Radionuclide Therapy for Bone Pain in Cancer Patients in Brazil (2015–2023): A Comparative Analysis of Public and Private Health Systems in the Context of the COVID-19 Pandemic

Abstract Bone metastases are common in advanced cancer and often result in severe pain. Radionuclide therapy with Beta-emitting radiopharmaceuticals, such as samarium-153 and strontium-89, is a recognized option for palliative management. The coronavirus disease 2019 (COVID-19) pandemic disrupted oncology care worldwide, including access to nuclear medicine services in Brazil. The present retrospective observational study analyzed administrative data from the Computer Sciences Department of the Brazilian Unified Health System (Departamento de Informática do Sistema Único de Saúde, DATASUS, in Portuguese) and the Data Pannel of the Information Exchange in Supplementary Health Pattern (Painel de Dados do Padrão de Troca de Informações na Saúde Suplementar, D-TISS, in Portuguese) of the Brazilian National Supplementary Health Agency (Agência Nacional de Saúde Suplementar, ANS, in Portuguese). We included procedures for Beta-emitting radionuclide therapy for bone pain from January 2015 to December 2023, identified using the codes of the Management System of the Table of Procedures, Medications, and Orthoses, Prostheses and Auxiliary Means of Locomotion of the SUS ((Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e OPM do SUS, SIGTAP, in Portuguese) and of the Unified Supplementary Health Terminology (Terminologia Unificada da Saúde Suplementar, TUSS, in Portuguese). Monthly procedure counts were analyzed by health sector across 3 periods: prepandemic (January 2015–February 2020), pandemic (March 2020–December 2022), and postpandemic (2023). Data were expressed as median and interquartile range (IQR) values due to data skewness. The time-series modeling estimated expected trends; observed and expected counts were compared using non-parametric tests. A total of 434 procedures were recorded in the SUS, and 749, in the Supplementary Health system. No significant difference was found between systems prior to the pandemic (median procedures/month: SUS – 7 [IQR: 1–11]; Supplementary Health – 5 [IQR: 0–11]; p = 0.21). During the pandemic, SUS volumes declined sharply, with no recorded procedures in 2023 (median during the pandemic: 0 [IQR: 0–0]). The private sector maintained higher levels (median: 9 [IQR: 7–12]). Compared to projections, the SUS showed a significant shortfall (p = 0.000000000116), while the Supplementary Health remained statistically aligned (p = 0.62). A direct comparison of the magnitude of the decline showed a significantly greater reduction in the public system. The pandemic caused a sharp sustained reduction in the access to radionuclide therapy for bone pain in Brazil's public health system, exposing systemic vulnerabilities that emphasize the need for resilient cancer care policies.