Statistical Analysis of malignant Brain Neoplasms ( ICD-10 : C 71 ) in the Lower Silesia Region of Poland in the Years 2006-2012

It is crucial for the society, the government and the medical community to retrieve the full and reliable statistical information on malignant brain neoplasms (C71-C71.9 ICD-10) to adjust the medical financing, staff and equipment properly. In order to retrieve information useful for public health policies, data from the years 2006-2012 concerning relevant cases registered by the Polish public healthcare insurance provider Narodowy Fundusz Zdrowia in Lower Silesia region of Poland (NFZ) and by the Polish national neoplasms registry Krajowy Rejestr Nowotworow (KRN) were analyzed. The number of new malignant brain neoplasms cases registered by the KRN has risen slightly in the years 2006-2012. At the same time the number of cases reported by the NFZ rose dynamically, which means a significant increase in medical care intensity, and thus also workload on the medical facilities and stuff associated with the care for grossly the same amount of brain malignant neoplasms patients and, supposedly, their longer survival times. It indicates that the level of public financing of the malignant neoplasms of brain treatment shall be adjusted adequately. The study revealed growing popularity among reporting Polish physicians of the least specific malignant neoplasms of brain ICD-10 categories, despite the rapid diagnostic techniques development and availability. It is alarming since the medical statistics data quality in the field of malignant brain neoplasms is deteriorating that way and proper evaluation of treatment costs and planning future financial allocations by both the public healthcare insurance provider NFZ and the Polish government becomes difficult. DOI : 10.14302/issn.2470-5020.jnrt-17-1530 Corresponding author: Robert Suslo, Gerontology Unit, Public Health Department, Health Sciences Faculty, Wroclaw Medical University, Poland; 5 Bartel St., 51-618 Wroclaw, Poland, e-mail: robert.suslo@umed.wroc.pl Running title Statistical analysis of malignant brain neoplasms.


Introduction
Brain neoplasms are not among the most common cancers but nevertheless they remain a serious threat as their diagnosis is late and thus prognosis is poor in many cases [1].Even in the case of prolonged survival the results of oncologic treatment leave many of the patients with serious incapacitation demanding medical and social support [2].It is crucial for the society, the government and the medical community to retrieve the full and reliable statistical information on brain neoplasms to adjust the medical financing, staff and equipment properly [3].In the Lower Silesia region of Poland the medical support system for the old, incapacitated and chronically ill is considered inadequate [4].
The data on incidence and prevalence of brain neoplasms in Poland are collected by several institutions and thus lack consistency.It is obligatory for any Polish physician to report any case of neoplastic disease to the governmental neoplasms registry but the reporting rate is still unsatisfactory for many years now; on the other hand many cases seem to be reported and recorded into databases many times concurrently by many different physicians and the backwards verification of the reports is often difficult.On the other hand, the Polish public healthcare insurance provider -that is involved in financing treatment of practically all oncology-related patients -has the proper data available but the information is focused on the amounts of medical services resulting from the neoplastic disease and not on the count of the patients who received them In such a data environment providing relevant epidemiological information to the authorities is highly difficult and recognizing even gross trends may be problematic [5].

Materials and Methods
The aim of the study was to estimate yearly current trends in malignant brain neoplasms statistics in the Lower Silesia's population and their meaning for public health agencies.Data on registered cases of The structure of the available data did not allow performing any broader spectrum data analysis.

Results
The population of the Lower Silesia region of          Figure 14 summarizes the data concerning the reported to the NFZ structure of malignant tumors of brain cases in the beginning and in the end of the analyzed period: the most commonly reported ICD-10 categories were the most unspecific ones: C71 and C71.9.

Discussion
The data from the Polish national registry of malignant neoplasms of brain (C71-C71.9according to ICD-10) in the years 2006-2012, made available due to courtesy of the public healthcare insurance provider Narodowy Fundusz Zdrowia in Lower Silesia region of Poland (NFZ), were analyzed.Comparable data on reported new cases of malignant brain neoplasms (major group C71 according to ICD-10) in the years 2006-2012 in the Lower Silesia region of Poland were also retrieved from the official Polish national neoplasms registry Krajowy Rejestr Nowotworow (KRN).The data were analyzed with Microsoft Office Excel 2007 software.

Figure 1 .
Figure 1.Number of new cases of malignant neoplasms of brain (main category C71 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 2 . 3 .Figure 3 .
Figure 2. Total number of cases of malignant neoplasms of brain (main category C71 with subcategories according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 4 .Figure 5 .
Figure 4. Number of cases of malignant neoplasm of brain: cerebrum, except lobes and ventricles (C71.0 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 brain: temporal lobe (C71.2 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 7 .
Figure 7. Number of cases of malignant neoplasm of brain: parietal (C71.3 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 8 .
Figure 8. Number of cases of malignant neoplasm of brain: occipital lobe (C71.4 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 9 .
Figure 9. Number of cases of malignant neoplasm of brain: cerebral ventricle (C71.5 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.

Figure 10 .
Figure 10.Number of cases of malignant neoplasm of brain: cerebellum (C71.6 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 brain: brain stem (C71.7 according 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 brain: overlapping lesion of brain (C71.8 according to ICD-10) registered yearly by the public healthcare insurance provider NFZ in the years 2006-2012.
neoplasms KRN seems not to be too alarming as the number of new cases of malignant neoplasms of brain (C71 according to ICD-10) has risen only slightly in the years 2006-2012.However, the number of cases reported by the public healthcare insurance provider NFZ rose dynamically as rose also the NFZ/KRN cases yearly ratio.Assuming that the reporting to the KRN efficacy did not change significantly in the analyzed years it means a significant increase in care intensity, and thus also workload on the medical facilities and stuff associated with the care for grossly the same amount of brain malignant neoplasms patients and, supposedly, also their longer survival times.It indicates that the level of public financing of the malignant neoplasms of brain treatment shall be adjusted adequately.Among the specific ICD-10 subcategories there was significant rise in the number of reported malignant neoplasms of brain located in temporal lobe, parietal lobe, occipital lobe and cerebral ventricle (C71.2,C71,3, C71.4 and C71.5 according to ICD-10, respectively) whereas a significant drop was to be observed in the case of malignant neoplasm of cerebrum, cerebellum and brain stem (C71.0,C71.6 and C71.7 according to ICD-10, respectively); the authors intend to seek for some medical explanation of those changes in the future.The growing popularity among reportingPolish physicians of the least specific malignant neoplasms of brain ICD-10 categories shall be interpreted as alarming since the medical statistics data quality is deteriorating that way, thus proper evaluation of treatment costs and planning future financial allocations by the public healthcare insurance provider NFZ and the Polish government becomes increasingly difficult.