Association of Healthcare Fragmentation and the Survival of Patients With Colorectal Cancer in Colombia.

OBJECTIVES: The objective of this study was to identify the association between healthcare fragmentation and survival for patients with colorectal cancer in Colombia. METHODS: A retrospective cohort study was performed using administrative databases, with an electronic algorithm to identify patients with colorectal cancer based on codes. The patients were enrolled between January 1, 2013, and December 31, 2016. The exposure variable was fragmentation, which was measured based on the number of different healthcare institutions that treated a patient during the first year after diagnosis. Matching was performed using propensity scores to control for confounding, and the hazard ratio for exposure to higher fragmentation was calculated for the matched sample. RESULTS: A total of 5036 patients with colorectal cancer were identified, 2525 (49.88%) of whom were women. The mean number of network healthcare institutions for the total sample was 5.71 (SD 1.98). The patients in the quartile with higher fragmentation had the highest mortality rate, 35.67 (95% CI 33.63-38.06) per 100 patients. The comparison of higher and lower quartiles of fragmentation resulted in an incidence rate ratio of 1.23 (95% CI 1.04-1.45; P = .02). Of the 5036 patients, 422 (8.38%) were classified as the exposed cohort (higher fragmentation). The total matched sample consisted of 844 subjects, and an HR of 1.26 (95%CI; 1.05-1.51) was estimated. CONCLUSIONS: Exposure to more highly fragmented healthcare networks decreases overall 4-year survival for patients with colorectal cancer in Colombia.

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

Objective: To analyze the cervix cancer mortality in Colombia, based on age, period and cohort effects. Methods: 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. Results: 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. Conclusions: 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.

Objetivo: Analizar las tendencias de la mortalidad por cáncer de cuello uterino en Colombia, teniendo en cuenta los efectos de edad, periodo y cohorte. Métodos: Los datos de mortalidad y de población se tomaron de las bases oficiales del Departamento Administrativo Nacional de Estadísticas, DANE. Se ajustaron cinco modelos, la significancia de los efectos se obtuvo comparándolos a través de la prueba de razón de verosimilitud. Resultados: La tasa de mortalidad ajustada por edad, en muertes fue de 15.09/100,000 mujeres, para el periodo 1985-1989 y 10.21 para el periodo 2010-2014. El cambio promedio porcentual anual fue de -1.45% (IC 95%: -1.57% a -1.34%). Se encontraron efectos de edad, periodo y cohorte. Conclusiones: Los factores demográficos podrían explicar el comportamiento de la mortalidad por cáncer de cuello uterino en Colombia, al igual que la instauración de medidas de salud pública en las dos últimas décadas.

Radiation Oncology Residency Training in Latin America: A Call to Attention.

Purpose: Despite the call to increase the number of radiation oncologists in Latin America, the quality, similarity, and number of residency training programs are unknown. We seek to describe the current state of residency programs in radiation oncology in Latin America. Methods and Materials: Latin American Residents in Radiation Oncology performed a cross-sectional analysis of universities and training centers for radiation oncologists in Latin America. Latin American Residents in Radiation Oncology members identified and contacted current residents and specialists at each center to obtain information and documents that described their training curricula. Results: As of 2020, 13 of 23 (56.5%) Latin American countries have radiation oncology training. Seventy-three training centers were identified (59 active and 14 inactive), associated with 28 universities. On average, each active center trains 2.6 new residents per year, and in total, 156 residents are trained annually. The average length of training programs is 3.6 years. Brazil and Mexico comprise 31 (52.5%) and 7 (11.9%) of active programs, respectively, and 64 (41.8%) and 50 (32.7%) residents, respectively. Training is available in 38 cities in 13 countries, and outside Brazil and Mexico, only 13 cities in 11 countries (9 capitals and 4 noncapital cities). Individualized curriculum documents were provided by 20 (83.3%) of 24 non-Brazilian programs, while 1 standardized guideline was provided for Brazilian training programs. These demonstrated variation between subjects taught, their devoted time, outside specialty rotations, and experiences in modern techniques. Seventy-five percent include volumetric modulated arc therapy, 70% stereotactic radiosurgery, and 55% stereotactic body radiation therapy training. One-hundred percent include gynecologic brachytherapy education and <50% brachytherapy education in other disease sites. Conclusions: Training is highly centralized in capital cities. The number of trainees is insufficient to close the current human resource divide but is limited by available job openings. Over 50% of training programs now include technological training in stereotactic radiosurgery, stereotactic body radiation therapy, or volumetric modulated arc therapy; however, substantial variation still exists. The development of radiation oncology specialists must be improved and modernized to address the escalating demand for cancer care.

