Access to treatment of women with breast cancer

Sousa, Samara Maria Moura Teixeira; Carvalho, Maria das Graças Freire de Medeiros; Santos, Luiz Ayrton; Mariano, Sarah Borges Carolina

doi:10.1590/0103-1104201912206

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ORIGINAL ARTICLE • Saúde debate 43 (122) • Jul-Sep 2019 • https://doi.org/10.1590/0103-1104201912206 copy

Access to treatment of women with breast cancer

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study was aimed at characterizing the access to treatment of women diagnosed with breast cancer in the state of Piauí, Brazil. A cross-sectional analytical study was developed in two referral hospital institutions from January/2018 to June/2018. The population comprised women diagnosed with breast cancer who underwent treatment in the period from 2016 to 2017. The sample amounted to 155 participants. Sampling was proportionally stratified. The data was processed in IBM® SPSS®, and uni and bivariate statistics were calculated. It was noted that the average time for treatment was of 112.7 (± 93.6) days, varying from 12 to 550 days (≡18.3 months or 1.5 years), with 71.6 % of the women starting treatment within a period higher than 60 days following breast cancer diagnosis. Statistically significant associations were verified between the delay to start treatment and the state territory of residence (p = 0.041) and the disease stage (p = 0.037). The conclusion is that women are not having access to breast cancer treatment as recommended. Therefore, it is worth noting the need for greater organization in the network of health services, taking into account the needs of the population through timely health care.

KEYWORDS
Women’s health; Breast neoplasms; Health services accessibility; Therapeutics; Time-to-treatment

Feature		M	SD	N	%
Age		53.6	12.4
Marital status	Single			27	17.4
	Married/common-law marriage			89	57.4
	Separated/divorced			17	11.0
	Widow			22	14.2
Educational Background (years of study)		6.9	5.8
Color/race	White			31	20.0
	Black			19	12.3
	Brown			90	58.1
	Yellow			14	9.0
	No Information			1	0.6
Paid Work	Yes			108	69.7
	No			46	29.7
	No Information			1	0.6
Individual Monthly Income (R$)		899.43	1,055.32
Monthly household income (R$)		1,245.85	1,311.34
Occupation	Maid			25	16.1
	Self-employed			21	13.5
	Retired			45	29.0
	Unemployed			45	29.0
	Healthcare benefit			17	11.0
	Pensioner			2	1.3
Children	Yes			136	87.7
	No			19	12.3
Age of first pregnancy		22.5	5.3
Menarche Age		13.5	1.7
Menopause	Yes			124	80.0
	No			31	20.0
Total		155	100.0

Characteristic	M	SD	n	%
Anterior Breast Cancer
Yes	-	-	47	30.3
No	-	-	108	69.7
Benign breast diseases
Yes	-	-	41	26.5
No	-	-	114	73.5
Diagnosis
C50	-	-	17	11.0
C50.1	-	-	29	18.7
C50.2	-	-	27	17.4
C50.3	-	-	6	3.9
C50.4	-	-	62	40.0
C50.5	-	-	4	2.6
C50.8	-	-	3	1.9
C50.9	-	-	7	4.5
Laterality
Right	-	-	72	46.5
Left	-	-	82	52.9
Bilateral	-	-	1	0.6
Disease stage
I A	-	-	17	11.0
I B	-	-	3	1.9
II A	-	-	28	18.1
II B	-	-	36	23.2
III A	-	-	27	17.4
III B	-	-	27	17.4
III C	-	-	6	3.9
IV	-	-	11	7.1
*Interval between symptom onset and diagnosis^ * in days.**	275.1	491.2	-	-
*Interval between diagnosis and initiation of treatment^ * in days.**	112.7	93.6	-	-
Greater than 60 days	-	-	111	71,6
Up to 60 days	-	-	44	28,4
Total			155	100.0

Variable	Time to begin treatment				p
	>60 days		≤60 days
	n	%	n	%
Residence (health region)					0.041^f
Cocais, Serra da Capivara, Vale Rio Piauí e Itaueira, Vale do Canindé, Planície litorânea e Carnaubais	34	30.6	6	13.6
Entre Rios, Tabuleiros Alto Parnaíba, Chapada das Mangabeiras, Vale do Rio Guaribas e Vale do Sambito	77	69.4	38	86.4
Place of treatment onset					0.131^f
HSM	103	92.8	37	84.1
HUUFPI	8	7.2	7	15.9
Appointment after first symptoms					0.593^f
PHC or specialized SUS	55	49.5	19	43.2
Private or Campaigns	56	50.5	25	56.8
Performance of Biopsy					0.472^q
Private	70	63.1	25	56.8
SUS	41	36.9	19	43.2
Primary care follow-up					0.809^q
Yes	35	31.5	13	29.5
No	76	68.5	31	70.5
Paid Work					0.738^q
Yes	78	70.9	30	68.2
No	32	29.1	14	31.8
Individual income					0.440^f
Up to R$ 954.00	8	10.0	1	3.3
Above R$ 954.00	72	90.0	29	96.7
Family income					0.940^q
Up to R$ 954.00	22	20.6	8	20.0
Above R$ 954.00	85	79.4	32	80.0
Breast cancer stage					0.037^q
Stages I and II	66	59.5	18	40.9
Stages III and IV	45	40.5	26	59.1
Total	111	100.0	44	100.0

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[1] Collaborators

Sousa SMMT (0000-0002-9611-7486)* contributed to the conception, planning and design of the study; acquisition, analysis and interpretation of work data; data collection; writing, preparation of preliminary versions of the article and critical review of important intellectual content; final approval of the version to be published. Carvalho MGFM (0000-0002-6161-7085)* contributed to the work orientation, relevant critical review of the intellectual content and final approval of the version to be published. Santos Júnior LA (0000-0002-6697-6167)* presented important suggestions incorporated into the work and approved the final version of the manuscript . Mariano SBC (0000-0003-0452-0516)* contributed to the data collection and presented important suggestions incorporated into the work. s