This article presents the characteristics of activity limitations caused by lung cancer, considering clinical data, stages of the disease, and severity of the disability. The dynamics shows that the restrictions of the first, second, and third degrees relating to self-care, movement, and labor activity make up the largest share in the structure of activity limitations, while the restrictions of the first, second, and third degrees relating to communication constitute the smallest share.
Key words: disability, impairment, activity limitations, lung cancer
*Corresponding author: Levkin Vladimir Gennadyevich, the Head of Bureau No. 84 The Branch of the Federal State Institution “Main Bureau of Medical and Social Expertise in Moscow” of the Ministry of Labour of the Russian Federation. Email: [email protected]
Submitted: 25 November 2021; Accepted: 12 January 2022; Published: 1 March 2022
©2022 Levkin VG et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/)
A sharp increase in lung cancer cases is becoming a serious medical and social problem. Around 1.6 million new cases of malignant tumors are identified each year worldwide of which 13% is accounted for by lung cancer. In Russia, 63,000 people are annually diagnosed with lung cancer, which is ranked the first among male malignant tumors and the ninth in female malignant tumors. The incidence of lung cancer is increased by 0.6– 0.8% annually.
The maximum morbidity rate is observed among people aged from 55 to 70.1–5 In the structure of the disability, malignant tumors are ranked the second, and in several of the Russian regions they are on top. In the structure of the people firstly recognized as disabled owing to malignant tumors, lung cancer is accounted for by 50–70%; in the structure of the people repeatedly recognized as disabled, lung cancer cases substitute 3–5%. In the age structure, the impaired people above the working age and the disabled people of the first and second degrees prevail.6–11
To assess activity limitations and the degree of their severity based on the degree of impairment of the body functions of the disabled people, caused by lung cancer.
The methods used in the research were as follows: a documentary method and copying of data (250 units). For processing and analysis, the primary database was loaded into the R-environment (environment for statistical data analysis [http://www.r-project.org]. For continuous distribution of variables, we calculated the mean value, the standard ratio, used the t-test when comparing two groups and ANOVA when comparing several groups. For continuous abnormally distributed variables, we calculated the median, the first and the third quartiles and used the Kruskal–Wallis test for comparison. For categorical variables, we calculated the absolute and relative frequencies and used the Chi-squared test when checking the contingency tables. If there were more than two categories in the variable, the contingency table was calculated by many comparisons, and the P-value was adjusted by the Benjamini–Hochberg procedure.
Categorical variables are ordinal, and for each change threshold from the Spearman test P-values were calculated; with P ≤ P critical, the Spearman correlation coefficient was calculated. P-criterion was taken as equal to 0.05.
The medical and social characteristics of the people with disabilities caused by lung cancer were as follows. Men accounted for 77%, while women represented 23%. People with higher, secondary vocational, and secondary education constituted 36%, 44%, and 13%, respectively. The average height of women was 164.5 cm, while average height of men was 176.2 cm. Among young people, men accounted for 63.6%, while women accounted for 36.4%; among the middle-aged people, men made up 91.2%, and 8.8% was accounted for by women. Among people above the working age, men constituted 69.3%, while women represented 30.7%.
The majority were disabled people with Stage III and Stage IV lung cancer (45.0 and 23.0%, respectively). The disabled people with Group I prevailed (60%), and among them 92.9% had Stage III disease and 52.1% had Stage IV lung cancer. Ordinal correlation coefficient was equal to 0.72. The largest share in the structure of disability caused by lung cancer was accounted for by adenocarcinoma (29%), squamous cell cancer (26%), and small cell cancer (17%).
The most clinically observed conditions were general weakness (63.2%), shortness of breath on walking (55.6%), fatigue (23.3%), chest pains (22.4%), wet cough (21.2%), weight loss (15.6%), dizziness (14.4%), and dry cough (14.6%).
