Sociodemographic effect on stage at diagnosis of melanoma patients treated in a public cancer center in Brazil

Abstract

INTRODUCTION: Melanoma is the most aggressive type of skin cancer, with a continuous increase in its incidence worldwide. The prognosis of patients is favorable, and the treatment is relatively simple and inexpensive when diagnosed at an early stage. However, early diagnosis requires easy access to the health system. In a continental and diverse country like Brazil, there is an urgent need to study the access conditions to health services for the development of satisfactory intervention tools. OBJECTIVES: This study aimed to evaluate the access to the health system for diagnosis, as well as the social, economic, and cultural characteristics of patients with melanoma treated at Barretos Cancer Hospital (BCH). METHODS: We performed a prospective study where 101 patients were interviewed. Data were collected regarding the time of symptoms until diagnosis, use of the Brazilian public health system or different forms of private medicine, time from diagnosis to care at the hospital, distance, travel time and transportation used, income, educational level, human development index of the municipality and Gini index. Clinical, pathologic, and treatment data were also evaluated. A multivariate analysis was performed to examine the chance of patients being diagnosed with advanced-stage melanoma. The results were analyzed using REDCap and SPSS software. RESULTS: The gender, human development index, type of transportation used for displacement to the BCH, and the time elapsed between the appointment and first consultation were associated with staging of the tumors. Males had a higher proportion (55.6%) of advanced cases (p=0.002). Those who lived in cities with medium human development index represented 77.8% of advanced tumors (p=0.037). For patients who used public transportation, 77.8% arrived with advanced disease (p=0.025). Finally, 66.7% of the patients consulted after one month of scheduling presented advanced tumors (p=0.017). CONCLUSION: Socioeconomic and demographic factors of patients with melanoma influence the diagnosis and, consequently, treatment conditions.

Keywords

• diagnosis
• melanoma
• health care quality
• access, and evaluation
• demography
• public health