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David S. Ettinger, MD, FACP, FCCP


CNS Metastasis From NSCLC: Discrepancies Between Public and Private Care in Brazil

By: Joshua Swore
Posted: Monday, August 22, 2022

A study published in JCO Global Oncology highlights the disparity between the public and private sectors of health care in Brazil among patients with central nervous system (CNS) metastasis from non–small cell lung cancer (NSCLC). “In Brazil, the majority of the population (around 75%) relies on the public health-care system, where limited resources are allocated to provide the best care possible,” said study author Luiz H. Araujo, MD, PhD, of Instituto Nacional de Câncer, Rio de Janeiro. “The social and economic disparities between public and private health-care systems are crucial to cause a late diagnosis and therefore [they] are [a] determinant of poor survival rates.”

The retrospective study looked at data associated with 273 patients diagnosed with NSCLC and CNS metastases. Patients were treated at a variety of institutions in both public and private sectors of Brazil. 

The authors found that Black or Brown patients were treated in a public setting more often than in a private one (38.8% vs. 15.4%). Patients in the public sector had a history of smoking (88.6% vs. 60.0%), and many had EGFR-negative and ALK-negative disease (95.9% vs. 74.9%). Assessment within the public setting was less frequently conducted with MRI (38.8% vs. 83.6%) than with CT imaging (59.6% vs. 19.2%).

Within public institutions, patients were more often symptomatic (78.1% vs. 44.6%) and had larger metastases (median size = 25 vs. 15 mm). This population was more often treated with whole-brain irradiation (72.9% vs. 45.4%) and less likely to undergo radiosurgery (6.3% vs. 24.1%). In addition, patients treated in the private sector had significantly longer rates of overall median survival than those treated in the public sector (24.2 months vs. 12.1 months).

“As novel and costly approaches are incorporated, continuous effort should be exercised to guarantee value in patient care, especially in settings marked by limited resources,” the investigators concluded.

Disclosure: For full disclosures of the study authors, visit

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