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Radiotherapy and the SUS: A collapse foretold
Rev Assoc Med B ras 2017; 63(2):93-94 93
EDITORIAL
Radiotherapy and the SUS: A collapse foretold
Radioterapia e SUS: o colapso anunciado
Eduardo Weltman1, Gustavo Nader Marta2*
1PhD Professor of the Course of Radiotherapy at Faculdade de Medicina da Universidade de São Paulo (FMUSP). Radio-oncologist at Hospital Albert Einstein and Instituto de Radiologia (Inrad), FMUSP.
President of the Sociedade Brasileira de Radioterapia (SBRT), São Paulo, SP, Brazil
2PhD in Medicine from FMUSP. Radio-oncologist at Hospital Sírio-Libanês and Instituto do Câncer do Estado de São Paulo (Icesp), FMUSP. General Secretary of the SBRT, São Paulo, SP, Brazil
Article received: 11/29/2016
Accepted for publication:12/19/2016
*Correspondence:
Hospital Sírio-Libanês. Centro de Oncologia. Serviço de Radioterapia
Address: Rua Dona Adma Jafet, 91
São Paulo, SP – Brazil
Postal code: 01308-050
Radiotherapy, along with surgery and chemotherapy, is
one of the pillars of the treatment of cancer patients. How-
ever, radiotherapy in Brazil is currently in a critical situation,
especially with regard to the care of patients assisted by the
Unified Health System (SUS, in the Portuguese acronym).
The main problems that contribute to this dicey scenario
are related to inadequate remuneration and poor installed
capacity, both from the point of view of the number of
devices and their geographical distribution.1
It is estimated that around 60% of all cancer patients
will require radiotherapy at some stage of their treatment.2
Thus, based on the rounded calculation of 600,000 pa-
tients diagnosed with cancer in Brazil in 2015,3 360,000
should have received radiotherapy in that year. Consid-
ering that approximately 80% of the demand comes from
the public health network, it is estimated that 288,000
individuals should have been treated through the SUS.
Nevertheless, data from the Ministry of Health indicate
that only 145,180 patients received radiotherapy covered
by the SUS.4 In addition, the World Health Organization
(WHO) recommends that there should be one radiother-
apy device for every 300,000 inhabitants.2 In Brazil, the
need would be 683 devices in operation for the demand
to be met. If we also consider that 80% of the patients are
assisted by the SUS, we conclude that there is a need for
an installed capacity of 546 devices totally dedicated to
the public health system. But according to the Ministry
of Health, there are currently only 269 radiotherapy de-
vices that serve social security patients and they are often
not exclusively dedicated to public care.1 Again, the num-
ber falls far short of the needs.
Another important aspect of this problem is the poor
distribution of radiotherapy devices throughout the coun-
try. In the South and Southeast regions, installed capac-
ity exceeds 60% of the demand, while in the North, North-
east and Midwest, it is less than 40%.1
In 2011, the Federal Audit Court5 audited a report on
care for cancer patients in Brazil. In this report, the lack of
radiotherapy was evident and the precarious situation of
a large number of patients treated by the SUS, who waited
on average 113.4 days between the date of diagnosis and
the beginning of radiotherapy, became clear. Five years
after the report, nothing concrete happened to increase
the offer of radiotherapy to the population.
Although it is recognized that the public health system
has a serious management problem and that by rational-
izing the resources allocated to it we could have better
results, the fact that the radiotherapy remuneration val-
ues have been frozen since August 2010 is decisive for the
current alarming scenario. Maintenance of equipment,
as well as the purchase of spare parts and new machines
are charged in US dollars, and the dollar exchange price
has been valued more than 115% since the freezing of the
remuneration. All other expenses also increased by at least
50%, leading to the insolvency of all services covered by
the SUS that do not receive supplementary funds.
In 2012, the Ministry of Health issued Ordinance no.
931 (May 10, 2012),6 which provided for the acquisition by
the Federal Government of 80 machines to be used by the
SUS network. This is a well-intentioned plan, including the
installation of a radiotherapy machine factory in Brazil,
and the implementation of a training center for profession-
als. However, due to bureaucratic and operational problems,
only two of the machines have been installed so far.
We understand that the economic situation of the
country is delicate and that seeking new resources is not
a simple task, but if nothing is concretely done, the already
installed collapse of public radiotherapy will become