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A historical analysis in the city showed that mortality caused by cancer (...) has surpassed deaths due to cardiovascular diseases since 2016. Such a situation shows the urgent need to investigate these cases to work on planning based on evidence and develop actions to minimize problems that directly affect the population’s health according to laws 12,732/2012 and 13,896/19 (CG1). |
(...) The Annual Health Program has a guideline providing for the implementation of a technical group to investigate deaths caused by cancer, to ensure people with cancer are respected, and to ensure that law 12,732/2012 (60-day law) is complied with. This guideline needed to be included in the program because there were no management instruments specifically determining goals and actions related to chronic non-communicable diseases or cancer (CG2). One of the management instruments used in the city is the Annual Health Program. It details annual goals and identifies monitoring indicators, determines the actions that will support the achievement of objectives in a specific year, fulfills the Health Plan goals, and presents the forecast for the allocation of budgetary resources necessary to comply with PAS (CG3). |
Therefore, based on the city’s needs, the following guideline was included in the Annual Health Program 2018: Strengthening the prevention of chronic non-communicable diseases and health promotion, along with implementing and maintaining a Technical Group to investigate deaths with the underlying cause of death being Cancer, in order to ensure people with cancer are respected and that Law 12732/2012 (60-day Law) is complied with (CG5). |
| Cancer Surveillance Technical Group’s Implementation Strategies |
| Delimitation of philosophical and theoretical bases |
Preparation of Statute and Work Strategy |
Preparation of Statute and Work Strategy |
Identification of Priorities |
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Health advocacy, which is broadly defined as a process of supporting, defending, or arguing a cause, idea, or policy, provides the basis for the group to perform its activities, aiming to investigate cancer deaths based on laws and diagnose problems, whether due to difficulties of people with cancer to access health services and propose sustainable and responsible solutions, through legal and ethical means, developing strategically planned actions to raise awareness and influence decision-makers to promote the necessary changes (CG7). |
The group prepared an internal regulation, establishing a set of rules to regulate the group’s functioning, ensure the correct implementation of tasks according to the guidelines, organize, systematize, and develop a continuous work process. This internal regulation was also officially published through an Ordinance on March 2, 2020, and its members and respective substitutes according to each area and place of activity (CG10). The group adopts systematic meetings to discuss patients’ deaths, seeking to detect potential causes. It routinely uses meetings to discuss the cases involving deaths, summoning, if necessary, the workers who provided care for such patients or the health department’s managers. The objective is to present the cases to these professionals or managers to obtain more information, clarify doubts, point out errors, request changes to the routine or practices harmful to the care of patients, prepare letters of recommendation for the services, propose and strengthen integrated and intersectoral actions to improve the care delivered to people with cancer, prevent avoidable deaths, and support the qualification of healthcare and death surveillance (CG12). |
To assist in investigations and standardize the cancer death surveillance process and how information is available to the group’s members. The researcher created an investigation form, considering that the diversity of content provided in the forms and medical records may prevent comparing information, possibly compromising the quality of data discussed in the meetings. According to the healthcare delivery logic, the information obtained from various sources is valuable for planning actions and evaluating health services at municipal, regional, and state levels. Furthermore, the data obtained after the investigation enabled an understanding of how cancer care is organized in the city’s health network (CG13). |
Due to the great demand for investigations and also because there is a member representing women's health in the city, the group agreed that priority would be given to cervical and breast cancer, considering these are the most common, especially among women under 69 years old, as recommended by the first indicator of the Inter-federative Agreement. It aims to present the qualification forms of the 23 indicators established between 2017 and 2021. The first indicator aims to monitor the mortality caused by NCDs, the primary cause of death in the country. It is also a relevant parameter for planning and obtaining agreement on health services at all levels of care aimed at people with chronic diseases (CG14). |
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Recognizing the Cancer Surveillance Technical Group from the Perspective of Health Advocacy
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| Integrality |
Humanization |
Knowledge |
Professional Competence |
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In addition to rights and duties, the entire context needs to be assessed so that patients enjoy whole health (M1). I think it has everything to do with it because it's about interests, legislation, meeting deadlines, investigation, and patients. There is a long period between the diagnosis and the beginning of treatment. Patients have the right to start treatment. How? I think it is in line with advocacy and these interests, and that is what we are checking: whether this legislation was complied with and whether patients had access to the resources they needed (M3). |
It aims to ensure patient rights in the sense of professionals (that is why it is advocacy) advocating for patients. I know a patient has rights, so I will try to ensure that he accesses such rights (M2). It is deeply associated with the dissemination of public health, the rights of patients, and the humanization and individualization of patient treatment (M5). |
It aligns with patients’ interests, well-being, and access to knowledge, defending the right of patients, users, and people to access knowledge (M3). |
But it has to do with the professional, like I, a nurse, advocate for a patient, or I, a doctor, advocate on a patient’s behalf. It is not just, “Oh, there is this legislation.” I am the one who is taking care of it; I am the one who clarifies it, and I am the one who asks for help. One of the things that happens is that we are educating new professionals and drawing attention to aspects of management that need to be taken care of, what we think professionals know how to do, but in reality, they do not know how to do, and this surfaces in the investigations (M2). |
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