Fatores associados ao atraso no início do tratamento de crianças e adolescentes com tumores de sistema nervoso central assistidas nos hospitais de referência da Paraíba

Abstract

Central Nervous System (CNS) tumors are one of the most frequent neoplasms in pediatric patients. Thus, in 2012, Law 12,732 was created, and establishes that, in the Unified Health System (SUS), the first treatment of a patient with proven malignant neoplasm must be instituted within 60 days after diagnosis. The present study aims to analyze the factors associated with the delay in starting treatment of children and adolescents with CNS tumors who underwent treatment at reference hospitals in Paraíba, from 2010 to 2019, using data available in the Hospital Records of Cancer (RHC). This is a historical and analytical study with a quantitative approach. The sample consisted of 115 records, available through IntegradorRHC on the website: https://irhc.inca.gov.br/RHCNet/, from the National Cancer Institute (INCA). The selected variables were classified into demographic, clinical and treatment. The outcome of interest corresponded to the time to start treatment, being categorized into intervals ≤ 60 days and > 60 days. Data were analyzed using descriptive and inferential statistics, using the survival analysis technique, the Kaplan-Meier method and Cox regression considering a significance level of 5%. The mean age of the children and adolescents was 9 years (±5.22), the majority being female 53.0% (n=61), with brown skin color 65.4% (n=70), residents in the first of the first health macro-region 46.1% (n=53) and attended at the Hospital Napoleão Laureano 58.3% (n=67). The brain (85.1%; n=98) was most affected, with the brain being the most affected detailed region (33.9%; n=39). Most referrals occurred through SUS (83.2%; n=89), being attended to in pediatric oncology (44.3%; n=51) and the most important basis for diagnosis was tumor histology (86.8 %; n=99). Radiotherapy was the most frequent first hospital treatment (28.7%; n=33) and most patients used only 1 therapeutic modality at the beginning of treatment (60.9%; n=70). The predominant clinical condition at the end of the first hospital treatment was disease stability (56.6%; n=13). The time interval between the diagnosis and the beginning of the treatment occurred according to the law in 59.3% (n=67) of the cases. In the Cox regression, the variables associated with the outcome were the primary location of the tumor being in the cerebellum (HR=3.1462, 95%CI=1.346358 - 7.3521), having histology/tumor markers as the most important basis for diagnosis (HR= 0.0188, 95%CI=0.001138 -0.33105) and imaging studies (HR=0.0221, 95%CI=0.001101 - 0.4434). It is concluded that cases of CNS disorders were more frequent in females, aged 5 to 14 years and who started treatment within 60 days after diagnosis. However, a significant number of them exceeded the time established by law. Cases whose primary tumor location is in the cerebellum are at higher risk of starting treatment after 60 days. On the other hand, those whose most important basis for the diagnosis was histology/tumor markers and imaging tests have a lower risk of treatment being started in a longer period than provided by law.