Análise do tempo para início de tratamento oncológico de neoplasia maligna do encéfalo no Brasil entre 2015 e 2024

Abstract

Malignant neoplasms of the brain constitute a major public health problem due to high morbidity and mortality, rapid clinical progression, and significant functional impact. Timely initiation of treatment is crucial to reducing tumor progression and expanding therapeutic options, and is also an indicator of the quality of cancer care. In Brazil, regional inequalities and structural limitations can affect access to treatment within the 60-day timeframe established by Law No. 12.732/2012. In this context, this study sought to answer the following research question: Are there sociodemographic, regional, and therapeutic factors associated with the timely initiation of cancer treatment in adult patients with brain cancer in Brazil? In this context, the present study aimed to evaluate the time to initiation of cancer treatment in adult patients with malignant brain neoplasms in Brazil, considering epidemiological, regional, and therapeutic characteristics. This is an observational, retrospective, cross-sectional study with a mixed-methods approach (qualitative and quantitative), conducted using secondary data from the Oncology Panel/DATASUS. Records of adult patients diagnosed with malignant neoplasm of the brain (ICD-10 C71) between January 2015 and December 2024 were analyzed. The outcome was the time from diagnosis to the start of treatment, categorized as ≤60 days or>60 days. Associations between variables were assessed using Pearson's chi-square test and Cox proportional hazards models (p-value < 0.05). 26,380 cases of malignant brain neoplasia were analyzed, of which 58.2% started treatment within 60 days after diagnosis. There was a significant association between the timely start of treatment and the variables age group, geographic region, and therapeutic modality (p<0.001), while gender showed no association in the general analysis. Surgical treatment had the highest proportion of timely initiation (96.7%), followed by the combination of chemotherapy and radiotherapy (47.1%), chemotherapy alone (44.8%), and radiotherapy alone (39.4%). In the multivariate analysis, an association was observed between regional factors and the timely initiation of surgical, chemotherapeutic, and radiotherapeutic treatments, whereas age and sex showed variable influence by therapeutic modality. No factors associated with the timing of treatment initiation were identified for the combination of chemotherapy and radiotherapy. The results show that, even more than a decade after the implementation of the 60-day law, a significant portion of patients still face delays in starting cancer treatment. The differences observed between regions suggest the influence of inequalities in the distribution of specialized services and healthcare infrastructure in the country. Furthermore, the association among age, therapeutic modality, and timing of treatment initiation underscores the need for targeted strategies to improve equity and efficiency in neuro-oncology care. The timely initiation of cancer treatment in patients with malignant brain neoplasms in Brazil was associated with regional, age, and therapeutic factors, highlighting the persistence of inequalities in care and the need to strengthen public policies aimed at ensuring access to treatment within the legal timeframe.