The COVID-19 pandemic affected health services, resulting in delays in cancer diagnosis and treatment. These impacts were not constant over time and space, varying according to pandemic waves and locations, highlighting regional disparities and differences in health services resilience and cancer care throughout the country.

To describe the impacts of the Covid-19 pandemic on hospital admissions and surgeries related to cancer in Brazil, as well as the recovery in the post-pandemic period.

Hospital admissions in general and surgical procedures related to cancer (ICD-10 C00-C97) were analyzed using data from the Hospital Information System of the Brazilian Unified Health System (SIH/SUS) from 2015 to 2023. Hospitalization and surgical procedure rates per 100,000 inhabitants were calculated monthly for Brazil and its five macro-regions.
Pandemic impacts and services recovery were estimated from the percentage change of monthly rates (2020-2023) compared to the pre-pandemic monthly average (2015-2019). Percentage changes with 95% Confidence Intervals were calculated by pandemic wave. Analyses were performed using R software version 4.5.2.

A total of 5,705,659 cancer-related hospital admissions were analyzed in Brazil from 2015 to 2023. Nationwide, hospitalizations for all cancer types showed a negative variation of -2.41% (95% CI -11.66% to 6.83%; SD = 11.06), while surgical procedures decreased by 6.47% (95% CI -17.57% to 4,63%; SD = 13.28), compared to the pre-pandemic period. Positive variations were observed starting from the second wave of the pandemic, with the highest percentage changes at the end of the pandemic: 11.02% (95% CI 0.10% to 21.93%; SD = 6.86) in admissions and 10.27% (95% CI -3.22% to 23.78%; SD = 8.48) in surgical procedures.
When analyzing the eight most incident cancer types in Brazil, the largest variation was observed for thyroid cancer in the first wave: -28.72% (95% CI -45.22% to -12.23%; SD = 19,73) for surgical procedures. This variation remained negative in all subsequent waves of the pandemic.
The largest monthly reduction in admissions occurred in May 2020 (-15.46%). By Brazilian Region, the largest reduction occurred in the Northeast Region: -33.06% in hospital admissions and -47.28% in surgical procedures, also in May.

These findings highlight the impacts of the pandemic on hospital cancer care at SUS, pointing to different impacts depending on the type of cancer and region. There was a higher impact on surgical procedures, which are critical for cancer treatment, and in regions that are less socioeconomically developed. When analyzing all types of cancer, the greatest impact occurred at the beginning of the pandemic, with services recovering hospitalization rates comparable to the pre-pandemic period only after the third wave. There was also a notable increase in hospitalizations and surgeries in the final months of the public health emergency in Brazil.
The evidence reported here documented disparities in access and resilience of services, reinforcing the importance of attention to cancer care in contexts of public health crises.