The effect of hospital care volume on overall survival of children with cancer in Southern Brazil

Abstract

Purpose The purpose of this study was to analyze the effect of hospital care volume on the overall survival of children with cancer in Southern Brazil. Patients and Methods We performed a retrospective cohort study of 1378 cancer patients aged 0‐19 years, diagnosed with cancer between August 1, 2009 and December 31, 2015 in Rio Grande do Sul, who received hospital treatment in institutions affiliated with the Universal Health Care System (Sistema Único de Saúde [SUS]). Results Most children and adolescents were male (56.9%) and White (75.8%). The most common types of cancer in our cohort were acute leukemia (40.7%), followed by lymphoma (15.9%) and central nervous system tumors (8.8%). Ninety‐five percent of the patients were treated in specialized pediatric oncology centers. The cumulative probability of survival at 5 years for all patients was 73.8% (95% confidence interval [CI] 71.4‐76.0%). Survival was significantly higher for patients younger than 4 years of age (P = .012) compared to all other age groups. Patients treated in institutions with a pediatric oncology patient volume of less than 15 patients/year were 41% more likely to die than patients treated in institutions with a volume of 60 patients/year or more (P = .029). Conclusion Cancer is the leading cause of death by natural causes in all age groups in Brazil, but, even so, childhood tumors are rare. This complexity makes childhood cancer care a challenge. In this study, we reiterate that pediatric cancer patients demonstrate better overall survival when treated in high‐volume hospitals.

Characterization of childhood cancer in Brazil from the hospital-based cancer registries, 2000-2016 / Caracterização do câncer infantojuvenil no Brasil a partir dos Registros Hospitalares de Câncer (RHC), 2000-2016

“…Research developed in the South region observed white individuals as the most affected by childhood and adolescent cancer. 12,16 Finally, a study carried out with the RHC records from all the units of the federation, in the period from 2000 to 2015, also verified a predominance of white children and adolescents. 21 This fact can be explained by the differences in human groups distributed in the country.…”

“…1 Male predominance was observed in this study and in another study involving children and adolescents, which covered the entire Brazilian territory 9 and isolated studies directed at states in different regions of the country. 4,[12][13][14][15][16] Males are more likely to have congenital diseases (chromosomal anomalies, monogenic syndromes, and nonsyndromic birth defects), which is associated with the risk of childhood cancers. 18 A higher number of records were found in the 0 to 4 years age group, corroborating a national study 9 and from different Brazilian states, 4,13,[15][16]18 as well as an international study.…”

“…4,[12][13][14][15][16] Males are more likely to have congenital diseases (chromosomal anomalies, monogenic syndromes, and nonsyndromic birth defects), which is associated with the risk of childhood cancers. 18 A higher number of records were found in the 0 to 4 years age group, corroborating a national study 9 and from different Brazilian states, 4,13,[15][16]18 as well as an international study. 8 Age is an important factor of analysis, because the occurrence of some tumors is higher in certain age groups, with patients in the first years of life being the most affected.…”

Children and adolescents with non-Hodgkin lymphoma in Brazil: A national survey identifies the challenges encountered and documents the diversity of care

“…Although the small centers have a role in pediatric cancer care, this aspect could be an obstacle, as it is well recognized that higher volume hospitals, higher case volume providers and specialized pediatric oncology hospitals positively impact survival outcomes. [ 10 , 11 ]…”