# Incidence of palliative treatment among breast cancer patients undergoing neoadjuvant therapy: an analysis of the Brazilian public health system

## TL;DR

This study examines how often breast cancer patients in Brazil need palliative care after initial treatment, finding that newer therapies and early diagnosis help reduce the need.

## Contribution

The study provides insights into palliative care incidence and factors influencing it in Brazil's public health system using a large national dataset.

## Key findings

- The 5-year Palliative Treatment Rate decreased from 44% to 36% after the introduction of anti-HER2 therapy in 2013.
- Younger age and Stage III disease increased the likelihood of needing palliative care, while HER2 positivity reduced it.
- Regional disparities were observed, with Southeast patients more likely to receive palliative care.

## Abstract

Breast cancer is the leading cause of cancer-related deaths among women globally, including Brazil. This study assesses neoadjuvant treatment patterns, the impact of new therapies, and factors determining palliative care for patients who failed initial treatments. A historical cohort study using secondary data from DATASUS (2008–2017) focused on women aged 18–90 with stages II and III breast cancer who received neoadjuvant treatment. Data on chemotherapy, hormonal therapy, and anti-HER2 treatment were analyzed. The Palliative Treatment Rate (PTR) was calculated by cross-referencing neoadjuvant treatment records with subsequent palliative care records, indicating cases where the initial curative intent was not achieved. The study included 71,181 patients, with a mean age of 51.5 years. Most were diagnosed at Stage III (85%). Anti-HER2 therapy was introduced in 2013, with 10.5% receiving it. The 5-year PTR decreased from 44% (2008–2012) to 36% (2013–2017). The combination of chemotherapy, endocrine therapy, and anti-HER2 therapy had the lowest PTR. Logistic regression identified younger age, higher histological grade, Stage III disease, and compromised lymph nodes as factors increasing the likelihood of needing palliative care, while HER2 positivity and hormonal therapy reduced it. Regional disparities were observed, with patients from the Southeast more likely to receive palliative care. Early diagnosis and access to anti-HER2 therapy significantly reduce palliative care needs. Socio-economic and regional disparities in treatment highlight the need for equitable access to diagnostic tools and therapies to improve survival outcomes in Brazil’s public healthcare system.