Impact of COVID-19 pandemic on the treatment of prostate cancer in the Brazilian public health system.

Abstract

e17106 Background: COVID-19 pandemic reached Brazil in the beginning of 2020 causing a profound impact in economic and social activities, up to the end of 2021. In Brazil, there is universal access to the public health system (BPHS-SUS); however, during the pandemic public resources were directed mainly to the management of COVID-19 infected patients. We evaluated the impact of the 2020/2021 pandemic on the treatment of prostate cancer in the BPHS-SUS. Methods: we compared data regarding the number of radical prostatectomies, radiotherapy treatments, and hormonal and chemotherapy treatments administered in the time frame from March 1st, 2020 (when lockdown measures were initially adopted in Brazil) to February 29th, 2022, with that of the two most recent pre-pandemic years (March 1st, 2018, to February 28th, 2020). A large proprietary healthcare data science platform offered by TECHTRIALSÒ was surveyed. Results: in the two pandemic years, 15,196 radical prostatectomies were performed in the BPHS, with a cost of U$ 14,271,297; there was a 23.3% reduction in the number of surgeries compared with the two pre-pandemic years (19,818 radical prostatectomies, with a cost of U$ 18,056,470). In the pandemic, 34,982 men were treated with radiation therapy, with a cost of U$ 39,616,736; this meant a 18.7% reduction in the number of patients treated with radiation therapy as compared with the two pre-pandemic years (43,013 men, with a cost of U$ 44,148,190). Regarding hormonal treatments, numbers were similar: 116,490 men were treated during the pandemic (cost of U$ 74,834,615); in the pre-pandemic timeframe, 115,949 patients received hormonal therapy (cost of U$ 75,179,674). As to chemotherapy for hormone-resistant disease, in the pandemic 14,946 men were treated (cost of U$ 23,402,947) compared with 12,695 men treated in the two pre-pandemic years (cost of U$ 19,239,099). Conclusions: there was a significant reduction in the number of radical prostatectomies and of radiation therapy treatments during the pandemic years in the BPHS-SUS. Abrupt reductions of potentially curative therapies will probably affect stage migration, costs to the public system and patients’ survival in the ensuing years. The number of systemic therapies (first- and second-line hormonal therapies, and chemotherapies) were slightly increased, probably reflecting the BPHS-SUS policy of maintaining systemic treatments active during the pandemic.