Therapeutic itinerary of hematological patients: the importance of early diagnosis

Authors

DOI:

https://doi.org/10.33448/rsd-v11i4.27670

Keywords:

Therapeutic Itinerary; Health Services; Hematology; Early Diagnosis; Delay.

Abstract

Objective: to identify the trajectory of patients with acute leukemia and severe aplastic anemia before the specialized care seeking care at the reference center. Methods: cross-sectional, observational, quantitative and analytical research. The research was carried out in a university hospital in the south of Brazil, in two services that care for onco-hematological patients. In the 18-month period, 237 patients were treated, according to the inclusion criteria: adults over 18 years of age, with prior treatment for education and with diagnostic confirmation, being eligible for the study, 31 patients with acute leukemia and 19 with severe aplastic anemia (n=50). Results: the median time of the search interval for help was 7 (0-158) days; diagnostic interval of 14 (0-390) days; and pre-treatment interval 2 (71-783) days. In search of care, in the first ten days after the onset of two symptoms, it occurred in 16 (61.5%) patients with acute leukemia and in 7 (41.2%) patients with severe aplastic anemia (p≥0.05). The time interval between the diagnosis, proximity to the specialized center and type of work will show statistical significance. Conclusion: the knowledge of two factors that led to the non-diagnostic delay of these actions, contributed to the understanding of health care, contributing to improve hematological assistance and the formulation of public policies, including effective strategies to improve access to specialized services.

Author Biographies

Solange Delazeri, Universidade Federal do Paraná

Enfermeira. Mestre em Enfermagem. Complexo Hospital de Clínicas da Universidade Federal do Paraná.

Ricardo Pasquini, Universidade Federal do Paraná

Médico emérito. Serviço de Transplante de Medula Óssea. Complexo Hospital de Clínicas da Universidade Federal do Paraná.

Letícia Pontes , Universidade Federal do Paraná

Enfermeira. Doutora em Enfermagem. Professora adjunta da Universidade Federal do Paraná.

Ingrid Meireles Gomes , Universidade Federal do Paraná

Enfermeira. Doutora em Enfermagem. Complexo Hospital de Clínicas da Universidade Federal do Paraná.

Eliane Mara Pereira Cesário Maluf , Universidade Federal do Paraná

Médica. Doutora em Medicina Interna. Universidade Federal do Paraná.

References

Brousselle, A., Breton M., Benhadj, L., Tremblay, D., Provost, S., Roberge, D. et al. (2020). Explaining time elapsed prior to cancer diagnosis: Patients’ perspectives. BMC Health Serv Res, 17(1),448. https://doi.org/10.1186/s12913-017-2390-1

Cabral, A. L. L. V., Martinez-Hemáez, A., Andrade, E. I. G., Cherchiglia, M. L. (2011). Therapeutic itineraries: State of the art of scientific production in Brazil. Ciência & Saúde Coletiva, 16(11):4433–42. https://doi.org/10.1590/S1413-81232011001200016

Dang-tan, T., Trottier, H., Mery, L. S., Morrison H. I., Barr, R. D., Greenberg, M. L., et al. (2010). Determinants of delays in treatment initiation in children and adolescents diagnosed with leukemia or lymphoma in Canada. Int J Cancer, 126(8):1936-1943. https://doi.org/10.1002/ijc.24906

Forbes, L. J. L., Warburton, F., Richards, M. A., Ramirez, A. J. (2014). Risk factors for delay in symptomatic presentation: a survey of cancer patients. Br J Cancer, 111:581-8. https://doi.org/10.1038/bjc.2014.304

Howell, D. A., Smith, A. G., Jack, A., Patmore, R., Macleod, U., Mironska, E., et al. (2013). Time-to-diagnosis and symptoms of myeloma, lymphomas and leukaemias: A report from the Haematological malignancy Research Network. BMC Hematol, 13(1):9. https://doi.org/10.1186/2052-1839-13-9

Instituto Nacional de Câncer José Alencar Gomes da Silva (2019). Estimativa 2020: incidência de câncer no Brasil [Internet]. Rio de Janeiro (RJ). https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2020-incidencia-de-cancer-no-brasil.pdf.

Kariyawasan, C. C., Hughes, D. A., Jayatillake, M. M., Mehta, A. B. (2007). Multiple myeloma: Causes and consequences of delay in diagnosis. QJM, 100(10):635-40. https://doi.org/10.1093/qjmed/hcm077

Leukaemia Care Living with Leukaemia 2018. Living with Leukaemia [Internet]. www.leukaemiacare.org.uk.

