Abstract:Efeito do tempo de espera para radioterapia na sobrevida geral em cinco anos de mulheres com câncer do colo do útero, 1995-2010Effect of waiting time for radiotherapy on five-year overall survival in women with cervical cancer, 1995-2010 Efecto del tiempo de espera para radioterapia en una sobrevida global en 5 años de mujeres con cáncer del cuello uterino,
“…35 . With regard to advanced-stage diagnosis, Nascimento and Silva 36 detected 78.9% of the women studied in the intermediate stages and 5% in the advanced stages of the disease, corroborating with the perspective that more advan-ced ages and social and racial inequalities are correlated with a higher CC risk and prevalence. The limited access to cervical cancer (CC) diagnosis services was related to organizational barriers and limited action by health professionals 33,37,38 .…”
Section: Care Line Milestonesupporting
confidence: 66%
“…In Brazil, there is a legal definition of the maximum term for the initiation of treatment by the SUS of 60 days from the establishment of the diagnosis obtained with the biopsy result 39 . According to Nascimento e Silva 36 , this period was considered taking into account the onset of radiotherapy, by most of the "patients". The same study evidenced equiChart access to radiotherapy, that is, waiting time for the start of radiotherapy was lower as the cases were diagnosed with increased advanced stages (Chart 2).…”
Section: Access To Services For Treatment Of Cervical Cancermentioning
confidence: 99%
“…The maximum term for initiation of cancer treatment in Brazil mentioned above is a valid parameter used in some studies, but Nascimento e Silva 36 emphasize that the treatment should occur as soon as possible and should not adopt the 60 days defined by law as the deadline. This term has relevance in terms of legal interpellation, but there are countries with a deadline of less than 30 days, as in the case of Canada.…”
Section: Access To Services For Treatment Of Cervical Cancermentioning
Resumo Este artigo revisa os fatores limitadores e facilitadores do acesso aos serviços públicos de saúde no Brasil na área da atenção ao câncer de colo de útero (CCU). Nesta revisão, foram utilizadas a base de dados bibliográficos Medline (interface com Biblioteca Virtual de Saúde/BVS e PubMed) e os portais Lilacs e SciELO. Buscou-se publicações referentes ao período 2011-2016, a partir do uso de termos específicos das fontes consultadas, relativos a ‘neoplasias do colo do útero’ e ‘acesso aos serviços de saúde’. Foram inicialmente encontrados 704 artigos, mas, considerando os critérios adotados, foram selecionados 31 artigos, dos quais foram incluídos 19. Foram mencionados aspectos facilitadores do acesso como ampla cobertura do exame Papanicolaou e de biopsias equivalente ao número de preventivos alterados. Entretanto, aspectos limitadores de acesso como periodicidade inadequada do Papanicolau, dificuldades para agendamento de consultas e exames, alto índice de estadiamento avançado e atrasos no diagnóstico e no início de tratamento, também foram apresentados.
“…35 . With regard to advanced-stage diagnosis, Nascimento and Silva 36 detected 78.9% of the women studied in the intermediate stages and 5% in the advanced stages of the disease, corroborating with the perspective that more advan-ced ages and social and racial inequalities are correlated with a higher CC risk and prevalence. The limited access to cervical cancer (CC) diagnosis services was related to organizational barriers and limited action by health professionals 33,37,38 .…”
Section: Care Line Milestonesupporting
confidence: 66%
“…In Brazil, there is a legal definition of the maximum term for the initiation of treatment by the SUS of 60 days from the establishment of the diagnosis obtained with the biopsy result 39 . According to Nascimento e Silva 36 , this period was considered taking into account the onset of radiotherapy, by most of the "patients". The same study evidenced equiChart access to radiotherapy, that is, waiting time for the start of radiotherapy was lower as the cases were diagnosed with increased advanced stages (Chart 2).…”
Section: Access To Services For Treatment Of Cervical Cancermentioning
confidence: 99%
“…The maximum term for initiation of cancer treatment in Brazil mentioned above is a valid parameter used in some studies, but Nascimento e Silva 36 emphasize that the treatment should occur as soon as possible and should not adopt the 60 days defined by law as the deadline. This term has relevance in terms of legal interpellation, but there are countries with a deadline of less than 30 days, as in the case of Canada.…”
Section: Access To Services For Treatment Of Cervical Cancermentioning
Resumo Este artigo revisa os fatores limitadores e facilitadores do acesso aos serviços públicos de saúde no Brasil na área da atenção ao câncer de colo de útero (CCU). Nesta revisão, foram utilizadas a base de dados bibliográficos Medline (interface com Biblioteca Virtual de Saúde/BVS e PubMed) e os portais Lilacs e SciELO. Buscou-se publicações referentes ao período 2011-2016, a partir do uso de termos específicos das fontes consultadas, relativos a ‘neoplasias do colo do útero’ e ‘acesso aos serviços de saúde’. Foram inicialmente encontrados 704 artigos, mas, considerando os critérios adotados, foram selecionados 31 artigos, dos quais foram incluídos 19. Foram mencionados aspectos facilitadores do acesso como ampla cobertura do exame Papanicolaou e de biopsias equivalente ao número de preventivos alterados. Entretanto, aspectos limitadores de acesso como periodicidade inadequada do Papanicolau, dificuldades para agendamento de consultas e exames, alto índice de estadiamento avançado e atrasos no diagnóstico e no início de tratamento, também foram apresentados.
