National Cancer Information System Within the Framework of Health Insurance in Colombia: A Real-World Data Approach to Evaluate Access to Cancer Care.

PURPOSE: The National Cancer Information System (NCIS) has been operating since 2014, including information reported by health care insurers and providers on people with cancer diagnosed and treated within the Colombian health system. Its main purpose is to identify barriers to an effective access to cancer diagnosis and treatment across the country. We aimed to describe the methodology, scope and results in terms of access to health services with real-world data provided by the NCIS. METHODS: Reporting of all cases of cancer by insurers and providers is mandatory by law. Data gathered include demographic and clinical information about new and old cases of cancer who receive health services. Over the years, the reporting process has been automated and it is currently performed in real time. Data quality is ensured through a standardized data-monitoring process. Access to health services is monitored by quality measures defined by consensus. RESULTS: Since 2015, prevalent cases of invasive cancer have increased from 163,776 to 331,021 in 2020 (increment of 102.12%). Regarding quality measures, the proportion of people staged at diagnosis has increased over the years, especially in breast cancer. Meanwhile, early diagnosis is still concerning for breast and prostate cancer. Time to diagnosis and treatment have not consistently reached the expected goals in breast, cervical, and prostate cancer, whereas they have shown a better level of compliance for stomach and colon and rectum tumors, still not reaching the highest performance. CONCLUSION: The real-world information approach provided by the NCIS may be complementary for cancer control planning in Colombia, emphasizing better management processes of health insurers and providers by identifying barriers for timely access to health care.

Factors associated with delays in time to treatment initiation in Colombian women with cervical cancer: A cross-sectional analysis.

Cervical cancer (CC) is one of the leading causes of morbidity in upper-middle income countries such as Colombia. Several studies have reported poor prognosis when treatment is delayed. We aimed to describe the factors associated with delays in time to treatment initiation (TTI) in Colombian women with CC. Cross-sectional analysis including newly diagnosed cases of CC during 2018 and reported to the National Administrative Cancer Registry. TTI was defined as days from diagnosis to the first treatment (chemotherapy, radiation, or surgery). Linear and multinomial logistic regression models were estimated to analyze the association of interest. 1,249 new cases of CC were analyzed (26.98% in-situ and 40.11% locally advanced). The median age was 46 years (IQR: 36-58). Median TTI was 71 days (IQR: 42-105), varying from 70 days (IQR: 43-106) among the surgery group to 76 days (IQR: 41-118) in women under chemotherapy. Only 12.41% were treated within 30 days from diagnosis. TTI was significantly longer in women with state insurance (ß = 18.95 days, 95% CI: 11.77-26.13) compared with those insured by the third payer. Women from the Pacific and Eastern regions also had a significantly longer TTI than those living in the capital of Colombia. Age, health insurance, region of residence, and stage at diagnosis were associated with TTI longer than 45 days in the multinomial model. We concluded that demographic variables (age, region of residence, and health insurance) which are proxies of social disparities and poor access to quality health care services, were associated with delays in TTI.

Patterns of breast, prostate and cervical cancer incidence and mortality in Colombia: an administrative registry data analysis.

BACKGROUND: Cancer is widely recognized as a global public health problem. Breast, prostate, and cervical cancer are among the most frequent types in developing countries. Assessing their incidence and mortality by regions and municipalities is important to guide evidence-based health policy. Our aim was to describe the incidence and mortality trends for breast, cervical, and prostate cancer across regions and municipalities in Colombia during 2018. METHODS: We performed a cross-sectional analysis with data from people with breast, prostate, or cervical cancer, reported to the National Administrative Cancer Registry during 2018. A descriptive analysis was performed. Age-standardized incidence and mortality rates were estimated at national, regional, and municipal levels. Finally, we identify the regions and municipalities with significantly higher or lower incidence and mortality rates compared to national estimations. RESULTS: Breast cancer was the most frequent type among all new cases and deaths in Colombia. Breast, prostate and cervical cancer incidence and mortality rates per 100,000 were: 18.69 (CI 95%: 18.15-19.25) and 10.48 (CI 95%: 10.07-10.91); 11.34 (CI 95%: 10.90-11.78) and 7.58 (CI 95%: 7.22-7.96); 5.93 (CI 95%: 5.62-6.25) and 4.31 (CI 95%: 4.05-4.58), respectively. Eastern region had both, incidence and mortality rates, significantly lower than national for all types of cancer. By municipalities, there was a heterogeneous pattern. Nonetheless, Agua de Dios (Cundinamarca), had one of the highest incidence rates for all types. CONCLUSIONS: We observed clear differences in cancer incidence and mortality across regions and municipalities, depending on each type of cancer. Our findings are important to improve screening coverage, early detection, and treatment in the country.

Space-time clustering of childhood leukemia in Colombia: a nationwide study.

BACKGROUND: Leukemia is the most common cancer in childhood. The estimated incidence rate of childhood leukemia in Colombia is one of the highest in America and little is known about its spatial distribution. PURPOSE: To explore the presence of space-time clustering of childhood leukemia in Colombia. METHODS: We included children less than 15 years of age with confirmed diagnosis of acute leukemia reported to the national surveillance system for cancer between 2009 and 2017. Kulldorff's spatio-temporal scan statistics were used with municipality and year of diagnosis as units for spatial and temporal analysis. RESULTS: There were 3846 cases of childhood leukemia between 2009 and 2017 with a specific mean incidence rate of 33 cases per million person-years in children aged 0-14 years. We identified five spatial clusters of childhood leukemia in different regions of the country and specific time clustering during the study period. CONCLUSION: Childhood leukemia seems to cluster in space and time in some regions of Colombia suggesting a common etiologic factor or conditions to be studied.

