Background: Timely referral and initiation of cancer treatment are essential for improving patient outcomes and lowering mortality. In Brazil, Federal Law No. 12.732/12 requires that patients with a confirmed cancer diagnosis start treatment within 60 days. Studies evaluating treatment delays in adult lymphomas are scarce.
Objectives: To analyse the time interval between diagnosis and initiation of first cancer treatment in patients with lymphomas in Brazil, and to identify factors associated with delays longer than 60 days.
Methods: Cohort study including lymphoma cases in Brazil from 2010 to 2022, using data from Hospital-Based Cancer Registries. Time between diagnosis and treatment was measured in days, depending on prior diagnosis status(with or without). Mean and median values in days were calculated. The cumulative probability of treatment initiation at 60 days was estimated for both groups using Kaplan–Meier analyses and the log-rank test. Poisson regression with robust variance was used to identify factors associated with an interval between diagnosis and treatment longer than 60 days.
Results: A total of 39,604 cases were identified, of which 50.3% had no prior diagnosis and 49.7% had a prior diagnosis. The majority of cases were male(53.4%), aged 20–49 years (40.1%), and diagnosed with non-Hodgkin lymphomas(78.0%). The interval between diagnosis and treatment was longer among those with a prior diagnosis(median: 55 days) compared with those without a prior diagnosis(20 days). The cumulative probability of treatment at 60 days for cases without a prior diagnosis was 54.0%(95% CI: 53.3–54.6) and 76.0%(95% CI: 75.3–76.6) for cases with prior diagnosis (log-rank p<0.001).
Among patients without a prior diagnosis, those treated in the Northeast region(PR=1.88; 95% CI: 1.74–2.03), diagnosed with indolent non-Hodgkin lymphomas(PR=1.50; 95% CI:1.39–1.63), females (PR=1.08; 95% CI: 1.02–1.14), older patients(PR ranging from 1.23 to 1.47 across age groups ≥50 years), and those with lower educational levels(PR up to 1.35) were more likely to start treatment more than 60 days after diagnosis compared with patients treated in the South, with aggressive lymphomas, males, younger patients, and those with higher education. Among patients with a prior diagnosis, females (PR=1.06; 95%CI:1.03–1.09), older patients(PR ranging from 1.16 to 1.17 across age groups ≥50 years), non-white patients(PR=1.11; 95%CI:1.06–1.15), those with lower educational levels (PR up to 1.33), and those diagnosed with indolent non-Hodgkin lymphomas (PR=1.41; 95% CI: 1.35–1.47) were more likely to start treatment more than 60 days after diagnosis compared with males, younger patients, white patients, those with higher education, and those with aggressive lymphomas, whereas receiving treatment in the municipality of residence was associated with a lower risk of delay (PR=0.87; 95% CI: 0.85–0.90) compared with patients treated outside their municipality.
Conclusion:The discrepancy in time intervals between groups suggests significant bottlenecks in the referral and counter-referral pathways within the health system, being longer among patients with a prior diagnosis before the first consultation at the treating hospital. These findings highlight inequalities in timely access to care and identify critical points in the care pathway that are amenable to intervention to reduce therapeutic delays.