Oncoguia event discusses access to cancer treatments

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The obstacles faced by Brazilian cancer patients in the Unified Health System (SUS) was one of the topics discussed by the 12th National Oncoguia Forum. The event, which took place between the 26th and 29th of April and was organized by the Oncoguia Institute, aimed to discuss cancer treatment beyond the bias of the Covid-19 pandemic, which has been the center of debates for the last two years. The Forum also pointed to a surplus in the budget for cancer treatments in the SUS.

Cancer patients who depend on the SUS often wait a long time for the most effective drug for their disease to be approved by the National Health Surveillance Agency (Anvisa) and undergo a price assessment by the Medicines Market Regulation Chamber. (CMED). Luciana Holtz, founder and president of Instituto Oncoguia, observes that “cancer patients await the arrival of new technologies, because they know that it is what can guarantee their cure or control their disease, allowing them to live longer and better in practice. . This advance often already exists and it is very frustrating to know that not everyone has access to it,” she says.

With Anvisa’s approval, to be made available by health plans, the drug will be analyzed by the National Supplementary Health Agency (ANS). In the SUS, the drug must be evaluated by the National Commission for the Incorporation of Technologies (Conitec), which has a period of 180 days, extendable for another 90 days, to complete the process.

At the Forum, Silvia, a patient with metastatic breast cancer, reported that she met women who share the same type of cancer, but who are not treated with the same technology in public health. The patient uses cyclin inhibitors (CDK), a drug that was incorporated by Conitec in December 2021 and is still within the deadline to be made available by SUS, as long as it fits in the budget for this type of cancer of health hospitals public.

Speaker André Ballalai, Director of Access & Value at IQVIA, USA; stated that the financing model for oncology technologies was designed in a context of two decades ago, when there was no talk of personalized medicine and targeted therapy for the treatment of cancer. “We need to think of a model that reflects the oncology sector of 2022 and that will reflect the advances of the next decades, with increasingly personalized therapies”, he says.

The Forum also pointed to a surplus in the budget for cancer treatments. The technologies provided by the health units are paid for by the SUS through the Authorization of High Complexity Procedures (APAC), which establishes the budget for each treatment of different types of cancer. However, hospitals have the autonomy to use the value in the way they choose, without the obligation to follow the most current recommendations.

This means that, even with Conitec’s positive assessment of the incorporation of a drug, the value of APAC to treat the disease is not always enough to cover the costs of the new drug and the hospital chooses to maintain a more outdated and less expensive treatment. . In these cases, there may even be a surplus in the budget, evidence, pointed out at the event, that this form of financing must be rethought, as it can generate difficulty in accessing treatments and inequality within the same health system.

Denizar Vianna, former secretary of Science, Technology and Strategic Inputs at the Ministry of Health and associate professor at UERJ, highlighted the importance of having a specific budget for oncology, as is already the case with HIV. Vianna explained that about 80% of the SUS oncological demand is made up of six main types of cancers and that it would be possible to focus on the most prevalent tumors in Brazil to create a model of explicit prioritization of them in “terms” of four years.

The event also showed that the obstacles to accessing a new technology can be even greater depending on which unit of the public network the patient is attended to. Speaker Tiago Farina Matos, strategic advisor for Advocacy at Oncoguia, presented the results of a survey carried out in 2017 by the institute.

The study analyzed, via the Access to Information Law, the uniformity in the provision of cancer treatment in more than 100 units enabled in the public network. The results showed that each hospital center has different protocols – most follow a standard below what is recommended, some are average and others – to a lesser extent – ​​are even above what is expected. “If from 2017 we bring this discussion up again, it’s because the problem still exists. The SUS should function as a kind of cafeteria franchise, where everything is standardized. Once inside the SUS, we should not be able to know which Brazilian state we are in because treatment should be the same in all places. Today, unfortunately, it is a person’s zip code that determines their life expectancy”, explained Matos.

Nurse Talita de Souza Matos, from the Brazilian Federation of Philanthropic Institutions, pointed out that the difference in care is often noticed even in municipalities of the same state, between nearby cities. “I have followed patients with the same type of cancer starting treatment in less than 60 days and others, in an almost neighboring place, having access to the same drug with a much longer time interval. Many of them do not even know the name of the drug administered and what is available on the market. There needs to be health literacy,” she says.

The survey “Perceptions of the Brazilian Population on Cancer”, carried out by Oncoguia in partnership with DataFolha and released during the opening of the Forum, showed that 63% of Brazilians choose cancer as a disease that should be prioritized by the government. In addition, 42% of the population associate the disease with negative feelings, often citing death. “Being well informed about the disease makes all the difference, because the more the patient has access to information, the more he participates in the treatment, questioning and charging his doctor and being better supported when he needs it”, concludes Luciana Holtz.

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