Delays in cancer treatment initiation in Brazil: A nationwide analysis.

Abstract

e13527 Background: Cancer continues to be a leading cause of mortality worldwide, but advancements in screening, early diagnosis, and treatment have improved survival rates in many high-income countries. However, low- and middle-income countries still encounter significant challenges in delivering appropriate cancer care. This often leads to delays in time to treatment initiation (TTI), which negatively impacts patient outcomes. This study examines the factors associated with TTI delays for the five most common cancers in Brazil. Methods: We reviewed data from the DATASUS database of the Brazilian Public Health System, which we accessed in January 2025. Using the International Classification of Diseases, 10th revision codes (C16, C18, C34, C50, and C61), we extracted data from 2022 to 2024 for patients diagnosed with stomach, colon, lung, breast, and prostate cancers. Our analysis included patient demographics (age, sex), type of treatment, disease stage, and region of residence. Delayed TTI was classified as more than 60 days. Results: During this period, 459,282 patients received oncologic treatment, and we were able to retrieve data from 310,766 patients: breast cancer (128,705), prostate (87,073), colon (45,151), stomach (21,890), and lung (27,947). More than half (50.9%) experienced TTI exceeding 60 days. The highest delays were seen in breast (57%) and stomach (64%) cancer patients. Regional disparities were noted, with the North and Northeast regions facing the longest delays (34.8%-58%) compared to the South (29.87%-49.35%). Only stomach cancer showed a sex difference, with women being nearly twice as likely to have TTI before 60 days. Younger patients (< 45 years) consistently began treatment sooner across all cancer types. Treatment modality also influenced wait times, with surgery having the shortest waits (6%-31%) and radiotherapy the longest (44%-86%). Additionally, metastatic patients received treatment earlier than those with early-stage cancer, at rates of 36%-55% and 45%-72%, respectively. Conclusions: This study reveals significant delays in cancer treatment initiation in Brazil, with disparities across regions, type of cancer, age, sex, disease stage, and treatment modality. These findings underscore the urgent need for targeted interventions to improve access to timely cancer care, particularly for the most vulnerable populations.