Attention Deficiencies Facing Colombians With Cancer

It should not be an international day, like the one that took place this Monday, to talk about cancer and its disastrous power to change the lives of millions of families around the world.

To measure its impact, it is necessary to say that in Colombia, At least 229,374 people suffer, according to the High Cost Account (CAC), who manages the most optimistic figures. And that in 2017 alone, 32,818 new diagnoses and 18,071 deaths were diagnosed, particularly because of bad and prostate cancer. Of course, these numbers could be larger because of underreporting.

But this report does not seek to quantify, as it usually does. On the contrary, he intends to explain why, despite advances in diagnosis and coverage, Because everything is covered on paper, the Colombian health system does not always help cancer patients. And if you want to clarify, in the fight against cancer, all is not rosy, many lives are lost amid the gaps.

But before, advances.

Better detection

The CCC's annual report on cancer in the country, which this journal has had access to, provides a better understanding of how cancer patients are treated. The increase in prevalence, incidence and mortality is appreciated, but it is also emphasized that early detection, Key indicator in the treatment, improves.

More specifically, 44% have been reduced since 2015, the number of days between when the patient suspects his doctor and the confirmation of the diagnosis. In new cases of childhood acute lymphoid leukemia, for example, it increased from 16 days to 10 days during this period.

From 2015 to 2017, the detection of bad cancer in the early stages (39.4 to 47.7%), prostate (66.6 to 74.1%) and cervix also increased. (60.2 to 63.8%).

However, as indicated in the ACC report itself, things get complicated after the diagnosis.

Precious Days

John Marulanda, Chief Medical Officer of the Colombian League Against Cancer, does not hesitate to point out that early detection and quick access to treatment literally save lives, which is why "every minute counts ".

In Colombia, in this second task, the situation is "critical", according to the CAC, because the time that elapses between the moment when a person receives the news of his illness and the beginning of the treatment remains an eternity. In bad, cervical, colon, stomach and prostate cancers, the average wait is greater than 45 days, two weeks more than expected. In the case of the cervix, the delay can be up to 73 days.

Lizbeth Acuña, director of the CAC, adds that only 13% of PHEs achieved this opportunity goal between diagnosis and the start of treatment.

And after?

The problem does not stop with the start of treatment because, although Colombia is one of the few countries in the region where care is completely covered, administrative obstacles persist that hinder the lives of patients.

The proof is a study of the Colombian Leukemia and Lymphoma Foundation published last year among 165 patients with chronic myeloid leukemia (CML). Participants did not report explicit refusals of procedures or treatments, although the authorizations were often delayed, and even more so when the drugs were dispensed. 24.2% of them reported that they had not received all the medication needed for their treatment for eight months, and 102 indicated that they had suspended their medication at some point for non-medical reasons, the main one being being the delay of the pharmacy.

Yolima Méndez, president of the foundation, explains that patients with CML receive oral treatment externally, so they depend on the speed with which the health system complies with medical indications. "What are the PSA control measures that do not guarantee the delivery of all treatments to their patients?", Mendez questions

The study conducted with people with CML also showed that 65% of them had to resort to legal action to ensure continuity of treatment. And to top it all off, 30% of those who sued in tutela filed a contempt complaint.

Because of all this, the fatal consequences can accelerate. And in this indicator, we also divided. According to the Concord 3 study, published last March in The Lancet and measuring patient survival in 71 countries, the percentage of Colombians who died before five years of diagnosis is increasing, with the exception of childhood leukemia, in which the forecast has improved.

"This country has made many efforts to ensure that patients and their families are fully covered in the event of a disaster such as this one, so we can not tolerate services being segmented, prevention not being prevented, that diagnoses and treatments be delayed and that palliative care and pain management be refused.César Burgos, president of the Colombian Association of Scientific Societies, concludes this illegal.

Subregistro: another serious problem

Although the High Costs Account presents figures conditioned by the attentions provided by the general health system, other sources of data indicate that the incidents and cases prevalent in the country are larger, which would indicate a serious under-reporting. declaration.

Projections for other cancer registries in Colombia indicate that there are more than 100,000 new cases in 2018, well above the 32,000 cases seen in 2017. Globocan, for example, the observatory of the International Agency of Cancer, notes that the most recent number of new cases per year was 90,000.

"Quality of care is the key"

Juan Pablo Uribe, Minister of Health, spoke about the health issues that need to be addressed so that cancer does not continue to die. He stressed that "the quality of care is fundamental and that we must be able to badess satisfaction and clinical outcomes and generate incentives around them".

On the remaining barriers, he badured that "Can be solved with proper management and structured processes and systems with the patient in mind". He concluded by stating that the actors of the system had to compete with quality and efficiency and guarantee the completeness and continuity of attention.

Oncologists and cancer centers

What will be said here is not new, but it is worrying: in Colombia, specialists are needed to treat cancer. In fact, it is not known how many doctors are willing to treat this disease in the country. The Ministry of Health does not have a registry of specialists, it is worth saying. And in the best of scenarios, there would be 250, adding hematologists, oncologists and hemato-oncologists, according to the Colombian Association of Scientific Societies.

Javier Ignacio Godoy, president of the Colombian Association of Hematology and Oncology, says that the figure of this specialist is essential to patient survival because he is responsible for the evolution of the disease as soon as the diagnosis. He admits that there are 180 members affiliated to this union.

If we take Globocan and other non-ACC records, that there are about 90,000 new annual diagnoses and divided with the provisional data from the scientific societies, in Colombia, every oncologist should receive 360 ​​new patients a year to cover all care.

A revealing proportion, taking into account that the recommendation of the Spanish Society of Medical Oncology, for example, is 158 new cases by medical oncologist full time and that in Peru, there is an oncologist for 331 new patients; in Argentina, one for 287; in Brazil, one in 170, and in Uruguay, one in 108, according to the global survey of the clinical oncology workforce published a year ago and in which our country does not appear.

"It is true that there are fewer specialists than necessary. For example, in Bogotá, there are only 60. However, it is important to take into account factors of an educational nature, such as the fact of obtaining a diploma in this subject can take up to 13 years of study " Godoy said.

In any case, any indicator constructed in Colombia in this regard must take into account the deep gray levels. One of them is that at the national level, oncologists and oncology departments are concentrated in capitals, which reveals shortcomings in effective access to d & # 39; Huge specialists in the regions.

The latest newsletter on oncology services from the National Cancer Institute (NIC) He points out that there are 1,779 cancer treatment sites in the country. After the play of proportions, this would mean that there are seven oncology centers for each doctor specialized in the subject. And although it can be argued that a professional can travel to multiple locations at once, the cancer experts consulted clearly indicated that the ideal was to have a professional to permanently.

And speaking of completeness, the INC newsletter also laid on the table that the private sector concentrates 90% of oncology services, but only 5% of them are "complete treatment centers", where chemotherapy, radiotherapy and surgery are offered.

CARLOS F. FERNÁNDEZ AND RONNY SUÁREZ
THE WEATHER
On Twitter: @SaludET