Effect of municipal and state regulation on access and outcomes for cervical cancer patients in Rio de Janeiro, Brazil: An interrupted time series analysis

Lara Vinhal Faria; Isabel Cristina Martins Emmerick; Mario Jorge Sobreira da Silva

doi:10.1016/j.jcpo.2022.100339

Effect of municipal and state regulation on access and outcomes for cervical cancer patients in Rio de Janeiro, Brazil: An interrupted time series analysis

J Cancer Policy. 2022 Sep:33:100339. doi: 10.1016/j.jcpo.2022.100339. Epub 2022 Jun 6.

Authors

Lara Vinhal Faria¹, Isabel Cristina Martins Emmerick², Mario Jorge Sobreira da Silva³

Affiliations

¹ National Cancer Institute José de Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil.
² Division of Thoracic Surgery, Department of Surgery, UMass Chan Medical School, Worcester, MA, United States.
³ National Cancer Institute José de Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil. Electronic address: mario.silva@inca.gov.br.

PMID: 35671920
DOI: 10.1016/j.jcpo.2022.100339

Abstract

Background: Cervical cancer (CC) is one of Brazil's most prevalent neoplasms, and organizing health care flows that guarantee adequate and timely referral is a challenge. This paper analyzes the effect of municipal and state regulation on access and outcomes for CC patients treated in Rio de Janeiro.

Methods: Retrospective, quasi-experimental study, applying interrupted time series, using data from Cancer Registry from January-2012 to December-2017. We analyzed the implementation of the municipal (August-2013) and state (June-2015) regulation systems for the treatment of CC. The primary outcomes were 1. Time from diagnosis to the first Specialist Visit (TSV); 2. Time from a specialist visit to Treatment Initiation (TSV-TTI); 3. Time from diagnosis to treatment initiation (DTTI); 4. Percentage of patients with adequate Time to Treatment Initiation (PATTI); 5. Percentage of patients with a positive outcome (PPO).

Results: were included 4119 women. 71.04 % were between 30 and 59 years old, 55.57 % were black or brown, and 50.52 % had completed elementary school. The monthly average TSV was 43 days in 2012. After the first intervention, TSV increased by seven days, with a decreasing trend of 1 day per month until December-2017. Similarly, after June-2015, DTTI increased to 63 days, decreasing by one day per month until December-2017. After both interventions, there was an increase of 11.98 % in PATTI, with an increasing monthly trend of 0.18 %. PPO remained stable throughout the analyzed period.

Conclusion: the results suggest that regulation organized access flow for specialized care. However, other relevant issues must be addressed, such as an internal backlog at the institutions, which compromises a timely start of treatment.

Policy summary: To improve access to the diagnosis and treatment of CC in its early stages, it is necessary to invest in health policies to adjust the supply to the required demand and thus reduce mortality from this pathology.

Keywords: Cervical Neoplasms; Health Regulation and Inspection; Time Series Analysis Interrupted.

MeSH terms

Adult
Brazil / epidemiology
Delivery of Health Care
Female
Humans
Interrupted Time Series Analysis
Middle Aged
Retrospective Studies
Uterine Cervical Neoplasms* / diagnosis