Dados do Trabalho

Título

TIMING AND DELAYS OF ADJUVANT RADIOTHERAPY FOR BREAST CANCER IN THE PUBLIC HEALTH SYSTEM IN BELO HORIZONTE

Introdução

Breast cancer demands a multidisciplinary approach, including surgical and clinical oncology and radiation. The synergy between these is associated with better outcomes and reduction in mortality. When chemotherapy is not indicated, radiotherapy (RT) should be initiated within 8 weeks after surgery, if it’s administered first, it should be started within 7 months from surgery. A delay in these terms can lead to poor results. Several problems in Brazil's public healthcare system, SUS, are responsible for the deficit of RT for patients with breast cancer.

Objetivo

The present study was developed to estimate the amount of time required to start adjuvant RT and its delays at Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG).

Método

122 charts of female breast cancer patients were randomly selected from patients submitted to treatment with curative intent from 2003-2017 in the presented service. Primary endpoint was to set median time from surgery to adjuvant RT and secondary was to set median RT time. 94 patients were included, 26 were not due to lack of information.

Resultado

Median age was 49 years old (21 to 90). 21,5% were stage I, 41,9% stage II, and 34,4% stage III at diagnosis. The first potential obstacle to delay breast cancer treatment would be the interval between the biopsy and its result, with a median time of 13 days, but with a heterogeneous interval (1 to 77). The longer median times were: referral to RT start and completion, 54 days (1 to 238) and 97 days (43 to 285), respectively. The median time from surgery to RT start was 7 months (1 to 16), from diagnosis of cancer to RT completion 9 months (2 to 29) and RT start and RT completion was 42 months (20 to 80).

Conclusão

The results show great heterogeneity for completion of adjuvant RT, mostly due to long delays in RT start. Although the same oncology team conducted all our cases, the system is fragmented, making it even more difficult to receive multidisciplinary care. Besides that, most patients have a low level of education and do not fully understand the value of RT and the importance of performing it at the right terms. Unfamiliarity with the bureaucracies of the health system and family insufficiency are also factors that contribute to delay treatment. Improving these deadlines is a complex task and it involves education, equipment acquisition and planning. Some of the proposed solutions are the RT2030 project, hypo fractionated RT techniques in addition to multidisciplinary support.

Palavras-chave

Delays; radiotherapy; Breast Cancer

Área

Oncologia - Políticas Públicas, Acesso, Farmacoeconomia e Gestão em Saúde