Abstract
The hospitalizations are part of cancer care and has been studied by researchers worldwide. A better understanding about their associated factors may help to achieve improvements on this area. The aims of this study were to investigate the association between demographic and clinical characteristics and hospitalizations, as well as between these characteristics and the length of stay (LOS), within the first year of outpatient treatment, for the most incident cancers in the Brazilian population. In this cohort study, we investigated 417,477 patients aged 19 years or more, who started outpatient cancer treatment, from 2010-2014, for breast, prostate, colorectal, cervix, lung and stomach cancers. The outcomes evaluated were: i) Hospitalizations within the first year of outpatient cancer treatment; and ii) LOS of the hospitalized patients. It was performed a binary logistic regression to evaluate the association between the explanatory variables and the hospitalizations and a negative binomial regression to evaluate their influence on the length of hospital stay. The hospitalizations occurred for 34% of patients, with a median of LOS of 6 days (IQR: 2-15). Female patients were 16% less likely to be hospitalized (OR: 0.84; 95% CI: 0.82-0.86), with lower average of LOS (AR: 0.98; 95% CI: 0.97-0.99), each additional year of age reduced in 2% the hospitalization odds (OR: 0.98; 95% CI: 0.98-0.99) and in 1% the average of LOS (AR: 0.99; 95% CI: 0.98-0.99), patients from South region had twice more chances of hospitalization than from North region (OR: 2.01; 95% CI: 1.93-2.10) and patients with colorectal cancer had greater probability of hospitalization (OR: 4.42; 95% CI: 4.27-4.48), with the highest average of LOS (AR: 1.37; 95% CI: 1.35-1.40). In view of our results, we consider that the government must expand the policies with potential to reduce the number of hospitalizations.
Highlights
Cancer is one of the main causes of worldwide morbidity and mortality [1]
Characteristics of hospitalizations of cancer patients treated by the Brazilian Public Health System (SUS), 2010–2014
Throughout this study, we observed several factors associated with the hospitalizations, as well as with the length of stay (LOS), of cancer patients treated by the Brazilian Public Health System (SUS)
Summary
In Brazil, the late diagnosis of this disease emphasizes a major public health problem [1,2,3]. The cancer diagnosis at advanced stages reduces the possibility of cure, increases patient’s vulnerability to clinical complications and raises the need for higher technological support during treatment, which results a greater economic burden [4]. The Brazilian Public Health System (SUS) is configured as a decentralized network of health services that offers primary, secondary, and hospital care for free, across the Brazilian territory and to its entire population [2]. Almost 75% of the population resort only to the SUS when need to health care. The Brazil is affected by severe socioeconomic disparities, and its health system often suffers from chronic underfunding and reduced access in poorer regions [5]. The current healthcare model has been shown to be fragmented, centered on hospital care and mostly focused on the acute demands by the population [2,5]
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