Geographic Distribution of Childhood Cancer in Brazil and the Time between the Diagnosis and the Start of Treatment: An Analysis of Hospital-Based Cancer Registries, 2010-2016

Moreira, Mayara dos Santos Camêlo; Lucena, Nyellisonn Nando Nóbrega de; Lima Filho, Luiz Medeiros de Araújo; , Ana Maria Gondim Valença

doi:10.1590/pboci.2021.103

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Pesquisa Brasileira em Odontopediatria e Clínica Integrada

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ORIGINAL ARTICLE • Pesqui. Bras. Odontopediatria Clín. Integr. 21 • 2021 • https://doi.org/10.1590/pboci.2021.103 copy

Geographic Distribution of Childhood Cancer in Brazil and the Time between the Diagnosis and the Start of Treatment: An Analysis of Hospital-Based Cancer Registries, 2010-2016

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the distribution of childhood cancer in Brazil and the time between the diagnosis and the start of treatment, according to hospital-based cancer registries (2010-2016).

Material and Methods:

This was an observational descriptive study using secondary data (36,187 records) from hospital databases of the National Cancer Institute (INCA) and the Onco-center Foundation of São Paulo (FOSP). Epidemiological data were obtained, and compliance with Federal Law 12,732/12 was verified, which establishes a maximum period of 60 days to start cancer therapy after the diagnosis. Absolute and percent frequencies, central tendency and dispersion measures, and the coefficient of prevalence of childhood cancer were calculated.

Results:

The mean age of the pediatric patients was 9.3 years (± 6.2); 54.1% (n=19,586) of them were males; 32.0% (n=11,440) were aged 0 to 4 years; and 43.4% (n=11,338) had a self-reported mixed-race skin color. The Southeast region of Brazil accounted for 40.2% (n=14,564) of the cases, of which 63.0% (n=9,178) corresponded to solid neoplasms, as opposed to the North region, where hematological neoplasms prevailed (53.9%, n=1,535). Most registered patients aged 0 to 19 years were treated in 60 days or less (77%, n=27,929). However, for 24.0% (n = 2,207) of adolescents (15 to 19 years) this time was more than 60 days after the diagnosis.

Conclusion:

The characteristics related to childhood cancer varied across the Brazilian geographic regions, and most patients were properly treated within the time enforced by law.

Keywords:
Medical Oncology; Oncology Service, Hospital; Pediatrics; Hospital Information Systems

Variables	Categories	2010		2011		2012		2013		2014		2015		2016		Total
Variables	Categories	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%
Sex	Male	2,732	54.3	2,882	55.3	2,674	52.6	2,822	53.0	2,909	55.1	2,740	53.8	2,827	54.8	19,586	54.1
	Female	2,302	45.7	2,334	44.7	2,413	47.4	2,499	47.0	2,372	44.9	2,351	46.2	2,330	45.2	16,601	45.9
	Total	5,034	100.0	5,216	100.0	5,087	100.0	5,321	100.0	5,281	100.0	5,091	100.0	5,157	100.0	36,187	100.0
Age Group	0 to 4 Years	1,599	31.8	1,569	30.0	1,624	32.0	1,677	32.0	1,661	32.0	1,623	32.0	1,687	33.0	11,440	32.0
	5 to 9 Years	962	19.1	1,033	20.0	939	18.0	975	18.0	1,002	19.0	1,013	20.0	973	19.0	6,897	19.0
	10 to 14 Years	1,158	23.0	1,179	22.5	1,056	21.0	1,134	21.0	1,124	21.0	1,019	20.0	995	19.0	7,665	21.0
	15 to 19 Years	1,315	26.1	1,435	27.5	1,468	29.0	1,535	29.0	1,494	28.0	1,436	28.0	1,502	29.0	10,185	28.0
	Total	5,034	100.0	5,216	100.0	5,087	100.0	5,321	100.0	5,281	100.0	5,091	100.0	5,157	100.0	36,187	100.0
Skin Color^* *Variable not registered in the FOSP-HCR database.	White	1,414	40.0	1,447	39.0	1,389	38.1	1,461	38.0	1,346	34.8	1,277	35.0	1,332	35.2	9,666	37.0
	Black	114	3.1	146	4.0	237	6.5	139	3.7	146	3.5	145	4.0	174	5.0	1,101	4.2
	Yellow	114	3.1	52	1.4	52	1.4	31	0.8	14	0.4	13	0.3	19	0.5	295	1.0
	Mixed-Race	1,532	42.3	1,583	42.6	1,502	41.3	1,691	44.0	1,699	44.0	1,528	41.7	1,803	48.0	11,338	43.4
	Indigenous	19	0.5	14	0.3	17	0.5	19	0.5	13	0.3	18	0.5	10	0.3	110	0.4
	No Information	424	12.0	471	12.7	442	12.2	500	13.0	654	17.0	684	18.5	441	12.0	3,616	14.0
	Total	3,617	100.0	3,713	100.0	3,639	100.0	3,841	100.0	3,872	100.0	3,665	100.0	3,779	100.0	26.126	100.0
Neoplasm	Solid	2,939	58.4	3,088	59.2	2,979	58.6	3,193	60.0	3,177	60.0	3,005	59.0	3,042	59.0	21,423	59.0
	Hematological	2,092	41.6	2,127	40.8	2,108	41.4	2,128	40.0	2,101	40.0	2,086	41.0	13	41.0	14,755	41.0
	No Information	03	0.0	01	0.0	-	-	-	-	03	0.0	-	-	02	0.0	09	0.0
	Total	5,034	100.0	5,216	100.0	5,087	100.0	5,321	100.0	5,281	100.0	5,091	100.0	5,157	100.0	36,187	100.0

