S1416
Interdisciplinary - Health economics & health services research
ESTRO 2026
13 Surgery, The University of British Columbia, Vancouver, Canada
Purpose/Objective: Access to radiotherapy for breast cancer in Brazil is uneven. Here we aimed quantify temporal and regional inequities in travel distance for breast radiotherapy in Brazil, stratified by race, from 2019– 2022. Material/Methods: We conducted a retrospective national analysis of breast radiotherapy procedures captured in the Brazilian Outpatient Procedure Authorization (APAC) database (2019–2022). Variables included procedure type, year, race, residence municipality, treatment location (state and macro-region), and whether care occurred outside the home municipality. Straight-line distance between residence and treating city was calculated via the Haversine formula. Factorial ANOVA and ANCOVA evaluated main and interaction effects of year, region, state, and race on travel distance; models adjusted for region area to probe geographic-scale confounding. Analyses used SPSS 29.0 with two-sided α =0.05. Results: Among 106,419 procedures, 61,703 (58.0%) required travel outside the home municipality. The national mean travel distance was 107.11 km and did not change significantly over time (p=0.15). Regional differences were pronounced (p<0.001): patients in the North traveled the farthest (mean 403.93 km), followed by the Midwest (218.01 km) and Northeast (156.97 km), whereas the South (64.77 km) and Southeast (62.53 km) had the shortest journeys. From 2019 to 2022, mean distance declined in the North ( − 34.64%; p<0.001), Northeast ( − 9.43%; p<0.001), Southeast ( − 7.36%; p<0.001), and Midwest ( − 5.01%; p<0.001), but remained stable in the South ( − 1.04%; p=0.42). State-level disparities were marked (p<0.001), ranging from 40.21 km in Rio de Janeiro to 1,392.23 km in Amapá. Racial inequities were evident: non- White patients traveled farther on average than White patients (130.98 vs 84.76 km; p<0.001). A significant year x race x region interaction (p<0.001) indicated persistent racial gaps within remote regions over time. Adjustment for region area did not attenuate these effects.
Conclusion: Substantial geographic and racial inequities in access to breast radiotherapy persist in Brazil despite modest regional improvements. Non-White patients and those in the North, Midwest, and Northeast bear the greatest travel burden. Equity-oriented expansion of radiotherapy capacity—paired with travel/lodging support and patient navigation—should prioritize underserved states to reduce avoidable travel and promote timely treatment. References: 1. Silverwood S, et al. Int J Radiat Oncol Biol Phys. 2024;118(4):891-899. doi: 10.1016/j.ijrobp.2023.10.030.2. Mendez LC, et al. Clin Oncol (R Coll Radiol) 2018; 30: e29–36.3. Moraes FY, Marta GN, Hanna SA, et al. Int J Radiat Oncol Biol Phys. 2015;92(4):707-12. doi: 10.1016/j.ijrobp.2014.12.063.4. Gouveia AG, et al. J Cancer Policy. 2024;39:100459. doi: 10.1016/j.jcpo.2023.100459.5. Viani GA, et al. Lancet Oncol. 2022;23(4):531-539. doi: 10.1016/S1470- 2045(22)00123-1.6. Hanna SA, et al. Lancet Reg Health Am. 2022;14:100333. doi: 10.1016/j.lana.2022.100333.7. Viani GA, et al. Int J Radiat Oncol Biol Phys. 2023;116(2):413-420. doi: 10.1016/j.ijrobp.2023.02.029. Keywords: Breast Cancer, Radiotherapy, Access
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Predicting Risk of Late Cancellations Including No- Show at Radiotherapy Series Start Using Machine Learning Kerstin Johnsson 1 , Tatiana Orlova 1 , Anna-Maria Lind 2 , Jorge Lazo 3,4 , Anders Stenberg 1 , Jonas Nilsson 2 , Martin Södergren 2 , Mårten Dalaryd 2 , Jakob Rutberg 1 , Monika
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