Background: Lung cancer (LC) is the second most common cancer and the leading cause of cancer mortality worldwide. In Brazil, it was the fourth most common malignant neoplasm and the most lethal in 2023. More than 80% of the cases are diagnosed in advanced stages, and consequently, there are low survival rates. Understanding health care utilization and patient navigation through the health care system can enable the organization of health services to better support patients in receiving the care they need.
Objectives: Analyze the utilization patterns of individuals with Lung Cancer in the Outpatient Information System in the Rio de Janeiro Municipality (RJM) for the years 2023 and 2024.
Methods: Data were accessed from the Mortality Information System (SIM) and the Outpatient Information System (SIA-APAC). As the LC symptoms are non-specific and in Brazil there is no LC screening as a public policy, the cohort was created based on the individuals who had an ICD-10 C34 death as the main or secondary cause of death. Step 1) All individuals who met the inclusion criteria in the year 2024 in RJM in SIM were identified. Step 2) The CPF, Brazilian tax ID, an unique identifier (UID), were recovered based on the full name, date of birth, and the mother's name. Step 3) Using the UID, the individual was linked to (SIA-APAC), and procedures and outpatient visits that occurred from October 2022 to November 2024 were included. The linkage was developed and conducted by RJM managers. The project was approved by the ethics committee. The researchers had access only to anonymized data.
Results: A total of 1,561 LC mortalities were registered in SIM for the year 2024 in the Rio de Janeiro Municipality. A total of 1,200 individuals (76.9%) had their UID obtained. A total of 832 (69.5%) individuals were identified in SIA-APAC, being 55.8% female, 53.5% non-white, 11.56% with more than 12 years of education, and 56% aged 61 to 75 years. A total of 64,508 procedures were performed on 832 individuals, averaging 77 per person. Over 70% of individuals had a CT scan, and 73% had a visit with a specialist; however, only 7% received radiotherapy services, and 13% received chemotherapy at health care facilities managed by the Rio de Janeiro municipality. Individuals who underwent chemotherapy had 15.8 months between their first entry in SIA-APAC and the time of death. While individuals who did not have chemotherapy this time was of 10.8 months (p-value 0.001).
Conclusion/Implications: The pattern of SIA-APAC utilization showed that individuals accessed urgent care and specialist services; however, only a small percentage had access to radiotherapy or chemotherapy in municipal facilities in the two years prior to death. Future analysis will explore the timeline, waiting times for procedures, and consider other information systems to better understand the challenges patients face on their journey.

Description of outpatient utilization patterns in SIA-APAC for the study cohort. Brazil, 2023 and 2024.