Análise de fatores que levaram ao encaminhamento tardio em casos novos de câncer de próstata recebidos no Hospital Amaral Carvalho nos anos de 2015 e 2016.
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2018-05-23
Autores
Moraes, Vanessa de
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Universidade Estadual Paulista (Unesp)
Resumo
O câncer de próstata é o tipo de tumor de maior incidência nos homens, atrás somente do câncer de pele não melanoma, é o segundo em mortalidade no Brasil, sendo um grave problema de saúde pública, pois mesmo sendo um câncer de crescimento lento e de simples detecção, muitos pacientes descobrem tardiamente a doença, diminuindo as chances de cura e de sobrevida. Os objetivos da pesquisa foram: desvelar alguns dos motivos do diagnóstico e encaminhamento tardio para um serviço de referência; analisar quais regiões encaminharam pacientes mais tardiamente e entender o itinerário terapêutico desses pacientes. Trata-se de uma pesquisa quanti-qualitativa, desenvolvida em duas etapas. No 1º momento realizou-se um estudo retrospectivo, descritivo e quantitativo de dados levantados junto ao RHC, de 1531 pacientes com câncer de próstata recebidos no Hospital Amaral Carvalho em 2015 e 2016. Na segunda etapa foi realizado um estudo qualitativo, com realização de 100 entrevistas, com perguntas fechadas e abertas. Entre os resultados destaca-se que a maioria dos pacientes está acima de 50 anos (97,77%), com média de 66 anos. A faixa etária de 70 a 79 anos apresentou o maior número de óbitos (3,66%) do total de 141 (9,21%), sendo o maior índice de pacientes com estádio IV (4,25%). 28,15% (431) dos pacientes chegaram com estádio avançado, sendo 131 da DRS VI (Bauru), 85 da DRS IX (Marília), 84 da DRS XVI (Sorocaba), 52 da DRS III (Araraquara) e os demais casos em menores números das demais DRS. Na 2ª etapa da pesquisa, constatou-se que dos 100 pacientes entrevistados: 78 são casados, 41 possuem de 3 a 4 filhos, 50 estudaram até o 4º ano, 67 já estão aposentados, 79 buscaram atendimento SUS. Dos sujeitos, 76 se autonomearam brancos, 68 não fumantes, 56 pacientes afirmaram possuir familiares com câncer, sendo o familiar mais citado foi o pai (21), e o câncer de próstata o de maior prevalência. Ainda 70 pacientes declararam fazer exames de prevenção, 55 tiveram sintomas, apenas 20 relataram encontrar dificuldades no encaminhamento ao serviço especializado e 43 aguardaram menos de um mês para o atendimento no HAC. A pesquisa constatou que os casos de pacientes com estágios mais avançados (III e IV) somaram 24,85% em 2015 e 32,53% em 2016. Os valores culturais relacionados à masculinidade se destacaram como o principal motivo do encaminhamento tardio destes pacientes. A desorganização e a falta de comprometimento de alguns profissionais da saúde básica também foram obstáculos no acesso aos serviços de alta complexidade. Como proposta de auxílio na detecção precoce do câncer de próstata, sugerimos: definição de um consenso sobre rastreamento; capacitação dos profissionais da rede básica para atendimento desta clientela; priorização de campanhas e trabalho coletivo com equipe multiprofissional; horário diferenciado para atendimento
Prostate cancer is the second most common type of tumor in men, behind only non-melanoma skin cancer. It is the second most common type of cancer in Brazil, being a serious public health problem. simple detection, many patients belatedly discover the disease, decreasing the chances of cure and survival. The objectives of the research were: to unveil some of the reasons for the diagnosis and late referral for a referral service; to analyze which regions referred patients later and to understand the therapeutic itinerary of these patients. It is a quantitative qualitative research, developed in two stages. A retrospective, descriptive and quantitative study of 1531 prostate cancer patients received at the Amaral Carvalho Hospital in 2015 and 2016 was carried out in the 1st stage. A second qualitative study was carried out with 100 interviews, with closed and open questions. Among the results it is highlighted that the majority of patients are over 50 years (97.77%), with a mean of 66 years. The age group from 70 to 79 years old had the highest number of deaths (3.66%) out of 141 (9.21%), being the highest rate of patients with stage IV (4.25%). 