WCLC 2025 - Posters & ePosters-EP.17.38 Intersecting Determinants of NSCLC Outcomes in Brazil: The Roles of Histology, Socioeconomic Status, and Healthcare Sector Disparities

EP.17.38 Intersecting Determinants of NSCLC Outcomes in Brazil: The Roles of Histology, Socioeconomic Status, and Healthcare Sector Disparities

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This retrospective cohort study analyzed 37,606 Brazilian adults diagnosed with non-small cell lung cancer (NSCLC) from 2000 to 2020 to explore how tumor histology, socioeconomic status (SES), and healthcare sector disparities impact diagnosis stage, treatment access, and survival. The cohort was predominantly male (61%) and treated mainly within the public healthcare system (87%). Most patients presented with advanced-stage disease (82% at stages III/IV). Adenocarcinoma cases (47%) were diagnosed slightly earlier and had longer median overall survival (mOS) than non-adenocarcinoma cases (53%), with adenocarcinoma patients also being younger on average (63 vs. 65 years).<br /><br />Significant disparities emerged between the public and private healthcare sectors: patients accessing private care had markedly better survival outcomes (mOS 2.00 years vs. 0.83 years in public care), a difference consistent across all disease stages. Higher SES, indicated by education level and municipal GDP per capita, was strongly correlated with private healthcare access, earlier diagnosis, and improved survival; university-educated patients had the highest mOS (0.99 years) compared to unschooled patients (0.58 years). Treatment wait times were shorter in the private sector, with fewer patients exceeding the 60-day legal limit to treatment initiation.<br /><br />Access to more costly therapies, such as immunotherapy, was much greater in the private sector and among those with higher education—private patients were eight times more likely to receive immunotherapy, and university-educated patients received it seven times more often. This suggests substantial SES-based inequities in access to advanced cancer treatments. The study concludes that NSCLC outcomes in Brazil are shaped by the intersection of tumor biology, healthcare infrastructure, and socioeconomic factors, with lower SES and public healthcare patients facing delayed diagnosis, limited treatment options, and poorer survival even in early-stage disease. The findings highlight the critical need for policy reforms to reduce systemic inequities and improve resource allocation within Brazil’s public cancer care system.

Asset Subtitle

Fabio Moraes

Meta Tag

Speaker Fabio Moraes

Topic Global Health, Health Services, and Health Economics

Keywords

non-small cell lung cancer

NSCLC

Brazil

retrospective cohort study

tumor histology

socioeconomic status

healthcare disparities

public vs private healthcare

treatment access

survival outcomes