Availability of Diagnostic Services and their Impact on Patient Flow in Two Brazilian Referral Centres of Breast Cancer Treatment

Abstract

Background: System delay (SD) is a leading cause of advanced stage of disease and poor prognosis among Brazilian breast cancer patients. Methods: Cox regression and Kaplan-Meier analysis were used to identify variables that contributed to SD among 128 breast cancer patients. Time intervals between first medical consultation and treatment initiation were compared among patients of two referral centres: Patients of a referral centre with outsourced (FAP), respectively, integrated (HNL) diagnostic services. Results: Women who used a specialized private clinic at the beginning of patient flow had an 2.32 fold increased chance (95% CI: 1.17-4.60; p = 0.016) of hospital admission within 90 days after first medical consultation, compared to women who used a public health care provider (HCP). Of 73 and 34 patients of the FAP hospital and the HNL, respectively, 10 (13.7%) and 11 (32.5%) used one HCP prior to hospital admission (p = 0.000). The median time between first medical consultation and treatment initiation was 150 days. The median time between first medical consultation and hospital admission was 136.0 and 52.0 days for patients of the FAP hospital, respectively the HNL (p < 0.050). The median time between first medical consultation and diagnostic mammography was 36.5 and 23.0 days for patients from the FAP hospital and the HNL (p < 0.050). Conclusions: Usage of public diagnostic services was associated with increased SD, whereas the usage of private diagnostic services diminished it. The usage of a lower number of HCPs accelerated patient flow.

Health seeking behaviours and private sector delivery of care for non-communicable diseases in low- and middle-income countries: a systematic review

“…A common theme was the private sector performing better on process quality for resource-intensive interventions such as those requiring more health worker time, specialised expertise, costly medications, or diagnostics. Such examples included thrombolysis for stroke patients, [ 70 ] interventions for acute coronary syndrome (ACS), post-ACS management, [ 76 , 113 , 114 ] and cancer treatment, [ 69 , 107 , 115 , 116 ] and routine screening for diabetes complications [ 117 ]. Two studies also reported that patients in the private sector had access to new or expensive medications for cancer treatment [ 118 , 119 ].…”

Tempo para diagnóstico e tratamento do câncer de mama na assistência pública e privada

“…No Piauí, estudo realizado com 155 mulheres com câncer de mama verificou tempo mediano de espera entre o início dos sintomas e o diagnóstico de 122,3 dias (13) . Também na região nordeste, estudo realizado na Paraíba, com 128 mulheres identificou tempo mediano de espera de 86 dias entre a mamografia e o diagnóstico (14) . Estudo realizado no Paraná, com 71 mulheres com câncer de mama identificou tempo médio de espera para o diagnóstico de 102 dias (15) .…”

“…O percentual de mulheres que iniciou o tratamento em até 60 dias a partir do diagnóstico (80,5%) foi similar ao encontrado em estudo brasileiro multicêntrico que analisou dados de 151.931 mulheres e identificou tempo de espera inferior a 60 dias em 81,6% (9) . Por outro lado, outras investigações encontraram menor percentual de mulheres que realizaram o tratamento em até 60 dias (7,(13)(14)16,(18)(19) .…”

“…Em sua maioria, estudos descrevem tempo mediano de espera para o tratamento do câncer de mama superior ao verificado nesta pesquisa na região Sul (15) , Sudeste (18) e Nordeste (8,(13)(14)16) do Brasil. Tempos de espera inferiores foram identificados em países de alta renda (12) .…”

“…Em consonância com outros estudos, o tempo mediano de espera para o início do tratamento foi menor para as mulheres assistidas pela rede privada de saúde (7)(8)(9)14) .…”