Challenges in building radiotherapy capacity: A longitudinal study evaluating eight years of the Brazilian radiotherapy expansion plan.

Autor: Gouveia AG; Department of Oncology, Division of Radiation Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil., Viani GA; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Ribeirão Preto Medical School, Department of medical imagings, hematology and oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil., Bratti VF; Department of Public Health Sciences, Queen's University, Kingston, ON, Canada., Marta GN; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Department of Oncology, Division of Radiation Oncology, Sírio Libanes Hospital, São Paulo, Brazil., Hanna SA; Department of Oncology, Division of Radiation Oncology, Sírio Libanes Hospital, São Paulo, Brazil., Jacinto AA; Radiation Oncology Department, Barretos Cancer Hospital, Barretos, SP, Brazil., Silva MS; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Unit, Santa Maria Federal University, Santa Maria; and Clínica de Radioterapia de Santa Maria, Brazil., Hamamura AC; Ribeirão Preto Medical School, Department of medical imagings, hematology and oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil., Rosa AA; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiotherapy Department Oncoclinicas Salvador and Hospital Santa Izabel, Salvador, BA, Brazil., Castilho MS; Radiotherapy Department of the Felicio Rocho Hospital, Belo Horizonte, MG, Brazil; President, Brazilian Radiotherapy Society - SBRT, Brazil., Carson L; Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Queen's University, Kingston, ON, Canada., Hopman WM; Kingston General Health Research Institute; Department of Public Health Sciences, Queen's University, Kingston, ON, Canada., Sullivan R; Institute of Cancer Policy, Global Oncology Group, King's College London, London, UK., Booth CM; Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada., Aggarwal A; Department of Oncology, Queen's University, Kingston, ON, Canada; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK., Hanna TP; Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada; Department of Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada., Moraes FY; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada. Electronic address: fymoraes@gmail.com.
Jazyk: angličtina
Zdroj: Journal of cancer policy [J Cancer Policy] 2024 Mar; Vol. 39, pp. 100459. Date of Electronic Publication: 2023 Nov 28.
DOI: 10.1016/j.jcpo.2023.100459
Abstrakt: Background: In 2012, the Brazilian government launched a radiotherapy (RT) expansion plan (PER-SUS) to install 100 linear accelerators. This study assesses the development of this program after eight years.
Methods: Official reports from the Ministry of Health (MoH) were reviewed. RT centres projects status, timeframes, and cost data (all converted to US dollars) were extracted. The time analysis was divided into seven phases, and for cost evaluation, there were five stages. The initial predicted project time (IPPT) and costs (estimated by the MoH) for each phase were compared between the 18 operational RT centres (able to treat patients) and 30 non-operational RT centres using t-tests, ANOVA, and the Mann-Whitney U. A p-value < 0.05 indicates statistical significance.
Results: A significant delay was observed when comparing the IPPT with the overall time to conclude each 48 RT centres project (p < 0.001), with considerable delays in the first five phases (p < 0.001 for all). Moreover, the median time to conclude the first 18 operational RT centres (77.4 months) was shorter compared with the 30 non-operational RT centres (94.0 months), p < 0.001. The total cost of 48 RT services was USD 82,84 millions (mi) with a significant difference in the per project median total cost between 18 operational RT centres, USD1,34 mi and 30 non-operational RT centres USD2,11 mi, p < 0.001. All phases had a higher cost when comparing 30 non-operational RT centres to 18 operational RT centres, p < 0.001. The median total cost for expanding existing RT centres was USD1,30 mi versus USD2,18 mi for new RT services, p < 0.0001.
Conclusion: After eight years, the PER-SUS programs showed a substantial delay in most projects and their phases, with increased costs over time.
Policy Summary: Our findings indicate a need to act to increase the success of this plan. This study may provide a benchmark for other developing countries trying to expand RT capacity.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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