Audit about first consultations on head and neck oncological surgery in Brazil
Fábio Muradás Girardi
Abstract
Introduction: The establishment of high complexity centers in Oncology aims to guarantee faster access to a specialist. Objective: to evaluate the profile of the cases referenced to a head and neck oncology center. Methods: Retrospective cohort study, selecting first consultations for head and neck surgical oncology in a public service of a philanthropic institution, for 12 consecutive months. Clinical and demographical data were obtained, besides information about diagnosis, staging of malignant cases, treatment and outcomes. Results: From the308 cases included, 197 (63.9%) cases confirmed malignancy (62.0%) or had high suspicion for cancer (1.9%). The remaining 111 (36.0%) cases were confirmed benign diseases (53 - 17.2%) or cases with high suspicion of benignity (58 - 18.8%). Non-melanocytic skin cancer comprised most of the malignant cases (63.3%); non-cancerous thyroid pathologies were the majority of benign cases (45.9%). Most cases of skin and lip cancer presented with disease at early stages (86.8%), while most cases of cancer of the upper airway and digestive tract (UADT) and thyroid/ salivary glands were in advanced stages (75.6 and 71.4%, respectively). There were not deaths related to the disease in the first year of follow-up, apart from the UADT cancer group. Among these, the 12-month survival was 45.9%. Advanced staging, history of alcoholism and irresectability/inoperability were associated with poorer prognosis. Conclusion: Compared to other global centers, the observed rate of first oncological consultations was high. Among the cases of UADT cancer, history of alcoholism and more advanced clinical and pathological presentation were associated with lower survival.
Keywords
References
1. Choudhury N, Hassen Y, Siddiqui J, Falzon A, Ghufoor K. A multidisciplinary audit of head and neck referrals: considerations for patients’ timelines and outcomes. Eur Arch Otorhinolaryngol. 2013;270(12):3121-6. http://dx.doi.org/10.1007/s00405-013-2453-9. PMid:23536138.
2. Brasil. Ministério da Saúde. Portaria GM/MS nº 741, de 19 de dezembro de 2005. Institui a Política Nacional de Atenção Oncológica. Diário Oficial da União [Internet]; Brasília; [citado em 2005 19/12]. Available from: http://bvsms.saude.gov.br/bvs/saudelegis/sas/2005/prt0741_19_12_2005.html
3. Brasil. Ministério da Saúde. Portaria GM/MS nº 1.559, de 1º de agosto de 2008. Institui a Política Nacional de Regulação do Sistema Único de Saúde. Diário Oficial da União [Internet]; Brasília; 2008 [cited em 2008 01/08]. Available from: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2008/prt1559_01_08_2008.html.
4. Centro de Oncologia Integrado [Internet]. Hospital Ana Nery. Santa Cruz do Sul: Hospital Ana Nery [cited 2018 24/07]. Disponível em: http://www.hospitalananery.com.br/CentroOncologia.
5. Genden EM, Rinaldo A, Bradley PJ, Lowry J, Suarez C, Shaha AR, Scully C, Ferlito A. Referral guidelines for suspected cancer of the head and neck. Auris Nasus Larynx. 2006;33(1):1-5. http://dx.doi.org/10.1016/j.anl.2005.09.008. PMid:16298505.
6. National Institute of Clinical Excellence [Internet]. London: NICE; 2004 [cited 2004 Nov]. Improving Outcomes in Head and Neck Cancers: The Manual. National Institute for Health and Care Excellence]. Disponível em: http://www.nice.org.uk/guidance/csghn/resources/improving-outcomes-in-head-and-neckcancers- the-manual2.
7. Brasil. Ministério da Saúde. Portaria GM/MS nº 516, de 17 de junho de 2015. Aprova as Diretrizes Diagnósticas e Terapêuticas do Câncer de Cabeça e Pescoço. Diário Oficial da Cidade de São Paulo [Internet]; Brasília; 2015; [cited 2015 17/06]. Available from: http://conitec.gov.br/images/Protocolos/DDT/DDT_CancerCabecaPescoco_2015.pdf.
8. Brasil. Ministério da Saúde. Portaria GM/MS nº 7, de 3 de janeiro de 2014. Aprova o Protocolo Clínico e Diretrizes Terapêuticas do Carcinoma Diferenciado da Tireoide. Diário Oficial da Cidade de São Paulo [Internet]; Brasília; [cited ANO MÊS DIA]. Available from: http://conitec.gov.br/images/Protocolos/PCDT_CarcinomaTireoide. pdf.
9. Dutra EJ, Hilsinger R. A Cadeia produtiva do tabaco na região Sul do Brasil: aspectos quantitativos e qualitativos. Geogr Ens Pesqui. 2013;17(3):17-33. http://dx.doi.org/10.5902/2236499412490.
10. Edge SE, Byrd DR, Carducci MA, Compton CA. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010.
11. Organização Mundial da Saúde. CID-10 Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde. 10a rev. São Paulo: Universidade de São Paulo; 1997.
