Socioeconomic status and delays diagnosis and treatment: are there influences on childhood cancer survival in Sao Paulo, Brazil?

Rafaela NAVES, Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Brazil
LUIZAGA C. 2 , LOMBARDO V. 2 , LEITE V. 2 , ELUF-NETO J. 2,3 , RIBEIRO K. 1,2

1 Department of Collective Health, Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Sao Paulo, Brazil
2 Fundacao Oncocentro de Sao Paulo, Sao Paulo, Brazil
3 Department of Preventive Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil

Purpose: This study aimed to evaluate the influence of socioeconomic status (SES) in the intervals first consultation-diagnosis and diagnosis-treatment among children with cancer living in the city of Sao Paulo, Brazil, as well as the impact of delays on 5-year overall survival (5y-OS). Methods: This is a retrospective cohort study including all first primary cancers diagnosed among individuals < 20 years, registered in the Central Hospital-based Cancer Registry of Sao Paulo State in the period 2000-2010. Patients were classified according to the Youth Vulnerability Index (YVI), based on the district of residence at diagnosis. Intervals categories for each tumor were defined based on median or percentile 75. Five-year OS was obtained through Kaplan-Meier method and curves were compared using log-rank test. Results: During the study period, 2,756 cases were registered. No significant differences on intervals first consultation-diagnosis and diagnosis-treatment according to YVI were observed. Children and adolescents from lower YVI strata presented worse outcomes (upper stratum, 5y-OS=69.2%; intermediate stratum, 5y-OS=66.4%; lower stratum, 5y-OS=61.7%, p=0.005). Disparities in survival according to delay in diagnosis (days) were found for patients with CNS tumors (<8: 5y-OS=52.7%, ≥8: 5y-OS=67.2%, p=0.013), neuroblastoma (<7: 5y-OS=35.9%; ≥7: 5y-OS=51.6%, p=0.033), retinoblastoma (<13: 5y-OS=96.8%; ≥13: 5y-OS=66.7%, p=0.016), germ cell tumors (<7: 5y-OS=89.2%; ≥7: 5y-OS=74.1%, p=0.041), and carcinomas (<12: 5y-OS=73.6%; ≥ 12: 5y-OS=84.4%, p=0.043). Disparities in survival according to delay in starting treatment (days) were observed for lymphomas (<18: 5y-OS=74.2%, ≥18: 5y-OS=84.4%, p=0.013), neuroblastoma (<7: 5y-OS=35.9%; ≥7: 5y-OS=51.6%, p=0.011), CNS tumors (<1: 5y-OS=63.9%; ≥1: 5y-OS=48.4%, p=0.022), bone tumors (<13: 5y-OS=40.6%; ≥13: 5y-OS=54.2%, p=0.022), and carcinomas (<13: 5y-OS=85.9%; ≥13: 5y-OS=71.1%, p=0.019). Conclusions: SES did not have influence in access to diagnosis and treatment for children with cancer in Sao Paulo, Brazil. However, survival rates were affected by both SES and delays in diagnosis and treatment. Funding source: FAPESP.