Oncology care should be reviewed – opinion

Cancer care in Brazil is at an important moment of reflection on the effects of current decisions on the health of the Brazilian population. The growing number of cancer cases and the difficulties faced by the SUS, further exacerbated by the significant reduction in expenditures for cancer care, with cuts of up to 61% in resources to purchase equipment. The recently announced renovation of oncology and maternity network hospitals is a major detriment to the care needed to treat the disease. Reducing investments in research is another factor set back in the search for new drugs against cancerous tumors and makes the country reliant on international solutions.

Aging and population growth are factors that are expected to generate more than 90% growth in new cancer cases in Latin America by 2035, according to data from the International Agency for Research on Cancer (IARC). Brazil is already experiencing this phenomenon as the longevity of Brazilians increases, causing an acceleration in the growth of oncology registries in recent years. We are no longer a country where infectious and infectious diseases prevail to become a nation of known chronic non-communicable diseases, which also include oncological diseases. Between 2018 and 2019, according to data from the National Cancer Institute (Inca), there were 600,000 new cancer cases annually, an increase of 22.6% compared to the 2010-2011 biennium. For the 2020-2022 triennium, the projection is 625,000 new cases each year.

The panorama of the world also shows significant changes in the diagnosis of the disease. A study conducted by specialists at Brigham and Women’s Hospital of Harvard University in the United States concluded that there has been an increase in the diagnosis of 14 carcinoid tumors in younger age groups since the 1990s in all countries. For scientists, this increase is linked to increased exposure to risk factors, such as consumption of ultra-processed foods, sugary drinks, obesity, a sedentary lifestyle, and alcohol consumption, among others, which have increased rapidly since the 1950s. Common in younger patients over 50 years of age in the breast, colon, rectum, esophagus, kidney, stomach, liver, and pancreas. The survey analyzed data from 44 countries available at the World Cancer Observatory.

In Brazil, 10% of municipalities have already registered cancer as the leading cause of death, and the COVID-19 pandemic has been another factor with direct impacts on the diagnosis and treatment of cancer patients. In 2020, the country recorded a 40% reduction in mammography and stomach cancer screenings. Biopsies decreased by 29% and prostate examinations by 25%. There was also a decrease in lung exams (-23%) and colorectal cancer (-25%).

The Brazilian public health system continues to face problems affecting appropriate care for cancer patients, such as a lack of standardization in screening for some types of cancer, as well as difficulties in accessing preventive examinations. Even the schedule and access to medication are at risk. However, in the private system, difficulties with referral and access to the specific treatment process also prevail.

In research, we’ve had a strong setback in recent years, seriously compromising cancer studies. Between 2007 and 2012, investments in the sector jumped from $37.6 million to $62.1 million, according to data from the Oswaldo Cruz Foundation (Viocruz) and the Inca. However, after this period, resources began to decline and reached US$38.4 million in 2016. The outlook is fraught with discontent among professionals specializing in oncology studies. The lack of resources is preventing important advances in the understanding of oncology and deeper investigations into effective anti-cancer drugs.

Low investment in research seriously increases our dependence on drug imports and should overwhelm the costs of oncology care by SUS. In 2008, we spent $316 million on treating these diseases, which is $638 million in 2019.

The public and private sectors face major challenges in the future to address oncological diseases. Prevention and early diagnosis are essential for a better outcome, as well as for the resumption of investments in research. The current panorama of cancer care shows that a service put in place because of the pandemic has the potential to cause an even more tragic waiting list in the face of recent cuts to the union’s budget. Brazil desperately needs to write a new history of cancer care for its population.

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MD, MD in Medical Oncology from the University of Porto, Portugal, Professor of Clinical Oncology at the Faculty of Medicine of the Universidad Nova de Jolo