Abstract:O câncer de cólon e reto apresenta alta incidência mundialmente, porém a letalidade da doença é maior em países em desenvolvimento. O objetivo deste estudo é analisar fatores sociodemográficos e clínicos associados ao atraso para o início de tratamento de câncer de cólon e reto em hospitais no Brasil. Trata-se de estudo retrospectivo com dados dos registros hospitalares de câncer no Brasil de 2006 a 2015. O desfecho analisado é o tempo para início do tratamento de câncer de cólon e reto e possíveis associações… Show more
“…There is some evidence that younger adults with CRC experience different interval lengths compared to older adults. Our review showed time from diagnosis to treatment can be short among younger adults, and several studies have shown this interval is significantly shorter compared to older patients [ 31 , 38 , 46 , 81 ]. Lima et al [ 81 ] reported the odds of the treatment interval being greater than 60 days were significantly higher among those aged 50–59 compared to age <40 (OR 1.32, 95% CI 1.07–1.64; adjusted for race, education, marital status, stage and municipality).…”
Section: Discussionmentioning
confidence: 95%
“…Our review showed time from diagnosis to treatment can be short among younger adults, and several studies have shown this interval is significantly shorter compared to older patients [ 31 , 38 , 46 , 81 ]. Lima et al [ 81 ] reported the odds of the treatment interval being greater than 60 days were significantly higher among those aged 50–59 compared to age <40 (OR 1.32, 95% CI 1.07–1.64; adjusted for race, education, marital status, stage and municipality). Redaniel et al [ 46 ] similarly showed in an adjusted analysis that patients aged 55–64 experienced an additional 2.92 days (95% CI 1.76–4.08) for the treatment interval compared to patients 15–44 years, increasing to an additional 3.76 days (95% CI 2.58–4.93) for those aged 65–74.…”
Section: Discussionmentioning
confidence: 95%
“…After duplicates were removed, a total of 7,421 potentially relevant citations were identified from our database and grey literature searches ( Fig 2 ). Full-text evaluation was performed on 464 publications and 55 were included in this review [ 27 – 81 ]. Four were published in French [ 55 , 57 , 62 , 63 ], one in Portuguese [ 81 ], and the remaining 50 were available in English.…”
Section: Resultsmentioning
confidence: 99%
“…Full-text evaluation was performed on 464 publications and 55 were included in this review [ 27 – 81 ]. Four were published in French [ 55 , 57 , 62 , 63 ], one in Portuguese [ 81 ], and the remaining 50 were available in English.…”
Background
The incidence of colorectal cancer is rising in adults <50 years of age. As a primarily unscreened population, they may have clinically important delays to diagnosis and treatment. This study aimed to review the literature on delay intervals in patients <50 years with colorectal cancer (CRC), and explore associations between longer intervals and outcomes.
Methods
MEDLINE, Embase, and LILACS were searched until December 2, 2021. We included studies published after 1990 reporting any delay interval in adults <50 with CRC. Interval measures and associations with stage at presentation or survival were synthesized and described in a narrative fashion. Risk of bias was assessed using the Newcastle-Ottawa Scale, Institute of Health Economics Case Series Quality Appraisal Checklist, and the Aarhus Checklist for cancer delay studies.
Results
55 studies representing 188,530 younger CRC patients were included. Most studies used primary data collection (64%), and 47% reported a single center. Sixteen unique intervals were measured. The most common interval was symptom onset to diagnosis (21 studies; N = 2,107). By sample size, diagnosis to treatment start was the most reported interval (12 studies; N = 170,463). Four studies examined symptoms onset to treatment start (total interval). The shortest was a mean of 99.5 days and the longest was a median of 217 days. There was substantial heterogeneity in the measurement of intervals, and quality of reporting. Higher-quality studies were more likely to use cancer registries, and be population-based. In four studies reporting the relationship between intervals and cancer stage or survival, there were no clear associations between longer intervals and adverse outcomes.
Discussion
Adults <50 with CRC may have intervals between symptom onset to treatment start greater than 6 months. Studies reporting intervals among younger patients are limited by inconsistent results and heterogeneous reporting. There is insufficient evidence to determine if longer intervals are associated with advanced stage or worse survival.
Other
This study’s protocol was registered with the Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020179707).
“…There is some evidence that younger adults with CRC experience different interval lengths compared to older adults. Our review showed time from diagnosis to treatment can be short among younger adults, and several studies have shown this interval is significantly shorter compared to older patients [ 31 , 38 , 46 , 81 ]. Lima et al [ 81 ] reported the odds of the treatment interval being greater than 60 days were significantly higher among those aged 50–59 compared to age <40 (OR 1.32, 95% CI 1.07–1.64; adjusted for race, education, marital status, stage and municipality).…”
Section: Discussionmentioning
confidence: 95%
“…Our review showed time from diagnosis to treatment can be short among younger adults, and several studies have shown this interval is significantly shorter compared to older patients [ 31 , 38 , 46 , 81 ]. Lima et al [ 81 ] reported the odds of the treatment interval being greater than 60 days were significantly higher among those aged 50–59 compared to age <40 (OR 1.32, 95% CI 1.07–1.64; adjusted for race, education, marital status, stage and municipality). Redaniel et al [ 46 ] similarly showed in an adjusted analysis that patients aged 55–64 experienced an additional 2.92 days (95% CI 1.76–4.08) for the treatment interval compared to patients 15–44 years, increasing to an additional 3.76 days (95% CI 2.58–4.93) for those aged 65–74.…”
Section: Discussionmentioning
confidence: 95%
“…After duplicates were removed, a total of 7,421 potentially relevant citations were identified from our database and grey literature searches ( Fig 2 ). Full-text evaluation was performed on 464 publications and 55 were included in this review [ 27 – 81 ]. Four were published in French [ 55 , 57 , 62 , 63 ], one in Portuguese [ 81 ], and the remaining 50 were available in English.…”
Section: Resultsmentioning
confidence: 99%
“…Full-text evaluation was performed on 464 publications and 55 were included in this review [ 27 – 81 ]. Four were published in French [ 55 , 57 , 62 , 63 ], one in Portuguese [ 81 ], and the remaining 50 were available in English.…”
Background
The incidence of colorectal cancer is rising in adults <50 years of age. As a primarily unscreened population, they may have clinically important delays to diagnosis and treatment. This study aimed to review the literature on delay intervals in patients <50 years with colorectal cancer (CRC), and explore associations between longer intervals and outcomes.
