Implications of Regionalizing Care in the Developing World: Impact of Distance to Referral Center on Compliance to Biopsy Recommendations in a Brazilian Prostate Cancer Screening Cohort

Abstract

Given growing specialization in medical care, optimal care may require regionalization, which may create access barriers. We tested this within a large prostate cancer (PC) screening program in Brazil. In 2004–2007, Barretos Cancer Hospital prospectively screened men for PC throughout rural Brazil. Men with abnormal screen were referred for follow-up and possible biopsy. We tested the link between distance from screening site to Barretos Cancer Hospital and risk of noncompliance with showing up for biopsy, PC on biopsy and, among those with PC, PC grade using crude and multivariable logistic regression analysis. Among 10,467 men undergoing initial screen, median distance was 257 km (IQR: 135–718 km). On crude and multivariable analyses, farther distance was significantly linked with biopsy noncompliance (OR/100 km: 0.83, P < 0.001 ). Among men who lived within 150 km of Barretos Cancer Hospital, distance was unrelated to compliance (OR/100 km: 1.09, P = 0.87 ). There was no association between distance and PC risk or PC grade (all P > 0.25 ). In Brazil, where distances to referral centers can be large, greater distance was related to reduced biopsy compliance in a PC screening cohort. Among men who lived within 150 km, distance was unrelated to compliance. Care regionalization may reduce access when distances are large.

Análisis espacial de mortalidad por cáncer de próstata y su relación con el acceso geográfico a los servicios de salud por cantón en Costa Rica, 2010-2016

“…El acceso físico a los servicios de salud ha sido medido como distancia física del paciente con CaP a los servicios (Freedland et al 2021), y como cobertura espacial de los servicios de salud (Rivera et al, 2021). En ambos estudios se comprobó su influencia en la letalidad y mortalidad.…”

“…En el Reino Unido se evidenció que la prolongación de la vida y la calidad con que viven los pacientes de cáncer se asocia con la oferta de servicios de atención primaria (Gao et al, 2020). El acceso a los centros de derivación de pacientes, que es, muchas veces, el primer contacto del paciente con el sistema de salud, resultan decisivos en el éxito del tratamiento a posteriori (Freedland et al, 2021).…”

“…Se ha comprobado en Canadá que las disparidades geográficas en la morbilidad por cáncer de próstata están asociadas al servicio de atención primaria y su cobertura (Andkhoie y Szafron, 2021), mientras que en Japón, a pesar de contar con cobertura universal, se advierte que podrían existir variaciones regionales (Hatakeyama y Ohyama, 2021). Se ha visto que la distancia del paciente al centro de derivación influye en su atención óptima (Freedland et al, 2021), y la cobertura de los servicios de salud es influyente sobre el conocimiento que se tiene del CaP (Rivera et al, 2021). En áreas rurales de los Estados Unidos de América, se encontró que los sobrevivientes a algunos tipos de cáncer, entre ellos el de próstata, cuentan con menor vitalidad, particularmente en su componente mental (Moss et al, 2021).…”

Evaluation of HNF1B, KLK3, ELAC2, TMPRSS2‐ERG, and CTNNB1 polymorphisms associated with prostate cancer in samples of patients from HUPE‐UERJ

“…2 Moreover, studies have shown that mortality rates from Pca have increased over time in all regions of Brazil. 3 A family history of Pca is linked to an increased risk of high-grade disease, particularly in black men, who are more likely to be diagnosed with a more aggressive form of the disease on biopsy than non-Black men. However, most population studies investigating the relationship between family history and Pca have primarily involved men from white populations, and it is uncertain if the results apply to the black population, as highlighted by Jenkins et al in 2021.…”

“…It is also among the top five causes of cancer‐related deaths in men globally in 2021 and remains the leading cause of death among men in 89 countries 2 . Moreover, studies have shown that mortality rates from Pca have increased over time in all regions of Brazil 3 …”