Impact of COVID-19 pandemic on the treatment of prostate cancer in Brazilian public health system, comparing pre and post pandemic data.

Abstract

373 Background: During the COVID-19 pandemic resources from the Brazilian Public Health System (BPHS) were directed to the treatment of COVID-19. The impact of the pandemic on the treatment of prostate cancer in Brazil has not yet been rigorously evaluated. Methods: We compared the number of radical prostatectomies (RP), radiotherapy (RT), and hormonal (HT) and chemotherapy (CT) treatments from March 1st, 2020 to February 29th, 2022, with that of the two pre-pandemic years (March 1st, 2018, to February 28th, 2020). Additionally, we evaluated the post-pandemic period from March 1st, 2022 to February 28th, 2024. A large proprietary healthcare data science platform offered by TECHTRIALS was surveyed. Results: In the pandemic, 15,364RPs were performed in the BPHS, (U$14,271,297); there was a 23.3% reduction in the number of surgeries compared with the pre-pandemic years: 19,778RPs, (U$18,056,470). In the post-pandemic years 18,716 RPs were performed (U$ 18,373,781.92), an increase of 21.8% in those treated by surgery. In the pandemic, 34,922 men received RT (U$39,616,736), a 18.7% reduction in the number of patients as compared with the two pre-pandemic years, when 42,614 men were treated (U$44,148,190). In the post-pandemic years, 43,142 men received RT, an increase of 19% compared to the pandemic years (U$48,870,739.03). Regarding HT, 116,490 men were treated during the pandemic (U$74,834,615); in the pre-pandemic, 115,949 patients received HT (U$75,179,674). In the post-pandemic years, 127,602 men were treated with HT (U$80,078,824), an increment of 6.5% in cost and 10% in the number of patients treated compared to the pandemic years. As to CT for hormone-resistant disease, in the pandemic period 14,946 men were treated (U$23,402,947) compared with 12,695 men treated in the two pre-pandemic years (U$19,239,099). In the post-pandemic years 18,850 men were treated (U$33.571.073,40) an increment of 48.4% in number of patients treated and with an increase of 74% in costs compared to the pandemic period. Conclusions: During the pandemic years, there was a significant reduction of potentially curative treatments for prostate cancer in the BPHS. The number of systemic therapies increased, probably reflecting the policy of maintaining systemic therapies active during the pandemic. In the post-pandemic years, there was an increase in the number of systemic treatments, while RT and RP returned to a state very close to their pre-pandemic numbers. The impact of the COVID-19 pandemic on prostate cancer mortality in Brazil remains speculative.