Methods
MEDLINE, Embase, and LILACS were searched until December 2, 2021. We included studies published after 1990 reporting any delay interval in adults <50 with CRC. Interval measures and associations with stage at presentation or survival were synthesized and described in a narrative fashion. Risk of bias was assessed using the Newcastle-Ottawa Scale, Institute of Health Economics Case Series Quality Appraisal Checklist, and the Aarhus Checklist for cancer delay studies.
Results
55 studies representing 188,530 younger CRC patients were included. Most studies used primary data collection (64%), and 47% reported a single center. Sixteen unique intervals were measured. The most common interval was symptom onset to diagnosis (21 studies; N = 2,107). By sample size, diagnosis to treatment start was the most reported interval (12 studies; N = 170,463). Four studies examined symptoms onset to treatment start (total interval). The shortest was a mean of 99.5 days and the longest was a median of 217 days. There was substantial heterogeneity in the measurement of intervals, and quality of reporting. Higher-quality studies were more likely to use cancer registries, and be population-based. In four studies reporting the relationship between intervals and cancer stage or survival, there were no clear associations between longer intervals and adverse outcomes.
Discussion
Adults <50 with CRC may have intervals between symptom onset to treatment start greater than 6 months. Studies reporting intervals among younger patients are limited by inconsistent results and heterogeneous reporting. There is insufficient evidence to determine if longer intervals are associated with advanced stage or worse survival.
Other
This study’s protocol was registered with the Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020179707).
“…De acordo com os resultados deste estudo, o sexo feminino apresentou maior prevalência de tratamento oportuno. Embora isso tenha sido corroborado por estudos anteriores 9,26 , as diferenças de tempo entre os sexos são mais pujantes no período anterior ao diagnóstico, em que os homens tendem a negligenciar mais os sintomas e postergar a procura por atendimento médico, em virtude de um modelo de masculinidade idealizada, no qual se associa a figura masculina à resistência a doenças e ao menor cuidado de si 13,27,28 .…”
Introdução: E reservado a todo brasileiro com câncer, pela Lei dos 60 Dias, o direito de começar o tratamento em até dois meses. Todavia, estudos anteriores apontam a dificuldade dos pacientes em fazer valer essa normativa ao esbarrarem em problemáticas macroestruturais dos sistemas de saúde. Objetivo: Avaliar a influência de fatores demográficos e relacionados a neoplasia sobre o tempo para início do tratamento oncológico no Brasil. Método: Estudo seccional, desenvolvido com dados oriundos do PAINEL-Oncologia, uma base publica nacional, alimentada por diversas fontes de informação do Sistema Único de Saúde. Como variáveis de interesse, elegeram-se: a) tempo de tratamento; b) sexo; c) idade; d) diagnostico; e) estadiamento; f) modalidade terapêutica. Então, foi analisado o tempo transcorrido entre o diagnóstico e o início do tratamento oncológico. Resultados: Percebeu-se aumento exponencial, ao longo dos anos, da proporção de casos tratados oportunamente, isto e, em até 60 dias, como regulamenta a Lei. Entretanto, ainda e considerável a prevalência de atrasos no início do tratamento, sobretudo entre indivíduos idosos, do sexo masculino, com canceres em estádios menos avançados e que precisaram de radioterapia como primeira modalidade terapêutica. Além disso, o tempo de espera foi especialmente maior para os canceres de órgãos genitais masculinos, de cabeça e pescoço e de mama. Conclusão: Alguns fatores demográficos e relacionados a neoplasia estão envolvidos no atraso do início da terapia oncológica.
BackgroundCancer disparities exist between and within countries; we sought to compare cancer‐specific incidence and mortality according to area‐level socioeconomic status (SES) in the State of São Paulo, Brazil.MethodsCancer cases diagnosed 2003–2017 in the Barretos region and 2001–2015 in the municipality of São Paulo were obtained from the respective cancer registries. Corresponding cancer deaths were obtained from a Brazilian public government database. Age‐standardized rates for all cancer combined and the six most common cancers were calculated by SES quartiles.ResultsThere were 14,628 cancer cases and 7513 cancer deaths in Barretos, and 472,712 corresponding cases and 194,705 deaths in São Paulo. A clear SES‐cancer gradient was seen in São Paulo, with rates varying from 188.4 to 333.1 in low to high SES areas, respectively. There was a lesser social gradient for mortality, with rates in low to high SES areas ranging from 86.4 to 98.0 in Barretos, and from 99.2 to 100.1 in São Paulo. The magnitude of the incidence rates rose markedly with increasing SES in São Paulo city for colorectal, lung, female breast, and prostate cancer. Conversely, both cervical cancer incidence and mortality rose with lower levels of SES in both regions.ConclusionsA clear SES association was seen for cancers of the prostate, female breast, colorectum, and lung for São Paulo. This study offers a better understanding of the cancer incidence and mortality profile according to SES within a highly populated Brazilian state.
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