Saldanha Raphael de Freitas, Xavier Diego Ricardo, Carnavalli Keila de Morais, Lerner Kátia, Barcellos Christovam
Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Cad Saude Publica. 2019 Jul 22;35(7):e00090918. doi: 10.1590/0102-311X00090918.
This study aims to analyze the flow of breast cancer patients treated outside of their municipality of residence, based on hospital admissions and chemotherapy and radiotherapy in the Brazilian Unified National Health System (SUS) from 2014 to 2016. Network analysis was used, considering the municipality of residence and of treatment as nodes in a graph, thus consisting of a "health system organizational network study". In addition, highway distances and travel time were estimated via the best feasible route according to the Open Street Maps highway project. According to the results, 51.34% of breast cancer patients in Brazil were treated outside their municipality of residence, following regionalized flows that respect state borders, generally towards the state capital or other large cities. The results also point to specific exceptions, where some municipalities occupy outstanding positions that extrapolate state borders. Median travel time from the municipality of residence to the municipality of care was nearly 3 hours, and 75% of trips totaled 324km for chemotherapy, 287km for radiotherapy, and 282km for hospitalizations. These results are indicative of the difficulties in access to oncology services, potentially aggravating the illness experience with cancer in terms of impact on the individuals and their families.
本研究旨在基于2014年至2016年巴西统一国家卫生系统(SUS)中的住院治疗以及化疗和放疗情况,分析居住地以外地区接受治疗的乳腺癌患者的流动情况。采用了网络分析方法,将居住地和治疗地视为图中的节点,从而构成一项“卫生系统组织网络研究”。此外,根据开放街道地图公路项目,通过最佳可行路线估算公路距离和出行时间。结果显示,巴西51.34%的乳腺癌患者在居住地以外地区接受治疗,遵循尊重州界的区域化流动模式,通常流向州首府或其他大城市。结果还指出了一些特殊情况,某些市占据了跨越州界的突出位置。从居住地到治疗地的中位出行时间接近3小时,75%的化疗行程总计324公里,放疗行程287公里,住院行程282公里。这些结果表明获得肿瘤学服务存在困难,可能会在对个人及其家庭的影响方面加剧患癌体验。