While cervical cancer (CC) is an important cause of premature mortality in Colombia, the impact of socio-demographic factors on CC mortality in young women is not well understood. The primary objective of this study was to identify differences in CC mortality among Colombian women aged 20–49 years associated with education, type of health insurance, urban or rural and region of residence, and to determine whether differences in mortality associated with education or insurance varied by age. Cervical cancer deaths for 2005–2013 and risk factors were obtained from the National Administrative Department of Statistics. Populations at risk were calculated from age-stratified population projections and the 2010 National and Demographic Health Survey. Negative binomial regression models, stratified by age, were used to examine associations between socio-demographic factors and mortality rates and whether the effects of education and health insurance varied by age. Multiple imputation was used to examine the importance of missing data. Differences of CC mortality were identified among women with limited to no education compared to highly educated women, with the largest disparity in the youngest age group (IRR 26.8, 95 % CI 6.65–108). Differences in mortality associated with health insurance also varied based on age group. Women with contributory and special health insurance had lower mortality rates than women with subsidised or no health insurance, except in the youngest age group. No differences were observed between women with subsidised and those with no insurance in any age group. Mortality rates were high among women who resided in urban areas and in the Atlantic, Central, Pacific, and Amazon-Orinoquia regions of Colombia. Missing values in the mortality database did not impact the findings from this study. Limited education was most strongly associated with premature CC mortality in the youngest women. Subsidised insurance did not appear to provide significant protection against CC mortality when compared to not having insurance, suggesting the need to examine diagnostic and treatment services available under the subsidised insurance plan. Our results could be used to target interventions to optimise the impact of resources to prevent premature mortality due to CC in Colombia.

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The role of socio-demographic factors in premature cervical cancer mortality in Colombia

Objetivo: Describir el comportamiento de la sobrevida relacionada con factores pronosticos en mujeres con cancer de mama tratadas en un centro cancerologico de la ciudad de Barranquilla durante el periodo 2011-2016 Materiales y metodos: Estudio analitico, tipo cohorte cerrada, retrospectivo Se analizo la informacion de 500 mujeres con cancer de mama de un centro cancerologico de la ciudad de Barranquilla Se diseno y desarrollo una base de datos en Microsoft Excel para almacenar y procesar sistematicamente los datos recogidos Para los analisis estadisticos se utilizo SPSS V 23 Los analisis de la distribucion estadistica de los tiempos de “fallo” (sobrevida e intervalo libre de enfermedad) se llevaron a cabo usando el metodo de Kaplan-Meier, para el contraste univariado se utilizo el Logrank test y para el analisis multivariado se empleo el modelo de riesgos proporcionales de Cox Resultados: El promedio de edad de las participantes fue 47,9 anos El 61% de las mujeres pertenecian al regimen subsidiado El carcinoma mas frecuente fue de tipo ductal (81,4%), el principal grado de diferenciacion fue el moderado (34,2%) y 80,6% se encontraban en estadio II La sobrevida fue mayor en edades menor a 45 (87,3%), regimen contributivo (86,2%), carcinomas de tipo lobulillar (87%), en los carcinomas bien diferenciado (100%) y en los carcinomas estadio de 0 a 2 (89,2%) Conclusion: La tasa de sobrevida fue del 83,2% No hubo diferencia significativa en las variables de estudio con respecto a las variables, con excepcion de la morfologia en la que se considera una diferencia “border line”

Análisis de sobrevida relacionada con factores pronósticos en mujeres con cáncer de mama tratadas en un centro cancerológico de la ciudad de Barranquilla, 2011-2016

Objective: describe the meaning of the experience in the face of the cancer diagnosis in the construction of the individual and subjective reality developed. Method: qualitative study with a phenomenological-hermeneutic approach, developed at a cancer service, involving four women and two men with different cancer diagnoses. The interviews, collected between January and March 2016, were recorded. For the analysis, the Analysis of Interpretative Phenomenology and Mishel’s Uncertainty Theory were employed. Results: uncertainty is an experience that invades the patients with chronic illness. Themes emerge on lack of knowledge/knowledge; The health staff and family, support to cope with the diagnosis and not falter; Positive attitude; Suffering in view of adversity; Holding onto God and The adversity of the health system. Conclusion: all patients experienced the period of uncertainty first as danger, but they made coping efforts, manifested by feelings of optimism and positive attitude, focused on reducing the uncertainty and controlling the emotional excitement their diagnosis aroused. DESCRIPTORS: Cancer. Uncertainty. Qualitative research. Nursing. Chronic disease. INCERTIDUMBRE FRENTE AL DIAGNÓSTICO DE CÁNCER

