Itinerário terapêutico de mulheres idosas com câncer de colo de útero: perspectivas das usuárias e dos(as) cuidadores(as)

Abstract

Introduction: Cervical cancer (CC) is emerging as a serious public health problem in Brazil. Older women constitute a highly vulnerable group for this condition, as current guidelines do not provide specific recommendations for screening in postmenopausal women, limiting themselves to evaluating past cytopathological history without establishing inclusion criteria that raise awareness among this group regarding the importance of the Pap test. Consequently, these women become more vulnerable due to gaps in care, the functional decline inherent to aging, and the accumulated disadvantages in their life trajectories. Objective: To understand the therapeutic journey of older women with cervical cancer from the time of diagnosis, from the perspective of the patient and the caregiver. Methodological Approach: A qualitative, exploratory, and descriptive study conducted in Fortaleza, Ceará. Data collection involved documentary research, semi-structured interviews with 6 patients and 3 informal caregivers, as well as the administration of the Zarit Caregiver Burden Scale to the caregivers. The analysis followed the principles of Thematic Content Analysis, supported by the literature on therapeutic pathways. The research was approved by the Research Ethics Committee of the Federal University of Ceará (Opinion No. 7.354.462). Presentation of findings: From an empirical perspective, strengths were identified in Primary Health Care (PHC), such as initial reception, ease in requesting tests, multidisciplinary care, strong patient-provider relationships, and follow-up measures. However, weaknesses in the network emerged, such as: delays in scheduling specialist appointments; failures in referral coordination; prolonged wait times for biopsy results; scarcity of high-tech diagnostic tests; fragmented care; and a lack of information regarding patient flow and prognosis. This situation leads to financial hardship, social isolation, and the invisibility of caregiving work. The results of the Zarit Scale indicated moderate burden for two caregivers (19 and 20 points) and severe burden for the third (over 22 points), confirming the strain resulting from daily caregiving demands. Commuting by public transportation revealed significant geographical barriers, with an estimated average travel time of 35 to 80 minutes to reach specialized oncology centers. It was not possible to conduct a quantitative analysis of SISCAN data due to chronic data entry failures in the SUS information systems. Final considerations: The study revealed a disconnect between the regulatory frameworks advocated by public policies and the actual experiences of service users and caregivers, demonstrating that weaknesses in the healthcare system directly contribute to family burden. In the context of primary health care marked by the coexistence of initial responsiveness and attitudinal barriers, preventive screening was often performed late in women who were already symptomatic, resulting in a diagnosis of cervical cancer predominantly at advanced stages.