Papel da navegação de pacientes na melhoria dos prazos para início e conclusão do tratamento radioterápico definitivo no sistema público de saúde de Belo Horizonte

Abstract

In Brazil, about 60% of cancer patients require radiotherapy (RT) and it contributes in 40% of the chances of neoplastic cure. There are several difficulties in accessing RT: deficit of devices, obsolete machines, heterogeneous distribution of services, lack of investment in human resources, sociodemographic obstacles for patients. Thus, it becomes necessary to optimize available resources, taking into account social difficulties. Considering the high incidence of cancer, a multifactorial difficulty in accessing treatment and the positive results with patient navigation in HICs, it was decided to test this tool to improve RT access in the public system in Brazil, Belo Horizonte. Methods: Pilot study carried out in partnership with the Global Cancer Institute, non-randomized, with a historical cohort as the control arm, with an estimated inclusion of 100 patients in each arm. Primary objective: to evaluate improvement in time for beginning and conclusion of RT in BH through PN. Secondary objectives: decrease the time between the beginning and the end of RT, identification and description of the main resources observed for access and quality of life data. For inclusion in the study, patients with cancer of the cervix, rectum, esophagus, anal canal, head and neck, lung and prostate who were considered candidates for neoadjuvant or definitive RT were evaluated. Statistical analysis would be performed in R software, using Wilcoxon Mann-Whitney test for independent samples. Results: 124 patients were included in the retrospective arm (112 being analyzed) and 73 in the navigation arm (only 1 excluded). Most had locoregionally advanced disease, the most prevalent sites being esophagus, head and neck and rectum. PN decreased the median time from biopsy result to the beginning of RT from 108 to 74 days (p<0.001). PN also decreased the time between biopsy results and referral to RT (53 X 40.5 days, p=0.011); between the referral and the first consultation in the RT (25 X 13 days, p<0.001) and between the referral and the end of the RT (98 X 78 days, p<0.003). There was an increase in the proportion of patients who started RT (in this case, their first treatment for cancer) within 60 days (maximum period established by law to start cancer treatment) from 20.5% in the retrospective arm to 38.5% in the prospective arm (p=0.026). Conclusions: Considering the full potential of the PN in an oncological context of socioeconomic vulnerability such as ours and the positive results of the project, we suggest an assessment of the expansion of this strategy, which, in addition, has no impediment costs.