METHODOLOGYIn the section CHILDHOOD CANCER IN THE STATE

OF RIO DE JANEIRO, for the calculation of the cancer in- cidence estimate we considered the median rate of can- cer incidence adjusted by age for the Southeast Region(INCA, 2016) and the populational estimate for the state in 2016 (DATASUS, 2017). For the calculation of the child and adolescent population, the cases were divided between the health regions by following the percentage distribution from 0 to 19 years from the 2010 Census.

The annual average of diagnosed cases was calcu-lated from the database of the hospital-based cancer regis- try in 2017. For the classification of tumors in pediatric can- cer cases, only the variable for location of the tumor wasused. Since the large number of cases did not allow for theclassification of the database in all of Brazil according to the histology of the tumor along with the location, the testwas only done in Rio de Janeiro, which demonstrated littlealteration in the percentage between the classification bythe location of the tumor and that made by the location and histology of the tumor.

The information about deaths by childhood cancer was extracted from the Information System about Mortality – SIM (DATASUS, 2017) and the official report on childhoodcancer from International Agency for Research on Cancer (IARC, 2016). For the projection of the annual incidence of childhood cancer, populational estimates were used for the year of 2016 in Brazil, the state and the city (DATASUS, 2017).Other data used was the information that the capital con- centrates 39.5% of the state's population (IBGE, 2010) andthe incidence rates in technical publications by the IARC

(STELIAROVA, 2017) and by the INCA (2016). The latter con- sidered: the Brazilian incidence average, the median rate ofincidence ajusted to the age range of 0 to 14 years in the Southeast Region and the median rate of incidence specific to 15 to 19 year olds in the Southeast Region (INCA, 2016).

The information in the section PUBLIC PEDIATRIC CARE was obtained from the National Database on HealthUnits (old version), considering its validity in April 2017 for primary care units and the distribution of doctors, and in October 2017 for other information.

In the section INFRASTRUCTURE FOR DIAGNOSIS AND TREATMENT the following sources were used: Ordi- nance nº 140, 02/27/2014, and its alterations, the NationalDatabase on Health Units (valid Oct. 2017), the HBCR data- base (from Oct. 2017), and the information of "Extension Project of School Services in Hospitals: shared knowledge"and the "Humanization Work Group from the 2017 Pediatric Oncology Forum"; as well as consultations done at the hospi-tals so as to update information that, until the final edition of the material, had not been made available by the responsible public entities.

The information in MONITORING OF INFORMA- TION was obtained from the HBCR in July 2017 consid- ering analytic cases without previous diagnosis and treat-ment with the first consultation between 2009 and 2013in the state of Rio de Janeiro, as well as information sup- plied by the Division of Situation Surveillance and Analysis – Conprev/ INCA about the implementation of the Hospi-tal-Based Cancer Registry (HBCR), and sending its criteriato specialized hospitals.

REFERENCES BRASIL. INSTITUTO BRASILEIRO DE GEOGRADIA E ESTATÍSTICA (IBGE). Atlas do Censo Demográfico 2010. Características gerais da população por residência e faixa etária (online). 2017.

MINISTÉRIO DA SAÚDE - CADASTRO NACIONAL DOS ESTABELECIMEN-TOS DE SAÚDE DO BRASIL (CNES). Tabnet - Rede assistencial e Recursos humanos. 2017.

MINISTÉRIO DA SAÚDE. DEPARTAMENTO DE INFORMÁTICA DO SUS (DATASUS). Estimativa populacional segundo regiões de saúde no Esta-do do Rio de Janeiro (online). Brasília, 2017.

MINISTÉRIO DA SAÚDE. Secretaria de Vigilância em Saúde. Sistema de Informações sobre Mortalidade (SIM), 2017.

Portaria nº 458, de 24 de fevereiro de 2017. Mantem as habilitações de estabelecimentos de saúde na Alta Complexidade e exclui prazo estabe-lecido na Portaria nº 140/SAS/MS, de 27 de fevereiro de 2014.

FONSECA, ES. Hospitais com Escolas no Brasil. Projeto de Extensão Aten-dimento Escolar Hospitalar: saberes partilhados. Faculdade de Educa-ção da UERJ. Mimeo. 2017.

