Acesso à assistência oncológica: mapeamento dos fluxos origem-destino das internações e dos atendimentos ambulatoriais. O caso do câncer de mama

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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.

Lan Luo, Veronica Escamilla, Fahui Wang … (2008)

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.