Determinar el tiempo hasta inicio de radioterapia en mujeres con cáncer mamario tratadas en el Hospital de Especialidades Teodoro Maldonado Carbo, año 2019.

Abstract

ackground: In Ecuador, according to Globocan 2020 statistics, in 2020 there were 29273 new cases of cancer, of which breast cancer was the most common among women (3 563 cases, 22.2%), with a mortality of 1056 women per year, a crude rate of 12 x 100000 inhab. and a cumulative risk of 2.49. Breast cancer was declared a public health problem by the Ministry of Public Health of Ecuador (MSP). In 2020, Hanna et al. published in the British Medical Journal a meta-analysis showing the negative effects of delayed radiotherapy in some cancers including breast cancer; and that a four-week delay in surgical treatment, systemic treatment and radiotherapy is associated with increased mortality for seven cancers. The decrease in overall survival in breast cancer caused by treatment delays due to multiple factors has become relevant in the face of the SARS-COV-2 (COVID-19) coronavirus pandemic, which has caused a major health, economic and social crisis worldwide. In Ecuador there is no study that determines the total time to treatment with radiotherapy, and even less the causes of the known delays, which shows the need to conduct a study on treatment delays in our environment, including the duration and causes of these delays. Objectives: The primary objective was to determine the total time elapsed from surgery to the start of radiotherapy treatment in patients with invasive breast cancer treated curatively in the radiotherapy area of the Hospital Teodoro Maldonado Carbo (HETMC), in the period from January 1 to December 31, 2019. As a secondary objective, we sought to establish the percentage of patients with delayed initiation of radiotherapy, defined as >6 weeks since the consultation for radiotherapy was received in the Radiotherapy unit of the HETMC. Hypothesis: More than 50% of radiotherapy treatments are delayed by more than 6 weeks, with most of the delays being associated with factors related to institutional problems (organizational and institutional equipment). Methods: A descriptive analysis of the socio-demographic, histologic and clinical characteristics of the sample was performed. The clinical records of patients whose XVI interconsultations were received between January 1 and December 31, 2019 were reviewed. Time intervals to initiation of radiotherapy were measured from: surgery for their breast cancer, request for consultation, initial evaluation by the radiation oncologist, radiotherapy processes and initiation of radiotherapy treatment. A statistical analysis was made of the different variables correlating with the time between surgery, referral to radiotherapy and the start of radiotherapy; considering the maximum time for the start of radiotherapy to be 6 weeks after receiving the Interconsultation. Analysis of variance (ANOVA) was used. Results: Ninety-eight patients met the inclusion criteria. Seventy-six patients (74.48%) received RT. RT started 39.66 weeks (SD ±17 s; range 6.29 to 93 weeks) after surgery; and 10.86 weeks (range 2 d to 59.86 s, SD± 26.34 s) after initial consultation. Patients treated during pandemic COVID-19 started RT >5.24 weeks above patients treated under normal conditions. Median follow-up was 2.43 years, with at least 73 patients followed for ≥3.51 years. Sixty-nine patients were alive with no evidence of disease at the end of the study. No correlation of time to initiation of radiotherapy with clinical characteristics was found. Applicability of the results: This will allow the development of strategies and/or policies that lead to a decrease in the start of radiotherapy treatment in order to improve the survival of patients. This study will be applicable in IESS or private institutions that have radiotherapy areas.