PURPOSE: This cross-sectional study examines disparities in access to radiation therapy (RT) across Brazil, a country with a population exceeding 210 million, focusing on the distances traveled by patients with cancer to receive RT. Using data from 2017 to 2022, the study aimed to assess geographic barriers to RT access and regional inequities.
METHODS AND MATERIALS: Data from the Brazilian National Outpatient Procedure Authorization (Autorização de Procedimento Ambulatorial) system were collected as .dbc files and processed using Python. Variables included procedure type, procedure year, patient demographics (sex and race), patient's city of residence, and treatment location (state and region). Additionally, the data captured whether the treatment necessitated travel to another city. Distances between patients' residences and treatment facilities were calculated using the Haversine formula and analyzed in kilometers (km). This data was incorporated into a Power BI database for analysis. Statistical significance was assessed using ttests analysis of variance, analysis of variance weighted, analysis of covariance, and to account for both location and demographic factors to account for both location and demographic factors, such as race and sex with a threshold of P < .05.
RESULTS: The study analyzed 840,779 RT procedures, of which 514,237 required intercity travel, whereas 326,542 were performed locally. The national average distance to access RT in Brazil was 120.1 km, with significant changes in nationwide distances from 2017 to 2022 (P < .001). Regional disparities were pronounced, with mean distances of 442.2, 238.9, 161.8, 73.8, and 71.3 km in the North, Midwest, Northeast, Southeast, and South regions, respectively (P < .001). The North region demonstrated the most significant improvement in the average distance to radiation from 2017 to 2022, with an 81.8 km reduction in distance (P = .009). The Southeast and South regions also experienced modest but statistically significant changes overtime (P < .05). Sex also influenced travel distances; women traveled an average of 122.3 km and men 117.3 km (P = .041). The distance also varied by procedure type and RT anatomic site indication (P < .001).
CONCLUSIONS: This study reveals considerable geographic disparities in RT access in Brazil, with marked differences observed among residents in less developed regions, and women. These findings point to potential and persistent inequities that may help to guide the strengthening of the health care infrastructure and developing targeted strategies to promote more equitable access to cancer treatment nationwide.
