Grupo Oncoclínicas, Belo Horizonte, Brazil.
Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
JCO Glob Oncol. 2023 Aug;9:e2300078. doi: 10.1200/GO.23.00078.
The global burden of cancer in adolescents and young adults (AYAs) emerges as a major public health issue, in which remarkable challenges and unmet needs are evident. Because of sociodemographic inequalities, initiatives to change this scenario need to be expanded globally, particularly to low-middle-income countries (LMICs). This study aimed to gain information about the standards of AYA cancer care in Brazil from the physician's perspective.
Physicians involved in AYA cancer care were invited to answer a national online survey. The questions covered several aspects from health care's demographics to specialized services availability, such as fertility and genetic counseling. The availability of a specialized AYA cancer care facility was the primary study end point, and the findings were stratified by region and treatment setting (public private).
Among the physicians who responded (N = 249), 90% reported no access to a specialized AYA service. Only 20% had access to a fertility specialist, and 30% to a survivorship program in their institutions. Even external referrals to medical specialties were challenging, with 24% of the physicians reporting challenges. Despite the potential cardiotoxicity related to treatments, 43% of the respondents reported to refer patients for cardio-oncologists hardly ever. Furthermore, 36% of physicians had never enrolled AYA patients into clinical trials and 42% had never ordered a genetic test. Lack of specialized human resources was particularly evident in Northern Brazil, and delays in cancer diagnoses were frequent.
This first study addresses standards of AYA cancer care across Brazil. Importantly, the data disclose significant infrastructural gaps, implying that major investments in training and infrastructure are urgently needed. These data may mirror other LMICs reality.
青少年和年轻成人（AYA）的全球癌症负担成为一个主要的公共卫生问题，其中明显存在挑战和未满足的需求。由于社会人口不平等，需要在全球范围内扩大改变这种局面的举措，特别是在中低收入国家（LMIC）。本研究旨在从医生的角度了解巴西 AYA 癌症护理的标准。
邀请参与 AYA 癌症护理的医生回答一项全国在线调查。问题涵盖了从医疗保健人口统计学到专门服务的可用性等各个方面，例如生育和遗传咨询。专门的 AYA 癌症护理机构的可用性是主要的研究终点，研究结果按地区和治疗环境（公立/私立）进行分层。
在回答问题的医生中（N=249），90%的人表示无法获得专门的 AYA 服务。只有 20%的人能够获得生育专家的咨询，30%的人能够在自己的机构获得生存方案。即使向医学专科转诊也具有挑战性，有 24%的医生报告存在挑战。尽管与治疗相关的潜在心脏毒性，43%的受访者报告很少将患者转诊给心脏肿瘤专家。此外，36%的医生从未将 AYA 患者纳入临床试验，42%的医生从未要求进行基因检测。在巴西北部，专门的人力资源特别缺乏，癌症诊断的延迟也很常见。
这是第一项针对巴西 AYA 癌症护理标准的研究。重要的是，数据揭示了重大的基础设施差距，这意味着迫切需要在培训和基础设施方面进行重大投资。这些数据可能反映了其他 LMIC 的现实情况。
