Cancer In Colombia Research Articles

RWD153 Attributable Costs of Breast Cancer in Colombia: A Cost-of-Illness Study Based on Administrative Claims Databases

Breast Cancer (BC) is associated with a substantial economic burden; however, real-world data regarding this burden for the Colombian Health System is very scarce. This study aims to describe the economic burden borne by the Health System in patients with BC affiliated with the contributory regime, which provides healthcare services to almost half of Colombian population, in 2019.

Cost-Effectiveness Analysis of Pertuzumab Plus Trastuzumab and Docetaxel Compared With Trastuzumab and Docetaxel in the Adjuvant Treatment of Human Epidermal Growth Factor Receptor 2–Positive Metastatic Breast Cancer in Colombia

ObjectivesThe addition of pertuzumab to the scheme of docetaxel plus trastuzumab (TH) in patients with metastatic breast cancer with overexpression of human epidermal growth factor receptor 2 increases survival. Nevertheless, this addition could represent a high cost for the health system of a middle-income country such as Colombia. Therefore, it is necessary to evaluate the efficiency of the pertuzumab plus TH (PTH) scheme in comparison with TH. MethodsA partitioned survival model-based cost-utility analysis was performed. Progression-free survival and overall survival curves for each scheme were obtained from the CLEOPATRA study. The time horizon was 30 years with a discount rate of 5% for costs and quality-adjusted life-years. Total direct costs were calculated using national tariffs. Utilities were obtained from external sources. Model uncertainty was evaluated by deterministic and probabilistic sensitivity analysis. A willingness to pay value of 5180 US dollars was used. ResultsThe discounted total average costs of TH and PTH were $24 109 and $60 846, respectively. These regimens’ average life-years were 5.78 and 8.38, and their quality-adjusted life-years were 3.28 and 4.51, respectively. The incremental cost-effectiveness ratio was $29 867. One-way sensitivity analysis showed that the cost of pertuzumab was the variable that explained the uncertainty in the model. The probability that PTH is cost-effective in the probabilistic sensitivity analysis is 0.0724. ConclusionsThe addition of pertuzumab to the TH regimen in patients with human epidermal growth factor receptor 2–positive metastatic breast cancer has a low probability of being cost-effective from the payer’s perspective in the Colombian health system.

Clinical and pathologic characteristics of gastric adenocarcinoma associated with Epstein-Barr virus in a region with a high incidence of gastric cancer in Colombia

Introduction and aimsEpstein-Barr virus (EBV) infection is an etiologic factor in EBV-associated gastric carcinoma (EBVaGC). The aim of our study was to describe the clinical and histopathologic characteristics of EBV infection in intestinal-type gastric adenocarcinoma samples. Material and methodsOf 180 paraffin-embedded gastrectomy samples, 28 were studied. Chromogenic in situ hybridization was performed to detect EBV. Sociodemographic and histopathologic data were obtained from the patients’ clinical histories. ResultsA total of 21.4% of the samples were positive for EBV. The predominant morphologic characteristic was the lace pattern, with dense inflammatory infiltration. Fifty percent of the EBVaGC+ patients were men, and the median age of the positive patients was 59 years (range: 50–75); 77.2% of the EBVaGC− patients were men, and the median age of the negative patients was 66 years (range: 34–89). Helicobacter pylori infection was associated with 10.7% of the EBVaGC+ patients and 53.6% of the EBVaGC− patients. In the EBVaGC+ patients, the cardia was the most frequent tumor location (17.9%), 7.1% had histologic grades 2 and 3, and 17.9% presented with Borrmann classification type III. In the EBVaGC− patients, the cardia and fundus were the most frequent tumor locations (71.4%), 35.7% had histologic grade 2, and 39.3% and 21.4% presented with Borrmann classification type III and IV, respectively. ConclusionsThe present study describes the clinical and histopathologic characteristics associated with EBVaGC positivity. Those data may aid in the selection of cases that are candidates for analysis through molecular methods aimed at identifying EBV infection in intestinal-type gastric adenocarcinoma.