INSTITUTO NACIONAL DE CÂNCER JOSÉ ALENCAR (INCA). Registros hos-pitalares de câncer: planejamento e gestão / Instituto Nacional de Cân-cer. 2 ed. – Rio de Janeiro: INCA, 2010.

INSTITUTO NACIONAL DE CÂNCER JOSÉ ALENCAR (INCA). Estimativa 2016: incidência de câncer no Brasil. Rio de Janeiro: INCA, 2015.

INSTITUTO NACIONAL DE CÂNCER JOSÉ ALENCAR (INCA). Incidência, mortalidade e morbidade hospitalar por câncer em crianças, adolescen-tes e adultos jovens no Brasil: informações dos registros de câncer e do sistema de mortalidade. Rio de Janeiro: Inca, 2016.

INTERNATIONAL AGENCY FOR RESEARCH ON CANCER (IARC). International Childhood Cancer Day: Much remains to be done to fight childhood cancer. Press Release N° 241: 2016.

STELIAROVA-FOUCHER, Eva et al. International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol. v.18, p.719-31, 2017.

INTRODUCTION

General coordination: Laurenice Pires and Evelyn K. Santos Technical revision: Marceli Santos and Rejane Reis General revision: Roberta Costa Marques Textual revision: Veronica Marques Collaborators: Alfredo Scaff, Isabel Rei Madeira, Rafael Vargas, Solange Malfacini.

Instituto Desiderata

Rua Dona Mariana, 137 - casa 07, Botafogo | Rio de Janeiro, RJ, Brazil - 22280-020. | Tel.: +55 (21) 2540-0066

Information is critical for better planning and ma- nagement practices. With this certainty, we launched the fourth edition of the Pediatric Oncology Bulletin with the objectives of contributing to the consolidation of in-formation and highlighting the challenges that must beovercome in order to specialize the treatment. Led by Instituto Desiderata, this publication was built in collab- oration with professionals from the Cancer Foundation and the National Cancer Institute (INCA).

In this edition, we can observe the low comple- tion of some mandatory variables in the Cancer Reg-istry Form of Hospital-Based Cancer Registries (HBCR),among them: "first treatment received in hospital" (57% without information) and "other staging differ-ent from TNM" (65% without information). The lowcompletion of this data can indicate a problem in the process of data collection in the medical records. The information in the medical records must be legible,only in this way will the information accurately repre-sent the treatment that was given.

Another point to highlight is the care of 15% of analytic cases1, in ages between 15 and 19 years, gi- ven in hospitals not specialized in pediatric oncology. In hospitals specialized in pediatric oncology, treat- ment is administered by a pediatric oncologist, the chemotherapy is given in an exclusive and human- ized room for children and adolescents, among other specifications.

On the other hand, the information on the pro- jection of incidence coincides with what is observedglobally, as well as the professional areas: nursing, physiotherapy, nutrition, odontology, psy-chology and social service, indicated in the last ordi- nance, are present in practically every hospital, even though it is not possible to say if in ideal amount s. The investment in the lively ambiance of six of the seven chemotherapy rooms used by children and ad- olescents is also a positive highlight.

When facing challenges it is necessary to create problem-solving strategies, especially in times of crisis.

These challenges include adapting the existing infra-structure, implementing lines of care for childhood can- cer control, and improving the management of the health care network in order to control this type of cancer byfocusing on the patient and treatment in a timely man- ner.

Information has a fundamental role in decision- making on local and global levels. It is our greatest ally for implementing actions, goals, and results, as well asfor monitoring and assessing what is being done for more assertive decision-making in cancer control, wheth-er in children and adolescents, or in adults.

