Análise do atraso no tratamento do câncer de mama na Paraíba

Abstract

Background: The total number of deaths due to breast cancer in Latin American countries is expected to double between 2008 and 2030 to 73,542 cases, and it has been reported that 30% to 40% of patients present at advanced stages (III and IV). One of the major problems contributing to increased mortality rates for breast cancer in developing countries is delay of treatment. Objectives: The analysis of Brazilian studies, aimed on literature between the years 2006 and 2018, about breast cancer treatment delay. A research project focused on evaluation of acceleration of patient flow by intervention of non-governmental organizations (NGOs). NGOs donated diagnostic mammographies and biopsies. Furthermore, system delay (SD) was compared between two public reference centers of cancer treatment: One with integrated and the other one with outsourced diagnostic services. Methods: The integrative revision of Brazilian literature was performed applying the descriptors "Breast cancer" and "Delay" in four databases on literature. In the cross- sectional study about treatment delay, Cox regression analysis was used to identify variables that contributed to SD among 128 breast cancer patients treated at two referral centres. Kaplan- Meier analysis was performed to compare time intervals between patient groups of both referral centers. Results: Integrative revision led to identification of 17 studies: Nine studies have addressed only the system delay and eight addressed system delay and delay patient. Most cited causes of treatment delay were non- performance of screening test and routine consultation, lack of the important aspects of the disease, fear of diagnosis and treatment, low educational level and low family budget. In the cross-sectional study, those women who used a specialized private clinic at the beginning of patient flow had an increased chance (HR = 2.32; 95% CI: 1.17 - 4.60; p = 0.016) of hospital admission within 90 days after the first medical consultation, compared to women who used a public health care provider (HCP). Of 73 and 34 patients of the referral center with outsourced diagnostic services and the referral center with integrated diagnostic services, 10 (13.7%) and 11 (32.5%) used one HCP prior to hospital admission (p = 0.000). Time between first medical consultation and hospital admission was an average of 515 (SD = 36.6) and 135 (SD = 21.2) days for patients who used the referral center with outsourced, respectively, integrated diagnostic services, compared to 370 (SD = 78.2) days, for those women who received help by NGOs and were treated at the referral center with outsourced services (p = 0.002). Conclusions: Literature about treatment delay focused mainly of causal socio- economic aspects of patients. There was no Brazilian study comparing SD among referral centers with integrated and outsourced diagnostic services. In the present study about SD, those patients who used a public HCP had an increased SD compared to patients who never used them prior to hospital admission and those who used specialized private clinics at the beginning of patient flow. Furthermore, data indicated acceleration of patient flow by integration of diagnostic services, respectively, a low number of health care providers used by patients. Intervention of NGOs accelerated patient flow.