Impact of health insurance type on access to vaccination and mortality due to COVID-19 on patients with cancer in Colombia: a cohort study

BackgroundIn Colombia, all paid workers earning minimum wage or higher contribute part of their salary for access to the national health-care system through a type of insurance called contributive plan, which supports the remaining low-income population that is enrolled on the subsidised plan. During the COVID-19 pandemic, Colombia documented high mortality rate in patients with cancer, with higher mortality among low-income patients, according to data from our national registry of COVID-19 infection in patients with cancer. The aim of this research was to establish the differential access to COVID-19 vaccination depending on health insurance type, and its impact on mortality due to COVID-19 infection.MethodsA cohort study was conducted with data from the Colombian National Cancer and COVID-19 Registry. Data were collected between June 1, 2021, when COVID-19 vaccines became available for patients with cancer in Colombia, and Oct 31, 2021. Included patients were aged 18 years or older, had a diagnosis of a solid tumour, were receiving active treatment or on follow-up, and had a confirmed SARS-CoV-2 infection. The cumulative incidence of mortality in the vaccinated and unvaccinated cohorts was compared. The estimation of the effect was done through relative risk (RR), and a multivariate analysis (generalised linear model, binomial family) was then done to estimate the effect of the type of health insurance.Findings896 patients were included. 470 (52%) were older than 60 years; 530 (59%) were women and 366 (41%) were men. 172 (19%) patients were vaccinated and 724 (81%) patients were not vaccinated (resulting in a ratio of 1:4). According to the type of health insurance, the vaccine was administered to 26 (12%) of 211 patients in the subsidised plan and to 146 (21%) of 685 patients in the contributive plan. The rate of vaccination according with socioeconomic status was 69 (16%) of 430 patients in the low-income group, 75 (23%) of 329 in middle-income group, and 12 (29%) of 42 in high-income group. The cumulative incidence of mortality for all causes was 17% (n=123) in the non-vaccinated cohort and 5% (n=8) in vaccinated cohort. The cumulative incidence of mortality per health-care insurance was 24% (n=50) in the subsidised plan and 12% (n=81) in the contributive plan. The adjusted RR for mortality was 3·4 (95% CI 1·7–6·8) in unvaccinated versus vaccinated patients, and 1·8 (1·3–2·4) in patients on the subsidised versus the contributive plan.InterpretationPatients on the subsidised health plan in Colombia had higher mortality due to COVID-19 infection and less access to vaccines than patients with a contributive plan. Strategies to promote COVID-19 vaccination for all patients with cancer should be strengthened, with implementation of special measures to improve care for the low-income population.FundingNone.

RWD120 Impact of Healthcare Fragmentation on Survival of Patients with Colorectal Cancer in Colombia

Patients with colorectal cancer (CRC) are susceptible to experiencing fragmentation of healthcare as they require complex treatments with multidisciplinary teams. Health systems of low-middle income countries have high fragmentation of care, making CCR patients prone to poor clinical outcomes. We aimed to identify the impact fragmentation of healthcare had on 5-year overall survival of patients treated for colorectal cancer in Colombia.

EE372 Cost-Utility of Ribociclib As the First-Line Treatment in Postmenopausal Women with Hormone Receptor Positive and Human Epidermal Growth Factor Receptor-2 Negative Advanced/Metastatic Breast Cancer in Colombia

To estimate the cost-utility of the currently approved Cyclin-Dependent Kinase 4 and 6 Inhibitors (CDK4/6i) as the first-line treatment in postmenopausal women with Hormone Receptor positive (HR+) and Human Epidermal Growth Factor Receptor-2 negative (HER2-) advanced/metastatic breast cancer, from the perspective of the Colombian health system.

RWD133 Adherence to Breast Cancer Screening Guidelines and Its Association with Survival in Women Treated for Breast Cancer in Colombia: A National Cohort Study Based on Administrative Claims

Breast cancer (BC) is the most common neoplasm among women in Colombia. Colombian guidelines recommend screening women aged 50 to 69 years with biannual mammography, yet adherence to screening or its impact on mortality at a national level have not been assessed. We aimed to determine adherence to BC screening guidelines and its association with 3-year overall survival in women treated for BC in 2015 in Colombia.

