Caracterização do atendimento à pessoa com câncer de pele residente na região centro-oeste do Brasil

Abstract

The main types of skin cancer are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. The first two are the most common cancers os skin, but they are less lethal compared to melanoma. The prognosis of cancer depends on the time to initiate treatment, and therefore, it is related to access to healthcare services. Due to the high incidence of non-melanoma skin cancers (NMSC) and the complexity of melanoma treatment, the care for these cancers significantly affects healthcare systems. OBJECTIVE: To characterize the care provided to individuals diagnosed with BCC, SCC and melanoma residing in the midwest region of Brazil, who received their first treatment through the Unified Health System (SUS), including surgery, radiotherapy or systemic therapy. METHODOLOGY: An analytical ecological study with time series analysis was conducted to analyze the characteristics of care for this population from 2008 to 2018. Publicly available databases, including the Hospital Cancer Registry and the Mortality Information System were used for data collection. Measures of association between variables were performed using Fisher's test and Chi-square test. RESULTS: Melanoma affected younger individuals and areas less exposed to sunlight compared to NMSC. Over 3/4 of our cohort initiated the first treatment for skin cancer within 60 days or less. Although surgery was the most frequent initial treatment, starting treatment with radiotherapy was associated with SCC, and starting treatment with systemic therapy was associated with melanoma. Approximately 40% of cases were referred to a different Federative Unit (FU) from their residence to receive the first treatment, and receiving the first treatment in a different FU from the residence was associated with NMSC, starting treatment within 60 days or less, and radiotherapy as the first treatment. Cases of residents in the state of Goiás were the most commonly referred to another FU, with the majority being in the state of São Paulo. The mortality rate for skin cancer in the midwest region increased over the evaluated period, with Goiás and Mato Grosso do Sul showing the highest average increase in mortality rate compared to other FUs. CONCLUSION: Residing in the midwest region of Brazil, being diagnosed with NMSC, and starting treatment with radiotherapy are associated with relocating to another state to undergo the initial treatment for the disease. The state of Goiás stood out for having the lowest proportion of cases that received their first treatment within the state of residence and showed a significant increase in the absolute number of deaths from skin cancer over the evaluated period. Mato Grosso do Sul presented the highest absolute number of registered skin cancer cases during the period. Despite 65.66% of cases having started treatment for the disease within their own state, Mato Grosso do Sul had the highest death rate from skin cancer during the evaluated period. Our findings highlight deficiencies in cancer care in the midwest region of Brazil, especially in Goiás and Mato Grosso do Sul, which contribute to planning assistance actions for individuals affected by the disease residing in this region of the country.