Survival analysis of stage IV NSCLC patients treated by the Brazilian public health system compared with patients treated at a research center in the same institution.

Lung cancer persists throughout the world as a major cause of death. In 2014, data from the Brazilian National Cancer Institute (INCA) estimated 16.400 new cases of lung cancer among men (second most common) and 10.930 new cases among women (fourth most common). These data are consistent for all Brazilian regions and reflect the trends of cancer in the country over the last decade. Brazil is a continental country, the largest in Latin America and fifth in the world, with an estimated population of >200 million. Although the discrepancy in the national income between rich and poor has diminished in the last 2 decades, it is still huge. More than 75% of the Brazilian population do not have private health insurance and rely on the national health care system, where differences in standard of cancer care are evident. It is possible to point out differences from the recommendations of international guidelines in every step of the lung cancer care, from the diagnosis to the treatment of advanced disease. This review aims to describe and recognize these differences as a way to offer a real discussion for future modifications and action points toward delivery of better oncology care in our country.

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“…The median overall survival was 5 months and 10 months, respectively, favoring the research center treatment, with the hazard ratio of 0.6. 49 …”

Section: Treatmentmentioning

confidence: 99%

Lung cancer in Brazil: epidemiology and treatment challenges

Sá

Coelho

Capelozzi

et al. 2016

LCTT

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“…The last review on lung cancer 10 could not identify as much as 10 studies in the country. The sum of all patients in previous studies might be smaller than our sample size (eg, Barrios et al 25 reported 41 patients). After matching the database records using the deterministic approach, we included more than 5,000 patients, which might not represent all patients with NSCLC who were referred to private health care institutions in Brazil, but certainly is the biggest source of information.…”

Section: Discussionmentioning

confidence: 75%

“…Using a 5% alpha, this study, which is composed of 5,000 patients, can be considered a powered sample (power > 80%) when testing the hypothesis that a 10-month median survival in the previous Brazilian studies is the true estimate. 25 …”

Section: Methodsmentioning

confidence: 99%

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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

Ferreira

Abadi

Batista

et al. 2021

JCO Global Oncology

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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.

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“…It is likely that there are differences regarding survival and quality of life of patients treated in the community oncology center compared with those treated in the scope of clinical trials. Barrios et al 30 evaluated the difference in survival of patients with stage IV lung cancer, comparing patients treated in the public health system of a Brazilian university cancer center versus a research center of the same institution. Forty-one patients were treated in the public health system and 66 patients in the research center, and the study demonstrated an impressive difference in OS.…”

mentioning

confidence: 99%