Determination of direct treatment costs of patients with metastatic and nonmetastatic castration-resistant (mCRPC, nmCRPC) and metastatic hormone-sensitive (mHSPC) prostate cancer in Colombia.

e18838 Background: The purpose of this study was to determine the direct costs associated with the management of patients with metastatic castration resistant (mCRPC), non-metastatic (nmCRPC) and metastatic hormone-sensitive (mHSPC) prostate cancer in the Colombian healthcare system. Methods: First, a literature review was carried out to identify the main clinical recommendations for the treatment and follow-up of patients with prostate cancer at local and international levels. Subsequently, a participation process was developed with clinical experts, through a modified Delphi panel, to validate the natural history of the disease, and identify treatment options, skeletal-related events management, resource utilization, and distribution of patients within stages. Based on the above, a cost analysis model was performed, using Colombian health technology assessment agency recommendations, to calculate direct cost of treatment for mCRPC, nmCRPC and mHSPC from payer’s perspective. Exchange rate used was USD $1 = COP $4,000. Finally, the results were estimated considering the cost per patient per year. Results: According to the cost analysis of each stage, in the non-metastatic castration resistant stage (nmCRPC) the associated yearly cost of a patient was lower than in the metastatic castration resistant stage (mCRPC) (USD $8,581 versus $24,590, respectively), with a difference of USD $16,008. The metastatic hormone-sensitive stage (mHSPC) had a lower yearly cost than the metastatic castration-resistant stage (mCRPC) (USD $15,030 versus $24,590, respectively), with a difference of USD $ 9,559. The event that generated the greatest impact on the cost is the incidence of skeletal-related events associated with disease metastasis (55%). The deterministic sensitivity analysis on key variables, such as the percentage of patients who responded to treatment and the incidence of skeletal-related events, showed consistency of results. Conclusions: Delaying or stopping disease progression to mCRPC could more than halve annual treatment costs for patients. Given the findings, advanced metastatic castration resistant stages demand more resource utilization associated with disease management. The Colombian healthcare system would benefit from risk management strategies that implement timely interventions associated with early diagnosis and screening. In this way, the resource utilization in health sector's institutions would be directly impacted through budget optimization, obtaining better results focused on the national follow-up indicators of the prostate cancer patient cohort.

Attributable Costs of Lung Cancer for the Colombian Health System: A Cost-of-Illness Study

ObjectivesLung cancer imposes a significant economic burden on most countries. Nevertheless, there is scarce information about this burden on health systems in low- and middle-income countries. This study aims to estimate the economic burden of lung cancer on the Colombian health system, a middle-income country with universal health coverage in Latin America. MethodsWe conducted a cost-of-illness study that included all direct costs generated by prevalent cases of lung cancer in Colombia during 2017. We used administrative databases containing patient-level information on consumption of healthcare services and reports on healthcare spending published by the Colombian Ministry of Health. To decrease the probability of misallocation of costs, we used propensity score matching to estimate the marginal costs of delivering healthcare services to patients with lung cancer. Additionally, ordinary least squares and variations in case definitions were used to assess the robustness of all estimates. ResultsTotal costs attributable to lung cancer in 2017 ranged from $50 039 588 to $74 468 111, with important differences across insurance regimes (from $4 629 938 for the subsidized regime to $55 342 357 for the contributory regime). Notably, 43% of all costs ($27 081 348) were caused by the consumption of services not included in the health benefit package. There were no significant differences between inpatient and outpatient costs. ConclusionsLung cancer imposes a significant economic burden on the Colombian health system. Although all affiliates are entitled to a unique health benefit package, there were important differences in costs across insurance regimes. Further research is needed to identify the main mechanisms underlying these differences.

Cultural adaptation and validity of the memorial symptom assessment scale in adults with cancer in Colombia

