Implementation of a Tool for Coordination of Oral Cancer Care in Primary Care in a Health Macroregion

Abstract

• Oral cancer is a malignant neoplasm that affects the oral cavity and lips, and the most affected anatomical locations are the tongue, floor of the mouth and lower lip.
• Recent epidemiological data show that oral cancer mainly affects people over 40 years of age, most of them males, with an estimated, in each year of the three-year period from 2023 to 2025, 15,100 new cases for Brazil, and 1,820 in Minas Gerais.
• The main factors associated with the development of this neoplasm are: smoking, alcoholism, HPV infections (for oropharyngeal involvement) and exposure to solar ultraviolet radiation (for lip involvement, especially in people with fair skin). When there is synergism between smoking and alcoholism, the risk increases considerably.
• Early detection of oral lesions with malignant potential and treatment of oral cancer at an early stage are considered the most effective means of reducing morbidity and mortality and mutilation caused by the disease. However, more than half of the cases have been diagnosed in advanced stages, which implies a worse prognosis and reduced survival rate.
• Despite advances in the diagnosis and treatment of malignant neoplasms that resulted in prevention, early diagnosis and increased survival, oral cancer remains a public health problem, indicating the need for innovative initiatives involving monitoring processes and communication between services, strengthening Primary Health Care as coordinator of the Care Network.
• The objective of this report is to present the experience of implementing a support tool in the Northern Health Macro-region, which was developed by state public servants, assigned to the Regional Health Superintendence of Montes Claros, of the Minas Gerais State Health Department.
• The tool, called Alert Plan, was built based on the methods defined by the Family Health Strategy guidelines and the technical-scientific data related to the risk factors for oral cancer and the conduct necessary for the integral follow-up of individuals, from longitudinally, strengthening Primary Health Care as coordinator of the Care Network.
• The use of the tool in the practice of the services was under the responsibility of the Community Health Agents for the active search and constant monitoring of cases in the territories, and of the dental surgeons in the clinical scope, evaluating the lesions, taking a biopsy when possible, carrying out the adequacy of the oral environment and guidance on self-care.
• Before implementing the tool, the state public servants held a meeting with representatives from all points of care that made up the line of care for oral cancer, including the State University of Montes Claros/UNIMONTES, in order to gather comments , expectations, needs and suggestions of each one.
• Subsequently, on November 8, 2019, a workshop was held with the presence of a Family Health dentist from each municipality under jurisdiction, and the macro-region headquarters municipality can send all its dentists, accounting for 220 professionals in action.
• In the workshop, professionals were trained in the themes: early diagnosis of oral cancer and management of cancer patients in Primary Health Care. There was also a presentation of macro models of oral lesions for visualization and palpation by professionals.
• After the workshop, the professionals were guided by the state servants to start the work by training the Community Agents, so that later they could start the actions with the constant use of the Alert Worksheet.
• In 2020, the group of representatives of the points of care was strengthened, receiving the name of Working Group for the Strengthening of the Boca Cancer Care Network in the North Macroregion, and, until now, maintained the periodicity in holding meetings in at least two per year, with the objective of discussing and planning actions to face the problems identified in the Network.
• In addition, over the years the partnership with UNIMONTES has been consolidated, through the carrying out of various face-to-face and virtual educational actions, raising awareness and training professionals, providing speed and safety to clinical conduct and strengthening the Care Network.

• As a result, we observed in 2023 that the Oral Cancer Care Network in the North Macro-region is stronger, recognizing the roles of each point of care, with more defined flows, safer professionals, promotion, prevention and clinical management actions gaining more space in the teams' routine schedules, improved communication between dentists and other team members and, most importantly, users starting to arrive at the oncology service with better oral conditions, less advanced stages and better quality of life.
• There are still many challenges to be faced in the North Macro-region, such as the increase in cases of osteradionecrosis in users after cancer treatment, among others, but the Working Group is monitoring the Network and the actions related to the Alert Sheet.

Descriptors: Oral Cancer; Health Unic System; Primary Health Care.

References: