Centralized coordination of decentralized assistance for patients with gestational trophoblastic disease in Brazil: A viable strategy for developing countries

Made available in DSpace on 2022-05-02T14:14:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-06-01 OBJECTIVE: To report on the Brazilian Association of Gestational Trophoblastic Disease’s (GTD) formation of a network of regional care at specialized centers for women with GTD. STUDY DESIGN: We developed a questionnaire composed of 15 questions, which was sent by email to the 38 Brazilian GTD Reference Center (BGTDRC) Directors who are members of the Brazilian Association of GTD, in order to characterize the professionals involved in the care of patients with GTD and the type of assistance provided. RESULTS: The Directors of the BGTDRCs are usually specialists in Gynecology and Obstetrics (97%), with a median experience of a decade in treating women with GTD. The BGTDRCs are linked to university hospitals in 75% of centers and provide completely free medical care in 87%. However, 52% of centers do not perform chemotherapy in their reference center, and patients are referred elsewhere for chemotherapy. Despite some difficulties, the rate of patients lost to follow-up before human chorionic gonadotropin remission is 9%, and the GTD mortality rate is 0.9%. CONCLUSION: Due to large regional disparities, the BGTDRCs are not uniformly organized. However, under the coordination of the Brazilian Association of GTD there is now strong communication and collaboration among reference centers, which has significantly advanced both patient care and research into the management of these diseases. Rio de Janeiro Trophoblastic Disease Center Maternity School of Rio de Janeiro Federal University and Antonio Pedro University Hospital Fluminense Federal University Porto Alegre Trophoblastic Disease Center Mario Totta Maternity Ward Irmandade da Santa Casa de Misericórdia Hospital Goiania Trophoblastic Disease Center Clinics Hospital of Faculty of Medicine Goiás Federal University São Paulo Trophoblastic Disease Center São Paulo Hospital Paulista School of Medicine São Paulo Federal University Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School São Paulo State University New England Trophoblastic Disease Center Trophoblastic Tumor Registry Division of Gynecologic Oncology Department of Obstetrics and Gynecology Brigham and Women’s Hospital Dana Farber Cancer Institute/Harvard Cancer Center Harvard Medical School Clinics Hospital of Paraná Federal University General Hospital of Caxias do Sul University Carmela Dutra Maternity Santa Casa Misericórdia de Vitoria Clinics Hospital of Espírito Santo Federal University Clinics Hospital of Minas Gerais Federal University Campinas University Clinics Hospital of São Paulo University Maternity School of Dr. Mário de Moraes Alten-felder Silva (Vila Nova Cachoeirinha) Guilherme Alvaro Hospital of Lusiada University Center University Hospital of Jundiai Medical Faculty Rio de Janeiro Federal University Fluminense Federal University Regional Hospital of Asa Norte Trophoblastic Disease Center, Distrito Federal Júlio Müller University Hospital of Mato Grosso Federal University Cuiabá Regional Hospital of Mato Grosso do Sul University Hospital of Piaui Federal University Instituto de Medicina Integral Professor Fernando Figueira Lauro Wanderley University Hospital of Paraíba Federal University University Hospital of Alagoas Federal University Januário Cicco Maternity School of Rio Grande do Norte University Maternal Child Unity of University Hospital Maranhão Federal University University Hospital of Sergipe Federal University Climério de Oliveira Maternity of Bahia Federal University University Hospital of Campina Grande Federal University Assis Chateaubriand Maternity School of Ceará Federal University Dona Regina Maternity Roraima General Hospital Getúlio Vargas University Hospital Santa Casa de Misericórdia do Pará Foundation Mãe Luiza Women’s Hospital Ary Pinheiro Hospital of Base Clinics Hospital of Acre Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School São Paulo State University