Background & Aim: The Memorial Symptom Assessment Scale measures the presence, frequency, severity, and distress of symptoms. The scale is available in Spanish, but it has not been validated in Colombia. This study aims to translate, validate, and culturally adapt the Memorial Symptom Assessment Scale for adults with cancer in Colombia.
 Methods & Materials: Adults with cancer undergoing chemotherapy in an oncological outpatient center in Bogota, Colombia, were invited to participate in the study. Patients in end-of-life care or with cognitive deficits were excluded. Psychometric research was carried out and included: 1) Translation and cultural adaptation of the scale from English, 2) Construct validity and reliability with a convenience sample of 249 cancer patients. A factorial analysis of principal components was carried out with the Varimax rotation method in IBM SPSS v26.0. The reliability of the scale was estimated using Cronbach's Alpha; subsequently, factor analysis was carried out using structural equations in MPlus.
 Results: The scale was adapted to the Colombian context. Two factors (physical and psychological) of the scale structure were produced by the factorial analysis that contributes 47.9% of the accumulated variance. The alpha coefficient of Cronbach ranged between 0.75 and 0.79. The final model goodness of fit was also adequate [X2 (128)=184.47, p = 0.008, CFI = 0.94, RMSEA: 0.04 [0.03, 0.06], SRMR: 0.06, TLI= 0.92].
 Conclusion: The Memorial Symptom Assessment Scale has adequate validity and reliability to measure the prevalence, frequency, stress, and severity of symptoms in adults with cancer in Colombia.

Age, period and cohort effects on mortality from cervical cancer in Colombia between 1985 and 2014.

To analyze the cervix cancer mortality in Colombia, based on age, period and cohort effects. The mortality and population data were taken from the official databases of the National Administrative Department of Statistics, DANE. Five models were adjusted, the significance of the effects was obtained by comparing them through the likelihood ratio test. The age-adjusted mortality rate, in deaths was 15.09/100,000 woman, at 1985-1989 period, and 10.21 at 2010-2014 period. The annual percentage average change was -1.45% (95% CI: -1.57% to -1.34%). Age, period and cohort effects were found. Demographic factors could explain the behavior of cervical cancer mortality in Colombia, as well as the establishment of public health measures in the last two decades.

Burden of skin cancer in Colombia

Levels of incidence and mortality of skin cancer in Colombia and Latin America are largely unknown. Present the available information from official and gray literature and governmental databases to grasp the magnitude and characteristics of skin cancer in Colombia (middle-income Latin American country). Narrative review based on a literature search (2005-2020), gray literature and cancer registry and governmental warehouse data, calculation of proportions and age-standardized incidence (ASIR) and mortality rates (ASMR), expressed per 100,000 person-years. ASIR of cutaneous melanoma in Colombia is around 3, corresponding ASMR between 0.7 and 0.8. Distinctive features are the high proportion and rates for acral melanomas, and the advanced stage at diagnosis in the general population but not in private clinics. For non-melanoma skin cancer, ASIR is at least around 35-40, ASMR 0.8. Among the wealthy Colombians, melanoma features are similar to those of high incidence countries (but of lower magnitude), whereas the majority of the population present distinct features with a much higher proportion of acral melanomas, very late stages at diagnosis, and poor prognosis. More advanced melanomas seem to have a relation with lower socioeconomic status. Non-melanoma skin cancer is common, with very high mortality rates at levels even above those of predominantly fair-skinned populations, implying high fatality rates for non-melanoma skin cancers. This could indicate a late diagnosis or difficulties in access to treatment, illustrating the need for primary and secondary prevention to reduce the burden of disease and improve the prognosis of this common cancer.

Incidence of Melanoma and Nonmelanoma Skin Cancer in Colombia: Trends and Projections from 2008 to 2022

Incidence of Melanoma and Nonmelanoma Skin Cancer in Colombia: Trends and Projections from 2008 to 2022

Regulation of nuclear medicine services: Perception of the problems and challenges in Colombia for the approach to cancer

ResumenIntroducción. La modificación de las normas sobre medicina nuclear en Colombia ha afectado la administración de la terapia de yodo radioactivo en el tratamiento del cáncer de tiroides.Objetivos. Determinar las áreas de acuerdo en torno al problema, los requisitos actuales y los nuevos exigidos en la normativa para el funcionamiento de los servicios de medicina nuclear.Materiales y métodos. Se hizo un estudio Delphi de dos rondas con cada grupo de expertos, ‘clínicos’ y ‘de entidades reguladoras’. En la primera ronda se exploraron los puntos de vista sobre las implicaciones de la normativa en medicina nuclear y, en la segunda, se calificaron las declaraciones de la primera según su relevancia.Resultados. La problemática de los servicios de medicina nuclear está relacionada con la claridad normativa, y la falta de sinergia y coherencia entre los organismos de inspección, vigilancia y control. Las exigencias del sistema de gestión de desechos requieren una alta inversión económica que puede influir en la oferta del servicio y repercutir en el control integral del cáncer de tiroides. Entre las necesidades presentes y futuras, se encuentran la unificación de criterios entre los auditores, la delimitación de funciones de los actuantes, la asistencia técnica para cumplir con la normativa, y la veeduría a los organismos de inspección, vigilancia y control por parte de los entes reguladores.Conclusión. Los hallazgos del estudio sugieren que los servicios de medicina nuclear atraviesan un momento de múltiples desafíos institucionales, normativos y económicos, que ponen en riesgo el desarrollo y mantenimiento de la medicina nuclear en la atención oncológica.