With the aggravation of the disease from Stage I to Stage III, the proportion of complaints about shortness of breath decreased from 82.1 to 55.6% (cor = −0.1). This is probably because the patients pointed out at the shortness of breath more seldom on the background of more significant complaints, whereas the complaint about the shortness of breath at Stage IV is much higher (63.4%) than at Stage III. Complaints about edema are presented only by patients with Stage III or Stage IV disease (2.8-7.1%), cor = 0.12. Complaints about chills are presented by persons with disability at Stage III or IV of the disease (4.2–7.1%), P = 0.05.
Table 1 shows the joint frequencies of the two symptoms. The grouping symptom splits the sampling into two groups, with the presence of the grouping symptom (yes) and without it (no). In Column N, the number of patients in each group is written, in the % column, the frequency of the second symptom in percent in both groups is indicated, in Column P, the result of the corresponding chi-squared test is stated, in the cor-column, the Spearman correlation value is specified.
Table 1. Results of contingency tables for complaints of disabled people due to lung cancer.
| Grouping symptom | Group | Number of patients in a group | Symptom | Number of patients with a symptom | Share of patients with a symptom (%) | P | cor |
|---|---|---|---|---|---|---|---|
| Throat, neck, arm, collarbones | No | 230 | Pain. Joints | 18 | 7.8 | 0.005 | 0.2 |
| Yes | 20 | 6 | 30 | ||||
| Pains, weakness in the lower limbs | No | 227 | Pain. Joints | 16 | 7 | 0 | 0.27 |
| Yes | 23 | 8 | 34.8 | ||||
| Weakness, fatigue | No | 83 | Pain. Headaches |
2 | 2.4 | 0.03 | 0.15 |
| Yes | 167 | 19 | 11.4 | ||||
| Dizziness | No | 214 | Pain. Headaches |
8 | 3.7 | 0 | 0.41 |
| Yes | 36 | 13 | 36.1 | ||||
| Mental disorders | No | 227 | Pain. Headaches |
15 | 6.6 | 0.005 | 0.2 |
| Yes | 23 | 6 | 26.1 | ||||
| Weakness, fatigue | No | 83 | Throat, neck, arm, collarbones | 12 | 14.5 | 0.016 | −0.17 |
Six out of 20 patients who reported throat-neck-hand-collarbone symptom (30.0%) and 18 of 230 patients who did not report this symptom (7.8%) noticed pain in joints, P = 0.005). The rank correlation coefficient between these two symptoms was cor = 0.2, which indicated a weak direct correlation.
Eight out of 23 people who reported pain and weakness in the lower limbs noticed pain in joints, which accounted for 7.0% (cor = 0.27). Ninteen out of 167 people who reported weakness and fatigue noticed headaches in the morning (11.4%), and 2 out of 83 patients reported this symptom (2.4%); P = 0.030, cor = 0.15. Thirty-six people reported dizziness, and 13 noted headaches (3.7%), cor = 0.41 (direct average correlation). Six out of 23 patients who reported mental disorders noticed a headache (26.1%), and only 15 people out of 227 people noticing mental disorders have a headache (6.6%); P = 0.005, cor = 0.2, which indicate a direct weak correlation. Eight out of 167 disabled people who reported weakness and fatigue (4.8%) and 12 out of 83 people who did not report weakness and fatigue (14.5%) noticed sore throat and pain in the neck, arms, and collarbones; P = 0.016, cor = 0.17, which indicate a weak inverse correlation. Six out of 8 impaired people who reported sweating (75.0%) and 64 out of 242 people who did not report sweating (26.4%) noticed chest pains; P = 0.009, cor = 0.19, which indicates a direct weak correlation according to Spearman. Five disabled people who reported pains in the back also reported of chest pains (26.5%); P = 0.002, cor = 0.23.
Ninety out of 110 disabled people who reported cough also noticed edema (81.8%), while 73 out of 140 patients who did not report cough noticed the shortness of breath (52.1%); cor = 0.31.
Ten out of 23 people who reported pain and weakness in the lower limbs (43.5%) and 153 out of 227 people who did not report pain and weakness in the lower limbs (67.4%) noticed the shortness of breath; P = 0.039, cor = −0.15.
Thirty two out of 36 disabled people who reported dizziness (88.9%) and 135 out of 214 people who did not report dizziness (63.4%) noticed weakness and fatigue (63.4%); P = 0.004, cor = 0.19.