1 Analytic cases are those in which the therapeutic plan, the trea- -

tment, and the follow-up are done by the unit responsible for the care of patients. (INCA, 2016)

RIO DE JANEIRO, BULLETIN VOL. 4, Nº 4, NOV. 2017ISSN 2594-6846 — Printed version

PANORAMA OF PEDIATRICONCOLOGY

PANEL OF OPINIONS

THE CRISIS AND CHALLENGES FOR THE CONTROL OF PEDIATRIC CANCER

In general, mortality by cancer is related to variables such as: economic crises, universal health coverage, public health expenditures, among other factors. An increase in unem- ployment has a direct relationship to an increase in mortality by cancer. The 2008-2010 economic crisis was responsiblefor about 260,000 more deaths by cancer in European Coun- tries of the OCDE (Organisation of Economic Co-operation and Development). On the other hand, in countries with universal health coverage, that is, with universal access tohealthcare, and with greater investments in public health, there is a protective effect that is associated with the reduc- tion of mortality by cancer. It is assumed that the access to healthcare could be at the base of these associations.

"United for the Cure" is a project that can face adversities and support the control of pediatric cancer. Currently, more than ever, it is necessary to monitor healthcare services, of- fer training and qualification courses for immediate diagno- sis and strengthen the information/regulation system forthe referral of suspected cases.

Alfredo Scaff - Health Physician, Fundação do Câncer (Cancer Foundation).

ABOUT THE EPIDEMIOLOGICAL TRANSITIONOF PEDIATRIC DISEASES TO THE COMMITMENT OF PUBLIC MANAGEMENT WITH CANCER IN CHILDREN AND ADOLESCENTS

The profile of mortality in children and adolescents changed greatly in the last decades. The implementation of preven-

tive actions reduced the incidence of communicable diseases, and the expansion of urban areas was followed by the in- crease in deaths caused by urban violence and accidents (external causes), especially among the young. We have mo- ved from a scenario of high rates of child mortality due to in- fectious and parasitic diseases, to a new moment in which these diseases are responsible for an ever-decreasing amount of deaths. On the other hand, deaths by external causes in- creased significantly, taking the first place. The second cause of death in children and adolescents are neoplasms, followed by other diseases of chronic evolution. In this way, if external causes are excluded, today cancer represents the first cause of death in this age group.

The early detection of cancer in children and adolescents is included in our agendas as one of the main challenges to be addressed for the organization of a network and the commitment of public management.

Solange Malfacini - Doctor, Cancer Manager for the Municipal Health Secretary of Rio de Janeiro.

HOSPITAL CANCER REGISTRY: POTENTIALITIES IN THE MONITORING OF HOSPITAL CARE

The World Health Organization (WHO) sustains that having reliable information is crucial for decision-making on all le- vels of the healthcare system. Quality information is essen- tial both from the macro point of view, for the develop- ment of public policies, for example, and for the evaluation of the quality of care in a hospital or healthcare service. The WHO also defends that the information systems should not be restricted only to the evaluation of monitoring, but also must stimulate research, allowing for situation analyses inhealth and its tendencies.

The participation of patients in clinical studies (clinical tri- als) is strongly recommended and is an indicator of the

quality of the care. Thus, RHC has a double role in this as- pect. First, to help with the identification of potential pa- tients to be recruited for a clinical trial. Second, to assess the number of patients that participated in the clinical trial. In our RHC we are creating a complementary variable that signals if the patient did or did not participate in a clinical trial.

Rafael Vargas - Clinical oncologist, coordinator of the Hospital Cancer Registry (RHC) of the Irmandade da Santa Casa de Misericórdia in Porto Alegre.

IN FAVOR OF THE PEDIATRICIAN INTEGRATED IN THE FAMILY HEALTH STRATEGY

Public Primary Care for children is currently going througha transition that takes the care from the pediatrician, and hands it to the Family Health Strategy (ESF). In ESF in theState of Rio de Janeiro, pediatricians are not a part of the team. The managers claim that there are not many pedia- tricians, which is not true. We are the most numerous medical specialty in the state. The Medical Residency Pro- gram (PRM) in Pediatrics is the most sought by doctors who have recently graduated.

Nothing against ESF, but everything in favor of the inte- grated pediatrician. The Pediatric Society of the State of Rio de Janeiro proposes to insert the pediatrician into the Support Centers for Family Health (NASF). In NASF, each pediatrician, besides offering childcare, would report to a number of ESF teams, for training of primary care for child health and for the mental health matrix. In this way, they would know all of the children under their care, and the strategy teams would have this specialist with more exper- tise be available, including for the care of a sick child, andfor the differential diagnosis of cancer, for example.

