Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
Radiation Oncology Department, Americas Centro de Oncologia Integrado, Rio de Janeiro, Brazil.
Lancet Oncol. 2022 Apr;23(4):531-539. doi: 10.1016/S1470-2045(22)00123-1. Epub 2022 Mar 14.
Similarly to several other upper-middle-income countries, there is a major shortfall in radiotherapy services for the treatment of cancer in Brazil. In this study, we developed the linear accelerator (LINAC) shortage index to assess the LINAC shortage and support the prioritisation of new LINAC distribution in Brazil.
This cross-sectional, population-based study used data from the National Cancer Institute 2020 Cancer estimates, the Ministry of Health 2019 radiotherapy census, the Minister of Health radiotherapy expansion programme progress reports, and the Fundação Oncocentro de São Paulo public database of the Cancer Hospital Registry of the State of São Paulo to calculate the LINAC shortage index. Data collected were number of new cancer cases in Brazil, number of LINACs per region and state, number of cancer cases treated with radiotherapy, patient state of residence, and radiotherapy treatment centre and location. National, regional, and state-level data were collected for analysis. LINAC numbers, cancer incidence, geographical distribution, and radiotherapy needs were estimated. A LINAC shortage index was calculated as a relative measure of LINAC demand compared with supply based on number of new cancer cases, number of patients requiring radiotherapy, and the number of LINCAS in the region or state. We then built a prioritisation framework using the LINAC shortage index, cancer incidence, and geographical factors. Finally, using patient-level public cancer registry data from the Fundação Oncocentro de São Paulo and Google maps, we estimated the geospatial distance travelled by patients with cancer from their state of residence to radiotherapy treatment in São Paulo from 2005-14. Non-parametric statistics were used for analysis.
Data were collected between Feb 2 and Dec 31, 2021. In 2020, there were 625 370 new cancer cases in Brazil and 252 LINAC machines. The number of LINACs was inadequate in all Brazilian regions, with a national LINAC shortage index of 221 (ie, 121% less than the required radiotherapy capacity). The LINAC shortage index was higher in the midwest (326), north (313), and northeast (237) regions, than the southeast (210) and south (192) regions. Four states (Tocantins, Acre, Amapá, and Roraima) in the north region were ranked first on the prioritisation rank due to no availability of LINACs. There was an association between LINAC shortage index and the number of patients who travelled to receive radiotherapy (p<0·0001). Patients living in the midwest (793 km), north (2835 km), and northeast (2415 km) regions travelled significantly longer average distances to receive radiotherapy treatment in São Paulo than patients living in the southeast or south regions (p=0·032). The reduced number of LINACs in these regions was associated with longer distance travelled (p=0·032).
There is substantial discordance between distribution of cancer cases and LINAC availability in Brazil. We developed a tool using the LINACs shortage index to help prioritise the development of radiotherapy infrastructure across Brazil; this approach might also be useful in other health systems.
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与其他几个中上收入国家类似，巴西在癌症放射治疗服务方面存在重大短缺。在这项研究中，我们开发了直线加速器（LINAC）短缺指数，以评估 LINAC 的短缺情况，并支持在巴西优先分配新的 LINAC。
这是一项基于人群的横断面研究，使用了国家癌症研究所 2020 年癌症估计数据、卫生部 2019 年放射治疗普查数据、卫生部放射治疗扩展计划进展报告以及圣保罗州癌症医院登记处公共数据库中的 Fundação Oncocentro de São Paulo 数据来计算 LINAC 短缺指数。收集的数据包括巴西新癌症病例数、每个地区和州的 LINAC 数量、接受放射治疗的癌症病例数、患者居住地以及放射治疗中心和位置。收集了国家、地区和州级别的数据进行分析。估计了 LINAC 数量、癌症发病率、地理分布和放射治疗需求。根据新癌症病例数、需要放射治疗的患者数以及该地区或州的 LINAC 数量，计算了相对 LINAC 需求的 LINAC 短缺指数。然后，我们使用 LINAC 短缺指数、癌症发病率和地理因素构建了一个优先级框架。最后，我们使用来自 Fundação Oncocentro de São Paulo 的患者级公共癌症登记数据和谷歌地图，估计了 2005 年至 2014 年期间，居住在巴西各州的癌症患者前往圣保罗接受放射治疗的地理空间距离。使用非参数统计进行分析。
数据收集于 2021 年 2 月 2 日至 12 月 31 日之间。2020 年，巴西有 625370 例新癌症病例和 252 台 LINAC 机器。巴西所有地区的 LINAC 数量都不足，全国 LINAC 短缺指数为 221（即放射治疗能力短缺 121%）。中西部（326）、北部（313）和东北部（237）地区的 LINAC 短缺指数高于东南部（210）和南部（192）地区。北部的四个州（托坎廷斯、阿克里、阿马帕和罗赖马）由于没有 LINAC，排名第一。LINAC 短缺指数与前往接受放射治疗的患者人数之间存在关联（p<0·0001）。居住在中西部（793 公里）、北部（2835 公里）和东北部（2415 公里）地区的患者前往圣保罗接受放射治疗的平均距离明显长于居住在东南部或南部地区的患者（p=0·032）。这些地区 LINAC 数量减少与距离较远有关（p=0·032）。
巴西癌症病例分布与 LINAC 供应之间存在很大差异。我们使用 LINAC 短缺指数开发了一种工具，以帮助优先在巴西发展放射治疗基础设施；这种方法在其他卫生系统中也可能有用。
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