Análise dos intervalos de diagnóstico e tratamento no itinerário terapêutico de pacientes ambulatoriais com câncer de mama em um Hospital Universitário Federal

Abstract

Breast cancer is a global public health problem. The increase in their mortality is directly proportional to changes in demographic patterns, such as population aging and economic development. The challenge is to ensure equitable and comprehensive access to timely diagnosis and treatment of the disease. In view of this, in 2012, Federal Law No. 12,732 (Law of 60 days) was enacted, which establishes that the first cancer treatment in the SUS must start within a maximum period of 60 days, from the signature of the pathological report, or in shorter term, according to the therapeutic need of the case. The objective of the study was to map the flow of care for breast cancer patients at the Institution and analyze the intervals of diagnosis and treatment of breast cancer, in women treated between January 2018 and December 2020, at a Federal University Hospital (HUF).), considering Law No. 12,732 of 2012 and the context of the Covid-19 pandemic. This is a study with a quantitative approach, of a descriptive, observational, cross-sectional, retrospective type, with a survey of secondary data. The research universe consisted of 276 female patients diagnosed with breast cancer. Data collection was performed using information available in medical records, in the Hospital Management System (AGHU) and in the Authorization Form for High Complexity Procedures (APAC). Data were submitted to descriptive statistical analysis for qualitative variables. Regarding sociodemographic and clinical characteristics, the median age of women at diagnosis was 58 years old, 67% are mixed race, 79% come from the central health macro-region and 52.2% arrived at UNACON in early stages (I and II) of the breast cancer. The type of therapy most indicated as the first treatment was surgery (58%). As for the time intervals, it was observed that the average between suspicion and diagnostic confirmation was 52 days and, between diagnosis and the beginning of treatment, it was 83 days, with 66.7% of patients having a longer time. to 60 days. In other words, the deadline recommended by Law 12,732 of 2012 was met in only 33.3% of cases. As for the associations of variables and intervals studied, it was found that the greater the age, the longer the time between diagnostic confirmation and initiation of treatment. The same was observed for patients with early stage breast cancer (I and II). Regarding the type of treatment, it was found that patients with chemotherapy as the first strategy are treated in a shorter time. Finally, it was evidenced that there was no difference in the time intervals, as well as in the proportion of staging and type of therapeutic treatment in the analyzed years, being considered normal period (year 2018), pre-pandemic (year 2019) and during the pandemic. Covid-19 (2020). It is essential to reduce the intervals between the different stages that make up the line of care for patients with breast cancer, in order to provide cancer treatment in an ideal time, as recommended by the legislation.