Isabel Rey Madeira - Pediatrician who acts in the area of pediatric endocrinology, president of the PediatricSociety of the State of Rio de Janeiro.

The ideas expressed here represent the authors' opinions. To read the complete texts access: www.desiderata.org.br

ESTIMATE OF CHILD AND ADOLESCENT POPULATIONFROM 0 TO 19 YEARS OF AGE IN 20164,579,102Source: IBGE, 2010; DATASUS 2017.

ESTIMATE OF THE INCIDENCE OF CANCER FROM 0 TO 19 YEARSRate: 139.88/million

PRIMARY CARE UNITSSource: CNES, April 2017.

Health Center Health Clinic Basic Health Unit 2,082

278

PUBLIC PEDIATRIC CARE

INFRASTRUCTURE FOR DIAGNOSIS AND TREATMENT

HISTORY OF IMPLEMENTATION OF HOSPITAL-BASED

CANCER REGISTRIES IN SPECIALIZED PEDIATRIC ONCOLOGY HOSPITALS

MONITORING OF INFORMATION

STATE OF RJCITY OF RJ

101,322

258,320

259,563

529,6982,806,400

205,916

78,247

95,380

South-Central

Mountain

North

Metropolitan IIMetropolitan I

Coastal Lowland

Ilha Grande Bay

Northwest

244,256Middle Paraíba

30

10

10

40

10

40

30

70390

TIME INTERVAL* of analytic cases without previous diagnosis and treatment, 2009 to 2013

Time between the diagnosis and the beginning of treatment

Source: SIS-RHC, 2017.

Time between the 1st consultation and the diagnosis

November 2017

INDICATORS OF REGISTRY QUALITY

0 to 15 days16 to 30 days31 to 60 days> 60 days

Hematological (n=524)

Solid (n=594)

Hematological (n=524)

Solid (n=597)

Source: INCA, 2016.

The Ordinance of the Healthcare Secretary / Health Ministry (SAS/MS) nº 140 from 02/27/2014, and its alterations are what define the criteria and parameters for the organization, planning, monitoring, control, and evaluation of the healthcare establishments qualified in specialized oncological attention, and define the structural, operational, and human resource conditions for the qualification of these establishments in the National Health System.All healthcare establishments that treat cancer must be qualified as Cacon, treating all cancer types, or as Unacon, treating the most prevalent cancers. Subcategories can be attributed to each of these classifications, among them the service of pediatric oncology.Other criteria for the specialization is the System of Cancer Information (Siscan) and the HBCR being implementedand working within the structure of the specialized hospital, being that the general hospital with cancer surgery and radiotherapy service, which integrates hospital complexes like Cacon or Unacon, must guarantee the collection, sto- rage, analysis, and dissemination of information on people with cancer in a systematic and continuous manner. 1 United for the Cure Centers: are hospitals from the public network, specialized in cancer or pediatrics, in the city of Rio de Janeiro. They are part of the investigation flow for suspicions of childhood cancer. Besides the centers listedabove is the Hospital Municipal Jesus, which specializes in pediatrics.2 Humanized and exclusive chemotherapy rooms for children & adolescents: "The room for applying chemo inchildren and adolescents should be different from the room for applying chemo in adults" (Ordinance 140 from02/27/2014). The Carioca Aquarium (AC) is a humanized chemotherapy room with a seabed theme, implemented by Instituto Desiderata since 2007 in public hospitals that are part of United for the Cure.

PERCENTAGE OF HISTOPATHOLOGICAL DIAGNOSIS

The percentage of histopathological diagnosis is the microscopic verification of histological, cytological, and hematological tests. It is a positive indicator of the validity of the information in the registry.

Source: INCA, Manual dos Registros Hospitalares de Câncer, 2008.

