Demographic and Clinical Outcomes of Brazilian Patients With Stage III or IV Non–Small-Cell Lung Cancer: Real-World Evidence Study on the Basis of Deterministic Linkage Approach

Abstract

PURPOSE Non–small-cell lung cancer (NSCLC) is the most common type of lung cancer and accounts for 80%-90% of the cases. In Brazil, between 2018 and 2019, lung cancer was ranked as the second most frequent cancer among men and the fourth among women. The primary objectives were to describe the journey and survival rates of patients with advanced NSCLC treated in the Brazilian private health care system (HCS). MATERIALS AND METHODS A retrospective cohort study was based on the search in administrative databases to analyze the Brazilian private HCS. Patients with advanced NSCLC diagnosed between 2011 and 2016 were included. The data on demographics, cancer-related information, treatment-related information, and resources used were collected. Survival analyses were performed using the semiparametric Kaplan-Meier method to assess mortality by NSCLC stage, with NSCLC diagnosis as the index date. RESULTS A total of 5,016 patients were included. Most patients were between 60 and 69 years old (33.6%) and had completed elementary school (52.2%). There was a greater proportion of men (58.1% v 41.9%), and the majority of patients had stage IV NSCLC (67%). It took an average of 31 days, from the first consultation, to have diagnosis. In 44% of the cases, a clinical oncologist was the first specialist in the HCS that the patient was referred to. After the diagnosis, the median time to start of treatment was 35 days. Chemotherapy alone was the most common treatment regimen (32%). The median overall survival was 11.5 months and 6 months for stage II and IV NSCLC, respectively. CONCLUSION This study provides contemporary data on stage III and IV NSCLC in private health care in Brazil, which has shown a high rate of metastatic disease diagnoses, high health care–related costs, and low survival rates.

Five‐year survival of resectable stage IIIA non‐small cell lung cancer in Brazil

“…For example, in a 2005 survey, the number of CT scanners per 1 000 000 population was 4.9 and 30.8 in public and private cancer hospitals in Brazil in 2005, respectively, showing the difficulties in accessing an adequate diagnostic evaluation in public cancer hospitals. However, the number of CT scanners was quite comparable to those in the best‐developed countries, such as the United States and Japan (31.5 and 32.2, respectively) 36–38 …”

“…Furthermore, we believe that over the years, the disparity in access to health care, which is a real problem in our region, has decreased. At the same time, multi- [36][37][38] Another example was that in Brazil, PET was approved for lung cancer staging in 2010 and was promptly incorporated in private cancer hospitals; however, in public cancer hospitals, the same technology was incorporated only in 2014. 37,38 According to recent statistics, 71.1% of the Brazilian population depends on the public healthcare system to have access to cancer treatment, whereas 28.4% of people have access to private cancer hospitals.…”

“…The third‐generation chemotherapy agents were only introduced in public cancer hospitals in the late 2000s. Pemetrexed is still unavailable and targeted therapies, such as monoclonal antibodies (bevacizumab) and first‐generation epidermal growth factor receptor tyrosine kinase inhibitors, are available only for private cancer hospital patients 37,38,40 …”

“…Another example was that in Brazil, PET was approved for lung cancer staging in 2010 and was promptly incorporated in private cancer hospitals; however, in public cancer hospitals, the same technology was incorporated only in 2014 37,38 …”

Body mass index and immune checkpoint inhibitor efficacy in metastatic cancer patients: A Brazilian retrospective study

“…Unlike other studies that included patients enrolled in RCTs, our study included real-world patients who were treated according to drugs approved by the Brazilian regulatory agency and available to the population at the time of the study. Thus, the lower proportion of patients treated in the first line with ICI may point to barriers in the access to immunotherapy and this issue is discussed in the literature (24). Finally, the fact that most of our patients had primary lung cancer may have influenced our analysis, whereas most studies have shown positive results in cohorts of patients with melanoma, renal cell carcinoma, and lung cancer (8, 9, 12, 14-16).…”