Alves Soares Ferreira Naidhia, Melo Figueiredo de Carvalho Sionara, Engrácia Valenti Vitor, Pinheiro Bezerra Italla Maria, Melo Teixeira Batista Hermes, de Abreu Luiz Carlos, Matos Leandro Luongo, Adami Fernando
Laboratory of Epidemiology and Data Analysis. School of Medicine of ABC, Santo André, SP, Brazil.
Oncológica Brasil Ensino e Pesquisa., Belém, PA, Brazil.
BMC Womens Health. 2017 Feb 21;17(1):13. doi: 10.1186/s12905-016-0359-6.
Considering the inequalities and the areas of low socioeconomic status in Brazil, access to health services is a challenge and the delay between diagnosis and treatment represents an important factor of worse prognosis in patients with breast cancer. Herein, we describe the clinical and epidemiological profiles of women with breast cancer and evaluate their access to health services, as well as treatment delays, at a reference centre of the Cariri region, Ceará, Brazil.
This is a retrospective study that included 473 women treated with breast cancer between 2009 and 2011 at the Oncology Centre of the Cariri.
The majority of these patients were aged between 40 and 69 years old (65.7%), without a completed high school degree (89.2%). They were married (62.9%) and were already diagnosed but had not yet been subjected to any previous treatment (77.8%). It was observed that 91.8% were referred from the public health service, and treatment was paid for by the public health service in 92.9% of the cases. The patients whose source of referral was the public system waited longer between diagnosis and the treatment initiation (p = 0.031; Mann-Whitney's test), with a median waiting time of 71.5 days versus 39 days for those receiving referrals from private services. In addition, those with public referrals prior to diagnosis also experienced a longer waiting time between the first medical visit and treatment initiation (77 days vs. 37 days; p = 0.036; Mann-Whitney's test), with the waiting time for the biopsy being an important factor in this delay.
Late diagnosis was often the result of inefficiency of the prevention policies coupled with difficulty accessing the public health network. It was commonly observed that, even after diagnosis, the patients needed to wait too long before entering the Oncology Service because of long waiting queues in the public health system.
考虑到巴西存在的不平等现象以及社会经济地位较低的地区，获得医疗服务是一项挑战，而乳腺癌患者诊断与治疗之间的延迟是预后较差的一个重要因素。在此，我们描述了巴西塞阿拉州卡里里地区一家参考中心的乳腺癌女性患者的临床和流行病学特征，并评估了她们获得医疗服务的情况以及治疗延迟情况。
这是一项回顾性研究，纳入了2009年至2011年期间在卡里里肿瘤中心接受乳腺癌治疗的473名女性患者。
这些患者大多数年龄在40至69岁之间（65.7%），未完成高中学业（89.2%）。她们已婚（62.9%），已被诊断出患有乳腺癌但此前尚未接受过任何治疗（77.8%）。据观察，91.8%的患者是由公共卫生服务机构转诊而来，92.9%的病例治疗费用由公共卫生服务机构支付。转诊来源为公共系统的患者在诊断与开始治疗之间等待的时间更长（p = 0.031；曼-惠特尼检验），中位等待时间为71.5天，而从私人服务机构获得转诊的患者为39天。此外，在诊断前由公共机构转诊的患者在首次就诊与开始治疗之间的等待时间也更长（77天对37天；p = 0.036；曼-惠特尼检验），活检的等待时间是造成这种延迟的一个重要因素。
诊断延迟往往是预防政策效率低下以及难以接入公共卫生网络的结果。普遍观察到，即使在诊断之后，由于公共卫生系统排队时间过长，患者在进入肿瘤服务部门之前仍需等待很长时间。