Eight out of 28 impaired people with reported mental disorders noticed dizziness (34.8%), while 135 out of 227 people who did not report these disorders also noticed dizziness.
Neuromuscular, skeletal, and statodynamic impairments were reported as mild among 73 people (29%) and as moderate among 14 people (5.6%); 4.4% and 1.6% were accounted for by significant and highly significant impairments, respectively. The impairment of the cardiovascular system was mild in 48% of cases (120 people), moderate in 6.8%, and significant in 0.4% of cases.
The impairment of the respiratory system was mild in 13% of cases, moderate in 18% of cases (45 people), significant in 15% of cases (37 people), and highly significant in 21% of cases (53 people). The impairment of the blood and immune system was reported as highly significant in 42% of cases (104 people), as significant in 21% of cases, as moderate in 23% of cases, and as mild in 0.8% of cases. The impairments of the functions of the digestive and endocrine systems were mild (Table 2). Patients at the first and second stages of the disease had mild impairments of the sensory functions. The neuromuscular, skeletal, and statodynamic impairments were observed in 19%, 12%, 31%, and 38% at Stages I, II, III and IV, respectively. The largest proportion of moderate impairments of the statodynamic functions (64%) was reported among patients at Stage IV; significant impairments of the statodynamic functions were characterized as significant at Stage III (36%) and Stage IV (55%); highly significant impairments of the statodynamic functions were also observed at Stage IV. The largest proportion of moderate and significant impairments of the functions of the cardiovascular system was noticed at Stages III and IV, while mild impairments of the functions of the cardiovascular system were observed at Stages I and II. The impairments of the functions of the respiratory system were mild in 25% of cases at Stage I, in 44% of cases at Stage III, and in 22% of cases at Stage IV; moderate impairments of the functions of the respiratory system were observed in 18% of cases at Stages I and II and in 36 and 49% of cases at Stages III and IV, respectively; they were described as significant and highly significant in 38% and 25% of cases, respectively, at Stage III and in 51 and 73% of cases, respectively, at Stage IV. The impairment of the functions of the digestive system was mild at all stages (ranging from 19 to 26%) and significant only at Stages III and IV. The impairment of the functions of the blood and immune system was moderate in 49% of cases at Stage I, in 9% of cases at Stages II and III, and in 33% of cases at Stage IV, significant in 32 and 53% of cases at Stages II and III, respectively, as well as in 8% of cases at Stages I–IV; the largest proportion of such impairments was accounted for by cases at Stages III and IV. The correlation coefficient between the impairments of the functions of the respiratory system and the disease stages was equal to 0.31, and it was 0.26 between the impairments of the functions of the blood and endocrine system and the disease stages.
Table 2. Characteristics of the main types of permanent impairments of the body functions caused by lung cancer with regard to their severity (absolute number, %).
| The name of the main types of permanent impairments of the human body | Severity | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Normal | Mild | Moderate | Significant | Highly significant | ||||||
| Absolute number | Proportion | Absolute number | Proportion | Absolute number | Proportion | Absolute number | Proportion | Absolute number | Proportion | |
| The impairment of language and speech functions | 247 | 99.0 | 2 | 0.8 | 1 | 0.4 | – | – | – | – |
| The impairment of sensory functions | 242 | 97.0 | 8 | 3.2 | – | – | – | – | – | – |
| Neuromuscular, skeletal, and statodynamic impairments | 148 | 59.0 | 73 | 29.0 | 14 | 5.6 | 11 | 4.4 | 4 | 1.6 |
| The impairments of the functions of the cardiovascular system | 112 | 45.0 | 120 | 48.0 | 17 | 6.8 | 1 | 0.4 | – | – |
| The impairment of the functions of the respiratory system | 83 | 33.0 | 32 | 13.0 | 45 | 18.0 | 37 | 15.0 | 53 | 21.0 |
| The impairment of the functions of the digestive system | 224 | 90.0 | 21 | 8.4 | – | – | 4 | 1.6 | 1 | 0.4 |
| The impairment of the functions of the endocrine system | 231 | 92.0 | 14 | 5.6 | 3 | 1.2 | 1 | 0.4 | 1 | 0.4 |
| The impairment of the functions of blood and immune system | 34 | 14.0 | 2 | 0.8 | 57 | 23.0 | 53 | 21.0 | 104 | 42.0 |
| The impairment of the functions of the urinary system | 237 | 95.0 | 4 | 1.6 | 2 | 0.8 | 6 | 2.4 | 1 | 0.4 |
| The impairment of the functions of the skin and the systems related to it | 249 | 99.6 | 1 | 0.4 | – | – | – | – | – | – |
Table 3. The structure of the severity of the main types of permanent impairments of the body functions depending on the disease stages (absolute, %).
