Gestão do cuidado para pacientes oncológicos na atenção primária à saúde do município de Santa Cruz – Paraíba

Abstract

Cancer is a major public health problem, characterized by uncontrolled cell growth and by increasing incidence and mortality, especially in developing countries. In Brazil, this scenario requires effective actions in prevention, early diagnosis, treatment, and follow-up, in accordance with the National Policy for Cancer Prevention and Control within the Unified Health System (SUS). Primary Health Care (PHC), organized through the Family Health Strategy (FHS), plays a central role in care coordination and in articulating the Health Care Network, although it still presents weaknesses that compromise the comprehensiveness and continuity of care for people with cancer. This study aimed to evaluate the management of care for oncology patients in Primary Health Care (PHC) in the municipality of Santa Cruz, Paraíba, as well as to develop technical-technological products aimed at strengthening the organization of care within the scope of the Family Health Strategy (FHS). This is a mixed-methods study conducted in Family Health Units in the municipality, structured in two stages. In the quantitative stage, 25 users with a confirmed diagnosis of cancer participated; sociodemographic, epidemiological, and clinical data were obtained from the Primary Health Care Information System (SIAPS) and the municipal regulation sector, in addition to the application of the reduced version of the PCATool-Brazil instrument. The qualitative stage included individual interviews with 13 users, selected from the quantitative phase based on the criterion of data saturation, which were analyzed using thematic content analysis, followed by triangulation of findings. In the quantitative stage, there was a predominance of elderly users, retirees, residents of rural areas, with low educational levels and a high prevalence of chronic comorbidities, especially systemic arterial hypertension and diabetes mellitus. Breast and prostate cancers were the most frequent, with oral home-based chemotherapy being the predominant treatment modality. The evaluation of PHC attributes revealed high scores for affiliation (10.0) and use as the preferred first point of contact (9.2), as well as satisfactory performance for longitudinality (7.0) and care integration (7.55). In contrast, attributes such as accessibility (6.8), information systems (6.39), and available services (6.48) presented scores close to or below the recommended cutoff point, indicating organizational weaknesses. The qualitative results reinforced the quantitative findings by revealing perceptions marked by discontinuity of care after the initiation of specialized treatment, difficulties in referral and counter-referral flows, access barriers related to the territory, and weakening of the bond with PHC throughout the therapeutic itinerary. Data integration pointed to a still fragmented care management, despite recognition of PHC as the initial point of reference and a space for bonding, highlighting the need to strengthen this level of care as the coordinator of oncology care. As technical-technological products, an informational podcast emphasizing the rights of people with cancer and a descriptive flowchart of the organization of the Oncology Care Network from PHC in Santa Cruz, Paraíba, were developed. It is concluded that, although it has strategic potential, PHC in the studied municipality faces organizational and territorial challenges that compromise the comprehensiveness and longitudinality of care for people with cancer.