Sociodemographic effect on stage at diagnosis of melanoma patients treated in a public cancer center in Brazil

ABSTRACT

Introduction: Melanoma is the most aggressive type of skin cancer, with a continuous increase in its incidence worldwide. The prognosis of patients is favorable, and the treatment is relatively simple and inexpensive when diagnosed at an early stage. However, early diagnosis requires easy access to the health system. In a continental and diverse country like Brazil, there is an urgent need to study the access conditions to health services for the development of satisfactory intervention tools.

Objectives: This study aimed to evaluate the access to the health system for diagnosis, as well as the social, economic, and cultural characteristics of patients with melanoma treated at Barretos Cancer Hospital (BCH).

Methods: We performed a prospective study where 101 patients were interviewed. Data were collected regarding the time of symptoms until diagnosis, use of the Brazilian public health system or different forms of private medicine, time from diagnosis to care at the hospital, distance, travel time and transportation used, income, educational level, human development index of the municipality and Gini index. Clinical, pathologic, and treatment data were also evaluated. A multivariate analysis was performed to examine the chance of patients being diagnosed with advanced-stage melanoma. The results were analyzed using REDCap and SPSS software.

Results: The gender, human development index, type of transportation used for displacement to the BCH, and the time elapsed between the appointment and first consultation were associated with staging of the tumors. Males had a higher proportion (55.6%) of advanced cases (p=0.002). Those who lived in cities with medium human development index represented 77.8% of advanced tumors (p=0.037). For patients who used public transportation, 77.8% arrived with advanced disease (p=0.025). Finally, 66.7% of the patients consulted after one month of scheduling presented advanced tumors (p=0.017).

Conclusion: Socioeconomic and demographic factors of patients with melanoma influence the diagnosis and, consequently, treatment conditions.

RESUMO

Introdução: O melanoma é o tipo de câncer de pele mais agressivo, com aumento continuo de sua incidência em todo o mundo. O prognóstico dos pacientes é favorável e o tratamento é relativamente simples e barato quando diagnosticado precocemente. Contudo, o diagnóstico precoce requer fácil acesso ao sistema de saúde. Em um pais continental e diversificado como o Brasil, há necessidade urgente de estudar as condições de acesso aos serviços de saúde para o desenvolvimento de ferramentas de intervenção satisfatórias.

Objetivos: Este estudo teve como objetivo avaliar o acesso ao sistema de saúde para diagnóstico, bem como as caracteristicas sociais, econômicas e culturais de pacientes com melanoma atendidos no Hospital do Câncer de Barretos (HCB).

Métodos: Foi realizado um estudo prospectivo onde foram entrevistados 101 pacientes. Foram coletados dados referentes ao tempo dos sintomas até o diagnóstico, uso do sistema público de saúde brasileiro ou diferentes formas de medicina privada, tempo desde o diagnóstico até o atendimento no hospital, distância, tempo de viagem e transporte utilizado, renda, escolaridade, indice de desenvolvimento humano do município e índice de Gini. Dados clínicos, patológicos e de tratamento também foram avaliados. Uma análise multivariada foi realizada para examinar a chance de pacientes serem diagnosticados com melanoma em estágio avançado. Os resultados foram analisados utilizando os softwares REDCap e SPSS.

Resultados: O sexo, o índice de desenvolvimento humano, o tipo de transporte utilizado para deslocamento até o HCB e o tempo decorrido entre o agendamento e a primeira consulta estiveram associados ao estadiamento dos tumores. O sexo masculino apresentou maior proporção (55,6%) de casos avançados (p=0,002). Aqueles que residiam em cidades com índice de desenvolvimento humano médio representaram 77,8% dos tumores avançados (p=0,037). Dos pacientes que utilizavam transporte público, 77,8% chegaram com doença avançada (p=0,025). Por fim, 66,7% dos pacientes consultados após um mês de agendamento apresentavam tumores avançados (p=0,017).

Conclusão: Fatores socioeconômicos e demográficos dos pacientes com melanoma influenciam no diagnóstico e, consequentemente, nas condições de tratamento.

Keywords:

Diagnosis - Melanoma - Health care quality - Access, and evaluation - Demography - Public health

Descritores:

Diagnóstico;Melanoma - Qualidade dos cuidados de saúde - Acesso e avaliação - Demografia - Saúde pública

Publikationsverlauf

Eingereicht: 03. Mai 2023

Angenommen: 12. September 2023

Artikel online veröffentlicht:
31. Oktober 2023

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