Porto Alegre

Diagnostic laboratories (clinical and pathology labs) and blood bank

• The assessment found that many pathology processes were not easily traceable.
• There was no standardised way to write pathology reports.
• The city’s blood donor drive was hindered by a lack of regular blood donors.

Surgical Care

• Patients suffered long waiting times between initial consultation and surgery, including the preoperative phase.
• The public health system lacked access to newer and less invasive technologies.

Medical oncology (adult and paediatric)

• There was no essential oncology medicines list for adults or children.
• Approval of oncology medicines by the regulatory authority was not aligned with the reimbursement of the payer.

Medical imaging (radiology and nuclear medicine)

• Medical imaging results for ambulatory staging were difficult to access.
• Diagnostic and interventional radiology were underfinanced by purchasers.
• Radiology reports were hindered by a lack of standardisation.
• Medical imaging reports were not transferred between institutions.
• There was a lack of coverage for positron emission tomography (PET) for other neoplasms in the public system, including paediatric.

Palliative and supportive care

• Essential palliative treatment was often uneven, due to lack of access to medicines.
• Specialised hospitals faced challenges when discharging patients receiving palliative care.

Radiotherapy

• Radiotherapy centres suffered from a technology gap due to a lack of financial coverage of current treatment procedures (such as IMRT and IGRT).

• The referral and counter-referral management system were inefficient.
• There was no data to reflect the real demand for oncology services and outcomes of cancer care.
• Time lags were identified between suspicion and diagnosis of cancer (due to difficulties establishing cancer diagnosis outside tertiary health hospitals).
• Medical specialists were unable to access formal continuing medical education programmes.
• Many health professionals at the primary healthcare level (including physicians, nurses and community health workers) lacked awareness of cancer signs and symptoms.

• Data for the planning, monitoring and evaluation of cancer care services and policies was not used systematically.
• The processes for making multidisciplinary clinical decisions and planning treatment were also fragmented.
• There were no resource-adapted guidelines for the management of common and curable cancer sites and corresponding treatment protocols.

• The social support to ensure patients are informed and can access treatment was inadequate.
• The mandate of NGOs was limited to a small number of tumours.
• Patients faced access challenges when trying to utilise the network of public cancer care services within the national health system.