Serviços de radioterapia no Brasil: cenário atual, desafios e propostas de soluções

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

doi:10.1590/0102-311XEN127324

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

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

Serviços de radioterapia no Brasil: cenário atual, desafios e propostas de soluções

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo:

Este estudo buscou fornecer uma pequena lista consensual de barreiras e desafios para o estabelecimento de serviços de radioterapia acessíveis no Brasil e discutir as ações gerenciais que foram propostas para reduzir o tempo de espera para o início desses tratamentos. Pesquisas virtuais foram enviadas a médicos com experiência em radioterapia nesse estudo e-Delphi sem interação direta entre os entrevistados. Uma lista básica de 15 barreiras já publicadas ao acesso à radioterapia em países de baixa e média renda foi colocada em tópicos. Os participantes tiveram que estabelecer a prioridade com que incluiriam cada um dos 15 tópicos em futuras intervenções governamentais usando uma escala Likert de cinco pontos. As pontuações médias para cada tópico foram calculadas e expressas em porcentagens. Considerou-se em consenso os tópicos com uma pontuação de > 70% de concordância entre os participantes que os classificaram como tendo alta ou muito alta prioridade e uma posição entre os cinco primeiros itens na lista de classificação de importância. No total, quatro tópicos obtiveram consenso. No mais, dois tópicos se relacionavam a custos (recursos, modelos de financiamento e estabilidade financeira), um ao ambiente político (instabilidade política) e um aos níveis de pobreza e planejamento da distribuição de tecnologia. Tais resultados formam a base para um plano de ação em que os tópicos prioritários abrangentes devem ser considerados nos esforços para fornecer melhor acesso a serviços de radioterapia.

Palavras-chave:
Neoplasias; Acesso a Serviços de Saúde; Países de Baixa e Média Renda; 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

vertical_align_top show_chart

more_horiz close
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

[TFN1] IAEA: International Atomic Energy Agency.

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