Completeness of cervical cancer staging information in Brazil: A national hospital-based study

Abstract

Background: Cancer staging information in Hospital Cancer Registries (HCR) is essential for cancer care quality evaluations. This study aimed to analyze the completeness of cervical cancer staging in Brazilian HCR and identify individual and contextual factors associated with unknown staging.

Methods: The outcome analyzed was missing or unknown staging (Malignant Tumor Classification System and/or International Federation of Gynecology and Obstetrics) in 2006-2015. Individual data on cancer cases were collected from the HCR Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil, the National Registry of Health Facilities, and the Outpatient Information System. The random intercept multilevel Poisson regression model was performed to identify the factors associated with the outcome.

Results: The prevalence of unknown staging data was 32.4% (95% confidence interval [CI], 32.1-32.7). Women aged 18-29 years (prevalence ratio [PR], 1.48; 95% CI, 1.42-1.54), referred by the public health system (PR, 1.16; 95% CI, 1.11-1.21), living in states with a low density of oncologists (PR, 1.70; 95% CI, 1.62-1.79), and with a low cytopathological testing rate (PR, 1.69; 95% CI, 1.57-1.82) showed a higher prevalence of unknown tumor staging data. A lower level of education (PR, 0.91; 95% CI, 0.84-0.98) was associated with complete staging data.

Conclusions: Individual and contextual factors were associated with missing staging data. It is necessary to improve information on cancer in the HCRs by improving the awareness and training of Brazilian cancer care professionals.

Keywords: Cervical cancer; Epidemiology; Hospital records; Neoplasm staging; Oncology.