Cancer risk management in Colombia, 2016.

OBJECTIVE: To describe the outcomes of risk management indicators for five types of cancer in population that is affiliated to the General System of Social Security in Health, in six cities of Colombia. METHODS: Based on the data from the administrative cancer registry for the period 2016, the High Cost Disease Fund (CAC in Spanish) as a technical organization of the Colombian health system, processed and analyzed the data for the calculation of risk management indicators established in consensus based on the evidence found in six cities. RESULTS: There is a diversity in the indicators results found among the different cities, evidencing strengths and weaknesses in each of them for the different types of cancer. From the set of indicators, those with the best results presented are related to the greater detection of cancer in early stages or in situ, as well as a decrease in mortality, especially in colorectal and in gastric cancer. Most indicators in gastric cancer showed optimal results. Important measurements such as the opportunity for diagnosis and treatment are below the proposed standard for most types in all the six cities. CONCLUSIONS: The descriptive analysis of cancer risk management indicators shows certain weaknesses in the quality and timeliness of the care of cancer patients, the standards agreed upon in the consensus with the different actors of the system are not being reached, situation which may be due to a reality of problems of the Colombian health system, as well as deficiencies in the quality of the report to the CAC.

OBJETIVO: Describir los resultados de los indicadores de gestión del riesgo para cinco cánceres en la población afiliada al Sistema General de Seguridad Social en Salud en Colombia en ciudades que tienen registros de cáncer. METODOS: La Cuenta de Alto Costo (CAC) procesó y analizó la información del registro administrativo nacional de cáncer del periodo 2016 en Cali, Pasto, Bucaramanga, Manizales, Barranquilla y Medellín; para calcular los indicadores de gestión del riesgo establecidos en el consenso basado en la evidencia para la atención en cáncer. RESULTADOS: Existe diversidad en los resultados de los indicadores entre las diferentes ciudades, evidenciando fortalezas y debilidades en cada una de ellas y para los diferentes tipos de cáncer. Los indicadores que mejores resultados presentaron se relacionan con la mayor detección del cáncer en estadios tempranos, así como disminución de la mortalidad, especialmente en cáncer de colorrectal y en cáncer gástrico. El cáncer gástrico fue aquel que mayor cantidad de indicadores obtuvieron resultados óptimos. Mediciones importantes como la oportunidad de diagnóstico y de tratamiento se encuentran por debajo del estándar propuesto para la mayoría de los tipos de cáncer y de las ciudades. CONCLUSIONES: Se evidencia ciertas debilidades en la calidad y la oportunidad de la atención oncológica, no se están cumpliendo los estándares acordados en los consensos con los diferentes actores del sistema: puede deberse a una realidad de problemas del sistema de salud colombiano, así como a la necesidad de fortalecer la calidad del reporte por parte de las entidades a la CAC.

Cancer risk management in Colombia, 2016 / Gestión del riesgo de cáncer en Colombia, 2016

Abstract Objective: To describe the outcomes of risk management indicators for five types of cancer in population that is affiliated to the General System of Social Security in Health, in six cities of Colombia. Methods: Based on the data from the administrative cancer registry for the period 2016, the High Cost Disease Fund (CAC in Spanish) as a technical organization of the Colombian health system, processed and analyzed the data for the calculation of risk management indicators established in consensus based on the evidence found in six cities Results: There is a diversity in the indicators results found among the different cities, evidencing strengths and weaknesses in each of them for the different types of cancer. From the set of indicators, those with the best results presented are related to the greater detection of cancer in early stages or in situ, as well as a decrease in mortality, especially in colorectal and in gastric cancer. Most indicators in gastric cancer showed optimal results. Important measurements such as the opportunity for diagnosis and treatment are below the proposed standard for most types in all the six cities. Conclusions: The descriptive analysis of cancer risk management indicators shows certain weaknesses in the quality and timeliness of the care of cancer patients, the standards agreed upon in the consensus with the different actors of the system are not being reached, situation which may be due to a reality of problems of the Colombian health system, as well as deficiencies in the quality of the report to the CAC.

Resumen Objetivo: Describir los resultados de los indicadores de gestión del riesgo para cinco cánceres en la población afiliada al Sistema General de Seguridad Social en Salud en Colombia en ciudades que tienen registros de cáncer. Metodos: La Cuenta de Alto Costo (CAC) procesó y analizó la información del registro administrativo nacional de cáncer del periodo 2016 en Cali, Pasto, Bucaramanga, Manizales, Barranquilla y Medellín; para calcular los indicadores de gestión del riesgo establecidos en el consenso basado en la evidencia para la atención en cáncer. Resultados: Existe diversidad en los resultados de los indicadores entre las diferentes ciudades, evidenciando fortalezas y debilidades en cada una de ellas y para los diferentes tipos de cáncer. Los indicadores que mejores resultados presentaron se relacionan con la mayor detección del cáncer en estadios tempranos, así como disminución de la mortalidad, especialmente en cáncer de colorrectal y en cáncer gástrico. El cáncer gástrico fue aquel que mayor cantidad de indicadores obtuvieron resultados óptimos. Mediciones importantes como la oportunidad de diagnóstico y de tratamiento se encuentran por debajo del estándar propuesto para la mayoría de los tipos de cáncer y de las ciudades. Conclusiones: Se evidencia ciertas debilidades en la calidad y la oportunidad de la atención oncológica, no se están cumpliendo los estándares acordados en los consensos con los diferentes actores del sistema: puede deberse a una realidad de problemas del sistema de salud colombiano, así como a la necesidad de fortalecer la calidad del reporte por parte de las entidades a la CAC.