Variables		North N (%)	Northeast N (%)	Midwest N (%)	Southeast N (%)	South N (%)	Total N (%)
Total		2,849 (7.9)	10,435 (28.9)	1,998 (5.5)	14,564 (40.2)	6,341 (17.5)	36,187 (100.0)
Sex	Male	1,637 (57.5)	5,571 (53.4)	1,057 (52.9)	7,821 (53.7)	3,500 (55.2)	19,586 (54.1)
	Female	1,212 (42.5)	4,864 (46.6)	941 (47.1)	6,743 (46.3)	2,841 (44.8)	16,601 (45.9)
	Total	2,849 (100.0)	10,435 (100.0)	1,998 (100.0)	14,564 (100.0)	6,341 (100.0)	36,187 (100.0)
Age Group	0 to 4 Years	971 (34.0)	3,238 (31.0)	713 (36.0)	4,463 (30.6)	2,055 (32.0)	11,440 (32.0)
	5 to 9 Years	602 (21.0)	2,127 (20.4)	368 (18.0)	2,637 (18.1)	1,163 (19.0)	6,897 (19.0)
	10 to 14 Years	571 (20.0)	2,222 (21.3)	436 (22.0)	3,142 (21.6)	1,294 (20.0)	7,665 (21.0)
	15 to 19 Years	705 (25.0)	2,848 (27.3)	481 (24.0)	4,322 (29.7)	1,829 (29.0)	10,185 (28.0)
	Total	2,849 (100.0)	10,435 (100.0)	1,998 (100.0)	14,564 (100.0)	6,341 (100.0)	36,187 (100.0)
Skin Color^* *Variable not registered in the FOSP-HCR database.	White	244 (10.2)	1,641 (16.0)	348 (20.5)	2,211 (40.0)	5,222 (83.6)	9,666 (37.0)
	Black	38 (1.6)	470 (4.6)	43 (2.5)	422 (8.0)	128 (2.0)	1,101 (4.2)
	Yellow	09 (0.4)	229 (2.2)	05 (0.3)	30 (0.5)	22 (0.4)	295 (1.0)
	Mixed-race	1,650 (69.0)	5,998 (59.0)	784 (46.1)	2,512 (45.0)	394 (6.3)	11,338 (43.4)
	Indigenous	52 (2.8)	17 (0.2)	10 (0.6)	09 (0.2)	22 (0.3)	110 (0.4)
	No information	400 (17.0)	1,839 (18.0)	510 (30.0)	402 (7.3)	465 (7.4)	3,616 (14.0)
	Total	2,393 (100.0)	10,194 (100.0)	1,700 (100.0)	5,586 (100.0)	6,253 (100.0)	26,126 (100.0)
Neoplasm	Solid	1,314 (46.1)	5,944 (57.0)	1,226 (61.4)	9,178 (63.0)	3,761 (59.4)	21,423 (59.2)
	Hematological	1,535 (53.9)	4,491 (43.0)	772 (38.6)	5,386 (37.0)	2,571 (40.6)	14,755 (40.8)
	No information	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	9 (0.0)	9 (0.0)
	Total	2,849 (100.0)	10,435 (100.0)	1,998 (100.0)	14,564 (100.0)	6,341 (100.0)	36,187 (100.0)
Time to Treatment	≤ 60 Days	2,009 (70.5)	7,561 (72.4)	1,574 (78.7)	11,767 (80.8)	5,018 (79.1)	27,929 (77.0)
	> 60 Days	661 (23.2)	1,737 (16.6)	297 (15.0)	1,988 (13.7)	719 (11.4)	5,402 (15.0)
	No information	179 (6.3)	1,137 (11.0)	127 (6.3)	809 (5.5)	604 (9.5)	2,856 (8.0)
	Total	2,849 (100.0)	10,435 (100.0)	1,998 (100.0)	14,564 (100.0)	6,341 (100.0)	36,187 (100.0)

