RSRO epidemiological studies: 1) Cancer of the cervix: the pattern of care Romania 1990- 1991. The experience of7 radiotherapy centers affiliated to RSRO; 2) Modalities and therapy results in breast cancer Romania 1990- 1992 RSRO’s multi -center study; 3) Head and Neck cancers. Romania 1990 – 1994. The experience of 6 centers affiliated to RSRO.
These studies are representative for our country, because more than 50% of new patients in Romania were treated in the participated centers. The main problems identified were: high incidence and mortality; low accessibility to treatment, late presentation to treatment, high variation in standard therapy, modest modem treatment, unsatisfactory follow up of patients and therapeutic results. In the following, we present the RSRO’ s proposals for improvement of cancer care, and the activities supported by RSRO in the general cancer field and especially for cervix, breast, head and neck cancers.
Key words: RSRO epidemiological studies, cervix cancer, breast cancer, head and neck cancer.
Radioterapie & Oncologie Medicală, 2001, 4;365-375
Daniela Coza, N. Todor
Oncological Institute “Prof I. Chiricuţă„, Cluj-Napoca
Hospital-based cancer register of Oncological Institute of Cluj is concerned with the recording of information on the cancer pacient seen in our hospital. The main purpose of such registry is to contribute to pacient care by providing readily accesible information on the subjects with cancer, the treatement they received and its result. The data are used mainly for administrative purposes and the analysis of clinical performance.
There is a description of the role of the Oncological Institute from Cluj, as a territorial coordinating center, the functional structure of hospital-based cancer registry, statistical data from the case load of our institute and the objectives that we have in view for the continuous improvement of the register.
Key words: register, new case, registration, reference, follow-up, quality control.
Radioterapie & Oncologie Medicală. 2001, 4:376-382
UMPh Tg. Mureş Dept. of Clinical Oncology
Supportive Care is the prevention and management of side effects of oncological therapy (chemotherapy, radiotherapy, surgery) for the patients suffering from cancer. Palliative care is understood to be the high level and professional treatment of noncreative and terminally ill patients, where curative measures are not possible anymore. Supportive Care and Palliative Care often overlap (pain release, cachexias). Both cares have the same goal: to reduce the patient’s subjective symptoms for keeping the patients quality of life on the highest possible level. Palliative Care is not just terminal care; it is practiced in hospices, at home, in hospitals with a consultative mobile palliative care team. Where can be done palliative care: on hospital or at home? The issue was analyzed by WHO and there are some standards in this field. In conclusion, palliative care is performed at home for 2/3 from patients and in hospitals for 1/3. A number of studies have documented that home is the site of care preferred by both patient and family. For developing the palliative care system is necessary to improve the professional knowledge by undergraduate and postgraduate teaching of all who are involved in this field.
Key words: palliation, supportive care, home care
Radioterapie &. Oncologie Medicală, 2001. 4:383-386
UMPh „I. Haţieganu”, Cancer Institute „Ion Chiricuţă”, Cluj Napoca
Practice of evidence-based medicine integrates individual competence with best external proof derived from clinical research. Systematic review of data allows defining levels of evidence, which constitute the basis for clinical guidelines (standards, options, recommendations). Adopting an evidence-based medical attitude does not limit the freedom of the medical decision. Simple distribution of the therapeutic guidelines has little impact on the medical behavior. An organized diffusion, within the frame or a politics of positive incitation can have beneficial effects. Quality and risk management and the accreditation are the pilars of this health politics.
Key words: evidence-based medicine, therapeutic guidelines, standards, options, recommendations.
Radioterapie & Oncologie Medicală, 2001, 4:387-394
Cancer Institute “Prof. I. Chiricuţă”, Cluj-Napoca
Continuing medical education (CME) is the process by which health professionals keep updated to meet the needs of patients, the health service, and their own professional development. We present the general characteristics of CME programs, with particulars for the american and european systems, together with the initiative for standardisation from the European Commission. In oncology, the CME process is fostered by the professional medical societies (ASCO, ESMO, ESTRO and ASTRO), whose programs ensure the accreditation/certification of the professional level. In Romania, the National program for Continuing Medical Education of the Medical Council is an attempt to meet the standards of the European Commission. Professional oncologists in Romania benefited from the SRRO initiative to develop an EMC program in oncology. To improve the results of such a system a good example can be the experience of other prestigious institutes, and we briefly present the CME programme of the European Institute of Oncology in Milan.
