Survival of breast cancer women in the state of Rio de Janeiro, Southeastern Brazil.
OBJECTIVE
To assess the association between breast cancer survival and infrastructure and practices of cancer care units.


METHODS
Retrospective longitudinal study based on data from the Brazilian information system of authorizations for highly complex cancer procedures covered by the National Health System and a sample of 310 medical records of prevalent breast cancer cases attended at 15 inpatient and outpatient cancer care units providing chemotherapy between 1999 and 2002 in the state of Rio de Janeiro, Southeastern Brazil. Independent variables were infrastructure of cancer units, interventions, and sociodemographic and clinical characteristics of women. Kaplan-Meier method and Cox proportional hazards model (pseudolikelihood) were used for data analysis.


RESULTS
Kaplan-Meier analyses pointed out significant associations between survival and time between diagnosis and treatment start, surgery, hormone therapy, type of adjuvant hormone therapy, therapy combinations, type of care unit and health insurance, unit size and category. Estimates obtained from the Cox model showed positive associations between hazard of death and time between diagnosis and treatment, unit size and type combined to use of health insurance, and negative associations between survival and surgery and type of hormone therapy.


CONCLUSIONS
The study findings show an association between breast cancer survival and health care provided by affiliated services with practical implications for policy making for cancer control in Brazil.
Brito
Claudia
C
Escola Nacional de Saúde Pública Sergio Arouc, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil. cbrito@ensp.fi ocruz.br
Portela
Margareth Crisóstomo
MC
Vasconcellos
Mauricio Teixeira Leite de
MT
D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality*; D002173:Cancer Care Facilities / Q000145:classification / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D020249:Hormone Replacement Therapy / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008875:Middle Aged; D013997:Time Factors