Acceso del paciente a la red oncológica en la vigencia de la “Ley de los Sesenta Días”: Revisión Integrativa

Acessibilidade / Reportar erro

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Sumário

REVIEW • Rev. Bras. Enferm. 73 (5) • 2020 • https://doi.org/10.1590/0034-7167-2019-0406 copiar

Acceso del paciente a la red oncológica en la vigencia de la “Ley de los Sesenta Días”: Revisión Integrativa

About the SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

analizar la producción científica brasileña sobre la accesibilidad del paciente a la red oncológica, según la vigencia de la “Ley de los Sesenta Días”.

Métodos:

se trata de una revisión integradora llevada a cabo según las bases de datos: Lilacs, PubMed y Scielo. Se utilizaron los descriptores: neoplasias, accesibilidad del servicio de salud y diagnóstico precoz del cáncer. Se incluyeron artículos publicados desde 2015 hasta marzo de 2019.

Resultados:

se analizaron 17 artículos, de los cuales surgieron cuatro temas: desigualdad en la accesibilidad; capacitación del profesional en la Atención Primaria; el tiempo como factor determinante; el sistema de información como factor limitador.

Conclusiones:

la accesibilidad de la red oncológica es desigual ya que hay muchas barreras que los usuarios deben enfrentar. La formación continua de los profesionales de la salud es imprescindible para poner en marcha estrategias preventivas. El inicio del tratamiento suele retrasarse, lo que demuestra la fragilidad en la aplicación de la legislación. Se observa la fragmentación de la red asistencial, la falta de articulación entre los servicios y como consecuencia, la falta de seguimiento de los pacientes.

Descriptores:
Neoplasias; Accesibilidad de los Servicios de Salud; Diagnóstico Precoz del Cáncer; Revisión; Instituto del Cáncer