Key words: continuous medical education.
Radioterapie & Oncologie Medicală, 2001, 4;395-399
UMPh .”Iuliu Haţieganu” Cluj-Napoca,
Cancer Institute “Prof I. Chiricuţă”
Therapeutic guidelines have been developed by professional and academic associations to provide help to the practicioners for assuring a standard quality of care, a reference for reimbursement of the different medical procedures and activities, and to reasonably predict the level of the results to be expected. The journal Radioterapie & Oncologie Medicală published in the last 2 years several therapeutic guidelines for the principal tumor sites in Romania and many others are in progress. The therapeutic guidelines present the best treatment to be followed by the individual patient, according to international stand- ards and the actual local possibilities, and in the same time, offer a complete and update information to the patient
Key worlds: therapeutic guidline, committee for therapeutical decision.
Radioterapie & Oncologie Medicală, 2001, 4:400-403
Cristina Vitoc1, R.Tănăsescu1,2, Daniela Grecea1,2, AI. Eniu1, N. Todor1, N. Ghilezan1,2
1Cancer Institute „Prof I.Chiricuţă”, Cluj-Napoca
2UMPh „Iuliu Haţieganu” Cluj-Napoca
After two years of activity, the Breast Tumor Center (BTC) was initiated a survey for answering the following questions: 1) Was the BTC necessary for the activity of the Institute and for the patients?; 2) What novelty does the BTC represent?; 3) Which were the difficulties encountered?; 4) What objective are for the future? Overall the experience of the BTC was j positive and we could be very confident on the opportunity to provide a multidisciplinary management for breast disease j through a specialized service. This model could be extended to other tumor type and cancer centers, as the benefit is real for patients and institutions alike.
Key words: Breast Tumor Center, survey of 2 years.
Radioterapie & Oncologie Medicală. 2001, 4:404-408
1UMPh „Iuliu Haţieganu” Cluj-Napoca;
2Cancer Institute „Prof I.Chiricuţă”, Cluj-Napoca
Translational research is a particular type of intellectual effort with the aim to develop new treatment strategies based on fundamental research data. The translational research chain is reviewed, and the way in which the research has modified radiotherapy practice. In the second part of the paper Research Center for Radiation Oncology organized under the frame of the UMPh „I. Haţieganu” at the Cancer Institute Cluj as a joint venture with Romanian Society for Radiation Oncology is presented as well as the perspectives of such center in the more general context of scientific research in our country.
Key words: translational research, radiotherapy, research center.
Radioterapie & Oncologie Medicală, 2001, 4:409-414
Prietenul şi colegul nostru, cel care a fost conferenţiarul Dr. Vasile Păcurar şi preşedinte al Societăţii noastre, abia intrat în al 50-lea an de viaţă, ne-a părăsit într-o zi tristă de noiembrie a anului 2001, mult prea devreme pentru câte dorea şi câte avea de făcut pentru cei rămaşi în urma lui.
Născut la 24 august 1954 în localitatea Subpiatră din judetul Bihor, a cunoscut incă de copil greutătile unei lumi puternic marcată de urmările celui de al doilea război mondial şi mai ales de răsturnarea şi pervertirea valorilor spirituale şi morale. Într-o perioadă în care originea socială era mai importantă decât valoarea profesională, tânărul Păcurar a avut nevoie de multa forţă şi tenacitate să-şi realizeze visul de a deveni medic. Absolvent al Facultatii de Medicină din Cluj în 1978, revine în perioada 1982-1985 pentru specializare în oncologie, în cadrul Institutului Oncologic, specialitate şi instituţie de care a rămas legat pentru totdeauna. Anii studenţiei clujene au fost importanţi nu numai pentru pregătirea profesională a doctorului Păcurar dar şi pentru formarea unei culturi generale solide şi diverse având un grup de prieteni cu preocupări literare şi filozofice în care a avut şansa să-şi cunoască tovarăşa de viaţă, pe Iulia, un sprijn de nădejde pentru tot ce a realizat în continuare. Invăţăturile de acasă şi personalitatea tatălui, de multe ori evocat in discuţiile cu prietenii, şi contactul cu lumea universitară a Clujului i-au modelat un carcater puternic, cinstit şi obişnuit să spună adevărul chiar şi atunci când ştia că nu este cel mai plăcut.
