Active Search of Patients in Cervical Cancer Control: The Initiative of a Pathology Laboratory in Brazil

Abstract

Background and context: According to the Global Cancer Observatory, in 2012, worldwide, there were an estimated 266,000 deaths from cervical cancer, accounting for 7.5% of all cancer deaths in females. The pathology and cytopathology laboratories have a very important role in screening and diagnosing cases of cervical cancer. A percentage of suspicious for or diagnosed patients for cervical cancer will be lost in the health system without getting any kind of treatment, resulting in early death. Aim: Analysis of a patient-centered initiative of Active Patient Search (APS) program in cervical cancer control to increase the access of patients to healthcare systems for early detection and treatment. Strategy/Tactics: Performance monitor of the active search program for patients with suspicion or positive for intraepithelial lesion or cervical cancer developed by Centro de Diagnósticos Anátomo-Patológicos (CEDAP) in Joinville-SC, Brasil from January 2002 to December 2017 in a transversal and observational study. Program/Policy process: The CEDAP Laboratory Information System was set to monitor patients suspicious for or positive for intraepithelial lesion or cervical cancer according to pre-established criteria based on the Brazilian National Cervical Cancer Screening Program directives by the National Institute of Cancer (INCA). The system automatically includes patients suspicious or positive for cervical cancer with either Papanicolaou test, biopsy, surgical specimen or high-grade HPV DNA exam. Within the given time interval determined for each category of diagnosis, the ASP starts a process of active search of the targeted patients, being the first step the contact with the clinician regarding the patient monitoring and treatment. Whenever there is lack of response from the clinician or loss of follow-up of the patient reported by the clinician, the laboratory would try to contact the patient or her family directly. Outcomes: From an amount of 1,105,712 cervical cytology exams, conventional and liquid based, with 8573 cases (0.75%) suspicious for or diagnosed with intraepithelial neoplasia or invasive cervical carcinoma and were inserted in the Active Patient Search Program (APSP). Direct contact with the assistant clinician were made in 66.4% of the cases inserted in the APSP, and 4.2% needed direct contact with the patients to finalize the process and bring those patients back to the system for monitoring or for treatment. The index of cases resolved with the APSP actions was 89.7%, with a loss of follow-up of patients of 10.3%. What was learned: Considering the index of clinician adherence and the index of affected patients, the patient-centered Active Search Program initiative is effective, allowing the pathology laboratory to act as a protagonist in monitoring patients with suspicion or positive for cervical cancer, not only as a diagnostic center but also as an active part of the healthcare system in cervical cancer control.