Geographic disparities and temporal trends regarding access to cancer treatment: a spatial analysis, Brazil, 2015-2022

Disparidades geográficas y tendencia temporal en el flujo de acceso al tratamiento del cáncer: análisis espacial, Brasil, 2015-2022

Abstract

Objective  To analyze spatial clusters and temporal trends regarding patients commuting to access cancer treatment in Brazil between 2015 and 2022.

Methods  This was a spatial analysis using data from hospital and outpatient information systems (2015-2022). Absolute and relative frequencies of treatments (surgery, chemotherapy, and radiotherapy) and commuting patterns were calculated. Cluster analysis (K-means) categorized distances into three intervals: low (2.1-261.4 km), medium (261.6-762.2 km), and high (764.0-3,865.8 km). Temporal trends were assessed by Prais-Winsten regression, estimating annual percentage change (β) and confidence intervals (95%CI) as a measure of dispersion.

Results  Of the 27,204,159 cancer services provided, 55.2% involved displacement to other municipalities. During the period, 3.6% of patients received surgical treatment, 7.1% received radiotherapy, and 89.3% received chemotherapy. There was a reduction in the distances traveled for hospitalization, from 93.0 km in 2015 to 84.2 km in 2022, with an annual decrease of 0.8% (95%CI -0.9; -0.7). For chemotherapy, the reduction was from 87.8 km to 83.5 km, with a variation of -0.4% per year (95%CI -0.4; -0.3). Distances for radiotherapy remained stable, with a slight variation of -0.3% (95%CI -0.9; 0.2).

Conclusion  The reduction in the distance traveled for hospitalization and chemotherapy contrasts with the stability in radiotherapy. The maintenance of long journeys for radiotherapy highlights disparities in the geographical distribution of these services. Thus, the urgency of decentralizing oncology services and investing in regional infrastructure is underscored to ensure access for the population, particularly those residing in rural and remote areas, and to guarantee equitable access to highly complex treatments.

Keywords
Equity in Access to Health Services; Health Information Systems; Unified Health System; Oncology Service, Hospital; Health Inequality Indicators