Tenacitatea, puterea de muncă, rcceptivitatea la nou, dorinţa de continua perfecţionare sau darul de a convinge pe cei din jur cu entuziasmul său pentru o idee şi mai ales pentru realizarea ei, sunt calităţi care l-au caracterizat pe Dr. Păcurar şi i-au adus stima şi aprecierea celor cu care a colaborat. Aceste calităţi anunţau o frumoasă carieră profesională care s-a concretizat în anii 1990: medic primar în 1991, şef de lucrări la Facultatea de Medicină şi Farmacie din Oradea în 1995, doctor în ştiinţe medicale al Universităţii „I. Haţieganu” din Cluj in 1997, conferenţiar în 2001 sau membru în Comisia Naţională de Oncologie a Ministerului Sănătăţii, sunt numai câteva din jaloanele care marchează devenirea personalităţii profesionale a doctorului Vasile Păcurar. Anul2001 însă, a pus capăt brutal unei cariere profesionale care pentru mulţi ar putea fi mai mult decât implinită dar care pentru Dr. Păcurar ar fi însemnat, cu siguranţă, doar încă o etapă spre alte şi alte împliniri în lupta închinată celui suferind.
Câteva perform anţe profesionale merită în mod special subliniate: înfiinţarea învăţământului de oncologie la Universitatea din Oradea şi modernizarea Clinicii de Oncologie Oradea – un model de urmat pentru multe alte servicii, gazda şi organizatorul bienalelor de cancer mamar de la Băile Felix, manifestare devenită de tradiţie pentru oncologia românească dar poate cea mai importantă este şi va rămâne Registrul Teritorial de Cancer al judeţului Bihor, o premieră naţională prin concepţie, integrarea în reţeaua internaţională de profil şi publicarea Anuarului statistic, aflat la a 4-a ediţie. La această bogată şi valoroasă activitate profesională se adaugă o intensă activitate didactică cu numeroase publicaţii în reviste sau monografii, o prezenţă constantă şi activă la diverse manifestări ştiinţifice în ţară şi străinătate.
Energia debordanta şi plăcerea de a lucra cu oameni pentru oameni precum şi calitatile înăscute de lider explică prezenţa lui activă în societatea civilă românească ca preşedinte al Societăţii Române de Radioterapie şi Oncologie Medicală, vice-preşedinte al Societatii Române de Cancer Bihor, vice preşedinte al Academiei de ştiinte, Arte şi Literatură Bihor sau ca simplu om care prin educaţie şi caracter îşi asumă apartenenţa şi responsabilitate faţă de cetatea în care trăieşte el şi ai lui. A fost un ferment viu care a ars ca o flacără din dorinţa de zidire trainică în tot ce a făcut dar ne place să credem că printre cele mai aproape sufletului lui a fast SRRO pe care a slujit-o cu dăruire şi pricepere şi care la rândul ei l-a onorat doi ani la rând să o reprezinte din poziţia de preşedinte.
Omul Vasile Păcurar, ne duce cu gândul la prietenia şi căldura lui, la humorul spontan şi graiul ardelenesc în care ne vorbea despre păţaniile lui din tinereţe, visurile lui, problemele care îl urmăreau, bucuria pentru reuşitele celor din jur. Nu l-am văzut odată supărat sau cu ranchiuni, întotdeauna ajutându-şi şi respectându-şi colegii mai tineri sau mai in vârstă, recunoscând valoarea oriunde şi oricând.
Vasile Păcurar lasă în urma lui pe soţia Iulia, fiica Bianca şi ginerele Marius, şi mama Viorica, cărora le înţelegem şi impărtăşim durerea.Vasile s-a despărţit prea repede de noi toţi dar îi vom cinsti memoria şi-1 vom păstra în sufletul şi gândurile noastre.
Dumnezeu să-l odihnească!