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      Acesso à assistência oncológica: mapeamento dos fluxos origem-destino das internações e dos atendimentos ambulatoriais. O caso do câncer de mama Translated title: Access to cancer care: mapping hospital admissions and high-complexity outpatient care flows. The case of breast cancer

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          Abstract

          Este estudo analisa o fluxo de pacientes atendidas com câncer de mama, no Brasil, no âmbito do SUS, segundo o tipo de tratamento recebido. Foram identificadas redes de atenção oncológica com base nas informações do Sistema de Informações Hospitalares e do Sistema Informações Ambulatoriais de Alta Complexidade em Oncologia, relativas ao período 2005-2006, utilizando os programas TabWin e TerraView. O atendimento está amplamente distribuído pelo território nacional, com forte concentração nos maiores centros, e indícios de escassez de atendimento mesmo nas regiões onde a oferta de serviços é maior. Grande proporção das pacientes reside a mais de 150km do local de atendimento. A identificação das redes constitui ferramenta com aplicação importante no planejamento e na melhoria da distribuição dos serviços, considerando que o acesso geográfico é relevante para o desfecho do tratamento. A redução das taxas de morbidade e mortalidade depende da identificação precoce, pois, uma vez identificado o caso, o tratamento adequado e ágil concorre para reduzir os impactos da doença.

          Translated abstract

          This study analyzes the flow of patients with breast cancer treated in Brazil's Unified National Health System (SUS) by type of treatment (surgery, radiotherapy, and chemotherapy). Hospital and outpatient services networks were identified based on data from the National Information System for Inpatient Care (SIH), and the National Information System for Outpatient Cancer Care, for 2005-2006, using TabWin and TerraView. Health services networks reach most of the country, and few municipalities are not connected to a network. However, treatment is highly concentrated in the largest cities, and even the latter show evidence of service shortages. Furthermore, a large proportion of patients live more than 150km from the respective service. Network identification is important for planning and improving services distribution, since geographic access is a relevant issue for treatment outcome. Reduction of morbidity and mortality requires early identification, and appropriate and prompt treatment can reduce the impacts of the disease.

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          Late-Stage Breast Cancer Diagnosis and Health Care Access in Illinois.

          The variations of breast cancer mortality rates from place to place reflect both underlying differences in breast cancer prevalence and differences in diagnosis and treatment that affect the risk of death. This article examines the role of access to health care in explaining the variation of late-stage diagnosis of breast cancer. We use cancer registry data for the state of Illinois by zip code to investigate spatial variation in late diagnosis. Geographic information systems and spatial analysis methods are used to create detailed measures of spatial access to health care such as convenience of visiting primary care physicians and travel time from the nearest mammography facility. The effects of spatial access, in combination with the influences of socioeconomic factors, on late-stage breast cancer diagnosis are assessed using statistical methods. The results suggest that for breast cancer, poor geographical access to primary health care significantly increases the risk of late diagnosis for persons living outside the city of Chicago. Disadvantaged population groups including those with low income and racial and ethnic minorities tend to experience high rates of late diagnosis. In Illinois, poor spatial access to primary health care is more strongly associated with late diagnosis than is spatial access to mammography. This suggests the importance of primary care physicians as gatekeepers in early breast cancer detection.
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            A graph theory interpretation of nodal regions

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              Global Cancer Facts & Figures 2007

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                csp
                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro )
                1678-4464
                February 2011
                : 27
                : 2
                : 317-326
                Affiliations
                [1 ] Instituto Brasileiro de Geografia e Estatística Brasil
                [2 ] Universidade Federal do Estado do Rio de Janeiro Brasil
                [3 ] Universidade Federal do Rio de Janeiro Brasil
                [4 ] Instituto Nacional de Câncer Brasil
                [5 ] Fundação Oswaldo Cruz Brasil
                Article
                S0102-311X2011000200013
                10.1590/s0102-311x2011000200013
                2011125e-f99a-4906-a721-6001d4cb0d53

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Public Health

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0102-311X&lng=en
                Categories
                Health Policy & Services

                Public health
                Breast Neoplasms,Spatial Analysis,Health Services Accessibility,Informations Systems,Neoplasmas de Mama,Análise Espacial,Acesso aos Serviços de Saúde,Sistemas de Informação

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