Cancer epidemiology · 2026
Breast cancer treatment delays in the Brazilian public health system: Evaluation using international and national quality metrics.
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Lima Anne Dominique Nascimento, de Aguiar Suzana Sales, Bergmann Anke, Bines José, Thuler Luiz Claudio Santos
Аннотация
PURPOSE: Despite advances in breast cancer treatment, delays in care delivery remain a major challenge in many health systems, particularly in low- and middle-income countries. Evidence evaluating adherence to oncology quality metrics within public health systems remains limited. This study evaluated adherence to breast cancer treatment timeliness quality metrics in a Brazilian public referral hospital using established benchmarks (ASCO and ESMO) alongside Brazil's national 60-day treatment law and identified factors associated with delayed treatment initiation.
MATERIALS AND METHODS: This retrospective cohort study included women with stage I-III breast cancer treated at the Brazilian National Cancer Institute between 2016 and 2018. Adherence to six treatment timing quality metrics was evaluated, and multivariable logistic regression models were used to identify factors associated with delayed treatment initiation.
RESULTS: A total of 966 patients were included. Only 35% of patients with hormone receptor-positive tumors initiated endocrine therapy within the recommended timeframe, and 23.6% of those undergoing breast-conserving surgery received radiotherapy within 365 days. In the ESMO-Q cohort, only 0.2% initiated chemotherapy within 120 days of diagnosis. Patients with Luminal A-like tumors were more likely to initiate treatment within recommended timeframes, whereas younger age and locally advanced disease were independently associated with treatment delays.
CONCLUSION: Substantial delays in breast cancer treatment initiation were observed across all evaluated quality metrics within the Brazilian public health system, revealing a marked gap between recommended treatment timelines and real-world care delivery. Improving adherence to national and international quality benchmarks will require a better understanding of the patient- and system-level factors associated with treatment delays and the implementation of targeted interventions across the cancer care continuum.
MICRO ABSTRACT: This retrospective cohort study evaluated adherence to international (ASCO, ESMO) and national quality metrics for breast cancer care in Brazil's public health system. Marked delays in treatment initiation were observed across endocrine therapy, radiotherapy, chemotherapy, and surgery, highlighting important gaps in timely cancer care delivery.
MATERIALS AND METHODS: This retrospective cohort study included women with stage I-III breast cancer treated at the Brazilian National Cancer Institute between 2016 and 2018. Adherence to six treatment timing quality metrics was evaluated, and multivariable logistic regression models were used to identify factors associated with delayed treatment initiation.
RESULTS: A total of 966 patients were included. Only 35% of patients with hormone receptor-positive tumors initiated endocrine therapy within the recommended timeframe, and 23.6% of those undergoing breast-conserving surgery received radiotherapy within 365 days. In the ESMO-Q cohort, only 0.2% initiated chemotherapy within 120 days of diagnosis. Patients with Luminal A-like tumors were more likely to initiate treatment within recommended timeframes, whereas younger age and locally advanced disease were independently associated with treatment delays.
CONCLUSION: Substantial delays in breast cancer treatment initiation were observed across all evaluated quality metrics within the Brazilian public health system, revealing a marked gap between recommended treatment timelines and real-world care delivery. Improving adherence to national and international quality benchmarks will require a better understanding of the patient- and system-level factors associated with treatment delays and the implementation of targeted interventions across the cancer care continuum.
MICRO ABSTRACT: This retrospective cohort study evaluated adherence to international (ASCO, ESMO) and national quality metrics for breast cancer care in Brazil's public health system. Marked delays in treatment initiation were observed across endocrine therapy, radiotherapy, chemotherapy, and surgery, highlighting important gaps in timely cancer care delivery.