Dissertação
Análise do período de espera do diagnóstico ao primeiro tratamento do câncer de mama
Fecha
2019-03-18Autor
Castro, Francine Coutinho Maia de
Institución
Resumen
Breast cancer presents the second highest cancer incidence rate in Brazil and in the
world. In addition, it’s the greatest worldwide cause of cancer mortality in women. In
this context, the treatment waiting time is a concern in many regions. Thus, this
thesis provides an integrated review about the effect of therapeutic delay on the
clinical progression of breast cancer, which showed, through the analysis of 22
articles published between 2013 and 2018, that waiting times over 60 days are
associated with higher rates of local and regional recurrence, as well as metastatic
disease. In addition, it was observed that Brazil has longer waiting times than other
countries. We also carried out a analytical retrospective study of 118 cases at the
Hospital Universitário de Santa Maria (HUSM), from January 1, 2012 to December
31, 2016, which showed an average waiting time for the 1st breast cancer treatment
of 104.4 days and a median of 92,5 days, 66,9% of which waited more than 60 days,
the limit recommended by Brazilian Law No. 12,732, of November, 2012. In addition,
85.2% of the cases whose treatment began with surgery exceeded the limit of 60
days, while 67.6% of the cases treated with neoadjuvant chemotherapy started
therapy in a timely manner. We believe that this significant delay for surgery is
associated to precarious hospital infrastructure. No statistically significant results
were found related to the influence of the delay on cancer progression. In conclusion,
the limit of 60 days imposed by the Ministry of Health is an appropriate
recommendation, since therapeutic delay contributes to the cancer progression,
according to the literature. However, further studies during a longer period and with a
greater number of cases are needed at HUSM to clarify the results found. It is hoped
that this research will encourage further research to stimulate the creation of public
health policies aimed at increasing the hospital structure. This way it is hoped to
reduce inequities in the care of patients and providing timely oncological treatment to
avoid an aggravation of clinical conditions.