Geographic Disparities in Specialized Palliative Care Availability Within Brazil’s Public Health System: Structural Inequities in Comprehensive Cancer Care Delivery
Fernando Augusto Siuta dos Santos, Pedro Dytz Marin, Giulia Scain, Isabela Alicia Fink, Isadora Cristyne Parise, Julia Loureiro Chaves Cé, Stéphanie Klein Brum, Mariana Weremeier Weber, Martina de Sá, Rafaela Sumienski Girardi, Solana de MeloPURPOSE
Equitable access to specialized palliative care is a critical component of comprehensive oncology care, yet significant disparities remain in low- and middle-income countries. This study aimed to evaluate geographic inequalities in specialized palliative care infrastructure within Brazil’s Unified Health System (SUS) and assess regional disparities relevant to cancer care delivery.
METHODS
An ecological and descriptive analysis was conducted using data from the 2024 Atlas of Palliative Care in Brazil published by the National Academy of Palliative Care, the Brazilian National Registry of Health Establishments, and Ministry of Health demographic data. The regional distribution of specialized palliative care services integrated into SUS was evaluated across Brazil’s five macro-regions and compared with population distribution and healthcare access indicators.
RESULTS
Brazil currently has 234 specialized palliative care services nationwide, with 123 (52.5%) integrated into SUS. Marked geographic disparities were identified: the Southeast region accounts for 98 services (41.8%), followed by the Northeast with 60 (25.7%), South with 40 (17.1%), Center-West with 28 (12.0%), and North with only eight services (3.4%). Nationally, SUS provides approximately one specialized palliative care service per 1.6 million inhabitants, substantially below the European Association for Palliative Care recommendation of two services per 100,000 inhabitants. More than 80% of services are concentrated in state capitals or metropolitan centers, limiting access for rural, remote, and socioeconomically vulnerable populations. This maldistribution creates major regional care deficits, particularly in Northern and interior regions, where access to multidisciplinary symptom management and end-of-life support remains severely restricted.
CONCLUSION
Brazil’s specialized palliative care infrastructure demonstrates profound structural inequities that undermine equitable cancer care delivery within SUS. Strategic decentralization, targeted regional investment, and broader integration of palliative care into oncology and primary care systems are urgently needed to reduce disparities and strengthen comprehensive cancer care access for underserved populations.