28,15% (431) of the patients arrived at an advanced stage, 131 of the DRS VI (Bauru), 85 of the DRS IX (Marília), 84 of the DRS XVI (Sorocaba), 52 of the DRS III (Araraquara) and the other cases in smaller numbers of the other DRS. In the second stage of the research, it was verified that of the 100 patients interviewed: 78 are married, 41 have 3 to 4 children, 50 have studied until the 4th year, 67 are already retired, 79 have sought SUS care. Of the subjects, 76 became white, 68 were non-smokers, and 56 patients reported having relatives with cancer. The most frequent family member was the father (21), and prostate cancer was the most prevalent. In addition, 70 patients reported having had preventive exams, 55 had symptoms, only 20 reported having difficulty in referral to the specialized service, and 43 waited less than one month for care at HAC. The research found that the cases of patients with more advanced stages (III and IV) totaled 24.85% in 2015 and 32.53% in 2016. The cultural values related to masculinity were the main reason for the late referral of these patients. The disorganization and lack of commitment of some basic health professionals have also been obstacles in accessing high complexity services. As a proposal to aid in the early detection of prostate cancer, we suggest: definition of consensus on screening; training of professionals in the basic network to serve this clientele; prioritization of campaigns and collective work with multiprofessional team; differentiated service hours.
Prostate cancer is the second most common type of tumor in men, behind only non-melanoma skin cancer. It is the second most common type of cancer in Brazil, being a serious public health problem. simple detection, many patients belatedly discover the disease, decreasing the chances of cure and survival. The objectives of the research were: to unveil some of the reasons for the diagnosis and late referral for a referral service; to analyze which regions referred patients later and to understand the therapeutic itinerary of these patients. It is a quantitative qualitative research, developed in two stages. A retrospective, descriptive and quantitative study of 1531 prostate cancer patients received at the Amaral Carvalho Hospital in 2015 and 2016 was carried out in the 1st stage. A second qualitative study was carried out with 100 interviews, with closed and open questions. Among the results it is highlighted that the majority of patients are over 50 years (97.77%), with a mean of 66 years. The age group from 70 to 79 years old had the highest number of deaths (3.66%) out of 141 (9.21%), being the highest rate of patients with stage IV (4.25%). 28,15% (431) of the patients arrived at an advanced stage, 131 of the DRS VI (Bauru), 85 of the DRS IX (Marília), 84 of the DRS XVI (Sorocaba), 52 of the DRS III (Araraquara) and the other cases in smaller numbers of the other DRS. In the second stage of the research, it was verified that of the 100 patients interviewed: 78 are married, 41 have 3 to 4 children, 50 have studied until the 4th year, 67 are already retired, 79 have sought SUS care. Of the subjects, 76 became white, 68 were non-smokers, and 56 patients reported having relatives with cancer. The most frequent family member was the father (21), and prostate cancer was the most prevalent. In addition, 70 patients reported having had preventive exams, 55 had symptoms, only 20 reported having difficulty in referral to the specialized service, and 43 waited less than one month for care at HAC. The research found that the cases of patients with more advanced stages (III and IV) totaled 24.85% in 2015 and 32.53% in 2016. The cultural values related to masculinity were the main reason for the late referral of these patients. The disorganization and lack of commitment of some basic health professionals have also been obstacles in accessing high complexity services. As a proposal to aid in the early detection of prostate cancer, we suggest: definition of consensus on screening; training of professionals in the basic network to serve this clientele; prioritization of campaigns and collective work with multiprofessional team; differentiated service hours.
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Palavras-chave
prostate cancer, late diagnosis, men's Health, câncer de próstata, diagnóstico tardio, saúde do homem