Background: Cancer is a growing public health concern in Brazil with 596 000 new cases projected for 2016. The most prevalent are breast, prostate, cervix, lung and colorectal cancer, excluding non-melanoma skin cancer. The rates of late diagnosis and mortality are high. Figs.1 and 2.
Objectives: In order to improve oncology care, ANS (Brazilian regulatory agency) in partnership with selected providers and health plans, launched ONCOREDE, a project created to improve the efficiency of the whole care line operation. Amil (health plan) COI (provider) and Optum (Big Data), all from United Health Group Brazil and Fundação do Cancer are part of the working group.
Methods: The group identified key points for a new oncology care model and ways to encourage its implementation. Fig. 3
For example, population-based risk screening programmes for breast, colorectal and cervix cancer with evidence-based protocols are part of the strategy advocated. However, this implementation remains challenging. Barriers include economic, management (access, processes, flows), quality, and cultural issues – as well as concerns regarding the optimal balance between underdiagnosis/undertreatment and overdiagnosis/overtreatment. Population-screening protocols for different types of cancer have been proposed based on evidence regarding the sensitivity and reproducibility of tests, their negative predictive value, and evidence that the potential benefits of screening outweigh the physical and psychological harms.
Results: 42 projects were sent by providers and health plans, of which 19 included screening and early diagnosis. The Oncorede Project will track results through epidemiological surveys. Moreover, the creation of a national registry for patients managed by the private health system has been proposed to track adherence to the ANS recommendations, and the outcomes of care.
Conclusions: Oncorede is a patient-centred cancer care model, proposing agility in the continuity of care through a navigator, quality of diagnostic tests, multidisciplinary care team, shared decisions and measured clinical outcomes.