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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2020.tde-27092021-141226
Document
Author
Full name
Priscila Berenice da Costa
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Terra, Ricardo Mingarini (President)
Araujo, Pedro Henrique Xavier Nabuco de
Gróss, Jefferson Luiz
Mejia, Omar Asdrubal Vilca
Title in Portuguese
Papel do nível socioeconômico na sobrevida de pacientes com câncer de pulmão no município de São Paulo
Keywords in Portuguese
Análise de Sobrevida
Classe Social
Mapeamento Geográfico
Neoplasias Pulmonares
Vulnerabilidade Social
Abstract in Portuguese
INTRODUÇÃO: Mesmo com avanços no diagnóstico e métodos de tratamento, o câncer de pulmão ainda está entre os mais prevalentes e mortais. Em São Paulo a distribuição de renda e acesso aos serviços de saúde constituem alguns dos obstáculos para aqueles que residem em áreas de vulnerabilidade social. OBJETIVOS: Analisar o papel do nível socioeconômico na sobrevida global em pacientes com câncer de pulmão no município de São Paulo. Analisar a relação entre nível socioeconômico e estadio da doença no momento do diagnóstico; tipo de tratamento recebido e sexo. MÉTODOS: Estudo de coorte retrospectivo com pacientes do Registro Hospitalar de Câncer (RHC) com 8.627 pacientes diagnosticados com câncer de pulmão entre 2000 e 2013. Foram excluídos registros com ausência de endereço completo. As variáveis analisadas foram demográficas, socioeconômicas (Índice Paulista de Vulnerabilidade Social-IPVS) e clínicas. Realizou-se análise de qualidade do banco de dados, estatística descritiva, inferencial e de sobrevida. Consideramos p < 0,05 estatisticamente significativos. Utilizamos software Stata 13 e o QGIS, para realizar o georreferenciamento. RESULTADOS: A maioria dos pacientes era do sexo masculino (61%) e média de idade 64 anos. 36% possuíam ensino fundamental completo e 52% residiam em áreas de IPVS 2. A sobrevida global foi de 10 meses (4-22), sendo maior em mulheres, pacientes com estadios clínicos iniciais, nível superior e residentes em áreas com baixíssima vulnerabilidade social. Quanto mais avançada a doença, menor a proporção de pacientes que receberam apenas cirurgia e maior a proporção daqueles que não receberam tratamento. Pacientes residentes em áreas com IPVS 4 tiveram maior média de tempo entre diagnóstico e tratamento (48 ± 57). Mulheres possuem menor risco de óbito que homens e aqueles com ensino fundamental completo, tinham 1,4 vezes mais chance de morrer que àqueles com ensino superior (HR=1,4 e p<0,000). CONCLUSÃO: Os fatores socioeconômicos (IPVS e escolaridade) são preditores independentes para sobrevida global em câncer de pulmão, assim como estão diretamente associados ao Estadio Clínico. A adequação de tratamento foi coerente com a literatura e a prática clínica. Moradores de áreas com IPVS 4, tiveram maior média de tempo entre diagnóstico e início do tratamento.
Title in English
Role of socioeconomic status in lung cancer patient survival in the city of São Paulo
Keywords in English
Geographic mapping
Lung Neoplasms
Social Class
Social vulnerability
Survival Analysis
Abstract in English
INTRODUCTION: Even with advances in diagnosis and treatment methods, lung cancer is still among the most prevalent and deadly. In São Paulo, income distribution and access to health services are some of the obstacles for those living in socially vulnerable areas. OBJECTIVES: To analyze the role of socioeconomic status in overall survival in lung cancer patients in the city of São Paulo. Analyze the relationship between socioeconomic status and disease stage at diagnosis; type of treatment received and gender. METHODS: Retrospective cohort study with patients from the Hospital Cancer Registry (RHC) with 8,627 patients diagnosed with lung cancer between 2000 and 2013. Records with no complete address were excluded. The analyzed variables were demographic, socioeconomic (Paulista Index of Social Vulnerability-IPVS) and clinics. Database quality analysis, descriptive, inferential and survival statistics were performed. We considered p < 0.05 statistically significant and used Stata software 13. QGIS software was used to perform georeferencing. RESULTS: Most patients were male (61%) and the average age of 64 years. 36% had completed elementary school and 52% lived in IPVS 2 areas. The overall survival was 10 months (4-22), being higher in women, patients with clinical clinical level, higher education and residents in areas with low social vulnerability. The more advanced the disease, the lower the proportion of patients receiving surgery alone and the greater the proportion of patients receiving no treatment. Patients living in IPVS 4 areas had a longer average time between diagnosis and treatment (48±57). Women have a lower risk of death than men with complete primary education, 1.4 times more likely to die with those with higher education (HR = 1.4 and p <0.000). CONCLUSION: Socioeconomic factors (IPVS and education) are independent predictors of overall survival, as well as directly associated with clinical stage. Adequacy of treatment was consistent with the literature and clinical practice. Residents of areas with IPVS 4 had a higher average time between diagnosis and intention to treat.
 
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Publishing Date
2021-09-27
 
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