“…Por exemplo, um estudo de coorte retrospectiva realizado em Taiwan com 9081 novos casos de câncer de colo de útero, entre 2005 e 2010 observou que as pacientes que atrasaram o tratamento por pelo menos 4 meses tiveram 2,31 vezes maior risco de mortalidade do que as pacientes submetidos a tratamento oportuno (p <0,05) 5 . A análise dos dados sobre possíveis atrasos para o diagnóstico e tratamento do câncer de colo de útero são de extrema importância para reduzir a morbidade e mortalidade pela doença e há poucos estudos realizados no Brasil sobre esse tema [6][7] . Assim, esse estudo objetivou identificar possíveis atrasos entre a suspeita diagnóstica, o diagnóstico definitivo e o início do tratamento em pacientes com câncer de colo de útero atendidas pelo Sistema Único de Saúde (SUS) em um centro de referência para tratamento oncológico no Sul do Brasil.…”
ResumoO objetivo desse estudo foi identificar possíveis atrasos entre a suspeita diagnóstica, o diagnóstico definitivo e o início do tratamento em pacientes com câncer de colo de útero atendidas pelo Sistema Único de Saúde em um centro de referência para tratamento oncológico no Sul do Brasil. Trata-se de um estudo descritivo de uma série de casos retrospectiva, referentes a 222 pacientes com câncer de colo de útero, encaminhadas para tratamento entre agosto de 2003 e julho de 2013. Foram coletados dados de prontuários, incluindo sociodemográficos, clínicos e os intervalos de tempo transcorridos entre a suspeita, o diagnóstico e o início do tratamento. Dentre as 95 pacientes que iniciaram o quadro clínico com um exame Papanicolaou alterado, apenas 27,4% realizaram biópsia em até 60 dias do exame. Apenas 19,3% das 57 pacientes que iniciaram o quadro clínico com sintomas sugestivos da doença realizaram a biópsia em até 60 após o início dos sintomas. Do total das pacientes, apenas 37,8% iniciaram o tratamento em até 60 dias após o resultado da biópsia, sendo que 15,3% demoraram mais de 180 dias para iniciar o tratamento. Conclui-se que houve atraso entre a suspeita diagnóstica e a realização da biópsia, bem como para o início do tratamento. Estratégias para redução do tempo para o diagnóstico e tratamento da doença devem ser priorizadas.
Palavras-chave:Câncer de Colo do Útero. Diagnóstico. Saúde Pública. Tratamento.
AbstractThe purpose of this study was to identify possible delays between the suspected diagnosis, the definitive diagnosis and the beginning of treatment in patients with cervical cancer treated by the Unified Health System in a reference center for cancer treatment in southern Brazil. This is a retrospective descriptive study of a series of 222 cervical cancer cases referred for treatment between August 2003 and July 2013. Data were collected from medical records, including sociodemographic, clinical and time intervals between suspicion, diagnosis and the beginning of treatment. Among the 95 patients who started the clinical picture with an abnormal Pap smear, only 27.4% performed a biopsy within 60 days of the examination. Only 19.3% of the 57 patients who started the clinical symptoms of the disease performed the biopsy within 60 days after the onset of symptoms. From the total number of patients, only 37.8% started treatment within 60 days after the biopsy result, and 15.3% took more than 180 days to start treatment. It was concluded that there was a delay between the suspected diagnosis and the biopsy, as well as the beginning of the treatment. Strategies to reduce the time for diagnosis and treatment of the disease should be prioritized.
“…[8][9][10][11] The outcome was measured by the following variable of the PMAQ: "Estimated waiting time of users for specialized consultations -Physiotherapy (of users referred in the last three months)", with answers given in number of days.ResumoIntrodução: Historicamente, discute-se a dificuldade de encaminhamentos para o serviço especializado de saúde. Objetivo: de saúde que recebem apoio para o planejamento do processo de trabalho (n = 25,48; 83,4%; p < 0,0001), como também para a gestão que disponibiliza informações sobre a situação de saúde (n = 26,55; 86,8%; p < 0,0016), recebe apoio para a discussão dos dados de monitoramento (n = 24,149; 79,1%; p < 0,0001), recebe apoio institucional permanente (n = 25,14; 82,3%; p < 0,0001) e obtém retorno da avaliação realizada pelos especialistas (n = 22,80; 76,6%; p < 0,0001).…”
Introduction Historically, the difficulty of referrals to specialized health services has been discussed. Objective To analyze the factors associated with waiting time for specialized physiotherapy services. Methods Cross-sectional, multilevel study, with secondary data, based on the external evaluation of the second cycle of the Access and Quality Improvement Program and the United Nations Development Program. The explanatory variables for the outcome "Estimated waiting time of users for specialized consultations – Physiotherapy" were grouped according to the characteristics of the family health teams and contextual factors. In the statistical analysis, Poisson’s Multilevel Regression was used. A significance level of 5% was adopted (p < 0.05). Results Observed association of the time of referral to physiotherapy with the health teams that receive support for the planning of the work process (n = 25.476; 83,4%; p < 0.0001), that the management provides information about the health situation (n = 26.505; 86,8%; p < 0.0016), receives support for the discussion of monitoring data (n = 24.149; 79,1%; p < 0.0001), receives permanent institutional support (n = 25.140; 82,3%; p < 0.0001), gets feedback from the evaluation carried out by the specialists (n = 22.801; 76,6%; p < 0.0001) and in the teams that are supported by the NASF physiotherapist (n = 5.666; 18,6%; p < 0.0001), with an association for the Gini Index (p < 0.044) and the HDI (p < 0.0001). Conclusion The referral time to the specialized physiotherapy service was shown to be associated with both system organization and management factors, as well as contextual variables.
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