Delays in the health care system for children, adolescents, and young adults with bone tumors in Brazil

Abstract

Health care delay among patients with a previous diagnosis was longer, and was probably associated with the time taken for to referral to cancer centers. Patients without a previous histopathological diagnosis had longer hospital delays, which could be associated with possible difficulties regarding demand and high-cost procedures. Despite limitations, this study helps provide initial knowledge about the healthcare pathway delays for patients with bone cancer inside several Brazilian hospitals.

The sarcoma diagnostic interval: a systematic review on length, contributing factors and patient outcomes

“…Four other studies reported similar results on total intervals for Ewing sarcoma and osteosarcoma; all had a trend towards a longer diagnostic pathway for patients with Ewing sarcoma 12 14 26 40. In a study by Widhe et al (n=106), the longer diagnostic pathway in Ewing sarcoma was a result of both a longer patient and primary care component12 whereas a study by Sneppen et al (n=124), reported a four times longer diagnostic interval for Ewing sarcoma than for osteosarcoma patients despite similar patient intervals 26.…”

“…Gender was not associated with the length of the total interval in four studies,12 26 39 40 however, there was evidence that patient age was a factor. Six studies reported a significantly longer total interval for older teenagers, adolescents or adults compared with younger children or (younger) teenagers (<12 vs ≥12–22 years1122; <20 vs ≥20–86 years26; <22 vs ≥22 years27; 0–14 vs 15–19 vs 20–29 years40; <12 versus ≥12 years11). Furthermore, Desandes et al found young adults were more at risk for a longer total interval than patients in puberty (15–19 vs 20–24 years; 10.1 vs 21.4 weeks respectively; p=0.04) 35.…”

“…Thirty-four studies involving a total of 17 258 patients investigated the total interval in BS (table 1)8–41; five of these studies prospectively collected follow-up data. A broad range in the length of the total interval was found, which varied from 9 to 120.4 weeks.…”

“…A qualitative study in Malaysia by Pan et al (n=30) demonstrated the multifactorial nature of diagnostic delay, which was dependent on the patient perception of symptoms and complaints, the influence of traditional healers and the proximity of health clinics 9. A Brazilian study with 1257 BS patients found differences in diagnostic intervals between geographic regions, possibly explained by the availability of CT scan equipment and the difference in number of hospital beds per region 40…”

Tempo até o Início do Tratamento Oncológico em Crianças e Adolescentes no Brasil

“…Com o intuito de evitar atrasos no processo entre a suspeição diagnóstica e a instituição terapêutica, recomenda-se que o paciente seja encaminhado ao serviço de referência na iminência da suspeita a fim de realizar o diagnóstico e, logo em seguida, iniciar o tratamento na mesma instituição, pois estudos apontaram que a necessidade de transferência após o diagnóstico se correlaciona com a extensão do tempo até o tratamento 15,16,20,24 . Tal achado pode ser em razão da demora no encaminhamento e da necessidade de percorrer maiores distâncias até a instituição que fornecerá o tratamento, o que pode implicar custos durante o deslocamento e estada do paciente e seu responsável, além da possível necessidade de este se ausentar temporariamente de suas atividades laborais, gerando impactos em todo o seio familiar.…”