OBJECTIVES:

Non-small cell lung cancer (NSCLC) is still diagnosed at late stages in Brazil, about 87% of lung cancer patients were diagnosed at stages III/IV between 2000-2014. The availability of newer treatment options, such as tyrosine kinase inhibitors and immunotherapy, have changed patient management in Brazil while potentially improving clinical outcomes, however, few real world data has been published since then. This study aims to evaluate NSCLC stage III/IV patients’ journey in the Brazilian supplementary healthcare system.

METHODS:

Population-based, retrospective cohort study using a hospital-based cancer registry database. Patients who attended a private hospital between 2016-2018, under C34 ICD-10 code and diagnosed with stages III/IV NSCLC were included. Patient and clinical characteristics were assessed.

RESULTS:

We analyzed 10,440 patients. Most patients were male (58.5%), stage IV disease (72.2%) and with a median age of 64.0 years. Diagnosis was usually established prior to first medical appointment (53.7%). Patients diagnosed at first medical appointment or after, median time elapsed until diagnosis was 15 days. First treatment was administered after a median of 25 and 57 days for patients without and with established diagnosis at first medical appointment.

Patients were treated with chemotherapy (34.4%), followed by chemotherapy + radiotherapy (22%), and radiotherapy alone (13.4%). Furthermore, <1% of patients were treated with immunotherapy. At the end of first treatment, patients were classified based on their status, as follows: death (14%); disease progression (10%); stable disease (8.9%); partial remission (2.8%); supportive care (2.1%); complete remission (1.3%); and missing data (47%). After 12 months, 57.1% of patients were still alive (median OS: 20.7 months).

CONCLUSIONS:

Despite the availability of immunotherapy the access to this drug is negligible, just 0.7% of the patients have been treated with it. These data highlight the need for strategies to allow access to technologies that improves NSCLC patient’s survival and quality of life in Brazil.