Trends in the frequency of potentially curable cancers treated in the Brazilian national health system and current time from diagnosis to initial treatment

INTRODUCTION:  Chronic non-communicable diseases are the leading cause of death worldwide and their control represent a major challenge. Brazil, a middle income country, has made considerable progress in the control of cardiovascular and chronic respiratory diseases, but much remains to be done, particularly regarding prompt diagnosis and treatment of curable/treatable cancers, as recently emphasized. The aim of this study is to describe recent trends in the number of such cases initiating treatment and the median time from diagnosis to treatment in the Brazilian unified health system (SUS), which covers over 80% of such treatments.

METHODS:  We obtained information about initial diagnosis and initial chemotherapy and radiotherapy for curable cancers (Farmer P et al. Lancet, 2010) in the SUS from the Subsistema de Autorização de Procedimentos  Ambulatoriais. (APAC/ONCOLOGIA) and from the national public hospitalization database. We performed deterministic linkage of registries using algorithms from the Statistical Analysis System – SAS and probabilistic linkage using Fine-Grained Record Linkage Software (FRIL).

RESULTS:  From 2001-2012, 877.604 individuals initiated chemo or radiotherapy for these cancers through the SUS. Overall, the number initiating treatment annually increased from 59.385 to 105.824 (+78%). The number of patients initiating treatment increased 5% for cervical cancer, 131% for colorectal cancer, 23% for Hodgkin´s lymphoma, 29% for non-Hodgkin lymphoma, 18% for lymphoblastic leukemia, 45% for myeloid leukemia, 70% for breast cancer, 194% for prostate cancer, 67% for testicular cancer, and 19% for thyroid cancer. The median (interquartile range) time from diagnosis to initial treatment over the period 2008-2012 ranged from 5 (0-21) days for leukemia to 69 (34-119) days for prostate cancer.

CONCLUSIONS:  Treatment of this group of cancers expanded notably over 12 years. Time from diagnosis to treatment varied considerably by cancer type. Continuous monitoring and analysis of these indicators is warranted to guide decisions on public policy.