Variables		Time to Start the Treatment
Variables		≤ 60 Days N (%)	> 60 Days N (%)	Total N (%)
Sex	Male	15,422 (84.9)	2,741 (15.1)	18,163 (100.0)
Sex	Female	12,507 (82.5)	2,661 (17.5)	15,168 (100.0)
Age Group	0 to 4 Years	9,407 (89.0)	1,168 (11,o)	10,575 (100.0)
	5 to 9 Years	5,561 (86.2)	892 (13.8)	6,453 (18.0)
	10 to 14 Years	5,959 (84.0)	1,135 (16.0)	7,094 (100.0)
	15 to 19 Years	7,002 (76.0)	2,207 (24.0)	9,209 (100.0)
Skin Color^* *Variable not registered in the FOSP-HCR database.	White	7,336 (84.3)	1,369 (15.7)	8,705 (100.0)
	Black	824 (82.4)	176 (17.6)	1,000 (100.0)
	Yellow	214 (84.3)	40 (15.7)	254 (100.0)
	Mixed-race	8,411 (81.4)	1,922 (18.6)	10,333 (100.0)
	Indigenous	90 (86.5)	14 (13.5)	104 (100.0)
Type of Neoplasm	Solid	15,462 (80.2)	3,820 (19.8)	19,282 (100.0)
Type of Neoplasm	Hematological	12,467 (88.8)	1,580 (11.2)	14,047 (100.0)

Region	Type of Neoplasm	Time to Start the Treatment
		≤ 60 Days		> 60 Days		Total
		N	%	N	%	N	%
North	Solid	813	68.0	382	32.0	1,195	100.0
North	Hematological	1,196	81.1	279	18.9	1,475	100.0
Northeast	Solid	3,884	75.5	1,230	24.1	5,236	100.0
Northeast	Hematological	3,717	88.0	507	12.0	4,302	100.0
Midwest	Solid	907	80.6	218	19.4	1,125	100.0
Midwest	Hematological	667	89.4	79	10.6	746	100.0
Southeast	Solid	7,090	83.0	1,452	17.0	8,675	100.0
Southeast	Hematological	4,677	89.7	536	10.3	5,280	100.0
South	Solid	2,808	83.9	538	16.1	3,477	100.0
South	Hematological	2,210	92.5	179	7.5	2,458	100.0

Variables		Year of the First Consultation
		Coefficient of Prevalence
		2010	2011	2012	2013	2014	2015	2016
Sex	Male	82.3	87.5	81.8	87.0	90.4	86.0	89.2
	Female	72.0	73.3	76.5	80.0	77.0	76.5	77.0
	Total	77.0	80.5	79.2	84.0	84.0	81.2	83.0
Age Group	0 to 4 Years	108.0	107.0	111.0	115.1	114.0	110.5	115.0
	5 to 9 Years	61.0	66.2	61.0	64.1	67.0	68.3	66.3
	10 to 14 Years	66.5	68.5	62.5	69.0	70.0	64.3	64.0
	15 to 19 Years	76.4	83.2	85.0	88.2	86.0	83.0	87.5
	Total	77.0	80.5	79.2	84.0	84.0	81.2	83.0

Variables		North	Northeast	Midwest	Southeast	South	Brazil
Variables		Coefficient of Prevalence
Sex	Male	474.5	591.7	428.5	639.8	847.3	618.1
	Female	366.0	536.6	397.3	574.9	718.3	545.6
	Total	421.4	564.7	413.2	608.0	784.2	1,105.5
Age Group	0 to 4 Years	600.4	776.8	596.7	772.0	1,051.8	777.4
	5 to 9 Years	362.2	484.1	320.9	470.1	627.7	470.3
	10 to 14 Years	334.0	467.7	361.1	531.0	649.3	492.1
	15 to 19 Years	397.8	551.2	373.9	650.4	800.1	593.7
	Total	421.4	564.7	413.2	608.0	784.2	1,105.5

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[1] Correspondence: Ana Maria Gondim Valença, Rua Miguel Satyro, 350, apt. 2301, Cabo Branco, João Pessoa, PB, Brazil. 58045-110. E-mail: anamvalenca@gmail.com.