12. Rio Grande do Sul. Secretaria da Saúde. Coordenadorias Regionais de Saúde. Relação dos municípios por coordenadorias, regiões e macrorregiões [Internet]. Porto Alegre: Governo do Estado Rio Grande do Sul; [cited 2018 26/07]. Available from: http://www.saude.rs.gov.br/crs.
13. Baughan P, O’Neill B, Fletcher E. Auditing the diagnosis of cancer in primary care: the experience in Scotland. Br J Cancer. 2009;101(Suppl 2):S87-91. http://dx.doi.org/10.1038/sj.bjc.6605397. PMid:19956170.
14. Brasil. Lei nº 12.732, de 22 de novembro de 2012. Dispõe sobre o primeiro tratamento de paciente com neoplasia maligna comprovada e estabelece prazo para seu início. Diário Oficial da União [Internet]; Brasília; 2012 23 Nov [cited 2012 20/11]. Disponível em: http://www.planalto.gov.br/ccivil_03/_ato2011-2014/2012/lei/l12732.htm.
15. Instituto Nacional de Câncer. Tipos de câncer. [Internet]. Rio de Janeiro: INCA; c1996-2018 [cited 2018 26/07]. Available from: http://www2.inca.gov.br/wps/wcm/connect/tiposdecancer/site/home.
16. Pitchers M, Martin C. Delay in referral of oropharyngeal squamous cell carcinoma to secondary care correlates with a more advanced stage at presentation, and is associated with poorer survival. Br J Cancer. 2006;94(7):955-8. http://dx.doi.org/10.1038/sj.bjc.6603044. PMid:16552440.
17. Gómez I, Seoane J, Varela-Centelles P, Diz P, Takkouche B. Is diagnostic delay related to advanced-stage oral cancer? A meta-analysis. Eur J Oral Sci. 2009;117(5):541-6. http://dx.doi.org/10.1111/j.1600-0722.2009.00672.x. PMid:19758250.
18. Brouha X, Tromp D, Hordijk GJ, Winnubst J, De Leeuw R. Role of alcohol and smoking in diagnostic delay of head and neck cancer patients. Acta Otolaryngol. 2005;125(5):552-6. http://dx.doi.org/10.1080/00016480510028456. PMid:16092550.
19. Hobson JC, Malla JV, Sinha J, Kay NJ, Ramamurthy L. Outcomes for patients referred urgently with suspected head and neck cancer. J Laryngol Otol. 2008;122(11):1241-4. http://dx.doi.org/10.1017/S0022215108002004. PMid:18371234.
20. Kennedy AM, Aziz A, Khalid S, Hurman D. Do GP referral guidelines really work? Audit of an electronic urgent referral system for suspected head and neck cancer. Eur Arch Otorhinolaryngol. 2012;269(5):1509-12. http://dx.doi.org/10.1007/s00405-011-1788-3. PMid:21984061.
21. Lyons M, Philpott J, Hore I, Watters G. Audit of referrals for head and neck cancer – the effect of the 2-week, fast track referral system. Clin Otolaryngol. 2004;29(2):143-5. http://dx.doi.org/10.1111/j.0307-7772.2004.00744.x. PMid:15113298.
22. Tikka T, Pracy P, Paleri V. Refining the head and neck cancer referral guidelines: a two-centre analysis of 4715 referrals. Clin Otolaryngol. 2016;41(1):66-75. http://dx.doi.org/10.1111/coa.12597. PMid:26611658.
23. Oxford Cancer Intelligence Unit. Head and Neck Cancers in England Relative survival by age and stage [Internet]. London: Oxford Cancer Intelligence Unit; 2011 [cited 2011 Maio]. Available from: http://www.ncin.org.uk/view?rid=801.
24. Girardi FM, Zanella VG, Kroef RG. Is there any difference between clinical and pathological data of patients with oral and oropharyngeal cancer from public and private system? Rev Bras Cir Cabeça Pescoço. 2013;42(1):18-22.
25. Carvalho AL, Pintos J, Schlecht NF, Oliveira BV, Fava AS, Curado MP, Kowalski LP, Franco EL. Predictive factors for diagnosis of advanced-stage squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg. 2002;128(3):313-8. http://dx.doi.org/10.1001/archotol.128.3.313. PMid:11886350.
26. Tromp DM, Brouha XD, Hordijk GJ, Winnubst JA, de Leeuw RJ. Patient and tumour factors associated with advanced carcinomas of the head and neck. Oral Oncol. 2005;41(3):313-9. http://dx.doi.org/10.1016/j.oraloncology.2004.09.008. PMid:15743694.
27. Brouha XD, Tromp DM, de Leeuw JR, Hordijk GJ, Winnubst JA. Laryngeal cancer patients: analysis of patient delay at different tumor stages. Head Neck. 2005;27(4):289-95. http://dx.doi.org/10.1002/hed.20146. PMid:15668927.
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