CHRONOLOGICAL ANALYSIS OF PATIENTS WITH A DIAGNOSIS OF INVASIVE BLADDER MUSCLE UROTHELIAL CANCER RELATED TO IMPACTS ON CONDUCT AND SURVIVAL

Introduction: Muscle invasive bladder neoplasm is among the leading causes of premature death worldwide. With a high potential for lethality, muscle invasive bladder cancer requires aggressive treatment and multimodal management. In the public health context, there are obstacles that can go against the therapeutic objective. Organizations and programs aiming to optimize public health care are needed for more promising results. For example, the CABEM project, started in 2018, in the ABC region of São Paulo, with the aim of centralizing patients with muscle invasive bladder cancer in an outpatient clinic at the ABC University of Medicine, composed of specialists prepared to define the best therapeutic strategy and offer adequate support. Objective: Define the epidemiological profile of patients with urothelial bladder carcinoma in the ABC region by the Unified Health System. Assess the chronological average from the onset of symptoms to the completion of surgical treatment and make a comparative analysis between the periods before and after the implementation of CABEM. Methods: A retrospective study, with data collection from 58 electronic medical records, of which 38 related to the period 20182020 and 20 records to the 2015-2017. Statistical analysis was performed with exposure of numerical and categorical variables. Boxplot graphs were constructed to visualize the distribution of quantitative variables. The statistical software RStudio, version 1.2.5042, was used. The significance level used was 5%. Results: The median age of patients was 67 years. Most were called male. A total of 70.6% of patients had a history of active smoking. The median time from symptom onset to treatment onset was shorter among patients who underwent surgery as the main treatment (p=0.028) and was also shorter among patients with clinical stage II (p=0.044). An important difference was found in the implementation of standard multimodal therapy, neoadjuvant chemotherapy followed by radical cystectomy, performed in 60.5% of patients treated after CABEM implementation and only 5% in patients treated prior to this period. Conclusion: In this descriptive comparison, there is a significant difference in the rate of completion of the treatment established as the gold standard between the two periods. It is suggested that delays in therapeutic proposals conflict with a worse outcome. The implementation of a project aiming at a central design supports greater optimization and converges to better care and control of the pathology.