92%

>95% Recommended

Where we are

www.cancer.org.brwww.desiderata.org.br

No information (92 registries) 57%Death 20%Advanced disease, lack of clinical conditions, or other associated diseases 11%Other reasons 4%Treatment received outside 3%Refusal of treatment 2%Abandonment of treatment 1% Treatment complications 1%

MAIN REASONS WHY 1st TREATMENT WAS NOT INITIATED, analytic cases without previous diagnosis, from 2009 to 2013 (n=161)

STATE OF THE DISEASE AT THE END OF FIRST TREATMENT,analytic cases without previous diagnosis and treatment* from 2009 to 2013 (n=861) Source: SIS-RHC, 2017

Source: SIS-RHC, 2017

First year made available by HBCR Source: SIS-RHC, 2017

89%

51%

86% 61%21%

4%19%16%

6%12%

12%4%

8%7%2%2%

Source: SiSRHC, 2017.

HFL

(HBCR not implemented)

INCA-HCI

1982(2000)

HEMORIO

2000(2000)

IPPMG

2013(2011)

SÃO JOSÉ DO AVAÍ

2002(2005)

HFSE

2013(2012)

HEC

2017

* Cases with negative time intervals or no information were excluded.

ANNUAL AVERAGE OF DIAGNOSED CASES registered in the HBCR according to place of residence, 2009 - 2013

BRAZIL Source: DATASUS, 2017 and INCA, 2016, SISRHC 2017.

STATE Source: DATASUS, 2017 and INCA, 2016.

CITY Source: DATASUS, 2017; INCA, 2016; IBGE, 2010.

4,290

261 101

No evidence of disease 42%Stable disease 20%Disease progressing 16%Partial remission 11%Death 10%Oncologic Therapeutic Support 1%

TOTA

L

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S

% NA

TIO

NA

LRE

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SYS

TEM

STA

TE

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E

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FO

R TH

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RS

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HU

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ND

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OM

FO

R CH

ILD

REN

AN

D A

DO

LESC

ENTS

2

HO

SPIT

AL

CLA

SS 3

CACON with service in pediatric oncology INCA - HCI (RJ) 854 61.5

UNACON exclusive for hematology Hemorio (RJ) 227 16.3

UNACON with services in radiotherapy, hematology

and pediatric oncologyHospital Federal dos Servidores (HFSE) (RJ) 51 3.7

UNACON exclusive for pediatric oncology IPPMG/UFRJ (RJ) 40 2.9

UNACON with services in radiotherapy and pediatric

oncologySão José do Avaí (Itaperuna) 5 0.4

UNACON with service in pediatric oncology

Hospital Federal da Lagoa (HFL) (RJ) - -

UNACON exclusive for pediatric oncology

Hospital Estadual da Criança (HEC) (RJ) - -

UNACON INCA - HC II (RJ) 81 5.8

CACON HUCFF - UFRJ (RJ) 38 2.7

UNACONSoc. Port. de Ben. de Campos (Campos dos Goytacazes)

32 2.3

UNACON with service in radiotherapy Mário Kroeff (RJ) 22 1.6

UNACON with service in hematology HUAP - UFF (Niterói) 15 1.1

UNACON with service in hematology

Hospital Geral De Bonsucesso (RJ) 7 0.5

UNACON Hospital Santa Isabel (Cabo Frio) 5 0.4

UNACONHospital Escola Álvaro Alvim (Campos dos Goytacazes)

5 0.4

UNACON São José (Teresópolis) 1 0.1

UNACONHospital Alcides Carneiro (Petrópolis) 3 0.2

UNACON Centro de Terapia Oncológica (Petrópolis) 3 0.2

UNACON with service in radiotherapy INCA HC III (RJ) 2 0.1

UNACON with services in radiotherapy and hematology HUPE/UERJ (RJ) - -

ANALYTIC CASES ENTERED IN CANCER REGISTRY FROM 2009 TO 2013 (n=1,391)

TYPES OF ACCESS TO OUTPATIENT CONSULTATION IN

PEDIATRIC ONCOLOGY

INFRASTRUCTURE FOR DIAGNOSIS AND TREATMENT, AND MANAGING ACCESS TO CACON AND UNACONSource: CNES, October 2017; E.S FONSECA, 2017; IntegradorRHC, 2017; Ordinance nº 140 from 02/27/2015 and its alterations.

