Retardo no diagnóstico e no tratamento cirúrgico do câncer de pulmão

Abstract

Introdução: O câncer de pulmão é a principal causa de morte relacionada a câncer no mundo.Objetivo: Determinar o tempo despendido com o diagnóstico, o estadiamento e o tratamento cirúrgico do cân-cer de pulmão em um hospital universitário.Método: Entre janeiro de 1990 e dezembro de 1998, 69 pacientes receberam diagnóstico de câncer de pulmão e foram tratados com cirurgia no Hospital das Clíni-cas de Porto Alegre. Os prontuários destes pacientes (53 homens e 16 mulheres) foram revisados, sendo coletados dados clínicos, histológicos, datas de consultas ambulatoriais, de internação hospitalar, de exames e de procedimentos, assim como o local de investigação.Resultados: Quinze pacientes foram investigados em ambulatório (grupo I), 28 em ambulatório e durante internação (grupo II) e 26 durante internação (grupo III). A idade dos pacientes variou entre 43 e 79 anos (média de 61 ± 10 anos). Quarenta e três pacientes eram tabagistas atuais e 23 ex-tabagistas. O tempo médio do aparecimento dos sintomas até a primeira consulta foi de 110 dias e da primeira consulta até o diagnóstico foi de 33 dias. Vinte e cinco dias transcorreram entre o diagnóstico e a cirurgia. A média de tempo da primeira consulta até a cirurgia (tempo total) foi de 58 dias. A média do tempo total foi de 72 dias no grupo I, 72 dias no grupo II e 35 dias no grupo III (p < 0,01). Não houve diferença significativa no tempo total, considerando-se os diferentes está-dios da doença (p = 0,16). Conclusões:Os resultados mostraram retardo na procura de atendimento médico e retardo adicional no tratamento do câncer de pulmão em pacientes cuja investigação foi ambulatorial. (J Pneumol 2003;29(6):358-64) Descritores -Neoplasias pulmonares/cirurgia. Avanços da doença.Background: Lung cancer is the leading cause of cancer-related death worldwide.Objective: To determine the time spent diagnosing, staging and surgically treating lung cancer in a university hospital. Method:Between January 1990 and December 1998, 69 (53 male, 16 female) patients were diagnosed with lung cancer and underwent surgery. The hospital records of these patients were reviewed to evaluate clinical and histological data, dates of outpatient visits, hospital admission, tests and procedures, as well as to determine if the patients were examined as inpatients or as outpatients. Results:The 15 patients investigated as outpatients were designated as group I, the 28 examined as both inpatients and outpatients as group II, and the 26 investigated as inpatients as group III. Age ranged from 43 to 79 years (mean ± SD; 61 ± 10). Of the 69 patients, 43 were smokers and 23 were ex-smokers. The mean time from onset of symptoms to the first outpatient visit was 110 days and 33 days from the first outpatient visit until diagnosis. There was a lapse of 25 days between diagnosis and surgery. The mean total elapsed time between the first outpatient visit and surgery was 58 days. The mean total time was 72 days for group I, 72 days for group II, and 35 days for group III (p < 0.01). There was no significant di...

Intervening factors for the initiation of treatment of patients with stomach and colorectal cancer

“…Thus, monitoring for chronic diseases favors greater access to the service and health professionals, thus increasing the chances of patients having their symptoms recognized, leading to the suspicion of the disease and referral for exams 10 .…”

“…For the sample calculation, at the time of conducting this study, the only investigation similar to this (evaluation of the time of onset of symptoms until diagnosis), had been conducted among patients with lung cancer 10 . Thus, despite the differences between tumor types, it was decided to use them, since it was considered that the system of public health care used by patients was the same, added to the fact that the cited research contained the necessary statistical data, allowing us to adequately estimate the number of observations to be made.…”

“…Thus, the sample calculation was based on the national study findings 10 in which the mean time between onset of symptoms and the first visit was 110 days with a standard deviation of 72.5 days. Thus, considering the time between symptoms and the first visit, it was estimated that it would be necessary to observe 90 patients, in order to obtain the average time of search for health care, with a margin of error of 15 days and a confidence interval of 95%.…”

“…Ideally, the time from diagnosis to tumor surgery should take a maximum of six to eight weeks 10 . However, due to the unequal distribution of healthcare resources and the large geographic extent of Brazil, health care conditions are very diverse, and frequently the demand is much higher than the services capacity, causing delays in diagnosis and treatment compromising the well-being and quality of patient recovery 9 …”

Quem espera nem sempre alcança

“…Neste número do Jornal de Pneumologia, Knorst e colaboradores (3) fazem importante retrato das razões pelas quais essas verdades não acontecem no Brasil. Os autores identificaram um atraso médio até o diagnóstico de câncer de pulmão de 140 dias, incluindo o tempo do iní-cio dos sintomas até a procura do médico e a partir deste momento até o diagnóstico final.…”