Patient survival and risk of death after prostate cancer treatment in the Brazilian Unified Health System

Abstract

OBJECTIVE Analyze the probability of specific survival and factors associated with the risk of death of patients with prostate cancer who received outpatient cancer treatment in the Brazilian Unified Health System, Brazil.METHODS Retrospective cohort study using the National Database of Oncology, developed through the deterministic-probabilistic pairing of health information systems: outpatient (SIA), hospital (SIH) and mortality (SIM). The probability of overall and specific survival was estimated by the time elapsed between the date of the first ambulatory treatment, from 2002 to 2003, until the patient’s death or the end of the study. Fine and Gray’s model of competing-risks regression was adjusted according to the variables: age of diagnostic, region of residence, tumor clinical staging, type of outpatient cancer treatment and hospitalization in the assessment of factors associated with risk of patient death.RESULTS Of 16,280 patients studied, the average age was 70 years, approximately 25% died due to prostate cancer and 20% for other causes. The probability of overall survival was 0.50 (95%CI 0.49–0.52) and the specific was 0.70 (95%CI 0.69–0.71). The factors associated with the risk of patient death were: stage III (HR = 1.66; 95%CI 1.39–1.99) and stage IV (HR = 3.49; 95%CI 2.91–4.18), chemotherapy (HR = 2.34; 95%CI 1.76–3.11) and hospitalization (HR = 1.6; 95%CI 1.55–1.79).CONCLUSIONS The late diagnosis of the tumor, palliative treatments, and worse medical condition were factors related to the worst survival and increased risk of death from prostate cancer patients in Brazil.

Prevalência de diagnóstico e tipos de câncer em idosos: dados da Pesquisa Nacional de Saúde 2013

“…Increased incidence rates of prostate cancer have been observed in the country due to increased life expectancy, improved diagnostic methods and case records/notification, in addition to greater use of prostate specific antigen (PSA) and digital rectal examination for the diagnosis of neoplasia 15 . Such advances have resulted in a greater proportion of patients cured or surviving longer 25 .…”

Identifying quality of life indicators to improve outpatient pharmacy services for prostate cancer patients: a comparison between brazilian and british experiences

“…The studies measured quality of care through different measures. Braga (1) used data on 16.280 prostate cancer patients from the Brazilian Base Oncology database to evaluate risk of death 5 years after diagnosis as a measure of patient safety. Sasse et al (19), interviewed an 18-man panel of prostate cancer specialists to evaluate their views on clinical effectiveness of the Brazilian prostate cancer guidelines.…”

“…Braga (1), found there was a mean time of 5 months between diagnosis and outpatient cancer treatment (SD of 6 months). On average, patients were followed up for 51 months (SD of 26 months).…”

“…At outcome level, the studies were heterogeneous and due to the differences in care measure, it was not possible to statistically combine the results between studies. Only the data reported by Braga (1) had a high quality assessment ranking, whilst the remainder of the studies were ranked medium to low quality. The lower quality ranking assigned to the studies of Sasse et al (19), Paterson (21) and Payne (24) was probably due to the use of selective measures of care and low sample numbers, which increased the risk of bias.…”

“…Survival rates amongst prostate cancer patients receiving treatment from the public healthcare system in Brazil (Unified Health System-SUS) are poor (1). Currently, treatment is based on the European urology guidelines which considers quality of life, but does not include outpatient pharmacy provision.…”