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Priority setting in head and neck oncology in low-resource environments

Kowalski, Luiz P.a; Sanabria, Alvarob

Current Opinion in Otolaryngology & Head and Neck Surgery: June 2019 - Volume 27 - Issue 3 - p 198–202
doi: 10.1097/MOO.0000000000000530
DEVELOPING WORLD PERSPECTIVES IN OTOLARYNGOLOGY: Edited by Johannes J. Fagan
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Purpose of review Most information about priority setting comes from developed countries. In low-resource settings, many factors should be considered to select the best candidate for the treatments that are available. The physician is always under pressure to obtain better results in spite of the lower quantity of resources. This exposes physicians to daily ethical dilemmas and increases their anxiety and burnout.

Recent findings Most low-resource settings have restrictions in major treatments, and the number of specialized centers that have all the services is low. The surgeon has to navigate through the system as a patient advocate, taking the responsibilities of other health system actors, has to ‘negotiate’ to design a treatment based on outdated results or to wait for new results and has to decide whether to start or to wait for other treatments to be ready to comply with protocol recommendations.

Summary The surgeons face the dilemma of offering the best treatment with scarce resources but with a higher possibility of completion. Finally, we must do the best we can with what we have.

aDepartment Otorhinolaryngology – Head and Neck Surgery, Centro de Tratamento e Pesquisa Hospital do Cancer A.C.Camargo, São Paulo, Brazil

bDepartment of Surgery, Universidad de Antioquia – Fundacion Colombiana de Cancerologia, Medellín, Colombia

Correspondence to Luiz P. Kowalski, MD, PhD, Department Otorhinolaryngology – Head and Neck Surgery, Centro de Tratamento e Pesquisa Hospital do Cancer A.C.Camargo, São Paulo, Brazil. E-mail: lp_kowalski@uol.com.br

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