Trends and burden of oncologic emergencies in Brazil: A nationwide time series analysis (2008-2024)

Oncologic emergencies are serious acute complications of cancer or its treatment, but their population-level burden in low- and middle-income countries (LMICs) is poorly characterized. We quantified national trends and inequities in hospitalizations and in-hospital deaths due to oncologic emergencies in Brazil's Unified Health System (SUS).

We conducted an epidemiological, nationwide, time-series analysis of publicly available data extracted from the Hospital Information System of SUS (SIH/SUS), including urgent hospitalizations with a primary diagnosis of malignant neoplasm (ICD-10 C00-C97) in Brazil from 2008 to 2024. We examined trends in hospitalizations, in-hospital deaths, mean length of stay, and in-hospital mortality overall and by sex, age, race/ethnicity, region, and cancer type. Age-standardized rates used the 2024 Brazilian population as reference, and log-linear models estimated average annual percentage change (AAPC) or average annual absolute change (AAAC).

From 2008-2024, 4909,925 oncologic emergency hospitalizations and 783,669 in-hospital deaths were recorded. Hospitalizations increased (AAPC, 3.49%); age-standardized admission rates also rose (AAPC, 1.26%). In-hospital deaths increased (AAPC, 4.15%), while age-standardized death rates showed a smaller rise (AAPC, 1.32%). Mean length of stay declined from 8.1 to 6.5 days (AAPC, -1.49%). The overall in-hospital mortality rate was 15.96% and rose slightly but significantly (AAAC, 0.07 %age points per year). Increases in hospitalizations and deaths were most pronounced among women, non-white groups, adults ≥ 60 years, and states in the North and Northeast regions.

Oncologic emergencies in Brazil increased between 2008 and 2024 beyond what would be expected from population aging alone and showed marked sociodemographic and regional inequities. Strengthening prevention and early diagnosis, expanding timely cancer treatment, and building equity-oriented emergency oncology networks should be priorities for Brazil and other LMICs facing a growing burden of acute cancer complications.