Age, period and cohort effects on mortality from cervical cancer in Colombia between 1985 and 2014 / Efectos de edad, periodo y cohorte en la mortalidad por cáncer de cuello uterino en Colombia entre 1985 y 2014

Abstract Objective: To analyze the cervix cancer mortality in Colombia, based on age, period and cohort effects. Methods: 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. Results: 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. Conclusions: 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.

Resumen Objetivo: Analizar las tendencias de la mortalidad por cáncer de cuello uterino en Colombia, teniendo en cuenta los efectos de edad, periodo y cohorte. Métodos: Los datos de mortalidad y de población se tomaron de las bases oficiales del Departamento Administrativo Nacional de Estadísticas, DANE. Se ajustaron cinco modelos, la significancia de los efectos se obtuvo comparándolos a través de la prueba de razón de verosimilitud. Resultados: La tasa de mortalidad ajustada por edad, en muertes fue de 15.09/100,000 mujeres, para el periodo 1985-1989 y 10.21 para el periodo 2010-2014. El cambio promedio porcentual anual fue de -1.45% (IC 95%: -1.57% a -1.34%). Se encontraron efectos de edad, periodo y cohorte. Conclusiones: Los factores demográficos podrían explicar el comportamiento de la mortalidad por cáncer de cuello uterino en Colombia, al igual que la instauración de medidas de salud pública en las dos últimas décadas.

Análisis de Costo-Efectividad de las Estrategias de Tamización de Cáncer Colorrectal en Colombia.

OBJECTIVE: To evaluate the cost-effectiveness of different screening strategies for colorectal cancer in Colombia. METHODS: We designed a Markov model to compare the clinical and economic impact in terms of reducing the incidence and mortality from colorectal cancer (CRC). Six screening strategies for adults were compared: fecal occult blood (FOBT) immunochemical and guaiac type, conventional colonoscopy, flexible sigmoidoscopy, and FOBT guaiac and immunochemical type more sigmoidoscopy. We used the third-party payer perspective, including only direct costs, the time horizon was the life expectancy of the Colombian population. We estimated cost-effectiveness ratios (CERs) and incremental cost-effectiveness (ICER). Were performed deterministic sensitivity analysis and probabilistic. We applied a discount rate of 3% in the costs and health outcomes. RESULTS: The screening strategy more cost-effective was the FOBT biennial guaiac type. The cost per life year gained was US$10,347.37, US$18,380.64, and US$45,158.05. For FOBT guaiac biennial, FOBT guaiac annual and FOBT inmunoquímica biennial respectively. The ICER is sensitive to the percentage of false positive test for FOBT guaiac type values greater than 10%, and the cost of the test. CONCLUSIONS: The screening strategy more cost-effective for Colombia is the FOBT biennial guaiac type, using as a threshold the gross domestic product (GDP) per capita in Colombia.

Análisis de Costo Efectividad de Estrategias de Tratamiento Antimicótico en Pacientes con Neutropenia Febril Persistente y Tratamiento Antibiótico de Amplio Espectro.

OBJECTIVE: To assess cost-effectiveness of antifungal treatment on patients with persistent fever neutropenia: empiric antifungal therapy (EAT) vs. anticipated antifungal therapy (AAT). METHODS: A decision model was performed to evaluate the cost-effectiveness of antifungal treatment strategies in patients with febrile neutropenia not responding to a broad spectrum antibiotic treatment. The strategies included were: 1) EAT with amphotericin B deoxycholate; 2) EAT with liposomal amphotericin B; 3) EAT with caspofungin; and 4) AAT with voriconazole and amphotericin B deoxycholate or liposomal amphotericin B or caspofungin in patients who initiate treatment despite having negative CT scan and galactomannan or fail to voriconazole. Effectiveness was measured as the number of deaths averted. Cost-effectiveness and incremental cost-effectiveness ratios were calculated. Deterministic and probabilistic sensitivity analyzes were performed. RESULTS: EAT with Amphotericin B deoxycholate was the least expensive and least effective strategy. The EAT with caspofungin was the most effective. The cost per death averted for caspofungin when compared with amphotericin B deoxycholate was $17,011,073.83, which would indicate that this strategy would be cost-effective for the country if the willingness to pay per death averted is equal to or greater than this value. EAT with liposomal amphotericin B and AAT with voriconazole were dominated by AET with caspofungin, which is less costly and more effective. CONCLUSIONS: EAT with caspofungin would be cost-effective for Colombia if the threshold per death averted is greater to $18.000.000. If the threshold is lesser the EAT with amphotericin B deoxycholate would be the election.