Shortages of essential medications for children with cancer in Colombia.

Publication of modern advances, tests, or treatments for childhood cancer is a great achievement, yet the reality in many low-income and middle-income countries is different. Colombia is an upper-middle-income country where overall survival for children diagnosed with cancer is lower than that reported in high-income countries. For children with acute lymphoblastic leukaemia, overall survival at 5 years is 50–60% in Colombia, whereas overall survival exceeds 90% in high-income countries.1–4 Over the years, the Colombian Association of Pediatric Hematology and Oncology (ACHOP) has developed strategies to increase overall survival in children with cancer.

Prevalence and Demographic Characteristics of Prostate Cancer Patients in Colombia: data from the National Health Registry from 2015 to 2019

Abstract Background and Objective Prostate cancer is a multifactorial disease and is among the top five causes of death in men worldwide. The Colombian Ministry of Health has adopted the Integrated Information System on Social Protection (Sistema Integrado de Información de la Protección Social, SISPRO, by its Spanish acronym) registry to collect comprehensive information from the Colombian health system. The system provides close to universal coverage (around 95%). We aimed to establish the prevalence of prostate cancer in Colombia and to describe its demographics, based on data provided by SISPRO, openly available for scientific analysis. Methods Using the SISPRO data from 2015 through 2019, we analyzed the prevalence and demographic characteristics of patients diagnosed with prostate cancer. Results We identified a total of 43,862 patients with prostate cancer in the 5-year period and estimated a prevalence of 4.54 cases per 1,000 habitants, using as denominator males over 35 years old. We calculated a prevalence of early-onset prostate cancer (i.e., 35–54 years) of 0.14 per 1,000 habitants (791 cases in 5 years). The highest prevalence was observed in patients > 80 years (33.45 per 1,000 habitants). The departments with the highest prevalence were Bogotá, Valle del Cauca, Risaralda, and Boyacá, and the region with the lowest prevalence was Amazonas. Conclusion We describe the prevalence and demographics of prostate cancer in Colombia using the national healthcare system database. We observed that the prevalence has been increasing over time, and the distribution is variable according to regions, which may be related to racial or environmental causes, or access to the urologist. These factors should be addressed in further studies.

Clustering of childhood cancer in Colombia: a nationwide study

BACKGROUND AND AIM: Childhood cancer is considered as one the most important causes of death in children and adolescents, despite having a low incidence in this population. Spatial analysis has been previously used for the study of childhood cancer to study the geographical distribution of leukemias. This study aimed to identify the presence of space-time clusters of childhood of cancer excluding leukemia in Colombia between 2014 and 2017. METHODS: All incident cancer cases excluding leukemia in children under the age of 15 years that have confirmed by the National Surveillance System of Childhood Cancer between 2014 and 2017 were included. Kulldorf’s circular scan test was used to identify clusters using the municipality of residence as the spatial unit of analysis and the year of diagnosis as the temporal unit of analysis. A sensitivity analysis was conducted with different upper limit parameters for the at-risk population. RESULTS:A total of 2006 cases of non-leukemia childhood cancer were analyzed, distributed in 432 municipalities with a mean annual incidence rate of 44 cases per million children under the age of 15. Central nervous system (CNS) tumors were the most frequent type. Four spatial clusters and two space-time clusters were identified in the central and southwest regions of the country. In the analysis for CNS tumors, a spatial cluster was identified in the central region of the country. CONCLUSIONS:The distribution of non-leukemia childhood cancer seems to have a clustered distribution in some Colombian regions that may suggest infectious or environmental factors associated with its incidence. KEYWORDS: Outcomes, Children's environmental health, Spatial statistics