| Type of impairment | Degree of severity | The disease stages | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| I | II | III | IV | |||||||
| Absolute number | % | Absolute number | % | Absolute number | % | Absolute number | % | |||
| The impairment of sensory functions | Normal | 38 | 16 | 25 | 10 | 73 | 30 | 106 | 44 | |
| Mild | 1 | 12 | 1 | 12 | — | — | 6 | 75 | ||
| Moderate | — | — | — | — | — | — | — | — | ||
| Significant | — | — | — | — | — | — | — | — | ||
| Highly significant | — | — | — | — | — | — | — | — | ||
| The impairment of neuromuscular, skeletal and statodynamic functions | Normal | 21 | 14 | 18 | 12 | 43 | 29 | 66 | 45 | |
| Mild | 17 | 23 | 6 | 8 | 23 | 32 | 27 | 37 | ||
| Moderate | — | — | 2 | 14 | 3 | 21 | 9 | 64 | ||
| Significant | 1 | 9 | — | — | 4 | 36 | 6 | 55 | ||
| Highly significant | — | — | — | — | — | — | 4 | 100 | ||
| The impairment of the functions of the cardiovascular system functions | Normal | 15 | 13 | 11 | 10 | 28 | 25 | 58 | 52 | |
| Mild | 23 | 19 | 14 | 12 | 37 | 31 | 46 | 38 | ||
| Moderate | 1 | 6 | 1 | 6 | 7 | 41 | 8 | 47 | ||
| significant | — | — | — | — | 1 | 100 | — | — | ||
| Highly significant | — | — | — | — | — | — | — | — | ||
| The impairment of the functions of the respiratory system | Normal | 21 | 25 | 12 | 14 | 16 | 19 | 34 | 41 | |
| Mild | 9 | 28 | 2 | 6 | 14 | 44 | 7 | 22 | ||
| Moderate | 8 | 18 | 8 | 18 | 16 | 36 | 13 | 29 | ||
| Significant | — | — | 4 | 11 | 14 | 38 | 19 | 51 | ||
| Highly significant | 1 | 2 | — | — | 13 | 25 | 39 | 74 | ||
| The impairment of the functions of the digestive system | Normal | 35 | 16 | 21 | 9 | 64 | 29 | 104 | 46 | |
| Mild | 4 | 19 | 5 | 24 | 6 | 29 | 6 | 29 | ||
| Moderate | — | — | — | — | — | — | — | — | ||
| Significant | — | — | — | — | 2 | 50 | 2 | 50 | ||
| Highly significant | — | — | — | — | 1 | 100 | — | — | ||
| The impairment of the functions of the endocrine system and metabolism | Normal | 36 | 16 | 24 | 10 | 68 | 29 | 103 | 45 | |
| Mild | 3 | 21 | 1 | 7 | 4 | 29 | 6 | 43 | ||
| moderate | — | — | 1 | 33 | — | — | 2 | 67 | ||
| Significant | — | — | — | — | — | — | 1 | 100 | ||
| Highly significant | — | — | — | — | 1 | 100 | — | — | ||
| The impairment of the functions of the blood and immune system | Normal | 2 | 6 | — | — | 13 | 38 | 19 | 56 | |
| Mild | — | — | 1 | 50 | — | — | 1 | 50 | ||
| Moderate | 28 | 49 | 5 | 9 | 5 | 9 | 19 | 33 | ||
| Significant | 4 | 8 | 17 | 32 | 28 | 53 | 4 | 8 | ||
