Breast cancer survival in Brazil: How much health care access impact on cancer outcomes?

Abstract

Background Breast cancer has a high incidence and increasing mortality in Southern Brazil. The present study evaluated clinical and sociodemographic characteristics, and their association with overall survival in a private cancer center. Methods 1113 breast cancer patients were included in this study. The association between survival and clinicopathological and sociodemographic characteristics was analyzed using Cox regression and Kaplan-Meyer curves. Results Median age at diagnosis was 52 years (SD 13.5). Most patients were diagnosed in stages 0 and I (62.7%), while only 1.3% had stage IV disease. Five- and 10-year overall survival were 93.5% and 83.8%, respectively. According to multivariate analysis, age at diagnosis (HR 1.05; CI95 1.03–1.06), staging (stage III: HR 4.04; CI95 1.34–12.19; stage IV: HR 9.61; CI95 2.17–42.50), high KI67 (HR 5.46; CI95 1.27–23.32) and distant recurrence (HR 7.28; CI95 4.79–11.06) were significantly associated with survival. Smoking status, years of education, BMI, and tumor biological status were not significantly associated with mortality. Conclusions This cohort of Brazilian patients, who received timely and appropriate treatment, achieved outcomes that are comparable to those from high income countries. Breast cancer mortality seems dependent on the quality of health care available to patients.

Fighting Cancer around the World: A Framework for Action

“…Access to cancer treatment highly depends on the concentration of services in large urban centers and also on the fact that some patients have to travel long distances to receive proper treatment. Taken into account the territorial extent of Brazil, it is even more important and challenging to assure a highly coordinated multi-layered health care system [ 79 , 80 ].…”

Breast imaging hindered during covid-19 pandemic, in Brazil

“…Some authors advocate that the best strategy for Brazil is prompt care for symptomatic patients 18 . However, a recent study found that, when diagnosed at early stages, survival rates in Brazil are greater than 90% 19 . This means that, despite all difficulties, Brazil's health authorities must not give up pursuing early detection for breast cancer.…”

Stakeholders’ Experiences and Perspectives Regarding Care Quality for Women With Breast Cancer

“…In this regard, we recommend proper patient and provider education and training to improve communication, social influences, and psychological and cognitive outcomes. 16,39 In this review, 13 studies contained issues on care coordination. 18,20,23,[25][26][27][28][29][31][32][33][34]36,37 Most patients with breast cancer expressed that they need appropriate care coordination in multiple settings from caregivers such as doctor's appointments, treatment, medications, support and follow-up care, answers to questions, patient navigation, and clear instructions and protocol.…”

“…1,15 Although there has been a steady rise in the development of initiatives and guidelines regarding the improvement of cancer care, the main attempts to develop and identify the scales that will evaluate what is important to the key stakeholders in breast cancer care are still unclear. 16,17 Providers, patients, payers, and managed care organizations have all shown interest to improve the quality of breast cancer care in healthcare services. However, improvement in the quality of cancer care may have a different innate meaning across the various groups, and disagreement in values could not be reflected in the key quality measures created by the stakeholder groups.…”

“…5,17 Thus, understanding the values and duties of key stakeholders is essential to improve the quality of breast cancer care. 16 The Effective Health Care program defines a "stakeholder" as a person or group with a vested interest in a particular clinical decision including patients, caregivers, patient advocacy organizations, clinicians, institutional healthcare providers, government agencies, purchasers, payers, healthcare industry representatives, healthcare policymakers, healthcare researchers, and research institutions. Toward a definition of stakeholder for healthcare service and hospital trust, stakeholders include patients, providers, staff, unions, voluntary organizations, social services, the local authority, and primary care groups.…”