Tuesday, July 16, 2024

Challenges and Outcomes in Gastric Cancer Treatment within Brazil’s Unified Health System

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The complexities of treating gastric cancer are compounded by the limitations in healthcare infrastructure, particularly within Brazil’s Unified National Health System (SUS). This study highlights the significant hurdles faced by patients, emphasizing the critical need for accessible, specialized treatment centers to improve overall survival rates and treatment efficacy. The research underscores the importance of multimodal treatment strategies and the adverse effects of delayed or inaccessible chemotherapy.

Study Overview

This retrospective study aimed to evaluate the outcomes of different treatment protocols for gastric cancer within the SUS framework. A total of 81 patients diagnosed with gastric adenocarcinoma were treated according to the INT0116, CLASSIC, and FLOT4-AIO trials, with surgical interventions focused on R0 resection and D2 lymphadenectomy. Patients with other histological types, those with gastric stump or esophageal cancer, and those in stage Ia or IV were excluded from the study.

Key Findings

Among the patients studied, 26 were treated under the FLOT4-AIO protocol, 25 under the CLASSIC protocol, and 30 under the INT0116 protocol. The research revealed that more than 60% of the participants were in pathological stage III, with an overall treatment completion rate of 56%. The CLASSIC group exhibited the highest 3-year overall survival rate at 79.8%, whereas the FLOT4-AIO group had a pathological complete response rate of 7.7%. Prognostic factors such as alcoholism, early postoperative complications, and pathological status pN2 and pN3 significantly influenced overall and disease-free survival.

The difficulty in accessing timely and effective treatment within the SUS was a critical factor impacting survival rates. In particular, the challenges in administering neoadjuvant therapy in the FLOT4-AIO group resulted in poorer outcomes, highlighting the need for improved market access to advanced treatment protocols.

Strategic Inferences

The study provides several strategic insights for enhancing gastric cancer treatment within the SUS:

  • Improving access to specialized cancer treatment centers is essential to increase treatment completion rates.
  • Early intervention and management of prognostic factors such as alcoholism and postoperative complications can significantly enhance survival rates.
  • Adopting multimodal treatment approaches, particularly the CLASSIC regimen, can provide better outcomes in the SUS setting.

The results suggest that while the CLASSIC protocol offers substantial benefits in terms of overall and disease-free survival, the limitations in the SUS regarding timely neoadjuvant treatment present formidable challenges. The INT0116 protocol also showed potential in reducing mortality, though not statistically significant. The study emphasizes the need for systemic improvements to ensure equitable access to effective gastric cancer treatments across Brazil.

Original Article:

Arq Bras Cir Dig. 2024 Jul 1;37:e1810. doi: 10.1590/0102-6720202400017e1810. eCollection 2024.

ABSTRACT

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BACKGROUND: Despite the preference for multimodal treatment for gastric cancer, abandonment of chemotherapy treatment as well as the need for upfront surgery in obstructed patients brings negative impacts on the treatment. The difficulty of accessing treatment in specialized centers in the Brazilian Unified National Health System (SUS) scenario is an aggravating factor.

AIMS: To identify advantages, prognostic factors, complications, and neoadjuvant and adjuvant therapies survival in gastric cancer treatment in SUS setting.

METHODS: The retrospective study included 81 patients with gastric adenocarcinoma who underwent treatment according to INT0116 trial (adjuvant chemoradiotherapy), CLASSIC trial (adjuvant chemotherapy), FLOT4-AIO trial (perioperative chemotherapy), and surgery with curative intention (R0 resection and D2 lymphadenectomy) in a single cancer center between 2015 and 2020. Individuals with other histological types, gastric stump, esophageal cancer, other treatment protocols, and stage Ia or IV were excluded.

RESULTS: Patients were grouped into FLOT4-AIO (26 patients), CLASSIC (25 patients), and INT0116 (30 patients). The average age was 61 years old. More than 60% of patients had pathological stage III. The treatment completion rate was 56%. The pathological complete response rate of the FLOT4-AIO group was 7.7%. Among the prognostic factors that impacted overall survival and disease-free survival were alcoholism, early postoperative complications, and anatomopathological status pN2 and pN3. The 3-year overall survival rate was 64.9%, with the CLASSIC subgroup having the best survival (79.8%).

CONCLUSIONS: The treatment strategy for gastric cancer varies according to the need for initial surgery. The CLASSIC subgroup had better overall survival and disease-free survival. The INT0116 regimen also protected against mortality, but not with statistical significance. Although FLOT4-AIO is the preferred treatment, the difficulty in carrying out neoadjuvant treatment in SUS scenario had a negative impact on the results due to the criticality of food intake and worse treatment tolerance.

PMID:38958346 | DOI:10.1590/0102-6720202400017e1810

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