Cancer deaths due to lack of universal access to radiotherapy in the Brazilian public health system: Beyond the Abstract

Radiotherapy (RT) plays an integral role in the treatment of oncological diseases. In the curative setting, approximately 53% of all patients with cancer in Brazil will require RT either as a radical modality or as a (neo) adjuvant therapy.

Despite of recent endeavours, the Brazilian public health system still faces a shortage of RT. Approximately 46% of the patients requiring treatment with RT (for non palliative purposes) are not having access to it. Undoubtedly, this shortage of RT has a tremendous negative impact in oncology outcomes, including overall survival. Our recent study quantifies the number of deaths potentially prevented if RT was universal for the most incident cancers in Brazil.

Prostate cancer is the most frequent oncological disease in Brazilian men with an estimated 61,200 new cases per year. Together with RT, radical prostatectomy has a curative role for selected prostate cancer population. Therefore, the impact of RT shortage in this population was calculated after excluding the number of patients treated with prostatectomy or presenting with low-risk disease (not requiring immediate radical therapy). Further adjustments for the rate of “de novo” metastatic disease and number of morbid patients not requiring treatment were also performed.

Approximately 5,040 men with intermediate or high-risk prostate cancers were estimated to not receive radiotherapy in the Brazilian public health system. This lack of radical treatment in 2016 is expected to result in extra 562 deaths in the next 13 years for patients in the intermediate risk and 298 deaths in the next 10 years for patients in the high-risk category. 

Likely, the number of preventable deaths would be even higher if the benefit of RT in the adjuvant/salvage setting and in initial low-risk patients with progressive disease were taken into consideration. 

Written by: Lucas C. Mendez, Fabio Y. Moraes, Gustavo dos S. Fernandes, Eduardo Weltman

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