Servicios de radioterapia en Brasil: escenario actual, desafíos y propuestas de solución

Silva, Raquel Guimarães Domingos da; Araujo, Claudia Affonso Silva

doi:10.1590/0102-311XEN127324

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ARTICLE • Cad. Saúde Pública 41 (8) • 2025 • https://doi.org/10.1590/0102-311XEN127324 linkcopiar

Servicios de radioterapia en Brasil: escenario actual, desafíos y propuestas de solución

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen:

Este estudio tuvo como objetivo proporcionar una lista corta basada en consenso acerca de las barreras y desafíos para establecer servicios de radioterapia accesibles en Brasil y discutir las acciones de gestión propuestas para reducir el tiempo de espera para iniciar los tratamientos de radioterapia. Se realizó un estudio e-Delphi sin interacción directa entre los encuestados. Se enviaron encuestas virtuales a médicos con experiencia en radioterapia. Se incluyó en los temas una lista de referencia de 15 barreras para el acceso a la radioterapia publicadas anteriormente en países de ingresos bajos y medianos. Los participantes tuvieron que calificar la prioridad de incluir cada uno de los 15 temas en futuras intervenciones gubernamentales utilizando una escala Likert de cinco puntos. Se calcularon las puntuaciones medias de cada tema, las cuales se expresaron en porcentajes. El consenso se logró si el tema obtuvo un puntaje de > 70% de acuerdo entre los participantes que lo calificaron como de muy alta o alta prioridad, además de estar entre los cinco primeros en la lista de clasificación de importancia. Cuatro temas alcanzaron consenso. Dos temas estaban relacionados con los costos (recursos, modelos de financiamiento y estabilidad financiera), uno con el entorno político (inestabilidad política) y otro con los niveles de pobreza y la planificación de la distribución de tecnología. Estos resultados constituyen la base de un plan de acción y los temas prioritarios globales deben ser considerados en los esfuerzos por proporcionar un mejor acceso a los servicios de radioterapia.

Palabras-clave:
Neoplasias; Acceso a los Servicios de Salud; Países de Bajos y Medianos Ingresos; Radioterapia; Método Delphi

CATEGORY	ELEMENT
Policy environment	Political impasses
	Bureaucratic corruption
	Lack of political leadership continuity
	Competing political demands on scarce resources
	Policymakers’ negative misperception about radiotherapy
Advocacy	Feelings of powerless to influence decision
Advocacy	Lack of coordinated advocacy effort
Radiation safety	Nonmember State of the IAEA
Radiation safety	Lack of legal and regulatory framework
Country-wide radiotherapy implementation plan	Poor planning
Country-wide radiotherapy implementation plan	Lack of reliable epidemiological data
Identifying a funding model	Lack of a comprehensive and reliable line-item budget
Identifying a funding model	Poor mobilization and allocation of financial resources
Building the facility and purchasing the right machinery	Lack of local radiotherapy expertise
	Poor stakeholder engagement
	Lack of a competent project manager
	Lack of negotiating power of LMICs
	Lack of coordination and communication among relevant stakeholders
	Lack of synchronization of different activities
Building the radiotherapy workforce	Absence of suitable trained workforce
	Lack of sufficiently qualified teachers and mentors
	Lack of appropriate incentives
	High degree of brain drains after overseas education and training
	Lack of staff succession plan
Gaining and maintaining financial stability	Lack of financial resources to support service operation
Gaining and maintaining financial stability	Financial hardship to patients and their families
Regular maintenance	Lack of a long-term service contract
	Poor spare parts supply and distribution
	Expensive spare parts
	Lack of qualified engineers
Building research culture and infrastructure	Lack of research capacity in radiotherapy
Good governance and management	Lack of clear roles and responsibilities
Improving patient outcomes	Lack of trust based on information and communication processes
	Lack of needed social support services
	Limited access to evidence-based clinical guidelines
Catalyzing comprehensive care and support service	Inability to plan and prioritize integration
Catalyzing comprehensive care and support service	Expensive process for governments
A multidisciplinary approach to care	Differences between professional perspectives
A multidisciplinary approach to care	Lack of understanding the role of radiotherapy
Information and communication technologies	Inadequate training and assistance for users

Characteristics	n (%)
Sex
Male	32 (59)
Female	22 (41)
Age (years)
30-39	13 (24)
40-49	25 (46)
50-59	6 (11)
≥ 60	10 (18)
Region (State of Brazil)
Bahia	3 (5)
Ceará	1 (2)
Pernambuco	2 (4)
Espírito Santo	2 (4)
Rio de Janeiro	19 (35)
São Paulo	13 (24)
Minas Gerais	4 (8)
Goiás	2 (2)
Paraná	1 (2)
Rio Grande do Sul	4 (8)
Federal District	3 (5)
Years of experience
< 5	2 (4)
5-10	10 (18)
11-15	11 (20)
16-20	12 (22)
21-25	9 (17)
> 25	10 (18)
Head of Department
Yes	27 (50)
No	27 (50)
Main job
Public	21 (39)
Private	21 (39)
Philanthropic	12 (22)

Category	Mean Likert scale	Degree of consensus *	Experts’ consensus **
Identifying a funding model	4.66	0.92	Included
Policy environment	4.60	0.92	Included
Advocacy	4.01	0.64	Included
Country-wide radiotherapy implementation plan	4.13	0.77	Included
Building the facility and purchasing the right machinery	4.13	0.75	Included
Gaining and maintaining financial stability	3.98	0.70	Included
Building the radiotherapy workforce	3.64	0.58	Excluded
Good governance (roles and responsibilities)	3.84	0.62	Excluded
Catalyzing comprehensive care and support service	3.69	0.62	Excluded
Regular maintenance	3.66	0.60	Excluded
Improving patient outcomes	3.58	0.43	Excluded
Multidisciplinary approach to care	3.54	0.47	Excluded
Building research culture and infrastructure	3.40	0.45	Excluded
Information and communication technologies	3.26	0.37	Excluded
Radiation safety	2.83	0.24	Excluded
Geographic allocation of the machines	NA	NA	Suggested by respondents/Included
High duties to import machinery	NA	NA	Suggested by respondents/Included

Category	Mean ranking score	Degree of consensus *	Final consensus **
Identifying a funding model	3.83	0.65	No
Policy environment	3.70	0.78	Yes
Advocacy	4.54	0.57	No
Country-wide radiotherapy implementation plan	3.48	0.73	Yes
Building the facility and purchasing the right machinery	4.05	0.73	Yes
Gaining and maintaining financial stability	2.81	0.81	Yes
Geographic allocation of the machines	4.02	0.67	NA
High duties to import machinery	4.05	0.65	NA

THEME	RECOMENDATION
Policy environment	To develop critical knowledge of politicians and positive perception of the importance of radiotherapy
	To promote political stability on planning continuity
	To favour political decision to invest in basic infrastructure
	To warrant strong political support on decisions and demands
Country-wide radiotherapy implementation plan	To provide safety and quality control
	To release a costed cancer control plan
	To provide accurate epidemiological data
	To enlarge allocation of machines
Building the facility and purchasing the right machinery	To share value cocreation of advancements in radiotherapy
	To stimulate access to experienced contractors
	To create a multidisciplinary implementation team
	To assure access to new technologies
Gaining and maintaining financial stability	To certificate clear financial mechanism for operational sustainability
	To plan correct allocation of investments
	To give supportive service operations to patients and their families
	To include tax incentives or reduction for private sector in public partnerships

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[TFN1] IAEA: International Atomic Energy Agency.

[TFN2] Source: based on Donkor et al. ¹⁸.