Cerqueira Erica R, Batista Paula M, Almeida Milena F, Rego Maria A C, Ribeiro-Pereira Ana C P, Alencar Fernando, Fernandes Roberta A, Calabrich Aknar F C, Schvartsman Gustavo
Global Medical Scientific Affairs, MSD Brazil, São Paulo, Brazil.
Department of Health Economics, Origin Health, São Paulo, Brazil.
Front Oncol. 2023 Oct 18;13:1257003. doi: 10.3389/fonc.2023.1257003. eCollection 2023.
Non-small cell lung cancer (NSCLC) is still diagnosed at late stages in Brazil. The availability of newer treatment options has changed patient management, however, few real-world data have been published since then. This is a population-based retrospective cohort study that aims to evaluate the characteristics of stage III/IV NSCLC patients and their journey in the Brazilian private healthcare system. Patients aged ≥18 years, residing in Brazil who had their first medical appointment between 2016 and 2018 were included in the study. The sociodemographic and clinical characteristics of the patients and time intervals of interest were described. A total of 10,394 patients were analyzed. The majority of the patients were male (58.5%) with a median age of 64.0 (IQR = 58.0 - 71.0) years. In relation to characteristics of the disease, most of the tumors were characterized as adenocarcinomas (52.3%) and diagnosed at stage IV (72.2%). Most patients arrived at the hospital with an established NSCLC diagnosis, while 45.7% were diagnosed at the first medical appointment in the hospital or later. For patients who were diagnosed at the first medical appointment or later, a median interval of 15.0 (IQR = 6.0 - 33.0) days was observed between the first medical appointment and the diagnosis. The first treatment was given after a median of 25.0 (IQR = 6.0 - 49.0) days after diagnosis for patients without a prior diagnosis, and 57.0 (IQR: 33.0 - 98.0) days for patients with a prior diagnosis. The most common treatments were chemotherapy alone (33.8%), chemotherapy combined with radiotherapy (21.5%), radiotherapy alone (13.1%), adjuvant or neoadjuvant treatment (9.3%), surgery (3.3%), and immunotherapy (0.7%; alone or combined). At the end of follow-up (September, 2020), 52.3% of the patients had died. Despite having more treatment options in the private sector, data show that there is a need to improve access to technologies.
在巴西，非小细胞肺癌（NSCLC）仍多在晚期才被诊断出来。尽管新治疗方案的出现改变了患者管理方式，但此后几乎没有真实世界数据发表。这是一项基于人群的回顾性队列研究，旨在评估III/IV期NSCLC患者的特征及其在巴西私立医疗系统中的就医历程。年龄≥18岁、居住在巴西且在2016年至2018年间首次就诊的患者被纳入研究。描述了患者的社会人口学和临床特征以及感兴趣的时间间隔。共分析了10394名患者。大多数患者为男性（58.5%），中位年龄为64.0岁（四分位间距IQR = 58.0 - 71.0岁）。关于疾病特征，大多数肿瘤为腺癌（52.3%），且在IV期被诊断出来（72.2%）。大多数患者到医院时已确诊为NSCLC，而45.7%的患者是在医院首次就诊时或之后被诊断出来的。对于在首次就诊时或之后被诊断出的患者，首次就诊与确诊之间的中位间隔时间为15.0天（IQR = 6.0 - 33.0天）。对于此前未确诊的患者，确诊后中位25.0天（IQR = 6.0 - 49.0天）开始首次治疗，对于此前已确诊的患者则为57.0天（IQR：33.0 - 98.0天）。最常见的治疗方式为单纯化疗（33.8%）、化疗联合放疗（21.5%）、单纯放疗（13.1%）、辅助或新辅助治疗（9.3%）、手术（3.3%）以及免疫治疗（0.7%；单纯或联合使用）。在随访结束时（2020年9月），52.3%的患者已经死亡。尽管私立医疗部门有更多治疗选择，但数据表明仍需改善技术可及性。
