IMPACT OF THE COVID-19 PANDEMIC ON CHEMOTHERAPY/RADIOTHERAPY BURDEN FOR PATIENTS WITH ACUTE MYELOID LEUKEMIA IN BRAZIL, 2017-2023

Abstract

Objectives: To assess the chemotherapy (CT) and radiotherapy (RT) burden among Brazilian patients with Acute Myeloid Leukemia (AML) from 2017 to 2023. Materials and methods: This retrospective evaluation utilized data from the High Complexity Procedures Authorization (APAC) in Brazil, covering the period from January 2017 to the end of September 2023. Included patients were 18 years or older, with AML diagnosed according to the Therapeutic Diagnostic Guidelines of the Ministry of Health. Statistical analysis included descriptive indicators evaluated per patient per year (PPPY), along with corresponding 95% confidence intervals (CI). The comparison of PPPY before and after the pandemic was conducted using the z-test. All analyses were performed using Python 3.6.9. Results: A total of 12,466 patients were included in the study. PPPY rates were significantly higher in the post-pandemic period (14.77 [95% CI 14.76; 14.78] pre-pandemic vs. 16.26 [95% CI 16.24; 16.28] post-pandemic, p < 0.001). When comparing pre- and post-pandemic periods within Brazilian regions, no significant change in PPPY was observed for the Southeast, Midwest, and North. However, both the Northeast and South regions showed an increase in PPPY (Northeast: 14.41 [95% CI 14.38; 14.43] pre-pandemic vs. 17.01 [95% CI 15.00; 19.00] post-pandemic, p < 0.001; South: 15.10 [95% CI 14.77; 15.43] pre-pandemic vs. 16.89 [95% CI 16.49; 17.29], p < 0.001). Discussion: The post-pandemic increase in PPPY for RT/CT in AML patients can be attributed to several factors. Firstly, the pandemic led to a higher overall demand for healthcare, potentially resulting in increased RT/CT sessions. Additionally, oncology patients were considered a high-risk group during the pandemic, and treatment plans may have been adjusted due to changes in healthcare demands and quarantine guidelines, leading to increased treatment frequency after the pandemic. Notably, while the Southeast region of Brazil showed no significant changes, the Northeast and South regions experienced a general increase. One hypothesis is that the more robust healthcare infrastructure in the Southeast allowed for alternative solutions to prevent interruptions or excessive spacing between planned RT/CT sessions. Conclusion: Restricted access to healthcare systems during the pandemic and potential disease progression in AML patients inadequately monitored during the COVID-19 period are hypotheses explaining the increased post-pandemic demand for CT/RT. The Southeast region appears less affected by this phenomenon, while the impact is pronounced in the Northeast and South. Further studies are needed to better understand the pandemic's effect on healthcare resource utilization among AML patients.