TIME TO ACCESS CARE: INEQUITIES IN THE NON-HODGKIN LYMPHOMA PATIENT JOURNEY ACROSS BRAZILIAN PUBLIC AND PRIVATE HEALTHCARE SYSTEMS

Lymphomas comprise a heterogeneous group of diseases, with more than 30 types, each possessing distinct clinical presentations, epidemiology, and pathological features. Early detection and diagnosis can be challenging, and delay in initiating therapy can adversely affect clinical outcomes in some types of lymphomas. In Brazil, a federal law known as the "30-day law" requires that patients with suspected cancer undergo diagnostic tests within 30 days. However, the Brazilian healthcare system is divided into public and private sectors, where access disparities are prevalent but not extensively documented in the literature. This study aims to elucidate the key barriers and differences faced in diagnosing and staging non-Hodgkin lymphoma (NHL) across these sectors in Brazil. To this end, an online survey was conducted targeting hematologists treating adults with NHL nationwide. This is a cross-sectional study utilizing an online form with 49 objective questions, divided into three sections: respondent demographics, public sector experiences, and private sector experiences. The survey was completed by 153 hematologists: 56% work in both sectors, 31% in private only, and 13% in public only. The majority of respondents practice in the Southeast region (54%), followed by the Northeast (23%), South (14%), and both the North and Center-West regions (4.5% each).The primary referring physicians in both settings are general practitioners, general surgeons, and head and neck surgeons. Over 50% of respondents indicated that the median time from suspicion of lymphoma to consultation with a hematologist exceeds four months in the public sector but is less than one month in the private sector. Additionally, 67% reported that it takes at least two months to perform a lymph node biopsy in the public sector, whereas 55% stated it takes between one and two weeks in the private sector. Regarding biopsy results, 46% in the public sector reported an average time of 15 to 30 days, while 58% in the private sector reported seven to 15 days. In both scenarios, 50% sometimes request a review of the anatomopathological diagnosis, considering the initial report inadequate. For the median time to perform a PET/CT scan, 28% in the public sector reported it takes more than one month, while 59% in the private sector estimated it takes seven to 15 days. Regarding the "30-day law," almost 40% in the public sector said it is rarely respected, with 34% indicating it is never respected, whereas, in the private sector, 51% said it is almost always respected, and 20% said it is always respected. No respondents in the public sector indicated it is always respected. This study highlights the significant differences in the patient journey for diagnosing and staging NHL in Brazil, emphasizing that the time to access care is a major discrepancy between the public and private sectors.