Delays in the health care system for children, adolescents, and young adults with bone tumors in Brazil

• Published in: Jornal de pediatria 2019-11, Vol.95 (6), p.744-751
• Main Authors: Balmant, Nathalie V., de Paula Silva, Neimar, de O. Santos, Marceli, de S. Reis, Rejane, de Camargo, Beatriz
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Atraso no diagnóstico; Atraso no tratamento; Bone Neoplasms - diagnosis; Bone Neoplasms - therapy; Bone tumors; Brasil; Brazil; Child; Child, Preschool; Delayed Diagnosis; Delivery of Health Care; Diagnosis delay; Female; Health care system; Humans; Infant; Infant, Newborn; Male; Osteosarcoma - diagnosis; Osteosarcoma - therapy; PEDIATRICS; Sarcoma, Ewing - diagnosis; Sarcoma, Ewing - therapy; Sistema de saúde; Time Factors; Time-to-Treatment; Treatment delay; Tumores ósseos; Young Adult
• ISSN: 0021-7557; 1678-4782; 1678-4782
• DOI: 10.1016/j.jped.2018.07.003

To identify delays in the health care system experienced by children and adolescents and young adults (AYA; aged 0–29 years) with osteosarcoma and Ewing sarcoma using information from the Brazilian hospital-based cancer registries. Patient data were extracted from 161 Brazilian hospital-based cancer registries between 2007 and 2011. Hospital, diagnosis, and treatment delays were analyzed in patients without a previous histopathological diagnosis. Referral, hospital, and health care delays were calculated for patients with a previous histopathological diagnosis. The time interval was measured in days. There was no difference between genders in overall delays. All delays increased at older ages. Patients without a previous histopathological diagnosis had the longest hospital delay when compared to patients with a previous histopathological diagnosis before first contact with the cancer center. Patients with Ewing sarcoma had longer referral and health care delays than those with osteosarcoma who had a previous histopathological diagnosis before first contact with the cancer center. The North and Northeast regions had the longest diagnosis delay, while the Northeast and Southeast regions had the longest treatment delay. Health care delay among patients with a previous diagnosis was longer, and was probably associated with the time taken for to referral to cancer centers. Patients without a previous histopathological diagnosis had longer hospital delays, which could be associated with possible difficulties regarding demand and high-cost procedures. Despite limitations, this study helps provide initial knowledge about the healthcare pathway delays for patients with bone cancer inside several Brazilian hospitals. Identificar atrasos no sistema de saúde em crianças e adolescentes e adultos jovens (AAJ; até 29 anos) com osteossarcoma e sarcoma de Ewing com informações dos registros de câncer de base hospitalar do Brasil. Os dados dos pacientes foram extraídos de 161 registros de câncer de base hospitalar brasileiros entre 2007 e 2011. Os atrasos no hospital, no diagnóstico e no tratamento foram analisados em pacientes sem um diagnóstico histopatológico anterior. Os atrasos no encaminhamento, no hospital e no sistema de saúde foram calculados para pacientes com diagnóstico histopatológico anterior. O intervalo de tempo foi medido em dias. Não houve diferença entre os sexos nos atrasos em geral. Todos os atrasos aumentaram na faixa etária mais velha. Os pacientes se