Estimation of the Need for Radiation Therapy Services According to the Incidence of Cancer in Colombia to 2035

PurposeTo estimate the supply and demand of current and future radiation therapy services by 2035 for Colombia. Methods and MaterialsThe present study was performed by surveying different radiation therapy services identified in Colombia through the Colombian Association of Radiation Oncology. The demand was estimated based on incident cases and published information on the use of radiation therapy by type of cancer. Future demand was estimated under the assumption that incidence rates do not change and therefore the change in the number of cases is due to the change in the age structure of the Colombian population. Sensitivity analyses were conducted on the percentage of radiation therapy use by type of cancer. A Monte Carlo simulation was carried out to estimate the distribution of cases requiring radiation therapy, the amount of equipment, and the number of staff needed for care with the use of this technology. ResultsIn total, Colombia has 69 linear accelerators, 2 radiosurgery equipment, 30 high-dose-rate brachytherapy pieces of equipment, 124 radiation therapy oncologists (113 working, 9 not working, and 2 not informed), and 275 radiation therapy technologists as of June 2020. It was estimated that to meet the current cancer burden the country would need a total of 162 radiation therapy oncologists, 121 medical physicists, and 323 radiation therapy technologists and to increase the number of radiation therapy technologists, radiation therapy oncologists, and medical physicists to 491, 246, and 184, respectively, to meet the disease burden by 2035 (73,684-88,743 cases per year). ConclusionsIn Colombia it is estimated that there is a deficit of human resources and technology for radiation therapy; therefore, there is need to investment resources from the public and private sectors to provide timely and quality care to cancer patients requiring this treatment.

NGS in Lung, Breast, and Unknown Primary Cancer in Colombia: A Multidisciplinary Consensus on Challenges and Opportunities.

Given the benefits and likely future applications, there is an urgent need to expand the use of next-generation sequencing (NGS) in breast, lung, and unknown primary cancers in Colombia. The objective of this review is to address the barriers limiting access to the use of NGS in Colombia, specifically for patients with breast, lung, and unknown primary cancers in the public health care system. A selected Panel of Colombian experts in NGS were provided with a series of relevant questions to address in a multiday conference. Each narrative was discussed and edited by the Panel through numerous drafts and rounds of discussion until consensus was achieved. There are limitations to the widespread adoption of innovative technology inherent to the Colombian health care system. Barriers identified to implementing NGS in Colombia include availability, accessibility, and affordability; limited infrastructure; training and awareness of health personnel; quality-control procedures; and collection of local data. Stakeholders must align to adapt the implementation of NGS to the constraints of resource-limited environments. Diagnostic algorithms were developed to guide molecular testing for lung, breast, and unknown primary cancers. Recommendations on overcoming the barriers to the widespread adoption of NGS include country-specific molecular testing guidelines, creating a national genetic registry, improving infrastructure, and creating health policy that favors the adoption of innovative technology.

Clustering of non-leukemia childhood cancer in Colombia: a nationwide study

Background: Childhood cancer is considered one the most important causes of death in children and adolescents, despite having a low incidence in this population. Spatial analysis has been previously used for the study of childhood cancer to study the geographical distribution of leukemias. This study aimed to identify the presence of space-time clusters of childhood of cancer excluding leukemia in Colombia between 2014 and 2017. Methods: All incident cancer cases (excluding leukemia) in children under the age of 15 years that had been confirmed by the National Surveillance System of Childhood Cancer between 2014 and 2017 were included. Kulldorf’s circular scan test was used to identify clusters using the municipality of residence as the spatial unit of analysis and the year of diagnosis as the temporal unit of analysis. A sensitivity analysis was conducted with different upper limit parameters for the at-risk population in the clusters. Results: A total of 2006 cases of non-leukemia childhood cancer were analyzed, distributed in 432 out of 1,122 municipalities with a mean annual incidence rate of 44 cases per million children under the age of 15. Central nervous system (CNS) tumors were the most frequent type. Two space-time clusters were identified in the central and southwest regions of the country. In the analysis for CNS tumors, a spatial cluster was identified in the central region of the country. Conclusions: The distribution of non-leukemia childhood cancer seems to have a clustered distribution in some Colombian regions that may suggest infectious or environmental factors associated with its incidence although heterogeneity in access to diagnosis cannot be discarded.