| Highly significant | 5 | 5 | 3 | 3 | 27 | 26 | 69 | 66 | ||
| The impairment of the functions of the urinary system | Normal | 38 | 16 | 25 | 11 | 68 | 29 | 106 | 45 | |
| Mild | 1 | 25 | 1 | 25 | 2 | 50 | — | — | ||
| Moderate | — | — | — | — | 1 | 50 | 1 | 50 | ||
| Significant | — | — | — | — | 1 | 17 | 5 | 83 | ||
| Highly significant | — | — | — | — | 1 | 100 | — | — | ||
Table 4 presents the results of the analysis of the relationship between permanent impairments of the body functions and the symptoms. In the upper cell, you can see a statistically significant correlation coefficient, and in the lower cell you can see the results of the Chi-squared test of the 2×2 table made up in accordance with the order of the degrees of impairment, categorized into two groups (1–3 and 4–5)—normal, mild, moderate, significant, and highly significant—with the greatest difference between them. There is a weak inverse correlation between pain in joints and the function of the blood system (cor = −0.13, P[1–3/4– 5] = 0.013). Between pain, weakness in the lower limbs, and neuromuscular, skeletal, and statodynamic dysfunctions, there is a weak correlation direct relationship (cor = 0.14, P[1–2/3–5] = 0.009).
Table 4. Correlation coefficients between clinical symptoms and impaired body functions of disabled people caused by lung cancer.
| Symptom | The impairment of neuromuscular, skeletal, and statodynamic functions | The impairment of the functions of the respiratory system | The impairment of the functions of the urinary system | The impairment of the functions of the blood and immune system | The impairment of the functions of the endocrine system and metabolism |
|---|---|---|---|---|---|
| Pains in joints | Cor = −0.13 P(1–3/4–5) = 0.013 |
||||
| Pains and weakness in the lower limbs | 0.14 P(1–2/3–5)=0.009 |
0.11 P(1–3/4–5) = 0.05 |
|||
| Chest pains | −0.16 P(1–3/4–5) = 0.014 |
||||
| Headaches | 0.09 P(1–3/4–5) = 0.032 |
0.14 P(1–2/3–5) = 0.057 |
|||
| Dizziness | 0.11 P(1–2/3–5) = 0.015 |
||||
| Cough | −0.13 P(1–4/5) = 0.033 |
||||
| Shortness of breath | 0.16 P(1/2–5) = 0.003 |
−0.19 P(1–4/5) = 0.002 |
|||
| Mental disorders | 0.1 P(1–2/3–5) = 0 |
0.18 P(1–2/3–5) = 0.002 |
|||
| Weakness and fatigue | −0.17 P(1–4/5) = 0.001 |
||||
| Fever and high temperature | 0.16 P(1/2–5) = 0.053 | ||||
| Edema | 0.1 P(1–2/3–5) = 0.003 |
Table 5. Characteristics of the life limitations of disabled people caused by lung cancer (absolute number, %).
