Overcoming Barriers in the Implementation of Programs for Breast and Cervical Cancers in Cali, Colombia: A Pilot Model

Abstract

Breast and cervical cancers are leading causes of mortality among women in Latin America. Colombia has universal health care and a government-sponsored 10-year cancer control plan focused on prevention, early detection, and treatment. However, many administrative and social barriers have hindered its success, and a majority of patients are diagnosed at a late stage. Established in 2012, Partners for Cancer Care and Prevention (PFCCAP) works to decrease the burden of these cancers by mitigating the obstacles women face during their cancer diagnosis and treatment. Through community outreach meetings with medical personnel, hospital directors, and government officials, PFCCAP identified major barriers, including lack of trained health care personnel, few centers with adequate screening equipment, and a fragmented health system with significant administrative delays and poor continuity of care. Its solution included monthly teleconferences, biannual on-site training, quality control programs, and improved access to screening equipment. PFCCAP also initiated a patient navigation project. After implementation of the PFCCAP plan of action, from 2012 to 2018, the average time from initial consult to biopsy decreased from 65 to 20 days; from biopsy to diagnosis, 33 to 4 days; and from diagnosis to surgery, 121 to 60 days. To date, more than 1,500 women have benefited from this initiative, which has expanded to other regions. Overall, PFCCAP is creating centers of excellence in strategically located hospitals and promoting the implementation of national guidelines. Although several barriers still exist, PFCCAP is helping to implement an efficient health care model that can be replicated in other underserved populations.

Health system strengthening: Integration of breast cancer care for improved outcomes

“…The results have been impressive, in reduced waiting times for all aspects of care and steady increases in women served, in a program now under public control. The program has begun expanding to other cities in Colombia and appears to be a successful and replicable model 41 …”

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

“…The median TTI estimated in our study was more than double the goal established in the protocol for public health surveillance and risk control of breast and cervical cancers in Colombia that is less than 30 days ( Jimenez Herrera, 2018 ). This protocol was proposed within the framework of the 10-year cancer control plan to decrease cancer burden through early detection, treatment, rehabilitation, and palliation by reducing health disparities in access and treatment ( Sardi et al, 2019 ). Despite the above, our results suggest that targeted interventions are required to guarantee a timeless treatment and prevent gaps in care from widening over time.…”

“…Delays in TTI observed in women with state insurance in Colombia are the result of a fragmented administrative health care system, which exhibits wider gaps in people with insurance subsidized by the government. It has been identified as the most significant barrier for an effective access to cancer diagnosis and treatment in the country ( Sardi et al, 2019 ). Further, health insurance is a proxy of socioeconomic conditions, and it is well known that lower socioeconomic status contributes to and exacerbates healthcare problems and explains the wide variation in cancer access in the Americas and within the countries ( Gribble et al, 1993 ).…”

Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control

“…Strengthening knowledge and awareness of cancer signs and symptoms among the healthcare workforce (particularly those working in frontline services) is of equal, if not greater, importance to raising awareness among the general population. 119 - 123 …”