Regionalization and regulation: impact on access to cancer treatment

To assess the impact of Redes Regionais de Atenção à Saúde (RRAS - Regional Health Care Network) and Oncology Regulation on geographical accessibility to oncology treatment for the main types of cancer in the state of São Paulo.

A before-after study comparing the three-year periods before (2007-2009) and after (2017-2019) the policies were implemented. Data from the São Paulo Hospital Cancer Registry were used to analyze indicators of displacement and attraction of patients for surgery, radiotherapy, or chemotherapy in six types of cancer: stomach, colorectal, lung, female breast, cervix, and prostate. The RRAS were adopted as the geographical units of analysis, and inter-RRAS displacements were categorized into quartiles (< 25%, 25%-49%, 50%-74%, and ≥ 75%). Temporal analysis was carried out using thematic maps (QGIS, version 3.28) and the chi-squared test (α = 5%).

Approximately 25% of patients traveled for treatment. RRAS 6 (Capital), 9 (Bauru), and 13 (Ribeirão Preto) remained the centers of attraction. In the North and Northwest, RRAS 11 and 12 showed a reduction in displacements for all types of cancer; in RRAS 10, the drop occurred for colorectal and lung tumors. In the Southeast, RRAS 3 and 5 do not have qualified services, requiring displacements, while RRAS 1, 2, and 4 maintained high percentages. In the East, RRAS 14 to 17 saw a reduction in displacements, except for lung cancer. In the South, displacements increased in RRAS 7 and 8. Overall, there was a reduction in displacements for cervical and prostate cancer, and an increase for lung cancer, especially for surgery.

The implementation of the RRAS and Oncology Regulation altered geographic accessibility in a heterogeneous way: there was an improvement in the North and Northwest, a worsening in the South, and stability in the reference centers. There is a need to improve regional planning, paying attention to territorial inequalities, the type of tumor, and the therapeutic modality.