Author, year of publication Level of Evidence	Type of Study	Sample and Synthesis of Characteristics	Study Setting	Type of Cancer
Melo et al, 2017⁽¹⁷17 Melo FBB, Marques CAV, Rosa AS, Figueiredo EN, Gutiérrez MGR. Actions of nurses in early detection of breast cancer. Rev Bras Enferm. 2017;70(6):1119-28. doi: 10.1590/0034-7167-2016-0155 https://doi.org/10.1590/0034-7167-2016-0... ⁾ LE 4	Cross-sectional Study	113 Primary Care Nurses.	UBS City of São Paulo. Southeast Region	Breast Cancer
Hallowell et al, 2018⁽¹⁸18 Hallowell BD, Perin DMP, Simoes EJ, Paez DC, Parra DC, Brownson RC, Saraiya M. Breast cancer related perceptions and practices of health professionals working in Brazil's network of primary care units. Prev Med. 2018;106(1):216-23. doi: 10.1016/j.ypmed.2017.11.002 https://doi.org/10.1016/j.ypmed.2017.11.... ⁾ LE 4	Cross-sectional Study	1251 coordinators of health services, 182 doctors and 347 nurses.	UBS. Pelotas, Rio Grande do Sul - South Region	Breast Cancer
Navarro et al, 2015⁽¹⁹19 Navarro C, Fonseca AJ, Sibajev A, Souza CIA, Araújo DS, Teles DAF, et al. Cervical cancer screening coverage in a high-incidence region. Rev Saúde Pública. 2015;49:17. doi: 10.1590/S0034-8910.2015049005554 https://doi.org/10.1590/S0034-8910.20150... ⁾ LE 4	Cross-sectional Study	612 women between 25 and 59 years old.	Municipality of Boa Vista, Roraima - North Region	Cervical Cancer
Silva et al, 2018⁽²⁰20 Silva MTA, Silva Jr VB, Mangueira JO, Gurgel Jr GD, Leal EMM. Distribution of mammograms and mammography offering in relation to the parametric care of the Public Health Care System in Pernambuco. Rev Bras Saúde Mater Infant. 2018;18(3):609-18. doi: 10.1590/1806-93042018000300009 https://doi.org/10.1590/1806-93042018000... ⁾ LE 4	Cross-sectional Study	Distribution of mammogram machines.	State of Pernambuco, Northeast Region	Breast Cancer
Cubero et al, 2018⁽²¹21 Cubero DIG, Steete CVM, Piscopo BCP, Monteiro CRA, Schouer JHM, Tavares HDA, et al. Epidemiological profile of Brazilian oncological patients seen by a reference oncology center of the public health system and who migrate in search of adequate health care. Rev Assoc Med Bras. 2018;64(9):814:8. doi: 10.1590/1806-9282.64.09.814 https://doi.org/10.1590/1806-9282.64.09.... ⁾ LE 4	Cross-sectional Study	217 cancer patients between 20 and 89 years old.	UNACON São Bernardo do Campo - São Paulo - Southeast Region	Several types of câncer
Abrão et al, 2017⁽²²22 Abrão FC, Abreu IRLB, Rocha RO, Munhoz FD, Rodrigues JHG, Younes RN. Impact of the delay to start treatment in patients with lung cancer treated in a densely populated area of Brazil. Clinics. 2017;72(11):675-80. 10.11606/s1518-8787.2019053000406 https://doi.org/10.11606/s1518-8787.2019... ⁾ LE 4	Retrospective Study	509 patients with malignant neoplasms.	CACON São Paulo - Southeast Region	Lung Cancer
Barros et al, 2019⁽²³23 Barros AF, Araújo JM, Murta-Nascimento C, Dias A. Clinical pathways of breast câncer patients treated in the Federal District, Brazil. Rev Saude Publica. 2019;53:14. doi: 10.11606/s1518-8787.2019053000406 https://doi.org/10.11606/s1518-8787.2019... ⁾ LE 4	Cross-sectional Study	600 women with breast cancer.	Public Hospitals Federal District - Central-west Region.	Breast Cancer
Moreira et al, 2018⁽²⁴24 Moreira CB, Fernandes AFC, Castro RCMB, Oliveira RDP, Pinheiro AKB. Social determinants of health related to adhesion to mammography screening. Rev Bras Enferm. 2018;71(1):97-103. doi: 10.1590/0034-7167-2016-0623 https://doi.org/10.1590/0034-7167-2016-0... ⁾ LE 4	Cross-sectional Study	40 women between 50 and 69 years old, without personal and family history of cancer.	Catholic Community. Fortaleza - Ceará - Northeast Region.	Breast Cancer
Lopes et al, 2016⁽²⁵25 Lopes TCR, Gravena AAF, Demitto MO, Brischiliari SCR, Borghesan DHP, Agnolo CM, et al. Mammographic screening of women attending a reference service center in Southern Brazil. Asian Pac J Cancer Prev. 2016;17(3):1385-91. doi: 10.7314/APJCP.2016.17.3.1385 https://doi.org/10.7314/APJCP.2016.17.3.... ⁾ LE 4	Cross-sectional Study	525 women that underwent breast cancer screening.	CACON South Region.	Breast Cancer
Bezerra et al, 2018⁽²⁶26 Bezerra IC, Silva RM, Oliveira CP, Brasil CCP, Vasconcelos MGF, Mamede MV, Oliveira MTP. Mastectomized women's perception of breast cancer early detection. PLoS One. 2018;13(11):e0206405. doi: 10.1371/journal.pone.0206405 https://doi.org/10.1371/journal.pone.020... ⁾ LE 4	Qualitative Study	26 women between 47 and 56 years old with breast cancer.	Outpatient Cancer Center Fortaleza - Ceará - Northeast Region.	Breast Cancer
Souza et al, 2017⁽²⁷27 Souza CIA, Araújo DS, Teles DAF, Carvalho SGL, Cavalcante KWM, Rabelo WL, et al. Factors related to non-adherence to mammography in a city of the Brazilian Amazonian area: a population-based study. Rev Assoc Med Bras. 2017;63(1):35-42. doi: 10.1590/1806-9282.63.01.35 https://doi.org/10.1590/1806-9282.63.01.... ⁾ LE 4	Cross-sectional Study	241 women between 40 and 69 years old.	Households. Boa Vista - Roraima - North Region.	Breast Cancer
Barcelos et al, 2017⁽²⁸28 Barcelos MRB, Lima RCD, Tomasi E, Nunes BP, Duro SMS, Facchini LA. Quality of cervical cancer screening in Brazil: external assessment of the PMAQ. Rev Saude Publica. 2017;51:67. doi: 10.1590/s1518-8787.2017051006802 https://doi.org/10.1590/s1518-8787.20170... ⁾ LE 4	Quantitative Observational Study	35.844 women between 25 and 64 years old.	UBS. North, Northeast, Midwest, Southeast and South Regions.	Cervical Cancer
Moraes et al, 2016⁽²⁹29 Moraes DC, Almeida AM, Figueiredo EM, Loyola EAC, Panobianco MS. Opportunistic screening actions for breast cancer performed by nurses working in primary health care. Rev Esc Enferm USP. 2016;50(1):14-21. doi: 10.1590/S0080-623420160000100002 https://doi.org/10.1590/S0080-6234201600... ⁾ LE 4	Cross-sectional Study	60 primary care nurses.	UBS. Ribeirão Preto - SãoPaulo - Southeast Region	Breast Cancer
Silva et al, 2019⁽³⁰30 Silva RP, Gigante DP, Amorim MHC, Leite FMC. Factors associated with having mammography examinations in primary health care users in Vitória, Espírito Santo, Brazil. Epidemiol Serv Saúde [Internet]. 2019 [cited 2019 Apr 12];28(1):e2018048. Available from: http://www.scielo.br/pdf/ress/v28n1/en_2237-9622-ress-28-01-e2018048.pdf http://www.scielo.br/pdf/ress/v28n1/en_2... ⁾ LE 4	Cross-sectional Study	400 women between 40 and 59 years old in health units.	ESF. Vitória - Espírito Santo - Southeast Region.	Breast Cancer
Signorelli et al, 2016⁽³¹31 Signorelli IV, Gonçalves PL, Gonçalves LL, Ferreira LSE, Mendonça ATP, Franklin GL, et al. Socioeconomic disparities in access to a hepatocellular carcinoma screening program in Brazil. Clinics [Internet]. 2016 [cited 2019 Apr 14];71(7):361-364. doi: 10.6061/clinics/2016(07)01 https://doi.org/10.6061/clinics/2016(07)... ⁾ LE 4	Cross-sectional Study	253 cirrhotic patients, 177 from public hospitals and 76 from the private sector.	Private Hospital and University Hospital. Vitória - Espírito Santo - Southeast Region.	Hepatocellular Carcinoma
Rocha-Brishillari et al 2018⁽³²32 Rocha-Brischillari SC, Andrade L, Nihel OK, Brischillari A, Hortelan MS, Carvalho MDB, et al. Spatial distribution of breast cancer mortality: Socioeconomic disparities and access to treatment in the state of Parana, Brazil. PLoS One. 2018;13(10):e0205253. doi: 10.1371/journal.pone.0205253 https://doi.org/10.1371/journal.pone.020... ⁾ LE 2C	Ecological, Descriptive and Analytical Study	To analyze socio-economic and access disparities related to breast cancer mortality in 399 cities in the state of Paraná, Brazil.	Paraná - South Region.	Breast Cancer
Carvalho et al, 2018⁽³³33 Carvalho PGC, O´Dwer G, Rodrigues NCP. Health assistance path of women between diagnosis and treatment initiation for cervix câncer. Saúde Debate [Internet]. 2018 [cited 2019 Apr 14];42(118):687-701. Available from: http://www.scielo.br/pdf/sdeb/v42n118/en_0103-1104-sdeb-42-118-0687.pdf http://www.scielo.br/pdf/sdeb/v42n118/en... ⁾ LE 4	Cross-sectional and Qualitative Study	174 medical records of women with malignant breast cancer, with 05 of these in the qualitative stage, between 31 and 60 years old.	CACON Rio de Janeiro - Southeast Region.	Cervical Cancer

