Origin-destination flows in chemotherapy for breast cancer in Brazil: implications for pharmaceutical services.

Mário Jorge Sobreira Da Silva,Claudia Garcia Serpa Osorio-De-Castro,Enirtes Caetano Prates Melo

doi:10.1590/1413-81232018243.10272017

Mário Jorge Sobreira Da Silva, Claudia Garcia Serpa Osorio-De-Castro + Show 1 more

Open Access

https://doi.org/10.1590/1413-81232018243.10272017

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Abstract

This study maps and analyzes patient flows for breast cancer chemotherapy in order to identify the potential implications for organization of pharmaceutical services in the cancer care network. An ecological study design sought to correlate the place of residence with place of care for breast cancer patients. All chemotherapy procedures financed by Brazil's Unified Health System (SUS) and performed from January to December 2013 were included. Flows were mapped using TerraView® software. A total of 1 347 803 outpatient chemotherapy procedures were delivered by 243 cancer care units located in 156 municipalities. Seventeen cities concentrated approximately 50.0 % of the procedures. A total of 8 538 origin-destination flows were generated and 49.2% of procedures were performed in services located outside the municipality in which the patient resided. Context challenges, related to inequality of access to chemotherapy and hindrances in planning and management of pharmaceutical services, were discussed.

Highlights

Breast cancer is an important source of morbidity in Brazil[1]
The study identified representative chemotherapy origin-destination flows for women with breast cancer, in 2013, and viewed cancer treatment occurring in s Unified Health System (SUS) health service networks
The study included all the procedures financed by the public system, as well as practically all the providers treating breast cancer

Summary

Introduction

Breast cancer is an important source of morbidity in Brazil[1]. It is the leading cause of cancer mortality and the most common neoplasm in women, except for non-melanoma skin cancer[2]. Breast cancer prevention and control are top health priorities in Brazil[3]. Despite the adoption of a significant set of measures for breast cancer prevention and control, since the 1970s, the mortality rates in the country appear to have stabilized[4,5,6]. A relative increment has been observed in the survival time of women diagnosed with breast cancer, attributed to the incorporation of new drugs and other health technologies[7]. Cancer patients’ survival is related to time of diagnosis and staging of the disease, it is largely associated with effective therapy, including pharmacotherapy, highlighting the importance of pharmaceutical services

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