Faculty of Health Sciences, Federal University of Grande Dourados - UFGD, Dourados, Mato Grasso do Sul, Brazil.
Faculty of Human Sciences, Federal University of Grande Dourados - UFGD, Dourados, Mato Grasso do Sul, Brazil.
Public Health. 2022 Sep;210:1-7. doi: 10.1016/j.puhe.2022.06.006. Epub 2022 Jul 18.
This study aimed at identifying the sociodemographic and first treatment characteristics affecting time-to-treatment initiation (TTI) of patients with cutaneous melanoma assisted by the Brazilian Unified Health System (SUS).
Retrospective observational study using cutaneous melanoma cases recorded in the Brazilian Hospital-Based Cancer Registries (HBCR).
A total of 12,783 cutaneous melanoma cases were included in the analysis. Based on the legislation, TTI in Brazil is 60 days; therefore, the cohort was dichotomized into TTI within 60 days and over. The association among variables was evaluated through the Chi-squared test. Kaplan-Meier method and log-rank hypothesis test were used to determine the probability of initiating treatment within 60 days. Cox proportional hazards regression model was used for multivariate analysis.
Median TTI was 28 days (95% CI, 25-29). First treatment in SUS provided more than 60 days after diagnosis (34.8%) was associated with females; low level of formal education; living or getting treatment in northern Brazil; being diagnosed in SUS and treated at different healthcare facilities, in addition to starting treatment with radiotherapy or systemic therapy. There were no significant differences in access to health care before and after the enactment of the 60-day law.
Increased TTI for cutaneous melanoma is associated with sociodemographic and first treatment characteristics in Brazil; approximately one-third of cases did not have access to first treatment within the period established by law. Receiving the diagnosis and treatment at different healthcare facilities (transitions in care) is the main independent factor associated with TTI longer than 60 days.
本研究旨在确定影响巴西统一卫生系统（SUS）辅助治疗的皮肤黑素瘤患者开始治疗时间（TTI）的社会人口学和初始治疗特征。
使用巴西基于医院的癌症登记处（HBCR）记录的皮肤黑素瘤病例进行回顾性观察性研究。
共纳入 12783 例皮肤黑素瘤病例进行分析。根据立法规定，巴西的 TTI 为 60 天；因此，该队列分为 TTI 在 60 天内和超过 60 天。通过卡方检验评估变量之间的关联。采用 Kaplan-Meier 方法和对数秩假设检验确定 60 天内开始治疗的概率。采用 Cox 比例风险回归模型进行多变量分析。
中位 TTI 为 28 天（95%CI，25-29）。在诊断后超过 60 天（34.8%）在 SUS 中接受首次治疗与女性有关；低正规教育程度；居住或在巴西北部接受治疗；在 SUS 中诊断并在不同医疗保健机构接受治疗，以及开始放疗或全身治疗。在 60 天法颁布前后，获得医疗保健的机会没有显著差异。
巴西皮肤黑素瘤的 TTI 增加与社会人口学和初始治疗特征有关；大约三分之一的病例未能在法律规定的期限内接受首次治疗。在不同医疗机构接受诊断和治疗（治疗转移）是与 TTI 超过 60 天相关的主要独立因素。
