73,000 patients go without radiotherapy per year in the SUS – 09/04/2023 – Health

An average of 73,000 cancer patients do not have access to radiotherapy in the SUS each year. Between 2008 and 2022, the sum reaches 1.1 million, which may have been the direct cause of more than 110,000 deaths, reveals a document from the SBR (Brazilian Society of Radiotherapy) delivered to the Ministry of Health.

During this period, the cumulative incidence of cancer in Brazil was 6.2 million new cases. At some stage of the disease, about 60% of patients will need radiotherapy, which is one of the pillars of cancer treatment, alongside surgery, chemotherapy and, more recently, immunotherapy.

The report, made in partnership with Fundação Dom Cabral, shows that, in these 15 years, 1.7 million patients received treatment in public services against an estimated demand of 2.8 million. About 75% of patients depend exclusively on the SUS. Other studies have already demonstrated inequality in access to cancer diagnosis and treatment in the country.

“Not having access to radiotherapy is a very serious problem, both for the patient, who will suffer without adequate treatment and the disease will progress, and for the country, which will have higher costs to treat the advanced disease”, says radio-oncologist Marcus Simões Castilho, President of SBR.

There are several bottlenecks, including the insufficient number of radiotherapy devices in the SUS, many of which are already obsolete, and the lag in the SUS table for paying for treatments. Ultimately, in addition to lack of access, this results in outdated and less effective therapies.

In 2012, the Ministry of Health paid US$ 1,567 (R$ 7,960) per treatment. In 2022, it was US$ 831 (R$ 4,221). In a decade, there was 80% accumulated inflation and 150% exchange rate devaluation.

“There is a lack of adequate financial resources for institutions to support themselves, keep their technology parks up-to-date and deliver quality treatment”, reinforces Castilho.

In 2012, the Ministry of Health launched an expansion plan in radiotherapy for the SUS, but, ten years later, it was only able to install just over half of the total number of linear accelerators proposed in the project.

Of the 91 new facilities planned, 58 were completed. Of these, 53 have an operating license and five are awaiting the processing of documents and license from CNEN (National Nuclear Energy Commission).

“In addition to the fact that we were unable to put that equipment into operation, the ones that are there already need to be replaced, both in terms of technology and to replace the old ones, which are no longer in condition.”

According to the report, in the last decade, the growth of nuclear accelerators was 17%, while the increase in the incidence of cancer was 32%, that is, almost double. The projection is that, by 2030, the country will need 230 new pieces of equipment. Castilho argues for more partnerships with the private sector.

“Radiotherapy for [câncer] breast can now be done in five sessions. In the past, we needed 25 to 30 sessions”, explains radio-oncologist Renato Pierre Lima, from Hospital Haroldo Juaçaba, in Fortaleza (CE), linked to the Cancer Institute, one of the oncological references in the North-Northeast.

The doctor refers to hypofractionated radiotherapy, which greatly reduces the treatment time. According to the report, it is present in 67% of radiotherapy services that exclusively serve SUS patients and in 88% of those exclusive to supplementary health.

According to Lima, his SUS patients only have access to this technology because the hospital invests its own resources in updating the machines. Many of the patients come from far away. This is the case of retiree Francisco Nascimento Silva, 73, from Ibiguitinga (CE), a city located three hours from the capital of Ceará.

Silva is being treated for a prostate tumor and underwent five consecutive sessions of radiotherapy. “It helps a lot that the treatment is shorter. These trips are very tiring for my father, who is already weakened by the disease”, says his daughter Almerinda, 37.

“You don’t need to be very smart to realize how much this impacts on cost reduction and also on accessibility to services. Radiotherapy with high technology is related to treatments with less toxicity and, sometimes, with better clinical outcomes”, says Gustavo Nader Mata, radio-oncologist at Hospital Sírio-Libanês (SP).

Intensity-modulated radiotherapy (IMRT), which generates higher doses of radiation in the tumor and lower in healthy tissues, is present in 21% of SUS services and in 77% of those that serve only health plans.

Another technique that allows for more beam precision, with less irradiation of healthy tissues, image-guided radiotherapy (IGRT) is offered in 14% of SUS services and in 57% of those in the supplementary network.

Another problem, according to Mata, is that SUS treatments are paid for in pre-established packages, without taking into account whether or not one institution offers a more appropriate technique than another.

“Instead of bundling, the government should prioritize the procedures, recognizing the different technologies. You pay exactly the same for services that have the most rudimentary technologies and those that try to offer quality radiotherapy.” In supplementary health, there is this hierarchy.

In the report, the SBR suggests changes to this model, which started in 2019, in addition to readjusting the sector’s financing, frozen since 2010.

According to Castilho, the document has already been presented and discussed at several meetings at the council of Inca (National Cancer Institute) in 2022, and the final report was presented at the end of the year to the ministry.

Helvécio Magalhães Júnior, Secretary of Specialized Care at the Ministry of Health, says that the current management is discussing several points that appear in the SBR report.

One of the authors of the radiotherapy expansion plan, in 2012, he says that there has been no progress because the oncology area has not been a priority for the federal government in recent years. “No one took care.”

The secretary affirms that his team has analyzed each one of the contracts of the approximately 460 providers in the oncology area and that there will be a “great investment” (he did not specify values) to update the radiotherapy devices, since in the last decade the technology has been very enhanced.

About the outdating of the SUS table, he says that this is a historical complaint, but that there is no forecast to review these values ​​for the time being. “We are going to allocate federal resources to balance contracts with providers, especially philanthropic ones.”

Another proposal is to individualize within the Apacs (authorization of outpatient procedures) and AIHs (authorization of hospitalizations) the values ​​of the products that will be used, remunerating in a differentiated way the institution that works with more updated technologies.