Maschmann Raíra Mesquita, De Jesus Rafaela Gomes, Werutsky Gustavo, Rebelatto Taiane Francieli, Queiroz Geraldo, Simon Sergio Daniel, Bines José, Barrios Carlos Henrique Escosteguy, Rosa Daniela Dornelles
Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre, Brazil.
Grupo Brasileiro de Estudos em Câncer de Mama (GBECAM), Porto Alegre, Brazil.
Breast Cancer Res Treat. 2023 Feb;198(1):123-130. doi: 10.1007/s10549-022-06809-8. Epub 2022 Dec 31.
Breast cancer (BC) is the most common type of cancer among women in Brazil. Evidence shows that delayed treatment onset is associated with increased mortality. This study aimed to evaluate median days between diagnosis and treatment and factors associated with delayed start of treatment (> 60 days after diagnosis): stage, treatment received, subtype, epidemiological characteristics, and type of healthcare coverage.
This analysis included 1709 stage I-III BC patients from AMAZONA III, a prospective, observational study, diagnosed from January 2016 to March 2018 in 22 centers in Brazil.
The median number of days from diagnosis to beginning of first oncologic treatment was 46 days (IQR 28-75) overall, 43 days (IQR 25-75) for stage I disease, 49 days (IQR 28-81) for stage II, and 44 days (IQR 30-68) for stage III, (p = 0.1180). According to first treatment received, diagnosis-to-treatment interval was 43 days (IQR 29-65) for neoadjuvant chemotherapy and 48 days (IQR 26-81) for surgery. Diagnosis-to-treatment interval was higher in women treated in the public system versus the private system (56 vs. 34 days, p < 0.0001). Patients in the public system had an increased odds of delayed treatment initiation (OR 4.74 95% CI 3.09-7.26, p < .0001). The longer interval from diagnosis to treatment in the public system was independent of clinical stage, type of treatment (systemic vs surgery first), subtype and region of the country.
By characterizing the delays in care delivery, our study will aid stakeholders to better design interventions and allocate resource to improve timely treatment for breast cancer in Brazil.
gov Identifier: NCT02663973, registered on January, 26th, 2016.
乳腺癌（BC）是巴西女性中最常见的癌症类型。有证据表明，治疗开始延迟与死亡率增加有关。本研究旨在评估诊断与治疗之间的中位天数以及与治疗开始延迟（诊断后>60天）相关的因素：分期、接受的治疗、亚型、流行病学特征和医疗覆盖类型。
本分析纳入了来自AMAZONA III的1709例I - III期BC患者，这是一项前瞻性观察性研究，于2016年1月至2018年3月在巴西22个中心进行诊断。
从诊断到开始首次肿瘤治疗的中位天数总体为46天（IQR 28 - 75），I期疾病为43天（IQR 25 - 75），II期为49天（IQR 28 - 81），III期为44天（IQR 30 - 68），（p = 0.1180）。根据接受的首次治疗，新辅助化疗的诊断至治疗间隔为43天（IQR 29 - 65），手术为48天（IQR 26 - 81）。与私立系统相比，公立系统治疗的女性诊断至治疗间隔更长（56天对34天，p < 0.0001）。公立系统中的患者延迟开始治疗的几率增加（OR 4.74，95% CI 3.09 - 7.26，p <.0001）。公立系统中从诊断到治疗的间隔时间更长，这与临床分期、治疗类型（先全身治疗还是先手术）、亚型和国家地区无关。
通过描述护理提供过程中的延迟情况，我们的研究将帮助利益相关者更好地设计干预措施并分配资源，以改善巴西乳腺癌的及时治疗。
gov标识符：NCT02663973，于2016年1月26日注册。
