OBJECTIVE: To evaluate in the last twenty years the remuneration model of Brazilian health system for the radiotherapy trying to demonstrate that the current model does not take into consideration relevant variables to adequate and better it.
METHODS: This observational study included the collected data of the budget and the number of radiotherapy procedures performed between 1995-2015 by the Ministry of Brazilian health. The model was tested to detected any relationship with the cancer incidence and inflation. The variables were tested for a linear, cubic, exponential and logarithmic relationship. To measure the power of the association between the variables the R-square was calculated with an R value > 0.75 and a p-value < 0.05 considered significant.
RESULTS: A linear increase as in the number of procedures (R=0.94 e p<0.05) as in the total of radiotherapy budget (R= 0.82 e p<0.05) was detected in the last 20 years. Since 1995, it has occurred an increase of the spendings for the Ministry of Brazilian health with the number of RT procedures. In the last twenty years, the number of RT procedures and the RT budget increased around 4.5 and 7.5 times. Except in 2010, in all other years, the budget was increased in the total value and no in the unit value of the procedure. There was not any relationship between the cancer incidence (p>0.05) or inflation (p>0.05) with the increased spending. There was a deficit of R$ 90 million corrected by the accumulated inflation in 5 years and about R$ 350 million in 20 years.
CONCLUSION: In the last 20 year, the ministry of health increased as the quantity of RT procedures as the budget for the RT. The spending with RT was constant and linear during the period. However, the model does not attend the needings of Brazilian's population, because this model does not take into consideration the cancer incidence, inflation and also because the increase in the value does not give in the RT procedure.
Keywords: Unified Health System; Remuneration; Radiotherapy
OBJECTIVE: To identify the frequency of occurrence of vestibular alterations in cancer patients treated with platinum-based chemotherapy, their vestibular signs and symptoms, and whether the pre-existing vestibular alterations exacerbate emetic symptoms during the treatment.
METHODS: Prospective, longitudinal and exploratory study. The sample was composed of adults, treated with platinum-based chemotherapy, who underwent vestibular evaluation pre and post-treatment. The vestibular monitoring involved the Brazilian Dizziness Handicap Inventory (DHI), Vestibular Function Tests and the description of emetic symptoms and dizziness during chemotherapy and vestibular evaluation.
RESULTS: Forty-eight patients completed the vestibular evaluation before the chemotherapy treatment, and 52% presented vestibular alteration. Sixteen patients underwent the evaluation before and after treatment, and 50% presented a change in the vestibular function. The DHI showed normal score in all patients in the pre-treatment assessment and in 81,3% of them post-treatment. The dose of cisplatin among patients who had a modification in the vestibular status varied from 160 to 400 mg/m2. Two patients were treated with carboplatin with doses of 2306 mg/m2 and 1801 mg/m2. There was no difference of emetic symptoms/dizziness among patients with or without previous vestibular alteration.
CONCLUSION: Vestibular alterations or modifications in the vestibular status were found in 50% of this sample. The most common sign of vestibular alteration was the predominance of labyrinth response in the caloric test with no symptoms in their daily life. The pre-existing vestibular alterations did not exacerbate emetic symptoms during chemotherapy.
Keywords: Neoplasms; Platinum; Signs and symptoms; Antineoplastic agents/toxicity; Emetics; Drug therapy; Vestibular function tests; Surveys and questionnaires; Vertigo
OBJECTIVE: Evaluate anthropometric profile, food consumption and functional capacity of hospitalized patients in a cancer hospital of Uberlândia, Minas Gerais.
METHODS: This was a cross-sectional study with oncologyc patients, in the period from April to August 2015. In relation to anthropometry was assessed: body mass index, arm circumference, arm muscle circumference, corrected arm muscle area, triceps skinfold and dynamometry. Were applied the assessment global subjective and surveys to evaluate food consumption, whose analyzed variables were, calorie, macronutrients, micronutrients (vitamin C, calcium, iron and zinc), cholesterol and dietary fiber.
RESULTS: The percentage of malnutrition ranged from 48% to 72% among the anthropometric indicators. There was an important inadequacy in the dietary intake of these patientes, especially calcium (98%), zinc (78%) and vitamin C (70%). In a logistic regression model, dynamometry showed that, at every 1 kgf preserved, there was a reduction of 11% in the chance of developing malnutrition, even when adjusted for sex and food consumption.
CONCLUSION: Oncological patients had a high frequency of malnutrition (48 to 72%) and several inadequacies in food consumption. In addition, the preserved functional capacity assessed by palmar grip strength was associated with a reduction of 11% in malnutrition at each 1kgf unit. The present study suggests that nutritional assessment should be performed early in order to identify the need for nutritional therapy and reduce the negative impact of malnutrition on the patient's quality of life.
Keywords: Nutritional assessment; Malnutrition; Neoplasmas; Food consumption; Compressive strength
OBJECTIVE: To identify differences in systemic cancer therapy for the four most incident cancers among different treatment centers in the PuHS and to compare these treatments to Protocol and Treatment Standards (PTS) established by the Ministry of Health (MH) as well as to the standard practiced in the private health system (PrHS).
METHODS: Using the Information Access Law, we collected information regarding systemic treatment guidelines from public cancer centers. We compared the treatment guidelines to the PTS for breast, lung, colorectal and prostate cancer, categorizing the treatments as adequate, above or below standard. We also compared the local treatment guidelines to the standard treatments in the PrHS.
RESULTS: Of 52 cancer centers that responded to the request, 18 did not have treatment guidelines for any of four tumor types. Local treatment guidelines for lung cancer (by 29 centers), breast cancer (33 centers), colorectal cancer (31 centers) and prostate cancer (33 centers) were obtained. We identified sub-standard treatment as compared to the one recommended in the PTS in 16 centers for lung and 8 centers for breast cancer, and a treatment standard better than the PTS in 8, 13, 10 and 14 centers for lung, breast, colorectal and prostate cancer, respectively. We also identified differences in treatment between centers from a same city for all four types of tumors. Few centers offer treatments equivalent to that practiced in the PrHS, though the majority offer sub-standard therapy in this comparison. Centers from all regions were heterogeneous in terms of treatment guidelines.
CONCLUSIONS: We confirm there are major differences in systemic cancer therapy for the four most incident cancers between cancer centers in the Public Health System (PuHS) in Brazil. Moreover, treatment offered at these public cancer centers can be below the standard established by the Ministry of Health, and well bellow the standard practiced in the PrHS.
Keywords: Antineoplastic protocols; Chemotherapy; Antineoplastic combined chemotherapy protocols; Delivery of health care