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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2022.tde-20012023-153444
Document
Author
Full name
Ilton de Oliveira Filho
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2022
Supervisor
Committee
Folgueira, Maria Aparecida Azevedo Koike (President)
Ruiz, Carlos Alberto
Campolina, Alessandro Gonçalves
Lyra, Eduardo Carneiro de
Title in Portuguese
Impacto da COVID-19 na jornada de pacientes com câncer de mama em um hospital do Sul de Minas Gerais
Keywords in Portuguese
Câncer de mama
COVID-19
Itinerário clínico
Mamografia
Navegação de pacientes
Abstract in Portuguese
Introdução: Câncer de mama (CM) tem alta prevalência em mulheres mundialmente e no Brasil, dentre os cânceres, representa a principal causa de morte feminina, sendo importantes, o diagnóstico e o tratamento precoces. Há evidências de queda da mortalidade por CM, entretanto, o acesso ao rastreamento e ao tratamento sofre disparidades em alguns grupos étnicos, sociais e culturais. Nos últimos anos, frente à pandemia COVID-19, há indicações que um conjunto de fatores como pandemia, sobrecarga do sistema de saúde e medidas necessárias à contenção do vírus acarretaram atrasos no diagnóstico e tratamento a pacientes com CM. Objetivos: avaliar o impacto da COVID-19 na jornada de pacientes com CM antes e após pandemia em um hospital de referência oncológica em cidade de médio porte do sul de Minas Gerais. Metodologia: Trata-se de análise quantitativa-qualitativa, observacional, retrospectiva de prontuários de pacientes, com coleta de perfil epidemiológico, tempos de acesso a consultas, a exames e a serviços de saúde de pacientes residente em Pouso Alegre (MG) diagnosticadas com CM de 2019 a 2021, comparando-se os grupos antes (grupo A) e durante a pandemia (grupo B). Resultados e discussão: Foram revistos os prontuários eletrônicos de 89 pacientes atendidas no período de 01/04/2019 a 31/03/2021. No período pré-pandemia e durante a pandemia, 67,9% e 87,7%, das pacientes foram admitidas na mastologia com sintomas mamários, respectivamente, revelando aumento significativo durante a pandemia (p=0,036). Antes da pandemia, 29% das pacientes apresentaram doença EC 0 ou I e apenas 5,8% tiveram diagnóstico com doença EC IV. Já durante a pandemia, foram 18% e 15% pacientes diagnosticados com doença 0 e I contra EC IV, respectivamente. 69,2% e 67,6% dos pacientes foram admitidos a mastologia com CM estadiamento clínico inicial (I e II) sem diferença estatística entre os períodos. Não houve diferença no tempo de acesso a consultas e exames entre os grupos A e B, p. Porém, quando analisado o número total de pacientes do estudo (A+B), houve aumento (p=0,016) do tempo entre mamografia (MMG) e biópsia para pacientes que se consultaram na mastologia SUS (x=119,8 dias) versus rede privada (x=24,5 dias). Entre todas as pacientes que realizaram punção aspirativa por agulha fina (PAAF), o tempo entre MMG e biópsia foi significativa maior (p=0,011) (em relação a quem não realizou o exame) para quem foi submetido ao exame, entretanto o tempo entre diagnóstico e início do tratamento foi significativamente menor (p=0,022). Conclusão: Em uma cidade de porte médio do Sudeste do Brasil, no período pré pandemia, mais de 65% das mulheres tiveram o diagnóstico firmado após apresentarem sinais ou sintomas da doença, indicando a necessidade de intensificação de informação sobre a mamografia de rastreamento. A pandemia afetou negativamente o diagnóstico do câncer de mama e um maior percentual de mulheres teve a doença detectada através de sinais ou sintomas e em estadiamento mais avançado. Medidas precisam ser tomadas para reduzir o tempo entre mamografia e biópsia entre pacientes atendidas pelo SUS
Title in English
Impact of COVID-19 on patient journey of breast cancer in a hospital in the south of Minas Gerais
Keywords in English
Breast câncer
Clinical itinerary
COVID-19
Mammography
Patient navigation
Abstract in English
Introduction: Breast cancer (BC) has a high prevalence in women worldwide and in Brazil, among the cancers, represents the leading cause of female death, so it is important, the early diagnosis and treatment. There is evidence of a decrease in BC mortality; however, the treatment and screening access have been suffering from inequality in some ethnic, social and cultural groups. In the last years, facing the COVID-19 pandemic, there are indicators that a set of factors such as pandemic, health system overload and the virus control required measures, have caused diagnosis and treatment delays in BC patients. Goals: To evaluate the COVID-19 impact in BC patients before and after pandemic in an oncology referral hospital, located in a medium-sized city in the south of Minas Gerais. Methodology: Refers to quantitative-qualitative analysis, observational study, patients medical records analysis, with an epidemiological profile collection, access time period for medical appointments, to exams and health services for patients who have been diagnosed with BC from 2019 to 2021, that lives in Pouso Alegre (MG), it has been compared groups before the pandemic (group A) and during the pandemic (group B).Results and discussion: Electronic medical records to 89 patients treated from 03/01/2019 to 04/30/2021 were reviewed. In the pre-pandemic period and during the pandemic, 67.9% and 87.7% patients that had been admitted in to mastology sector had breast symptoms, respectively, which means an increase during the pandemic (p=0.036). Before the pandemic 29% of the patients had clinical staging (CS) disease 0 or I and only 5.8% were diagnosed with CS disease IV. During the pandemic, 18% and 15% were diagnosed with disease 0 and I versus CS IV, respectively. There were no differences between the access time periods for medical appointments and exams between the groups A and B. However, when analyzed the total number of patients in study (A+B) there was a percentage increase (p=0.016) in the time taken between the mammograms (MMG) and the biopsy for patients that had been taken a mastology medical appointment in the public healthcare system (x=119.8 days) versus the private healthcare system (x=24.5 days). Among all the patients that were submitted to fine needle aspiration biopsy (FNAB), the time between MMG and biopsy was higher (p=0.011) if compared who the ones that were not submitted to this exams, meanwhile, the time between diagnosis and the treatment beginning was lower (p=0.022). Conclusion: In a medium-sized city in Southeast Brazil, in a pre-pandemic period more than 65% of the women were diagnosed after show the diseases symptoms, which indicating the need of increasing people information about screening mammography. The pandemic had been negatively affected the breast cancer diagnosis and higher women percentage had the disease detected by presenting signs or symptoms in an advanced-stage. Measures must to be taken to decrease the time between mammography and biopsy among patients treated by the public healthcare system
 
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Publishing Date
2023-02-01
 
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