Tempo entre o diagnóstico e o início do tratamento: uma avaliação da qualidade da assistência ao câncer de pele tipo melanoma no Brasil

Abstract

Melanoma is the most aggressive skin cancer due to its high capacity for metastasis. Several factors make it difficult to start the first treatment of the disease, resulting in a worse prognosis. In Brazil, it has been a law since 2013 that cancer treatment begins within a maximum period of 60 days after the histopathological diagnosis. The aim of this research was to evaluate the socioeconomic and clinical characteristics that influence the time between diagnosis and the start of the first treatment for melanoma. A retrospective study of cutaneous melanoma cases registered in the Hospital Cancer Registry (RHC) database was carried out between 2009 and 2017. Data regarding sociodemographic, clinical and care characteristics have been collected. Socioeconomic and geographic disparities were observed. Performing the first treatment 60 days after diagnosis was associated with female gender, low education and living or receiving treatment in the northern region of the country. Education increased 26% the risk of starting the first treatment within 60 days for those with higher education. Those treated in the northern region of the country had the longest median time to start the first treatment (56 days). Cases treated in the Unified Health System, diagnosed outside the recording hospital and with treatment initiated by radiotherapy or systemic therapy were also associated with a delay in the first treatment of melanoma. Although 65% of the analyzed cases started the first treatment within 60 days, the implementation of the law did not significantly impact the proportion of cases that underwent the first treatment for the disease in that period. Thus, it was concluded that access to the first treatment for melanoma is unequal in Brazil, and that sociodemographic and clinical factors are associated with longer waiting times for it, thus reflecting barriers to access to treatment in the period of time recommended by law.