Appropriatezza diagnostico-terapeutica in oncologia - Quaderni del ...

Ministero della Salute
Foreword
The document “Diagnostic and therapeutic appropriateness in oncology”
aims to define the standards for diagnoses, therapy, assistance and care of
oncological and oncohematological patients. Just a few neoplastic diseases have
been considered (breast, lung, colon-rectum, prostate, pancreas, lymphomas),
which comprise two thirds of oncological disease.
One may ask the reason for such an emphasis on oncological disease. In our
country, cancer is second only to cardiovascular disease as cause of death; in
2010 there is a forecast of 250,000 new cases of cancer and an estimated prevalence
of 2,000,000 of existing cases; moreover the increasing life expectancy of
the population implies a gradual increase of the incidence of this disease. This
has a substantial impact in terms of costs for care and of hospital admittance
and, consequently, the need for adequate health planning.
The present document aims at providing a “reflection” on the best possible use
of the new diagnostic techniques and of innovative therapeutic strategies. It is
indeed unquestionable that in the two last decades there has been a revolution
in the prognosis and the therapeutic approach for oncological patients. However,
this has resulted in a sometimes uncontrolled increase in the health expenses.
In order to try to create regular and coherent standards of care, there has been
an effort to define the criteria of appropriateness for diagnosis, staging, therapeutic
strategy, the approach according to stage and follow-up procedure, so that
a global view of patient management by each pathology can be obtained.
The main inspiration in the preparation of this document was the search for a
multidisciplinary approach, a “veritable multidisciplinary approach” that
would involve all the professional figures, i.e. general practitioners, specialists
in radiology/nuclear clinicians, pathologists, surgeons, medical oncologists, radiotherapists
and pain therapists.
This process is in accord with the National Oncological Plan, that includes “full
management” of patients by the National Health System, in combination with
the best possible use of diagnostic and therapeutic approaches. The ever increasing
“shift” of patient care from the hospital to the surgery and to home care will
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