Cancer deaths in the state of Sao Paulo, Brazil: Is there a solution for disparities among private and public services?

Abstract

e18677 Background: There is a notable discrepancy between resources available for the private and public health care services that care for Brazilian people living with cancer. Barretos Cancer Hospital (Barretos) is a Sao Paulo countryside public hospital that stands out in Brazil for its approach of supplementing government receipts with philanthropy and fundraising, allowing it to incorporate state-of-the-art technology in the prevention, screening, and treatment of cancer. However, the availability of systemic therapies in Barretos is still restricted to the list contemplated in the public health system procedures. Lack of access to innovative systemic therapies may hinder survival. As such we aimed to evaluate the outcomes of patients treated in Barretos compared to other public and private institutions in Sao Paulo, Brazil. Methods: We performed a retrospective analysis of the public database of the Fundação Oncocentro de São Paulo, including new patients diagnosed with cancer in the period from 2013 to 2017, assessing tumor type, clinical staging, cancer survival, and treatment site (private/public/Barretos). We used Cox proportional-hazards regression for survival data with R Statistical Software, taking Barretos as reference compared to private and public services (excluding Barretos). Results: We analyzed data from 133,868 patients with the most prevalent cancers in the state: breast (n = 45,402), prostate (n = 36,046), colorectal (n = 23,951), cervical (n = 13,801) and lung (n = 14,668). More than two thirds of patients (69.88%) received treatment in public services, 16.71% in private centers and 13.41% in Barretos. There were no significant differences in OS between private centers and Barretos for patients with cancer stages 0 and I (HR 1.1; p = .48; CI 95%). For patients with stage II breast, cervical and lung cancers, and for patients with stage III cervical and prostate tumors, there were no significant differences in OS between Barretos and private services. For all patients in stages 0-I, II and III, Barretos had better survival than other public centers (HR 2.8; 1.3; 1.3, respectively p < .001; CI 95%). In stage IV cancers, Barretos had worse survival than private institutions (HR 0.6; p < .001; CI 95%) and only patients with stage IV prostate and cervical cancers had better outcomes in Barretos than in other public services. Conclusions: Strategies for earlier incorporation of health technologies have the potential to decrease disparities between public and private services in Brazil. The lack of access to novel systemic therapies likely led to poorer outcomes for patients with metastatic disease in Barretos and other public services. These data indicate that greater government investment in early diagnosis and treatment programs are needed to improve outcomes in resource-limited settings.