Avaliação da Política Nacional de Atenção Oncológica (PNAO) e o câncer de mama - dificuladade no acesso: do diagnóstico ao tratamento oncológico

Abstract

The breast cancer is the most feared by women, due to its high frequency. There is a good prognosis if properly diagnosed and treated. In Brazil the mortality rates caused by breast cancer are still high, probably because the disease is diagnosed in advanced stages. The Política Nacional de Atenção Oncológica - Oncological Attention National Policy (PNAO) was instituted by the Ordinance N. 2.439/2005. It comprises promotion, prevention, diagnosis, rehabilitation and palliative care, to be implanted at all federal units, respecting the competence of all three management levels. It is organized in coordination with the Health Ministry and States and Cities Health Departments. It aims to organize a line care that permeates all levels of care and service. The line care describes the set of actions and activities to be carried out at each health care unit and diagnostic support which forms a certain system, as well as it points out the professionals involved and the necessary resources, including medication and inputs. This study aimed to promote an evaluation of the PNAO - through checking service records - concerning the time between the diagnostic and the treatment of breast cancer patients, in order to identify the possible barriers in the access. A retrospective study was carried out, where the breast cancer patients medical records at the Oncology Service at the School Hospital from the Federal University of Pelotas were analyzed, in the year of 2011, identifying the time intervals between the suspicion, the diagnosis and the beginning of the chemotherapy treatment. A data collection tool was used to collect variables such as: age, skin color, date of birth, marital status, and the dates concerning the diagnosis stages - exams and therapy sessions - beginning of the oncological treatment. Forty-nine women were included in the study. The ages ranged between 35 and 81 with an average age of 58,9 and the standard deviation of 12, 02 years. The predominant age range was 60 to 69 years old in 32% of the cases. The predominant skin color was white in 84% of the cases, followed by black in 14%. Variables such as marital status (96%) and occupation (78%) presented high levels of absence of such information. Concerning staging, 25% and 47% of the cases were, respectively in the stadiums I and II, whereas 28% of the total was in the stadiums III or IV. In terms of the exams taken 67% used the SUS Service. The interval between the mammography and the oncological treatment was the biggest interval found, in a total of 160,5 days. When comparing this interval to the initial and advanced stadium, it was bigger in patients in the advanced stadium of the disease. The time interval between the diagnosis and the chemotherapy is too long for most patients. This causes a late breast cancer diagnosis and the patients reach an advanced stadium of the disease. When there is an early diagnosis, it decreases the mortality, improves the survival and the treatment is less complex. The health public system needs to be organized so that there is a better integration between the primary, secondary and tertiary levels, where the patients go pursuing diagnosis and treatment