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Paula Bhering Nogueira A, Drummond-Lage AP, Drummond Pinho Ribeiro G, Ferreira Leite E, Henrique Xavier M, Julius Alves Wainstein A. Factors Related to Delayed Diagnosis of Cutaneous Melanoma in the Brazilian Public Health System. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1253-1259. [PMID: 35578128 DOI: 10.1007/s13187-022-02176-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
In Brazil, 75% of the population uses the Sistema Único de Saúde (SUS), public health system, where the general practitioner (GP) is responsible for melanoma diagnosis. Identify the factors related to the delay in diagnosing melanoma patients assisted by SUS. A prospective observational study based on a questionnaire and medical records review assessed the sociodemographic features, melanoma signs and symptoms, previous knowledge of the disease, and factors related to delays in seeking medical care. One hundred sixty-six patients were included. Healthcare professionals suspected a lesion in only 23.5% of cases. The average time between lesion suspicion by patient/relative and first medical appointment with GP was over 6 months (31%). The time between the first GP exam and biopsy conducted by a specialist ranged from less than 1 month (34.9%) to more than 1 year (18.7%). Half of the patients (49.4%) experienced delays in histopathological diagnosis due to SUS bureaucracy/slowness. Most (80%) patients did not know what melanoma was before diagnosis. Delay in melanoma diagnosis was related to a lack of knowledge about the disease's signs and symptoms for both the study population and the primary physicians, indicating that both players must receive proper education about melanoma. Also, the infrastructure and work processed at SUS impeded the patient flow, contributing to the diagnosis of the lesions at more advanced stages.
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Affiliation(s)
- Ana Paula Bhering Nogueira
- Faculty of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias 275, Centro, Belo Horizonte, MG, 30130130, Brazil
- Hospital Alberto Cavalcanti, Rua Camilo de Brito 636, Padre Eustáquio, Belo Horizonte, MG, 30730540, Brazil
| | - Ana Paula Drummond-Lage
- Faculty of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias 275, Centro, Belo Horizonte, MG, 30130130, Brazil.
| | | | - Estevão Ferreira Leite
- Faculty of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias 275, Centro, Belo Horizonte, MG, 30130130, Brazil
| | - Marcus Henrique Xavier
- Faculty of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias 275, Centro, Belo Horizonte, MG, 30130130, Brazil
| | - Alberto Julius Alves Wainstein
- Faculty of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias 275, Centro, Belo Horizonte, MG, 30130130, Brazil.
- Hospital Alberto Cavalcanti, Rua Camilo de Brito 636, Padre Eustáquio, Belo Horizonte, MG, 30730540, Brazil.
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Marcelino BA, Soares FH, Curi MLDC, Alves Wainstein AJ, Drummond-Lage AP. Is a law enough to provide a better prognosis for Brazilian melanoma patients or education is still a gap? Int J Health Plann Manage 2022; 37:2479-2484. [PMID: 35484704 DOI: 10.1002/hpm.3491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 12/24/2022] Open
Abstract
According to Brazilian Law 12.732/12 ("60-day law"), cancer patients have 60 days after diagnosis for beginning treatment at the Unified Health System (SUS). The study aimed to evaluate the achievement and effectiveness of the '60-day law' for melanoma patients in a SUS cancer reference unit. A retrospective study analysed 58 medical charts from patients with the initial diagnosis performed before and after the "60-day law". The Law does not change the time interval between diagnosis and the beginning of treatment, and after the Law, patients presented a worse overall survival (p < 0.001). In conclusion, the '60-day law' was not effective.
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Affiliation(s)
- Bruno Aquino Marcelino
- Department of Post Graduation, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda Hermeto Soares
- Department of Post Graduation, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Ana Paula Drummond-Lage
- Department of Post Graduation, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
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Naik PP. Cutaneous Malignant Melanoma: A Review of Early Diagnosis and Management. World J Oncol 2021; 12:7-19. [PMID: 33738001 PMCID: PMC7935621 DOI: 10.14740/wjon1349] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
Cutaneous melanoma (CM) is a malignant tumor formed from pigment-producing cells called melanocytes. It is one of the most aggressive and fatal forms of skin malignancy. In the last decades, CM's incidence has gradually risen, with 351,880 new cases in 2015. Since the 1960s, its incidence has increased steadily, in 2019, with approximately 96,000 new cases. A greater understanding of early diagnosis and management of CM is urgently needed because of the high mortality rates due to metastatic melanoma. Timely detection of melanoma is crucial for successful treatment, but diagnosis with histopathology may also pose a significant challenge to this objective. Early diagnosis and management are essential and contribute to better survival rates of the patient. To better control this malignancy, such information is expected to be particularly useful in the early detection of possible metastatic lesions and the development of new therapeutic approaches. This article reviews the available information on the early diagnosis and management of CM and discusses such information's potential in facilitating the future prospective.
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Affiliation(s)
- Piyu Parth Naik
- Department of Dermatology, Saudi German Hospitals and Clinics, Hessa Street 331 West, Al Barsha 3, Exit 36 Sheikh Zayed Road, Opposite of American School, Dubai, United Arab Emirates.
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