CACON - High Complexity Oncology Center :: treats all types of cancer UNACON - High Complexity Oncology Assistance Units :: treats themost prevalent cancers

*Excluded 42 cases for which the variable does not apply, and 227 with no information

*Category does not apply and was excluded

Non-completion of mandatory variables in the cancer registry form for analytic cases without previous diagnosis or treatment, from 2009 to 2013

The Hospital Estadual da Criança has a chemotherapy room and tomograph with the Intergalactic Theme (TI), executed by the State Department of Health. Two other tomographs in the city were also adapted for children. One in 2012, at the Hospital Municipal Jesus, was transformed into the Carioca Submarine (Instituto Desiderata); and in 2013 the Instituto Fernandes Figueira transformed its tomograph into a boat; in 2016, the INCA made a lively transformation to its whole pediatric oncology sector. 3 Hospital class: has the objective of guaranteeing the continuity of school content to hospitalized children and adolescents, so as to allow them to return to their school of origin without difficulty. According to the National Council of Children and Adolescent Rights, it is the right of hospitalized children and adolescents to enjoy some form of recreation, educational health programs, and the monitoring of the school curriculum during their stay at the hospital (RESOLUTION n° 41/1995 Conanda).4 Multidisciplinary and multi-professional team: indicated in Ordinance nº140, this considers that the care services for the ostomized, rehabilitation, speech therapy, psychiatry, and renal replacement therapy can be formally referred to services installed outside the structure of Cacon or Unacon.

Observations: The Instituto do Cérebro Paulo Niemeyer is the first center in the country focused on the treatment of neurosurgical diseases, and is essential for the treatment of pediatric tumors in Central Nervous System (6 exclusive beds). Rio Imagem is the center for image diagnosis in the state of Rio de Janeiro and possesses 2 magnetic resonance imaging devices, 2 tomographs, and 9 ultrasound machines.

DEATHS BY CHILDHOOD CANCER

140.6 / million (from 0-14 years)

126.5 / million (from 0-14 years)

132 / million (from 0-14 years)

185.3 / million (from 15-19 years)

157.2 / million (from 15-19 years)

166 / million (from 15-19 years)

WORLDWIDE Source: STELIAROVA-FOUCHER et al, 2017.

BRAZIL Source: INCA, 2016.

SOUTHEAST OF BRAZIL Source: INCA, 2016.

PROJECTION OF ANNUAL INCIDENCE OF CHILDHOOD CANCER

New cases/year:630 in the state 250 in the citySource: DATASUS, 2017

New cases/year:8,600Source: DATASUS, 2017

PER YEAR PER WEEK

WORLDWIDESource: IARC, 2016.

80,000 1,540

BRAZILSource: SIM, 2017

(average from 2009 to 2013)

2,884 55

STATE OF RIO DE JANEIRO

Source: SIM, 2017 (average from 2009 to 2013)

222 4.2

CASES OF PEDIATRIC CANCER treated in the hospitals that have HBCR, 2009 - 2013

SolidSolid in Central Nervous System

Hematological

BRAZIL STATE CITY

40%

60% 59% 61%

41% 39%

28% 23% 27%

Source: SISRHC, 2017

HOSPITAL PEDIATRIC INFRASTRUCTURE of medium andhigh complexity by health region in the public network

(*) Emergency Care Units work as intermediate units between basic health units and emergency hospitals.

(**) Emergency Room - Unit that provides assistance to patients with or without risk of life, but whose issues require immediate care.General and specialized pediatric emergency rooms were included.

(***) The pediatric ICU beds are classified in categories I, II or III, according to Ordinance 3,432 from August 12, 1998. All three kinds of hospital beds were included in this table.

