Perfil dos pacientes com câncer de mama encaminhados pela regulação municipal para a oncologia clínica de um hospital público e análise do tempo de acesso ao tratamento

Abstract

Introduction: The time elapsed between diagnosis and initiation of oncologic treatment constitutes a central indicator of quality of care and is directly associated with breast cancer prognosis. In Brazil, Federal Law No. 12,732/2012 establishes a maximum period of 60 days for the initiation of treatment after diagnostic confirmation. However, formal compliance with this legislation is a challenge, especially in contexts of fragmentation of the Health Care Network. Objective: To evaluate in an integrated manner the care-related time intervals between diagnosis and initiation of oncologic treatment in patients with breast cancer referred through municipal regulation to the public oncology referral hospital, as well as to characterize the sociodemographic and clinical profile of these patients. Methods: Quantitative, retrospective, and descriptive study, carried out through the analysis of 82 care records of patients with breast cancer referred through municipal regulation, seen at the first consultation in the Medical Oncology Department of a public oncology referral hospital in the municipality of Uberlândia, Minas Gerais, between May 2024 and February 2025. The following time intervals were analyzed: time between histopathological diagnosis and initiation of first treatment (primary time), stratified between patients with prior treatment outside the institution and those without prior treatment; time between diagnosis and referral through municipal regulation (T1); time between referral and first specialized consultation (T2); and time between the first consultation and initiation of treatment at the specialized service (T3). Data were subjected to descriptive statistical analysis, with emphasis on measures of central tendency and dispersion. Results and Discussion: There was a predominance of female patients (97.6%), the median age was 62 years, and most patients resided in the municipality of Uberlândia (93.9%). Patients were mainly stage II (45.1%), and quadrantectomy was the most frequently performed procedure (72%). A mean time of 72 days was observed between diagnostic confirmation and initiation of treatment, with a median of 66 days and a high standard deviation, indicating wide variability in care pathways. Stratification of the primary time revealed relevant differences between patients who underwent prior treatment before access to the specialized service and those who initiated treatment exclusively at the referral hospital. The interval between diagnosis and referral (T1) showed a median of 71 days, configuring the main bottleneck in the care pathway. In contrast, intrahospital times, especially between referral and the first oncology consultation (T2) and between the specialized consultation and initiation of treatment (T3), were shorter and more homogeneous. The results indicate that delays in the initiation of oncologic treatment are predominantly cumulative and are concentrated in the pre-hospital stages of the care pathway, reflecting weaknesses in diagnostic capacity, articulation between levels of care, and access regulation processes. Conclusion: It was observed that the mean time between histopathological confirmation of breast cancer and initiation of treatment is mostly longer than the period recommended by law and that the main causes involved are in the pre-specialized care phase.