Disparities in Access to Radiotherapy for Prostate Cancer across Brazil: A Cross-Sectional Analysis

Abstract

Purpose/Objective(s) In Brazil, prostate cancer (Pca) is the most common malignancy among men. This observational study investigates access to prostate cancer radiotherapy in Brazil, specifically focusing on the distances that patients must travel. By utilizing official data from 2019 to 2022, it quantifies the geographical barriers that patients encounter. Materials/Methods Data from Brazil's national Outpatient Procedure Authorization (APAC) system, covering the period from 2019 to 2022, were gathered in .dbc format and processed using Python. The dataset contained information about the type and year of the medical procedure, patient demographics (including race), city of residence, treatment location (by state and region), and whether the treatment was given in a different city to the patient's residence. The distances to treatment centers were calculated using the Haversine formula and were expressed in kilometers. This dataset was then integrated into a Power BI database for further analysis. The number of radiotherapy procedures performed during the same period was compared to the official annual estimates of prostate cancer cases in the Public System to evaluate the utilization rate of radiotherapy. The statistical analysis used the two-sided Student's t-test and 1-way ANOVA, with significance at p < 0.05. Results Out of the 67,779 prostate radiotherapy procedures examined, 43,510 necessitated travel beyond the patient's hometown, while 24,269 took place within the resident city. On a national scale, the average distance traveled for radiotherapy access was 106,20 kilometers, showing no significant yearly fluctuation (p=0.999). Regional inequalities were striking, with average travel distances being 370.66 kilometers in the North, 247.82 kilometers in the Midwest, 148.09 kilometers in the Northeast, 70.58 kilometers in the Southeast, and 66.41 kilometers in the South (p < 0.001). Disparities at the state level were even more pronounced, ranging from 43.75 kilometers in Rio de Janeiro (Southeast) to 1,222.31 kilometers in Amapa (extreme North) (p < 0.001). Racial disparities were also evident in travel distance; white patients traveled an average of 87.28 kilometers, whereas non-white patients traveled 124.95 kilometers (p < 0.001). The estimated radiotherapy utilization rates for prostate cancer in the public System varied regionally: Midwest (22.30%), Northeast (25.40%), North (31.87%), Southeast (41.40%), and South (44.67%), with p<0.001. A lower average travel distance was significantly associated with a higher radiotherapy utilization rate (p < 0.05). Conclusion This study reveals significant disparities in prostate radiotherapy access across Brazil, particularly among regions and racial groups, with the largest gaps in underdeveloped areas and for non-white patients. The low overall utilization underscores the need for targeted improvements in health care infrastructure.