# Therapeutic modalities in the first cancer treatment: percentage variation before and during the pandemic, in Ceará, a state in the Northeast region of Brazil

## TL;DR

The pandemic caused a significant drop in new cancer cases and most treatments in Ceará, Brazil, but some therapies like radiotherapy were less affected.

## Contribution

This study quantifies the pandemic's impact on cancer treatment modalities in Ceará, Brazil, using real-world data from hospital and cancer information systems.

## Key findings

- New cancer cases dropped by 30.85% in 2020 and 28.37% in 2021 in Ceará.
- Surgery was most often performed in a timely manner, while chemotherapy was delayed.
- Radiotherapy alone and combined with surgery+iodine therapy were less affected by the pandemic.

## Abstract

To evaluate the percentage variation of the different therapeutic modalities used in new cases of cancer, before and during the pandemic, in Ceará.

Descriptive study with information from records of the Hospital Information System and Authorization of Highly Complex Procedures, and Cancer Information Systems in the state of Ceará, Brazil.

There was a reduction of 2,575 (-30.85%) new cases in 2020 and 2,368 (-28.37%) in 2021. Regarding the therapeutic modalities, it was possible to observe that there were decreases in the numbers of all institutions in the first cancer treatment, except for isolated radiotherapy and for combined surgery+iodine therapy+radiotherapy. Surgery was the modality most often performed in a timely manner (<30 days) and chemotherapy in an untimely manner (>60 days). The impact on the initiation of timely treatment (<30 days after diagnosis) was greater in 2021 than in 2020. In general, late treatments (>60 days) were lower than in 2019. The period of 31-60 days was shown to be above 2019 almost the entire year, in 2020 and 2021.

The number of new cancer cases in Ceará may occur during the pandemic. This situation impacted the reduction of all therapeutic modalities, except for radiotherapy alone and associated with surgery+iodine therapy. However, it did not harm the number of new cases treated in a timely manner.

Avaliar a variação percentual das diferentes modalidades terapêuticas empregadas nos casos novos de câncer, antes e durante a pandemia, no Ceará.

Estudo descritivo com informações de registros do Sistema de Informações Hospitalares, da Autorização de Procedimentos de Alta Complexidade e dos Sistemas de Informação do Câncer no Estado do Ceará, Brasil.

Houve redução de 2.575 (-30,85%) casos novos em 2020 e 2.368 (-28,37%) em 2021. Quanto às modalidades terapêuticas, pôde-se observar que houve quedas nos números de todas instituídas no primeiro tratamento de câncer, exceto para radioterapia isolada e para cirurgia+iodoterapia+radioterapia combinadas. A cirurgia foi a modalidade mais realizada em tempo oportuno (<30 dias) e a quimioterapia em tempo não oportuno (>60 dias). O impacto no início do tratamento oportuno (<30 dias do diagnóstico) foi maior em 2021 que em 2020. Em geral, os tratamentos tardios (>60 dias) foram menores que em 2019. O período de 31–60 dias mostrou-se quase o ano todo acima de 2019, em 2020 e 2021.

O número de casos novos por câncer no Ceará reduziu durante a pandemia. Essa situação impactou na redução de todas as modalidades terapêuticas, exceto radioterapia isolada e associada à cirurgia+iodoterapia. Entretanto, não reduziu o número de casos novos tratados em tempo oportuno.