Influence of treatment access on survival of metastatic renal cell carcinoma in brazilian cancer center

Abstract

Background: Tyrosine kinase inhibitors (TKI) and immunotherapy improved survival in metastatic renal cell carcinoma (mRCC). Disparities in treatment access are present in healthcare systems globally. The aim of this study was to analyze survival outcomes of mRCC patients treated with first-line TKIs in the public (PHS) and private (PrS) health system in a Brazilian Cancer Center. Materials and Methods: Records from all mRCC patients treated with first-line TKIs from 2007-2018 were reviewed retrospectively. Categorial variables were compared by Fisher's exact test. Survival was estimated by Kaplan-Maier method and survival curves were compared using the log-rank test. Prognostic factors were adjusted by Cox regression model. Results: Of the 171 eligible patients, 37 (21.6%) were PHS patients and 134 (78.4%) were PrS patients. There were no difference in age, gender, or sites of metastasis. PHS patients had worse performance status (ECOG ≥2, 35.1% vs. 13.5%, p=0.007), poorer risk score (IMDC poor risk, 32.4% vs. 16.4%, p=0.09), and less nephrectomies (73% vs. 92.5%, p=0.003) than PrS patients. Median lines of therapy was one for PHS versus two for PrS patients (p=0.03). Median overall survival (OS) was 16.5 versus 26.5 months (p=0.002) and progression-free survival (PFS), 8.4 versus 11 months (p=0.01) for PHS and PrS patients, respectively. After adjusting for known prognostic factors on multivariate analysis, PHS patients still had a higher risk of death (HR: 1.61, 95% CI: 1.01-2.56, p=0.047). Conclusion:Patients with mRCC treated via the PHS had worse overall survival, possibly due to poorer prognosis at presentation and less drug access.

Impact of healthcare inequities on survival in Mexican patients with metastatic renal cell carcinoma

“…Unsurprisingly, healthcare insurance status was an independent prognostic factor for survival in the multivariate analysis. The impact of healthcare insurance on OS has also been described in other upper-middle- and high-income countries ( 29 – 32 ), and more recently, in other Latin American countries such as Brazil ( 21 , 33 ). These data highlight the importance of access to treatment in an era during which the most effective cancer therapies are extremely expensive and cannot be systematically covered by healthcare systems in LMICs.…”

Access to treatment among patients with advanced kidney cancer in Mexico

“…A Brazilian study showed that patients with mRCC treated in the government-supported public health system (PHS) had significantly worse overall survival than patients with access to a private health system (PrHS). Overall survival was 16.5 months for PHS patients, compared to 26.5 months for PrHS patients (p = 0.002), which may be due to the worse prognosis and status at the time of presentation among patients who were treated at public institutions, as well as their reduced access to first-and second-line drugs 8 .…”

“…FT is also often associated with lower quality of life and treatment non-adherence. FT has been described among patients in countries with universal health coverage and countries that do not have it, although the related costs were different 8 .…”

Clinical and Epidemiologic Evaluation of Desmoid Tumors in a Brazilian Sarcoma Reference Center

“…Another important prospective, phase 3 trial, the DeFi trial 12 showed that the gamma secretase inhibitor Nirogacestat promoted tumor shrinkage in almost all the patients with objective response rate of 40% and the study demonstrated an improvement in the quality of life of patients treated with Nirogacestat. Disparity and inequity in treatment access is an important barrier that patients with cancer face, 13 especially in the Brazilian health system where there is no officially approved chemotherapy or target agent for DT. This data could partially explain the high frequency of surgery and less indication of systemic treatment.…”