Health Services Access Inequalities in Brazil Result in Poorer Outcomes for Stage III NSCLC—RELANCE/LACOG 0118

Vladmir C. Cordeiro de Lima MD, PhD , Ana Gelatti MD, MSc , José F.P. Moura MD, PhD , Aline F. Fares MD, MSc , Gilberto de Castro Jr. MD, PhD , Clarissa Mathias MD, PhD , Ricardo M. Terra MD, PhD , Gustavo Werutsky MD, PhD , Marcelo Corassa MD , Luiz Henrique L. Araújo MD, PhD , Eduardo Cronenberger MD, MSc , Fernanda K. Fujiki MD , Sandro Reichow MD , Antônio Vinícius T. da Silva MD , Tércia V. Reis MD , Mônica Luciana A. Padoan MD , Patrícia Pacheco MD , Rosely Yamamura MD , Caroline Kawamura MD , Eldsamira Mascarenhas MD, MSc , Clarissa Baldotto MD, PhD
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Abstract

Introduction

Stage III NSCLC is a heterogeneous disease, representing approximately one-third of newly diagnosed lung cancers. Brazil lacks detailed information regarding stage distribution, treatment patterns, survival, and prognostic variables in locally advanced NSCLC.

Methods

RELANCE/LACOG 0118 is an observational, retrospective cohort study assessing sociodemographic and clinical data of patients diagnosed with having stage III NSCLC from January 2015 to June 2019, regardless of treatment received. The study was conducted across 13 cancer centers in Brazil. Disease status and survival data were collected up to June 2021. Descriptive statistics, survival analyses, and a multivariable Cox regression model were performed. p values less than 0.05 were considered significant.

Results

We recruited 403 patients with stage III NSCLC. Most were male (64.0%), White (31.5%), and smokers or former smokers (86.1%). Most patients had public health insurance (67.5%), had stage IIIA disease (63.2%), and were treated with concurrent chemoradiation (53.1%). The median follow-up time was 33.83 months (95% confidence interval [CI]: 30.43–37.50). Median overall survival (OS) was 27.97 months (95% CI: 21.57–31.73), and median progression-free survival was 11.23 months (95% CI: 10.70–12.77). The type of treatment was independently associated with OS and progression-free survival, whereas the types of health insurance and histology were independent predictors of OS only.

Conclusions

Brazilian patients with stage III NSCLC with public health insurance are diagnosed later and have poorer OS. Nevertheless, patients with access to adequate treatment have outcomes similar to those reported in the pivotal trials. Health policy should be improved to make lung cancer diagnosis faster and guarantee prompt access to adequate treatment in Brazil.

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巴西医疗服务获取不平等导致 III 期 NSCLC 治疗效果较差 - RELANCE/LACOG 0118
导言 III 期 NSCLC 是一种异质性疾病,约占新诊断肺癌的三分之一。方法RELANCE/LACOG 0118是一项观察性、回顾性队列研究,评估2015年1月至2019年6月期间确诊为III期NSCLC患者的社会人口学和临床数据,无论患者接受何种治疗。该研究在巴西的 13 个癌症中心进行。疾病状态和生存数据收集至 2021 年 6 月。结果我们招募了403名III期NSCLC患者。大多数患者为男性(64.0%)、白人(31.5%)、吸烟者或曾经吸烟者(86.1%)。大多数患者有公共医疗保险(67.5%),疾病为 IIIA 期(63.2%),同时接受化疗和放疗(53.1%)。中位随访时间为 33.83 个月(95% 置信区间 [CI]:30.43-37.50)。中位总生存期(OS)为 27.97 个月(95% 置信区间:21.57-31.73),中位无进展生存期为 11.23 个月(95% 置信区间:10.70-12.77)。治疗类型与OS和无进展生存期独立相关,而医疗保险类型和组织学仅是OS的独立预测因素。尽管如此,能够获得适当治疗的患者的疗效与关键试验报告的结果相似。巴西应改进医疗政策,加快肺癌诊断速度,确保患者能及时获得适当的治疗。
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CiteScore
4.20
自引率
0.00%
发文量
145
审稿时长
19 weeks
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