Vigilância oncológica e iniquidades no câncer do colo do útero: completude da informação e sobrevida global na rede de atenção à saúde do Espírito Santo
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Data
2025-04-29
Autores
Schuab, Sara Isabel Pimentel de Carvalho
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Universidade Federal do Espírito Santo
Resumo
Introduction: Cervical cancer remains a major public health concern in Brazil, particularly in socially vulnerable contexts and regions marked by health inequities. Strengthening oncological surveillance and care pathways depends on the quality of information recorded in Hospital Cancer Registries (HCRs), as well as an understanding of care patterns and survival determinants. This dissertation, comprising three interconnected studies, analyzed data completeness, clinical-care profiles, and cause-specific survival among women with cervical cancer treated within the Oncology Care Network (RAO) of Espírito Santo (ES). Aim: To comprehensively examine the quality of cancer registry data and cause-specific survival of women diagnosed with cervical cancer in the RAO of Espírito Santo between 2000 and 2020, based on HCR data. Methods: Retrospective observational study, developed from secondary data from the RHC of Espírito Santo. The first study evaluated 10,140 cases (2000–2020), applying the Mann-Kendall test to assess temporal trends in data incompleteness and the Friedman test to evaluate changes in information quality over time. The second study was a retrospective cohort of 7,633 women diagnosed between 2000 and 2016. HCR data were linked deterministically to the Mortality Information System (SIM/ES). Five-year cause-specific survival was estimated using the Kaplan-Meier method, and factors associated with cancer-related mortality were analyzed through Cox proportional hazards regression. Results: In the first study, most variables showed excellent completeness (<5%). However, key clinical variables—such as TNM staging, family history of cancer, and disease status at the end of treatment—had very poor completeness (>50%). A significant worsening in completeness was observed for variables such as history of alcohol consumption(p=0.001), history of tobacco consumption (p=0.007), and disease status at the end of first treatment (p<0.001). Conversely, completeness improved over time for 18 variables, including initial clinical presentation (p<0.001) and screening year (p=0.005). In the second study, the overall five-year cause-specific survival was estimated at 80.3% (95%CI: 79.4%–81.2%). Women aged ≥70 years had a 93.5% higher risk of cervical cancer-related death (HR=1.935; 95%CI: 1.520–2.464; p<0.001). Marital status without a partner was associated with higher mortality: widowed/divorced (HR=1.187; 95%CI: 1.017–1.386; p=0.030) and single women (HR=1.266; 95%CI: 1.092–1.468; p=0.002). The presence of distant metastases increased the risk of death nearly fourfold (HR=3.945; 95%CI: 3.265–4.766; p<0.001). Higher education level was protective (HR=0.621; 95%CI: 0.406–0.951; p=0.028). Regarding first-line treatment, risk of mortality was significantly higher for patients treated with chemotherapy (HR=19.576; 95%CI: 11.819–32.423), radiotherapy (HR=15.072; 95%CI: 11.291–20.121), or combined chemoradiotherapy (HR=17.953; 95%CI: 13.319–24.199), compared to surgery. Conclusion: This dissertation highlights that, although HCR data completeness is generally satisfactory, significant gaps persist in key clinical variables. Inequities in access to care, reflected in referral source and treatment patterns, compromise continuity of care. Cervical cancer survival is strongly influenced by sociodemographic and clinical factors, underscoring the need for more effective screening strategies, standardized data collection, and policies to promote equitable access to diagnosis and treatment. The findings reinforce the strategic role of HCRs in cancer surveillance, health system management, and public policy planning.
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Câncer do colo do útero , Análise de sobrevida , Saúde pública