# Inequalities in time to cancer treatment initiation over a decade in Brazil

## TL;DR

This study shows that cancer treatment delays in Brazil are influenced by cancer type, region, race, and education, with disadvantaged groups facing longer waits.

## Contribution

The study reveals persistent regional and sociodemographic disparities in cancer treatment access across multiple cancer types in Brazil over a decade.

## Key findings

- Patients in the North region had significantly lower odds of receiving treatment within 30 days for all cancers.
- White individuals and those with higher education had higher probabilities of timely treatment initiation.
- Cancers requiring advanced treatments like radiotherapy faced longer delays in treatment initiation.

## Abstract

To evaluate access to treatment for cervical (CVC), colorectal (CRC), thyroid (CT), and central nervous system (CCNS) cancers that differ in incidence, prognosis, early detection program, and in their requirements for high-complexity and technologically advanced treatments

Data from Integrador RHC INCA (2013–2022) were extracted. Sociodemographic and clinic characteristics and time diagnosis-to-treatment were analyzed using multinomial logistic regression and cumulative incidence function

395,225 cases of cancers were identified, CRC = 168,951, CVC = 141,189, CT = 57,755 and CCNS = 27,330. Patients with CCNS and CRC had higher cumulative probability (CPob) of treatment initiation within 60 days compared to CVC/CT. The North region was less likely to receive treatment within 30 days for all cancers (odds ratio — OR: CCNS = 0.34; CVC = 0.30; CT = 0.17; CRC = 0.49). Radiotherapy showed a lower chance of earlier treatment for all cancers (94% lower CCNS; CVC = 48%; CRC = 81%). There was a greater chance of treatment initiation within 30 days for patients with higher education for CVC (OR = 1.42); CT (OR = 2.09). White individuals demonstrated a consistently higher CPob of treatment initiation at 60 days for all cancers compared to Black (CCNS: 60% versus 49%; CVC: 37% versus 29%; CT: 32% versus 21%; CRC: 52% versus 45%). For CT, males had a higher CPob of treatment 37% in males compared to 30% in females at 60 days). For CRC, CPob of treatment initiation at 60 days was higher among individuals at younger (60% compared to 46% for those aged > 69 years) and clinical stage IV (56% compared to stage 1 — 45%).

In Brazil, patients requiring multimodal treatments or therapies demanding technology, such as radiotherapy or chemotherapy, faced longer delays. Regional and sociodemographic disparities persist, with timely access to cancer treatment limited in socioeconomically disadvantaged regions, such as the North and Northeast, among Black patients and individuals with lower education.