e13513 Background: Delays in cancer treatment initiation are associated with increased morbidity and mortality. In Brazil, federal policy mandates treatment initiation within 60 days after diagnosis; however, many patients experience delays, particularly those with clinical or social barriers. Care coordination and navigation strategies may improve timely access to treatment in complex public health systems. Methods: Retrospective cohort study including all consecutive patients undergoing first oncologic evaluation at a public cancer center in São Paulo (2022–2025). Patients with clinical and/or social barriers to treatment initiation were identified through institutional dashboards. Interventions included multidisciplinary case management, structured assessment, therapeutic optimization, active monitoring, patient education, and psychosocial support. In 2023, institutional care pathways and communication flows were standardized. Descriptive and comparative analyses were performed to evaluate changes in time to treatment initiation (TTI). Results: A total of 9,455 patients were analyzed. In 2022, 2,956 patients were included, of whom 439 had relevant comorbidities and 180 had low adherence. In 2023, 2,325 patients were included (315 with comorbidities; 135 with low adherence); in 2024, 2,165 (188; 80); and in 2025, 2,029 (203; 87). The proportion of patients with significant clinical or social barriers decreased from 20.9% in 2022 to 14.3% in 2025. Major clinical barriers included decompensated heart failure, advanced chronic kidney disease, severe infections, malnutrition, severe anemia, and the need for cardiology interventions. Social barriers involved low adherence, socioeconomic vulnerability, and limited access to care. Following the implementation of standardized care pathways in 2023, median TTI decreased from 72 to 44 days, representing a 38.9% reduction. Improvements were consistent across both clinical and social risk subgroups. Conclusions: Coordinated care and navigation-based interventions were associated with substantial reductions in treatment delays and improved care delivery for oncology patients facing complex barriers. Findings support the adoption of integrated care models to optimize treatment initiation in resource-constrained public health systems.
Tanoue et al. (Thu,) studied this question.