Disparities in the Distances Traveled for Gynecological Radiotherapy in Brazil: A Cross-Sectional Study (2019–2022)

Abstract

Purpose/Objective(s) This cross-sectional study investigates disparities in radiotherapy (RT) accessibility for gynecological tumors across Brazil, by examining the distances cancer patients travel for RT. Using official data from 2019 to 2022, the research aims to quantify the geographic obstacles affecting RT access and highlight inequities across Brazil’s diverse regions. Materials/Methods Data were sourced from the Brazilian National Outpatient Procedure Authorization (APAC) system in .dbc format and were processed using Python. The variables included procedure type (external beam radiotherapy or brachytherapy), treatment year, ethnic group, and demographic details such as patient residence and treatment location (state and region). The dataset also tracked whether the treatment required travel to another city. Distances between patients' homes and treatment centers were calculated in kilometers using the Haversine formula and analyzed using Power BI. Statistical significance was evaluated using T-tests and ANOVA, with a significance threshold set at p < 0.05. Results Data from 81,710 radiotherapy (RT) treatment authorizations were analyzed, with 51,341 cases (62.8%) involving intercity travel included in the analysis. The national average travel distance gradually decreased each year, from 152.0 km in 2019 to 133.5 km in 2022 (p < .001). Significant regional disparities were observed in travel distances: the average distance was 397.6 km in the North, 201.9 km in the Midwest, 164.6 km in the Northeast, 80.1 km in the South, and 74.1 km in the Southeast (p < .001). In the analysis per state, the average distance ranged from 1,573.6 km in Amapa to 46.8 km in Rio de Janeiro (p < 0.001). Additionally, ethnic group differences influenced travel distance. White patients averaged 103.2 km, black patients 118.6 km, mixed-race patients 169.4 km, Asian patients 184.8 km, and Native patients 250.6 km (p < .001). Travel distances also varied by procedure type, with external beam radiotherapy (EBRT) averaging 129.8 km and brachytherapy averaging 151.3 km (p < .001). Conclusion This study highlights significant geographic disparities in access to gynecological radiotherapy (RT) in Brazil, with non-white patients and those in less developed regions being disproportionately affected. Although there was a modest reduction in these disparities observed during the study period, the findings underscore the urgent need for improvements in healthcare infrastructure and targeted initiatives aimed at promoting equitable access to treatment for all populations.