Banca de DEFESA: AMANDA ALMEIDA GOMES DANTAS

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : AMANDA ALMEIDA GOMES DANTAS
DATE: 28/08/2025
TIME: 08:30
LOCAL: REMOTA - https://meet.google.com/phj-ieyn-hwk
TITLE:

INEQUALITIES IN THE DIAGNOSIS, TREATMENT, AND MORTALITY OF COLORECTAL CANCER IN BRAZIL

KEY WORDS:

Colorectal cancer; Diagnosis; Treatment; Mortality; Social determinants of health; Health inequalities; Epidemiology

PAGES: 186
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUMMARY:

Understanding the inequalities in diagnosis, timely access to treatment, and mortality from colorectal cancer (CRC) allows for a deeper comprehension of the dynamics of this disease at both individual and population levels. The aim of this thesis was to analyze the stage at diagnosis, treatment, and mortality due to colorectal cancer, and their association with the socioeconomic context and the availability of health services in Brazil.To achieve this, three observational studies were conducted, using cross-sectional and ecological designs. Individual-level data related to cancer diagnosis were obtained from the Hospital Cancer Registry Integrator (RHC). Mortality data were extracted from the Mortality Information System (SIM). Socioeconomic contextual variables were obtained from the Human Development Atlas of Brazil and the Institute for Applied Economic Research (IPEA). Data regarding the availability of health services were collected from the National Registry of Health Establishments (CNES) and the Ambulatory Health Information System (SIA).For the analysis of advanced stage at diagnosis, a multilevel Poisson regression model with random intercept was used. The prevalence of advanced-stage CRC (stages III and IV) at the time of diagnosis was 65.6%. This outcome was associated with both younger and older age groups, low Human Development Index (HDI), and low density of Family Health Strategy teams.In the evaluation of compliance with the 60-day window for treatment initiation, a multilevel Poisson regression model with random intercept was also applied. A total of 42.1% of patients experienced delays in initiating treatment. Delay was associated with younger age, non-white race, low education level, rectal tumor location, referral through the Brazilian Unified Health System (SUS), and receiving treatment outside the patient’s municipality of residence.Spatial analysis was conducted using the Global Moran’s Index and the Local Indicator of Spatial Association (LISA). In the multivariate analysis, spatial regression with global spatial effects models, specifically the Spatial Error model, was applied. The age-adjusted mortality rate for CRC was 11.25 per 100,000 inhabitants for females and 14.29 per 100,000 for males. Adjusted CRC mortality rates were associated with the Social Vulnerability Index, and the density of general practitioners, colorectal surgeons, and specialized oncology services.The findings from this set of studies highlight the social determinants of advanced-stage diagnosis, treatment delays, and CRC mortality in Brazil. These results underscore the need to assess and reorient public policies, focusing on expanding early detection and ensuring timely access to treatment. Such strategies are essential to promote tangible progress in reducing health inequities and improving CRC-related outcomes in the country.

COMMITTEE MEMBERS:
Externa à Instituição - CRISTIANE MURTA RAMALHO NASCIMENTO - UNESP
Presidente - 3926907 - DYEGO LEANDRO BEZERRA DE SOUZA
Interna - 2495705 - GRASIELA PIUVEZAM
Externa ao Programa - 2305247 - ISABELLE RIBEIRO BARBOSA MIRABAL - nullExterna à Instituição - MARIA TERESA BUSTAMANTE TEIXEIRA - UFJF