| Limitation | Degree of severity | |||||||
|---|---|---|---|---|---|---|---|---|
| Normal | I | II | III | |||||
| Absolute number | % | Absolute number | % | Absolute number | % | Absolute number | % | |
| Self-care | 20 | 8.0 | 112 | 45.0 | 81 | 32.0 | 37 | 15.0 |
| Movement | 118 | 47.0 | 69 | 28.0 | 52 | 21.0 | 11 | 4.4 |
| Communication | 249 | 99.6 | 1 | 0.4 | – | – | – | – |
| Work | 6 | 2.4 | 37 | 15.0 | 63 | 25.0 | 144 | 58.0 |
Table 6. Characteristics of the life limitations of disabled people caused by lung cancer with regard to surgery interventions (absolute number, %)
| Statistics on the relationship between the ITU indicator and the presence of an operation | Category | Number of patients | Got operated | % |
|---|---|---|---|---|
| Self-care ability P = 0.01 cor = −0.18 Operation = yes, 68 out 132 (51.5%) in group ≤ first degree vs 38 out of 118 (32.2%) in group ≥ second degree (P = 0.003) |
Not established | 20 | 8 | 40 |
| First degree | 112 | 60 | 53.6 | |
| Second degree | 81 | 28 | 34.6 | |
| Third degree | 37 | 10 | 27 | |
| Work capability P = 0 cor = −0.45 Operation = yes, 71 out of 106 (67%) in group ≤ second degree vs 35 out of 144 (24.3%) in group ≥ third degree (P = 0) |
Not established | 6 | 1 | 16.7 |
| First degree | 37 | 36 | 97.3 | |
| Second degree | 63 | 34 | 54 | |
| Third degree | 144 | 35 | 24.3 |
The correlation between pain, weakness in the lower limbs, and the impairments of the functions of the urinary system equals to 0.11, P(1–3/4–5) = 0.05. Between headaches and statodynamic function, the correlation equals to 0.09, P(1–3/4–5) = 0.032; the correlation between headaches and the function of the respiratory system is 0.14, P(1–2/3– 5) = 0.0057. The correlation between the symptoms of dizziness and the impairment of neuromuscular and skeletal functions is 0.11, P(1–2/3–5) = 0.0015. There is a weak inverse correlation (cor = −0.13), P(1–4/5) = 0.033, between the clinical symptom of cough and the dysfunction of the blood and immune system. There is a direct weak correlation between the shortness of breath and impaired statodynamic function, cor = 0.16, P(1/2–5) = 0.003. The correlation between the shortness of breath and the impairment of the blood and immune system is weak and inverse, (cor = −0.13), P(1–4/5) = 0.002. The correlation between mental disorders and the impaired statodynamic function is 0.1, and the correlation between mental disorders and the impairment of the urinary system is cor = 0.18, P(1–2/3–5) = 0.002.
The correlation between symptoms of weakness and fatigue and the impairment of the respiratory function is (cor = 0.17), P(1–4/5) = 0.001. The correlation between symptoms of chills and high temperature and the dysfunction of the endocrine system equals to cor = 0.16, P(1/2–5) = 0.053, while the correlation between the edema and the impairment of the functions of the endocrine system is cor = 0.1, P(1–2/3–5) = 0.003. It has been found that disabled people with lung cancer have limitations regarding self-care, 45, 32, and 15% have limitation of first, second, and third degrees, respectively. Movement limitations include 28% limitations of the first degree, 21% of limitations of the second degree, and 4.4% limitations of the third degree. Regarding working limitations, they are of the first degree in 58% of cases, second degree in 25% of cases, and of the third degree in 15% of cases. Regarding self-care limitations, 68 out of 132 (51.5%) disabled people who underwent surgical interventions have the first degree of limitations, and 38 out of 118 (32.2%) have the second degree of self-care limitations; P = 0.003, cor = 0.18.
Among the disabled who underwent surgery, 71 out of 106 (67%) people have the work capability of the first and second degrees, while 35 out of 144 (24.3%) have third-degree work capability.
According to the data in Table 7, a direct correlation is established between the impairments of language and speech functions and the ability to communicate, (k = 0.58). The correlation coefficient between the impairments of neuromuscular, skeletal, and statodynamic functions and the self-care and movement limitations equals to 0.17 and 0.27, respectively. The correlation coefficient between the dysfunctions of the cardiovascular system and self-care limitations is k = 0.12, while the one between the dysfunction of the respiratory system and self-care and limitation and work capability equals to 0.3 and 0.21, respectively. The correlation coefficient between the impairments of the blood and immune system and self-care, movement, and working limitations is 0.14, 0.27, and 0.14, respectively.
