Fatores associados ao tempo para o início do tratamento do câncer de boca e orofaringe

Abstract

Three studies were carried out in order to understand the factors involved in time to start treatment of oral and oropharyngeal cancer (OOC), especially in Brazil. The first aimed to identify the association between socioeconomic factors and delay in OOC treatment through a systematic review (SR). The second set out to investigate the factors that explained the time to treatment initiation (TTI) for OOC in Brazilian municipalities. The third aimed to analyze the temporal trend of OOC records from 2019 to 2023 and factors that impacted TTI. For SR, observational studies were searched in five databases and gray literature, with no restrictions on language or year of publication. The Joanna Briggs Institute tool assessed the risk of bias. The delay was defined by the cut-off points of the included studies. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach assessed the certainty of the evidence. In the second study, data from municipalities that registered cases of OOC in 2019 were collected from the Panel-Oncology and other public platforms. Classification and Regression Trees (CART) were used to analyze associations between TTI and explanatory variables, grouped into five dimensions: patient characteristics, access to health services, cancer diagnosis support structure, human resources, and municipal characteristics. In the third study, a time series analysis of OOC records was carried out using the Box-Ljung, Sen's Slope and Mann-Kendall tests. Cointegration between TTI<30 days or TTI>30 days and the independent variables was assessed using the Engle-Granger test, and the quality of the models was assessed using the Breusch-Godfrey test. Article I included 10 cohort studies. Type of health insurance, gender, elderly, non-white patients, low schooling, treatment in a public or regional hospital, need for referrals, and residence in regional/remote areas were factors associated with the treatment delay of OOC. However, methodological limitations in terms of adjusting for confounding factors, heterogeneities in the definition of delay and socioeconomic variables, and the lack of studies from different countries resulted in very low certainty of the evidence with serious problems of bias, inconsistency, and indirect evidence. Article II showed that the type of treatment (chemotherapy, radiotherapy or both), tumors in the oral cavity and oropharynx, and the number of computed tomography services per 100,000 inhabitants were predictors of higher TTI in the municipalities. Article III revealed an upward trend in total OOC records from 2019 to 2023, especially in the sex and age group series. The North and Northeast regions showed an upward trend in TTI>30 days. Male, aged over 60 years, advanced stages, radiotherapy, and the Southeast region contributed to TTI>30 days. Records of surgery contributed most strongly to TTI≤30 days. The association between socioeconomic factors and delay in treatment of OOC remains inconclusive from the available data. Further research is recommended in different countries, especially in Brazil. The findings of Articles II and III show that there is a permanent need to expand early diagnosis actions and the availability of oncology services so that OOC treatment can take place promptly.