Ilha Grande Bay 0 5 2 0 1 4 0 49 12 0 5Coastal Lowlands 1 13 3 1 3 9 4 107 15 4 15

South-Central 0 7 2 0 0 2 1 45 9 0 10Middle Paraíba 0 17 8 0 3 7 3 139 26 0 24Metropolitan I 9 29 17 10 14 45 20 917 117 96 49

Metropolitan II 1 7 7 1 3 12 3 116 46 5 15Northwest 0 14 7 1 2 3 6 82 17 4 16

North 0 10 6 2 4 14 5 144 31 12 13Mountain 0 17 6 0 3 6 2 173 19 0 20

TOTAL IN RJ 11 119 58 15 33 102 44 1,772 292 121 167

Spec

ializ

ed

pedi

atric

ho

spita

ls

Gen

eral

hos

pita

ls

with

ped

iatr

ic se

rvic

e

Hosp

itals

with

bed

s in

ped

iatr

ic su

rger

y

Hosp

itails

with

bed

s in

the

pedi

atric

ICU

Hosp

itals

with

bed

s in

neu

rosu

rger

y

Emer

genc

y Ca

re

Uni

t*

Clin

ical

Ped

iatr

ics

Pedi

atric

surg

ery

Pedi

atric

ICU

***

Neu

rosu

rger

y (a

dults

and

chi

ldre

n)

Emer

genc

y Ro

om**

Source: CNES, October 2017.

NUMBER OF HOSPITAL BEDSTOTAL ESTABLISHMENTS

Note: only beds in general and specialized pediatric hospitals that accept the SUS (public healthcare system) were considered.

CASES BY PLACE OF RESIDENCE (n=1,391) received in specialized and unspecialized hospitals, 2009 to 2013Source: SISRHC, 2017

59% other cities in the state of Rio de Janeiro

39% city of Rio de Janeiro

2% other states

PERCENTAGE OF TOTAL ANALYTIC CASES (n=1,391) received in unspecialized hospitals, 2009 to 2013Source: SISRHC, 2017

8% of children (0 to 14 years)

DISTRIBUTION OF DOCTORS in the Public Health Network

Doctors in General and Specialized Hospitals

pediatricians in RJ2,2001,090

neurosurgeons15392

pediatric oncologists

3938

pediatric surgeons

7336

Doctors in Primary Care

pediatricians in RJ505122

family doctors

2,3111,300

other medical specialties

1,460459

4,2761,881 TOTAL

Source: CNES, April 2017.

hematologists11395

other medical specialties

16,56011,128

19,14611,389 TOTAL

PRESENCE OF PALLIATIVE CARE Source: GT de Humanização FOP, 2017

Send compliments, criticisms, and suggestions to desiderata@desiderata.org.bror click here to evaluate us.

4 / 7 perform some activity in palliative care

In Brazil, 25.8% of children and 42.9% of adolescents were treated in unspecialized hospitals from 2009 to 2011.Source: INCA, 2016.

Source: SIS-RHC, 2017

MULTIDISCIPLINARY SUPPORT AND EQUIPMENT USED IN THE SPECIALIZED HOSPITALS

MULTI TEAM IN HOSPITALS

Nursing Physiotherapy

Nutrition Odontology Psychology

Social Service EQUIPMENT IN HOSPITALS

Ultrasound Tomograph

Magnetic ressonance

Source: CNES, October 2017.

HOSPITALS SPECIALIZED IN PEDIATRIC ONCOLOGY

HOSPITALS SPECIALIZED IN ONCOLOGY

MAIN CAUSES OF DEATH IN CHILDREN AND ADOLESCENTS, 2009 to 2013

Total deaths from 1 to 19 years in the period: 173,318 14,023 |

External causes of morbidity and mortality

57.4%57.5%

Neoplasms (tumors)

8.3%7.9%

Respiratory diseases

6.9%7.0%

Source: SIM, 2017

BRAZIL

STATE

Neoplasms: Main cause of death by disease.

15% of adolescents (15 to 19 years)

Carioca Aquarium

intergalactic theme

CHILDHOOD CANCER IN THE STATE OF RIO DE JANEIRO

Other staging, different from TNM, and age up to 18 years (n=570)* 65% no information or empty

First treatment received at hospital (n=1130) 56% no information

State of the disease at the end of first treatment (n=1130) 20% no information

Start date of treatment (n=1130) 0 .35% no information

Main reason why the first treatment was not at the hospital (n=1130) 8% no information (92 registr ies)