Cancer care in Brazil: structure and geographical distribution

Abstract

BackgroundThe organisation and systematisation of health actions and services are essential to ensure patient safety and the effectiveness and efficiency of cancer care. The objective of this study was to analyse the structure of cancer care envisaged in Brazilian norms, describe the types of accreditations of cancer services and their geographic distribution, and determine the planning and evaluation parameters used to qualify the health units that provide cancer care in Brazil.MethodsThis observational study identified the current organisation of cancer care and other health services that are accredited by Brazil’s national health system (SUS) for cancer treatment as of February 2017. The following information was collected from the current norms and the National Registry of Health Establishments: geographic location, type of accreditation, type of care, and hospital classification according to annual data of the number of cancer surgeries. The adequacy of the number of licensed units relative to population size was assessed. The analysis considered the facilitative or restrictive nature of policies based on the available rules and resources.ResultsThe analysis of the norms indicated that these documents serve as structuring rules and resources for developing and implementing cancer care policies in Brazil. A total of 299 high-complexity oncology services were identified in facilities located in 173 (3.1%) municipalities. In some states, there were no authorised services in radiotherapy, paediatric oncology and/or haematology-oncology. There was a significant deficit in accredited oncology services.ConclusionsThe parameters that have been used to assess the need for accredited cancer services in Brazil are widely questioned because the best basis of calculation is the incidence of cancer or disease burden rather than population size. The results indicate that the availability of cancer services is insufficient and the organisation of the cancer care network needs to be improved in Brazil.

Hospitalizations and length of stay of cancer patients: A cohort study in the Brazilian Public Health System

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Net survival for colorectal cancer in Cuiabá and Várzea Grande (state of Mato Grosso), Brazil

“…Its creation represented an increase in the supply of services, but regional differences, underfunding, changes in the age structure of the population and changes in its health conditions compromise its effectiveness [ 37 ]. Silva et al [ 38 ] showed that the provision of specialised services for cancer is still deficient in the country. The low survival rate in the study region may reflect the difficulty in accessing health services, when existent, due to social, economical, cultural and information barriers.…”

Challenge of Incorporating New Drugs for Breast Cancer in Brazil: A Proposed Framework for Improving Access to Innovative Therapies

“…The regions with the most qualified health care facilities are in the South and the Southeastern Brazil, accounting for more than two thirds of centers, as compared with three other regions that have < 10% each. 11 This inequality in resource distribution leads to important restrictions in diagnosis, staging, and comprehensive treatment. Additionally, conflicting regulations in specific areas of cancer care, insufficient funding of cancer programs, weak epidemiologic surveillance, and unclear pathways for patients with cancer increase barriers for adequate care.…”