Category	Evidence	Articles
Inequality in access	Preventive examination conducted on opportunity, not favoring prevention Difficulty to make appointments and schedule exams, and lack of professionals	18,19,20, 26, 27, 31
	Equipment poorly distributed, allocated in large centers to the detriment of places with higher incidence of the disease; lack of a coordinated care network	20,21,25, 32, 33
	Primary care does not meet the demand. It also takes time to perform the exams. Private examinations are performed for faster diagnosis.	22, 23, 29
	Socio-economic factors show that access is favorable for users with more years of education and higher purchasing power	24, 27, 28, 30
Qualification of Primary Care professionals	Primary Care health professionals do not have enough knowledge on INCA guidelines to conduct effective screening	17, 18, 22, 25, 26, 27, 29
	Work overload leads to superficial care and no active search for altered exams nor preventive activities	19, 28, 31, 32
	Primary care professionals do not organize and coordinate care	23, 29, 30, 32, 33
Time as determining fator	Lack of equity in access means more time for doing exams.	17, 30
	It takes time to get consultations and examinations by the SUS, which is not in the line with guidelines	18, 26, 33
	Reduced diagnostic time is achieved by private-sector examinations	22, 23, 31
Information system as limiting factor	Monitoring system implemented by the Ministry of Health is not properly filled. Professionals do not know how to use the platforms	17, 20, 29
Information system as limiting factor	Lack of a system to monitor individuals who are examined, leading to over-examination of some and lack of examination of others	18, 21,26, 29

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[1] Corresponding author: Mariela Santos Lombardo. E-mail: marilombardo@gmail.com