# Discrepancies at clinical presentation of patients with soft tissue sarcoma according to the type of health insurance in a Brazilian population

## TL;DR

Patients with soft tissue sarcoma in Brazil covered by public health insurance are diagnosed with larger tumors and more advanced disease compared to those with private insurance.

## Contribution

This study is the first to investigate how health insurance type affects clinical presentation in Brazilian soft tissue sarcoma patients.

## Key findings

- Patients with public health insurance had larger tumors (median 10.3 cm) compared to those with private insurance (median 7 cm).
- Public insurance patients had a higher rate of metastases at diagnosis (26.3%) compared to private insurance patients (8.9%).

## Abstract

In Brazil, 75% of the population is covered by public health insurance (PubHIn), and the rest pay for private insurance (PrivHIn). The impact of the type of health insurance on clinical presentation of Brazilian patients diagnosed with soft tissue sarcoma (STS) is unknown. We aim to describe the clinical characteristics at diagnosis of patients with STS, stratifying them by type of health insurance, and to evaluate the symptom-diagnosis and -treatment intervals.

Observational, retrospective cohort, single-center study conducted in a Brazilian cancer center that admits both private and public patients. Medical records of individuals with 18 years old or more diagnosed with selected types of STS who started treatment in our center between January 2011 and December 2019 were reviewed. Kaplan–Meier method and log-rank test were used for survival analyses. Chi-square and Mann Whitney test were used for univariate analysis. Significance was defined as a p-value <0.05.

225 patients were included: 25.3% (n=57) with PubHIn and 74.7% (n=168) with PrivHIn. Median tumor size in PrivHIn was 7 cm (0.9–45 cm) versus 10.3 cm (0.8–30.5 cm) in PubHIn (p=0.0001). Metastases were present in 8.9% of patients with PrivHIn (n=15) and in 26.3% (n=15) of those with PubHIn (p=0.002). Median symptom-diagnosis interval was 195 days in the PubHIn group and 163 days in the PrivHIn group (p=0.74). For the whole series, median age at diagnosis was 51 years (18–85 yo). Lower limbs were the most frequent location of tumors (53.8%), and 86% had histological grade 2/3.

Patients with STS covered by PubHIn presented larger tumors and more metastatic disease at diagnosis, suggesting that there may be disparities in health care delivery and limited access to health resources. A better understanding of the barriers in the journey of patients with STS could improve outcomes.