Changes in Statistics of Malignant Neoplasms of Central Nervous System Excluding Brain ( ICD-10 : C 70 , C 72 ) in the Lower Silesia Region of Poland in the Years 2006-2012

Epidemiological data concerning malignant neoplasms of meninges and central nervous system parts other than brain in Poland are reported to many medical databases run by various institutions and are incongruent with each other which makes their practical interpretation highly difficult. Data on registered cases of malignant neoplasms of meninges (C70-C70.9 ICD-10) and of spinal cord, cranial nerves and parts of central nervous system other than brain (C72-C72.9 ICD-10) in the years 2006-2012, made available by public healthcare insurance provider Narodowy Fundusz Zdrowia in Lower Silesia region of Poland (NFZ) and data on new cases from Polish national neoplasms registry Krajowy Rejestr Nowotworow (KRN), were analyzed. The study revealed that those neoplasms are rare in Lower Silesia region of Poland population, number of new cases dropped in the analyzed period, but the NFZ/KRN cases ratio increased significantly especially in case of malignant neoplasms of central nervous system parts other than brain or meninges, which suggests big, and increasing with time, amount of medical procedures needed by those patients. It points at the need of respective adjustment of the level of public financing of treatment of malignant neoplasms of meninges and other central nervous system parts than brain. The study results indicate also that epidemiological reporting system in Poland shall be improved as there is growing number of Polish physicians who report mainly unspecific broad ICD-10 categories and there are year-to-year alternations of reported numbers of cases that do not have any explanation other than formal shifting in reported ICD-10 categories. DOI : 10.14302/issn.2470-5020.jnrt-17-1529 Corresponding author: Jaroslaw Drobnik, Gerontology Unit, Public Health Department, Health Sciences Faculty, Wroclaw Medical University, Poland; 5 Bartel St., 51-618 Wroclaw, Poland, e-mail: jaroslaw.drobnik@umed.wroc.pl Running title : Changes in statistics of malignant neoplasms of CNS...


Introduction
The epidemiological data concerning malignant neoplasms of meninges and central nervous system parts other than brain in Poland are reported to many medical databases run by various institutions.It is demanded from all Polish medical professionals that vast data on all cases of cancer are sent to the national neoplasms registry.The respective legal regulation is often disobeyed by physicians overloaded by bureaucratic burdens, but in some occasions one case is reported by several different physicians in a row which is difficult to be detected on a routine basis.
Payments to the healthcare providers are made mainly by the Polish public healthcare insurance provider so theoretically this institution shall have the most reliable data on oncologic treatment.Unfortunately, the structure of the databases is mirroring the field of competences of the institution and allows retrieving data rather on medical procedures than on patients' diagnoses.The data from different sources are highly incongruent and in result even interpreting the direction of changes is difficult [1].
The part of medical care and social support system In the Lower Silesia region of Poland that shall be oriented on ageing society and long term care was reported to need adjustments [2].Availability of trustworthy statistical data concerning those rare conditions is important for long term planning of medical and social financing and development in order to avoid overlooking the existent needs [3].Although malignant neoplasms of meninges and central nervous system parts other than brain shall be considered rare in comparison to the most common cancers but unfortunately they pose a serious threat as their diagnosis is often delayed, final prognosis is bad [4] and even if the patients show positive response to treatment the results are often crippling and the patients remain dependent on others and thus require medical assistance and supportive care [5].

Materials and Methods
The aim of the study was to estimate yearly current changes in medical statistics of chosen malignant central nervous system neoplasms in the Lower Silesia's population.Data on registered cases of malignant neoplasms of meninges (C70-C70.9according to ICD-10) and of spinal cord, cranial nerves and parts of central nervous system other than brain (C72-C72.9

Discussion
The results of the study revealed that both malignant neoplasms of meninges and of other central nervous system parts other than brain (C70-C70.9and   Among the specific categories of malignant neoplasms of parts of central nervous system other than brain and meninges the biggest number of reported cases was concerning spinal cord lesions (C72.0 according to ICD-10) while the other specific categories were extremely rare.
The study results indicate that epidemiological reporting system in Poland shall be improved in many aspects.Not only there is big and growing number of

Figure 7 Figure 1 .
Figure 7 summarizes the number of cases of malignant neoplasm of meninges (C70-C70.9according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the beginning and the end of the analyzed period; the most reported cases fit into the unspecific categories.The total number of new cases of malignant neoplasms of spinal cord, cranial nerves and parts of central nervous system other than brain (main category C72 according to ICD-10, not divided into subcategories) in the Lower Silesia region of Poland reported to the Polish national neoplasms registry KRN in the years 2006-2012 was 55 and the yearly amount of those cases dropped in the analyzed period to reach in the end 50% of the initial value, as it is visualized in Figure 8.At the same time, the total number of cases of malignant neoplasms of spinal cord, cranial nerves and parts of central nervous system other than brain (main

Figure 2 .
Figure 2. Total number of cases of malignant neoplasms of meninges (main category C70 with subcategories according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 3 . 4 Figure 4 .
Figure 3. Number of cases of malignant neoplasm of meninges, specified as main category only (C70 according to ICD-10) registered yearly by

Figure 5 .
Figure 5. Number of cases of malignant neoplasm of spinal meninges (C70.1 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 6 .
Figure 6.Number of cases of malignant neoplasm of meninges, unspecified (C70.9 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 8 .
Figure 8. Number of new cases of malignant neoplasms of spinal cord, cranial nerves and parts of central nervous system other than brain (main category C72 according to ICD-10, not divided into subcategories) in the Lower Silesia region of Poland reported yearly to the Polish national neoplasms registry KRN in the years 2006-2012.

Figure 9 .
Figure 9.Total number of cases of malignant neoplasms of spinal cord, cranial nerves and parts of central nervous system other than brain (main category C72 with subcategories according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 19 summarizes the
Figure 19 summarizes the number of cases of malignant neoplasm of spinal cord, cranial nerves and parts of central nervous system other than brain (C72-C72.9according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006 and 2012; the most reported cases fit into the unspecific categories and they demonstrate the biggest rise in number.

Figure 10 .
Figure 10.Number of cases of malignant neoplasm of spinal cord, cranial nerves and parts of central nervous system other than brain, specified as main category only (C72 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 11 .
Figure 11.Number of cases of malignant neoplasm of spinal cord (C72.0according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 12 .
Figure 12.Number of cases of malignant neoplasm of cauda equina (C72.1 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 13 .
Figure 13.Number of cases of malignant neoplasm of olfactory nerve (C72.2 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 14 .
Figure 14.Number of cases of malignant neoplasm of optic nerve (C72.3 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 15 .
Figure 15.Number of cases of malignant neoplasm of acoustic nerve (C72.4 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 16 .
Figure 16.Number of cases of malignant neoplasm of cranial nerves other than olfactory, optic or acoustic nerve and of unspecified cranial nerves (C72.5 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 17 .
Figure 17.Number of cases of malignant neoplastic overlapping lesions of brain and other parts of central nervous system (C72.8according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 18 .
Figure 18.Number of cases of malignant neoplasm of central nervous system, unspecified (C72.0 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 19 .
Figure 19.Number of cases of malignant neoplasm of spinal cord, cranial nerves and parts of central nervous system other than brain (C72-C72.9according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006 and 2012.