Table 7. The table of correlation between impaired functions and life limitations of the disabled people caused by lung cancer.
| Impairment | Self-care | Movement | Communication | Working activity |
|---|---|---|---|---|
| Language and speech functions | — | — | 0.58 | — |
| Neuromuscular, skeletal, and statodynamic functions | 0.17 | 0.27 | — | — |
| Functions of the cardiovascular system | 0.12 | — | — | — |
| Functions of the respiratory system | 0.3 | — | — | 0.21 |
| Functions of the blood and immune system | 0.14 | 0.27 | — | 0.4 |
| Functions of the urinary system | 0.17 | 0.24 | — | — |
In the process of analyzing the life limitations caused by lung cancer with respect to clinical data, disease stages, and disability severity, it was found that self-care, movement, and working limitations of the first, second, and third degrees make up the largest share in the structure of life limitations, while communication limitations of the first, second, and third degree constitute the smallest proportion.
1. Dymochka MA, Verigina NB. Primary disability of adult population in the Russian Federation for the period of 2012–2017. Med Social Problems Disability. 2018;(2):8–6.
2. Krapivina EV, Sergrrva EV, Ivanov DV, Menkova AA, Malyavko IV. Homeostasis of pigs at different schemes of use of “Protamin” feed additive. J Pharm Negat Results. 2021;12(2):6–17. 10.47750/pnr.2021.12.02.002
3. Zapariy SP, Kosenok VK, Ivanilov AK. Main tendencies in the primary incidence of malignant tumors and primary disability of adult population of Omsk region for the period of 2007–2012. Siberian J Oncol. 2014;2(62):31–35.
4. Merabishvili VM. Cancer statistics (Traditional methods and new information technologies). Guidelines for doctors. Saint Petersburg; 2015. Part 2, 248 p.
5. Puzin SN, Shurgaya MA, Memetov SS. Disability in the 21st century. The state of the problem of medical and social rehabilitation and habilitation of the disabled people in modern Russia. Med Social Expertise Rehabs. 2018;21(1–2):10–17. 10.18821/1560-9537-2017-21-1-10-17
6. Alkhasove KA. The phenomenon of disability and social rehabilitation of the disabled people. Ufa; 2017. The Interaction of Science and the Society: The Problems and the Perspectives (Collection of research papers of the International Research and Practice Conference, Kazan, 2017); p. 140–3.
7. Verigina NB, Krasnovskaya ES, Volkova ZM. A comparative analysis of the dynamics of the level of the primary disability caused by main classes of the diseases of adult population in the Russian population and its districts for the period of 2016–2017. Med Social Problems Disability. 2018;(2):26–31.
8. Ihedioha TE, Odo RI, Onoja US, Nwagu CA, Ihedioha JI. Hepatoprotective properties of methanol leaf extract of Pterocarpus mildbraedii Harms on carbon tetrachloride–induced hepatotoxicity in albino rats (Rattus norvegicus). J Complement Med Res. 2019;10:162–9. 10.5455/jcmr.20190716093120
9. Vladimirova ON, Bashkireva AS, Korobov MV, Khorkova OV, Lomonosova OV. Primary disability of people of working age and above as a medical and social indicator of the health and greying of the population in the Russian Federation. Clin Gerontol. 2017;23(7/8):28–36.
10. Gumerova ZB, Nurullin RA, Fatkullina NM. The analysis of the primary disability caused by malignant tumors among adult population of the Republic of Bashkortostan in the dynamic for the period of 2015–2017. Med Social Problems Disability. 2018;(3):102–6.
11. Kaprin AD, Starinskiy VV, Petrova GV. The state of cancer care of adult population in Russia in 2016. Moscow: Federal State Budgetary Institution “P. Hertsen Moscow Scientific and Research Oncological Institute”; 2018. 235 p.
12. Sklyarenko RT, editor. Medical and social expertise on malignant tumors. Guidelines for doctors. Saint Petersburg; 2014. 341 p.
13. Angelovska B, Sersemova ED, Miceva D, Makraduli L. Analysis of the consumption of drugs for the treatment of peptic ulcer and gastroesophageal reflux issued on prescription in a four-year period. Int J Pharm Res Technol. 2021;11(2):53–6. 10.31838/ijprt/11.02.09
14. Sklyarenko RT, Dovgaluk AZ. Malignant tumors and disability: A guide for doctors. Saint Petersburg; 2021. 693 p.