Assistência oncológica mamária pública e privada em São Luís Maranhão: vivências médicas durante a pandemia de covid-19

Abstract

The COVID-19 pandemic produced profound repercussions on breast cancer care in Brazil, affecting both the public and private health sectors. This thesis aimed to analyze, from the perspective of specialist physicians, the impacts of the pandemic on the organization of care and on clinical practices related to breast cancer in São Luís, Maranhão, with emphasis on inequalities between sectors and on changes generated by technological mediation. The study is based on the hypothesis that health crises can aggravate pre-existing disparities and reconfigure routines and meanings of health care, especially in contexts marked by the historical segmentation of the health system. This is a qualitative study based on 18 semi-structured interviews with physicians specializing in breast cancer care who worked in both public and private sectors during and after the pandemic. Data analysis followed the procedures of content analysis (Bardin), guided by thematic categories related to the chronological trajectory of the pandemic and to transformations resulting from the virtualization of care. The thesis is composed of two scientific articles. The first analyzes the experiences of professionals across different phases of the pandemic, revealing organizational, emotional, and structural impacts on the health system. The second discusses the effects of digital mediation—such as telehealth, social media, and digital platforms—on oncological practice, highlighting both innovations and ethical, technical, and communicational tensions. The findings indicate that, although important institutional adaptations occurred, historical inequalities deepened, and technological mediation, far from being neutral, produced new forms of exclusion and professional overload. It is concluded that the pandemic acted as a catalyst for changes in ways of caring, communicating, and organizing health work, whose effects still demand critical analysis and the development of equity-oriented public policies. This thesis contributes to the field of Collective Health by integrating structural analysis, attentive listening to professional experiences, and ethical reflection on cancer care in times of crisis.