Outcome of Patients With Breast Cancer Treated in a Private Health Care Institution in Brazil

Abstract

PurposeMiddle-income countries like Brazil often have a dichotomous health care system in which patients may be treated in either public or private institutions that differ substantially in terms of level of access to diagnostic and therapeutic procedures.Patients and MethodsThis was a prospective, observational study to assess real-world data in 1,230 female patients with breast cancer who were treated in a private health care institution between 2012 and 2016 in Brazil.ResultsBreast cancer in these patients mostly was diagnosed at early (79.0% stages I or II) or locally advanced (16.1% stage III) stages. The primary tumor was resected in 89.0% of cases, most often through breast-conserving surgery (55.1%). Patients with locally advanced disease received more aggressive therapy (eg, higher rates of mastectomy, axillary dissection and chemotherapy use) than patients with early-stage disease. The estimated 2-year overall survival (OS) was 95.3%. Survival was significantly longer among patients with stage I or II disease (2-year OS, 97.9% and 97.5%, respectively) than those with stage III or IV disease (89.4% and 69.5%, respectively; P < .01). Tumor grade was also correlated with OS in the overall cohort (P = .05); triple-negative status was only prognostic for patients with stage III disease (P < .01).ConclusionThe data provided aid understanding of the current scenario of breast cancer presentation and treatment in the Brazilian private health care system and may serve as a foundation to guide resource allocation. Our results reinforce the need to pursue adequate access to cancer care in low- and middle-income countries to optimize patient outcome.

Waiting Time between Breast Cancer Diagnosis and Treatment in Brazilian Women: An Analysis of Cases from 1998 to 2012

“…Regarding the origin of access, women who had a health plan or who had access by private means were less likely to experience delays greater than 60 days between diagnosis and treatment, which is in agreement with a study carried out in Mexico [3] and another prospective study carried out in Brazil [5]. In both studies, women who had access to health services through private or health plans received better and more efficient treatment, reflecting positively on the outcome of the disease.…”

“…The major cancer treatment centers are located in the Southeastern region, where a significant proportion of women from other regions of the country are referred, which may be related to the longer waiting times in this region. Large territorial extension, poor distribution of income, as well as low socioeconomic development, are factors that represent barriers to health services [4,5].…”

“…Waiting time for the commencement of cancer treatment after diagnosis is used to assess the accessibility and quality of health services. There are several factors associated with delayed access to health services such as bureaucratization, a lack of human resources, the unequal geographical distribution of health services, education level, age, ethnicity, and type of treatment financing [3][4][5][6]. These must be taken into account when considering the treatment of breast cancer, as delayed access to health services, and thus, delayed treatment, may influence prognosis and survival [7].…”

Locally advanced breast cancer in Brazil: current status and future perspectives

“…In the entire study population, stage distribution was: 20% stage I, 48% stage II, 28% stage III and 5% stage IV. Almost 33% of patients diagnosed in public institutions were stage III versus 16% in private institutions [7, 16]. In another cohort [16] of 1230 patients from 2012 to 2016 in a private institution in Rio de Janeiro, 79.0% had stages I or II and 16.1% were stage III.…”

“…Almost 33% of patients diagnosed in public institutions were stage III versus 16% in private institutions [7, 16]. In another cohort [16] of 1230 patients from 2012 to 2016 in a private institution in Rio de Janeiro, 79.0% had stages I or II and 16.1% were stage III. Therefore, patients from the public health system presented with a higher rate of locally advanced breast cancer (LABC) disease probably due to lower educational level and poor access to screening programmes for BC.…”