Lins, M. M., Amorim, M., Vilela, P., Viana, M., Ribeiro, R. C., Pedrosa, A. , et al. (2012). Delayed diagnosis of leukemia and association with morbid-mortality in children in Pernambuco, Brazil. J Pediatr Hematol Oncol, 34(7):e271-6. https://doi.org/10.1097/MPH.0b013e3182580bea

Majeed, I., Majeed, I., Rana, A., Rafique, M, Anwar, A.W., Mahmood. F. (2018). Time delay barriers in diagnosis and treatment of cancer. WCRJ, 5(3):e118. https://doi.org/10.32113/wcrj_20189_1118

Maluf, E. M. C. P., Pasquini, R., Eluf, J. N., Kelly, J., Kaufman, D. W. (2002). Aplastic anemia in Brazil: Incidence and risk factors. Am J Hematol, 71(4):268-74. https://doi.org/10.1002/ajh.10232

Mota, R. T., Martins, E. F., Vieira, M. A., Costa, S. M. (2021). Percurso assistencial de pacientes convivendo com o câncer de pulmão. Rev Bioét, 29(2):363-73. http://dx.doi.org/10.1590/1983-80422021292474

National Health Service (NHS). (2019). Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit | Enhanced Reader [Internet]. https://www.ncpes.co.uk/wp-content/uploads/2020/05/CPES-2018-National-Report.pdf

Obtel, M., Berraho, M., Abda, N., Quessar, A., Zidouh, A., Bekkali, R. et al. (2017). Factors associated with delayed diagnosis of lymphomas: Experience with patients from hematology centers in Morocco. Asian Pac J Cancer Prev, 18(6):1603-1610. https://doi.org/10.22034/APJCP.2017.18.6.1603

Shephard, E. A., Hamilton, W., Neal, R. D., Rose, P. W., Walter, F. M. (2016). Symptoms of adult chronic and acute leukaemia before diagnosis: Large primary care case-control studies using electronic records. Br J Gen Pract, 66(644):e182-8. https://doi.org/10.3399/bjgp16X683989

Soares, D. A., dos Santos, E. M., Arruda, I. S. (2017). Itinerários Terapêuticos De Pessoas Com Câncer: Produção Científica No Brasil. Rev APS, 20(1):118–29. https://doi.org/10.34019/1809-8363.2017.v20.15906

Sousa, N. P., Rehen, T. C. M. S. B., Santos, W. S., Santos, C. E. (2016). Internações sensíveis à atenção primária à saúde em hospital regional do Distrito Federal. Rev Bras Enferm, 69(1). https://doi.org/10.1590/0034-7167.2016690116i

Souza, K. A., Souza, S. R., Tocantins, F. R., Freitas, T. F., Pacheco, P. Q. C. (2016). O itinerário terapêutico do paciente em tratamento oncológico: implicações para a prática da enfermagem. Cienc Cuid Saúde, 15(2):259-267 https://doi.org/10.4025

Souza, F. F., Zambenedetti, G. (2018). Percurso de cuidado: pistas sobre itinerários terapêuticos em saúde mental. Tempus, Actas de Saúde Colet, 11(4):105-122. http://dx.doi.org/10.18569/tempus.v11i4.2485

Walter, F., Webster, A., Scott, S., Emery, J. (2012). The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis. J Health Serv Res Policy, 17(2):110–8. https://doi.org/10.1258/jhsrp.2011.010113

World Health Organization (WHO). (2020). WHO report on cancer: setting priorities, investing wisely and providing care for all [Internet]. World Health Organization. 149 p. https://apps.who.int/iris/handle/10665/330745

World Health Organization (WHO). (2017). Guide to cancer early diagnosis. https://apps.who.int/iris/handle/10665/254500.

Published

25/03/2022

How to Cite

DELAZERI, S.; PASQUINI, R. .; CASTRO , A. da S.; PONTES , L. .; GOMES , I. M.; MALUF , E. M. P. C. .; MARINHO , D. H.; PEREIRA , J. de F. G. .; RODRIGUES , J. A. P. . Therapeutic itinerary of hematological patients: the importance of early diagnosis. Research, Society and Development, [S. l.], v. 11, n. 4, p. e50611427670, 2022. DOI: 10.33448/rsd-v11i4.27670. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/27670. Acesso em: 16 nov. 2024.

Issue

Section

Health Sciences