Disparities in access to health care system as determinant of survival for patients with pancreatic cancer in the State of São Paulo, Brazil

Abstract

Little is known about the features and outcomes of Brazilian patients with pancreatic cancer. We sought to describe the socio-economic characteristics, patterns of health care access, and survival of patients diagnosed with malignant pancreatic tumors from 2000 to 2014 in São Paulo, Brazil. We included patients with malignant exocrine and non-classified pancreatic tumors according to the International Classifications of Disease (ICD)-O-2 and -O-3, diagnosed from 2000 to 2014, who were registered in the FOSP database. Prognostic factors for overall survival (OS) in the subgroup of patients with ductal or non-specified (adeno)carcinoma were evaluated using Cox proportional hazard model. The study population consists of 6855 patients. Median time from the first visit to diagnosis and treatment were 13 (Interquartile range [IQR] 4–30) and 24 (IQR 8–55) days, respectively. Both intervals were longer for patients treated in the public setting. Median OS was 4.9 months (95% confidence interval [95% CI] 4.7–5.2). Increasing age, male gender, lower educational level, treatment in the public setting, absence of treatment, advanced stage, and treatment from 2000 to 2004 were associated with inferior OS. From 2000–2004 to 2010–2014, no improvement in OS was seen for patients treated in the public setting. Survival of patients with malignant pancreatic tumors remains dismal. Socioeconomical variables, especially health care funding, are major determinants of survival. Further work is necessary to decrease inequalities in access to medical care for patients with pancreatic cancer in Brazil.

The influence of socioeconomic status on access to cancer care and survival in resectable pancreatic cancer: a systematic review and meta‐analysis

“…For each study that fulfilled the criteria, the following information was extracted: Name of the first author, year of publication, study design and time period, data source, health care system, sample size, SES (defined individually by each study based on specific factors pertinent to that study, Table 1. In studies 4,[13][14][15][16][17][18] where >2 SES groups were defined, the lowest SE group was deemed to be the LSES, while the highest ones were regarded as the HSES), cancer stage at diagnosis, treatment centre characteristics, time interval between diagnosis and treatment initiation, number of patients offered surgery, number of patients offered adjuvant and neo-adjuvant therapies, recurrence rates, and time to recurrence and survival. In studies which separately mentioned number of patients who had a surgical consult and who actually underwent surgery, the former was entered into the analysis, as the latter would be affected by tumour factors/resectability criteria.…”

“…The database search retrieved 363 publications, including 13 targeted studies, from 2007 to 2021 which met the inclusion criteria and were included in the review 4,5,[13][14][15][16][17][18][20][21][22][23][24] (Fig. 1).…”

“…All the studies were retrospective in design. While 5 studies 14,17,18,20,21 had patients with resected/resectable disease alone, others included patients with metastatic disease, as well.…”

“…Similarly, LSES patients were also less likely to be treated at a teaching/academic facility. 5,21 de Jesus et al 14 noted delays not only in the diagnosis, but also the initiation of therapy in LSES patients. Twelve studies 4,5,[13][14][15][16][17][18]20,[22][23][24] reported decreased access to surgical evaluation/care in the LSES group, the difference being statistically significant in nine studies.…”

Disparities on Pancreatic Cancer Mortality Trends and Human Development Index (HDI) in Brazil

“…There were 112,533 deaths, among men ranging from 4.2/100,000 in 2000 to 5.1/100,000 in 2014 8 . The prognosis of adenocarcinoma remains unclear, with no overall survival (OS) improvement in Brazil 9 .…”