PurposeRadiotherapy access in low- and middle-income countries is constrained by underfunding. We assessed the financial and utilization impact of Brazil's 2019 transition from fragmented fee-for-service to episodic radiotherapy reimbursement in the public health system (Sistema Único de Saúde [SUS]), alongside a national equipment expansion program.MethodsWe retrospectively analyzed Brazil's national outpatient database (SIA-SUS/TabNet), covering all external beam radiotherapy treatments—complete courses, not individual fractions—in public and philanthropic facilities from May 2018 to August 2023. A pre-model reference year was compared with four post-model years for treatment volumes and reimbursed values in nominal Brazilian reais (BRL), inflation-adjusted BRL, and US dollars.ResultsAcross 5 years, 657,456 treatments were reimbursed at R$2,726,816,871. In post-model year 1, volume increased by 1.6%, whereas reimbursed values rose by 29.3%, and the mean reimbursement per treatment rose from R$3,438 to R$4,375. Over four post-model years, nominal reimbursement rose by 44.7%, a 12.9% real increase after inflation adjustment; the North showed the greatest gain (82%) with a 15% treatment increase. Of the 92 procured linear accelerators, 33 were installed by 2023, increasing the capacity by 12% to 305 units; productivity reached 474.6 treatments per unit per year, below the Ministry of Health's 600-treatment threshold in every region and period.ConclusionImplementation of the episodic model was followed by a substantial rise in absolute reimbursement, consistent with the elimination of billing losses rather than a price change, without proportional treatment growth. Reimbursement remains far below treatment costs, and much of the gain was offset by inflation and depreciation. Equipment expansion alone does not resolve the barriers limiting radiotherapy access.
PurposeNeuroendocrine tumors (NETs) require accurate pathology, functional imaging, targeted therapies, and multidisciplinary care. We described NET care patterns and resource availability among Mexican medical oncologists in public and private settings.MethodsWe conducted a nationwide survey of Mexican medical oncologists. The questionnaire assessed NET caseload, perception of pathology report completeness, use of biomarkers and echocardiography, access to multidisciplinary teams (MDTs) and interventional radiology (IR), availability of nuclear medicine studies and systemic therapies, and management in key clinical scenarios. For oncologists working in both sectors, responses were reshaped into a long format, yielding 142 practice-specific observations (71 public, 71 private).ResultsOne hundred oncologists responded, and 54% reported seeing fewer than five NET patients per year. Nearly 80% perceived that NET pathology reports were incomplete or incongruent, only 9.9% reported frequent MDT meetings, and IR was available in 19.7% of practices. NET-specific somatostatin receptor (SSTR) positron emission tomography was concentrated in private practice (60.6% v 19.7% public), and peptide receptor radionuclide therapy was available in 20.4% (similar for both practices). Somatostatin analogs were the most widely available systemic therapy (73.2% overall; 84.5% private v 62.0% public). Active surveillance, chemotherapy use, and post-somatostatin analogues sequencing were heterogeneous, with sector differences in first-line treatment for SSTR-positive grade 3 NETs.ConclusionThis first nationwide survey of Mexican oncologists highlights substantial public-private inequities in NET diagnostics, therapies, and multidisciplinary support, alongside concerns about pathology quality and low NET caseloads. Strengthening pathology practice, imaging, treatment access, MDTs, and education may help close NET care gaps in Mexico and other middle-income settings.
PURPOSEBreast cancer mortality is highest in sub-Saharan Africa, where oncology nursing capacity is limited. A train-the-trainer strategy was used in Ethiopia to build regional capacity and support local sustainment.MATERIALS AND METHODSAn education intervention focused on breast cancer was purposely designed, implemented, and analyzed. Training materials included lectures, videos, discussions, and skills laboratories. Cohort 1 included nurses from an oncology unit and nursing faculty. Cohorts 2 and 3 nurses worked in peripheral hospitals. Participants completed demographic, precourse, and 6-month surveys. Chi square, repeated measured analysis of variance, and paired t-tests were used for descriptive results and to assess changes in knowledge, confidence, motivation, and practices. A P value of <.05 determined statistical significance.RESULTSThe intervention reached 79 nurses: 29 in cohort 1 and 50 in cohorts 2 and 3. In total, 65 (82%) completed baseline and 6-month surveys. Of these, 2 of 3 were male. The mean professional experience was 10 years. The majority had a bachelor's degree. The average percent of clinical time spent with patients with cancer was 62% for cohort 1 and 24% for cohorts 2 and 3. Cohort 1 more often provided spiritual care, discussed goals of care, performed clinical breast examination, and communicated to patients of different religious backgrounds. For all participants, there was a significant improvement in knowledge, confidence, and motivation at 6 months, with no differences between cohorts 1 and cohorts 2 and 3.CONCLUSIONThe short-term breast cancer training program for nurses addressed barriers to providing comprehensive care in the local context. The multimodality course leveraged local resources and faculty expertise to build foundational knowledge and practical skills. The intervention can be scaled up regionally and adapted to reach other audiences.
PurposePediatric pathology in Mexico remains limited by an uneven distribution of specialized training and constrained resources, which can affect the accuracy of pediatric malignancy diagnosis. This study aimed to evaluate national diagnostic capacity for common organ-based pediatric solid tumors—renal tumors, neuroblastic tumors, and hepatic neoplasms—through a retrospective hybrid central pathology review. A secondary objective was to identify targeted areas for capacity building and strengthen collaborative networking.Materials and MethodsA hybrid retrospective pathology review (2005-2023) was conducted across eight institutions that treat pediatric oncology patients. Eligible cases included off-therapy patients age 0-18 years diagnosed with renal, hepatic, or neuroblastic tumors. Paraffin blocks, slides, clinical data, and original pathology reports were submitted. Cases underwent conventional pathology review, digital slide scanning, and joint virtual evaluation. Final diagnoses were compared between original, conventional central pathology review, and digital review, and individualized feedback was provided to each institution.ResultsA total of 162 specimens were reviewed, including 584 original stained slides, 940 paraffin blocks, and 1,168 digitized slides. At least 54 online review sessions were conducted, and 24 virtual feedback sessions were held. Overall diagnostic concordance across original, central, and digital evaluations was 80% for renal tumors, 90.9% for neuroblastic tumors, and 92.1% for hepatic neoplasms. Common limitations included inconsistent/inadequate sampling and incomplete/erroneous subclassification and reporting.ConclusionFindings confirm strong baseline diagnostic capabilities for common pediatric solid tumors across participating Mexican centers, while highlighting specific gaps in sampling, reporting standardization, and access to ancillary testing. The project facilitated the creation of a pediatric pathology network, demonstrating that a hybrid centralized-digital review model can strengthen specialized pediatric pathology capacity in resource-limited settings.
