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Time interval between diagnosis to treatment of breast cancer and the impact of health insurance coverage: a sub analysis of the AMAZONA III Study (GBECAM 0115)

  • Epidemiology
  • Published:
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Abstract

Purpose

Breast cancer (BC) is the most common type of cancer among women in Brazil. Evidence shows that delayed treatment onset is associated with increased mortality. This study aimed to evaluate median days between diagnosis and treatment and factors associated with delayed start of treatment (> 60 days after diagnosis): stage, treatment received, subtype, epidemiological characteristics, and type of healthcare coverage.

Methods

This analysis included 1709 stage I–III BC patients from AMAZONA III, a prospective, observational study, diagnosed from January 2016 to March 2018 in 22 centers in Brazil.

Results

The median number of days from diagnosis to beginning of first oncologic treatment was 46 days (IQR 28–75) overall, 43 days (IQR 25–75) for stage I disease, 49 days (IQR 28–81) for stage II, and 44 days (IQR 30–68) for stage III, (p = 0.1180). According to first treatment received, diagnosis-to-treatment interval was 43 days (IQR 29–65) for neoadjuvant chemotherapy and 48 days (IQR 26–81) for surgery. Diagnosis-to-treatment interval was higher in women treated in the public system versus the private system (56 vs. 34 days, p < 0.0001). Patients in the public system had an increased odds of delayed treatment initiation (OR 4.74 95% CI 3.09–7.26, p < .0001). The longer interval from diagnosis to treatment in the public system was independent of clinical stage, type of treatment (systemic vs surgery first), subtype and region of the country.

Conclusion

By characterizing the delays in care delivery, our study will aid stakeholders to better design interventions and allocate resource to improve timely treatment for breast cancer in Brazil.

ClinicalTrials.gov Identifier: NCT02663973, registered on January, 26th, 2016.

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Data availability

Data can be made available upon request and according to LACOG policies.

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Acknowledgements

We would like to thank the patients, the research teams, and investigators for the dedication to this study. We acknowledge Instituto Avon, Itaú Seguros, and Grupo Bamaq for the financial support under the PRONON (Ministry of Health, Brazil) program and SAS Institute Inc. for providing license-free access to SAS®.

Funding

This study was funded by a Grant from Programa Nacional de Apoio à Atenção Oncológica (PRONON) of the Brazilian Health Ministry (No. 25000.173.901/2013-73).

Author information

Authors and Affiliations

  1. Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre, Brazil

    Raíra Mesquita Maschmann & Daniela Dornelles Rosa

  2. Grupo Brasileiro de Estudos em Câncer de Mama (GBECAM), Porto Alegre, Brazil

    Raíra Mesquita Maschmann, Gustavo Werutsky, Sergio Daniel Simon, José Bines, Carlos Henrique Escosteguy Barrios & Daniela Dornelles Rosa

  3. Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil

    Raíra Mesquita Maschmann, Rafaela Gomes De Jesus, Gustavo Werutsky, Taiane Francieli Rebelatto, Sergio Daniel Simon, José Bines, Carlos Henrique Escosteguy Barrios & Daniela Dornelles Rosa

  4. Hospital Moinhos de Vento, Porto Alegre, Brazil

    Daniela Dornelles Rosa

  5. Instituto Nacional do Câncer, Rio de Janeiro, Brazil

    José Bines

  6. Hospital Araújo Jorge, Goiás, Brazil

    Geraldo Queiroz

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  1. Raíra Mesquita Maschmann
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Corresponding author

Correspondence to Daniela Dornelles Rosa.

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Competing interest

RMM, RGJ, GW, TFR, GQ, SDS, JB, DDR have nothing to disclose. CHB declares no relevant conflicts of interest under consideration for publication. CHB reports grants/research support: (to the institution) Pfizer, Novartis, Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Roche/Genentech, Lilly, Sanofi, Taiho Pharmaceutical, Mylan, Merrimack, Merck, AbbVie, Astellas Pharma, BioMarin, Bristol-Myers Squibb, Daiichi Sankyo, Abraxis Biosciences, AB Science, Asana Biosciences, Medivation, Exelixis, ImClone Systems, LEO Pharma, Millennium, Merck KGaA, Shanghai Henlius Biotech, Polyphor, PharmaMar. Advisory Boards and Consulting: Boehringer-Ingelheim, GSK, Novartis, Pfizer, Roche/Genentech, Eisai, Bayer, MSD, Astra Zeneca, Zodiac, Lilly, Sanofi.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Hospital Moinhos de Vento (Date September, 18th, 2015 /No 1.234.499).”

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Informed consent was obtained from all individual participants included in the study.

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Maschmann, R.M., De Jesus, R.G., Werutsky, G. et al. Time interval between diagnosis to treatment of breast cancer and the impact of health insurance coverage: a sub analysis of the AMAZONA III Study (GBECAM 0115). Breast Cancer Res Treat 198, 123–130 (2023). https://doi.org/10.1007/s10549-022-06809-8

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