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Uncertainty in the face of the cancer diagnosis

Objective: To describe the barriers to diagnosis and treatment of cancer patients in Colombia. Method: A systematic review of literature sources from extensive databases was conducted, containing journal articles, theses, degrees, monographs and research. Results: The barriers were described as: a) structural barriers: related to the organization of the General System of Social Security in Health; b) administrative barriers: related to the service of insurers and the public hospital network; c) economic barriers: related pocket spending; d) barriers related to medical personnel; e) cultural barriers; f) barriers related to social determinants; g) barriers originated in structural determinants: related to socioeconomic status, social discrimination and ignorance; and h) intermediate barriers: related to geographical location, work environment and the health system. In addition, some mechanisms are described to address barriers. Limitations: Studies that refer to barriers to access to health services are associated with cancers where screening is performed: breast cancer, cervix and prostate. Conclusions: The Colombian health system is disjointed in its financial and administrative structure in which inequalities persist in access and opportunity for the use of services. It introduces barriers that not only reduce the perception of quality of care but also lead to worsening patients’ clinical condition which has consequences for the patient, their family, the health system and the state.

https://repository.ces.edu.co/bitstream/10946/2735/1/Autorizacion.pdf

Barreras en el acceso a servicios de salud en pacientes con diagnósticos de enfermedades oncológicas en Colombia: revisión sistemática de la literatura

Objective: describe the meaning of the experience in the face of the cancer diagnosis in the construction of the individual and subjective reality developed. Method: qualitative study with a phenomenological-hermeneutic approach, developed at a cancer service, involving four women and two men with different cancer diagnoses. The interviews, collected between January and March 2016, were recorded. For the analysis, the Analysis of Interpretative Phenomenology and Mishel’s Uncertainty Theory were employed. Results: uncertainty is an experience that invades the patients with chronic illness. Themes emerge on Ignorance/knowledge; The health staff and relatives, support to cope with the diagnosis and not falter; Positive attitude; Suffering in view of adversity; Holding onto God and The adversity of the health system. Conclusion: All patients experienced the period of uncertainty first as danger, but they made coping efforts, manifested by feelings of optimism and positive attitude, focused on reducing the uncertainty and controlling the emotional excitement their diagnosis aroused

/pdf/incertidumbre-frente-al-diagnostico-de-cancer-3vjz47rc29.pdf

Incertidumbre frente al diagnóstico de cáncer

Resumen Objetivo: explorar la existencia de barreras de acceso a los servicios de salud en las historias de mujeres con cancer de mama, que han recibido apoyo de seis ong colombianas. Metodologia: se llevo a cabo un estudio cualitativo descriptivo interpretativo, en cinco ciudades colombianas: Bogota, Medellin, Cali, Valledupar y Santa Marta, incluyendo 44 mujeres apoyadas por seis ong . Se realizaron grupos focales y entrevistas en profundidad. Resultados: en el proceso emergieron cuatro categorias: barreras ligadas a los determinantes estructurales, barreras originadas en los determinantes intermedios, herramientas para enfrentar las barreras y una categoria que hace referencia a la oportunidad de obtener un diagnostico y un tratamiento de cancer de mama. A partir de estas categorias, se propone un modelo de barreras de acceso en cancer de mama, desde la perspectiva de los determinantes sociales. Discusion: a pesar de los esfuerzos del pais por mejorar la oportunidad en prevencion, diagnostico y tratamiento del cancer —incluyendo la promulgacion de la ley 1384 de 2010 (Ley Sandra Ceballos)—, las mujeres con cancer de mama enfrentan barreras de acceso a los servicios de salud, que estan determinadas socialmente, y frente a las cuales el sistema muestra cierto nivel de incapacidad.

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Barreras de acceso a los servicios de salud: narrativas de mujeres con cáncer de mama en Colombia Barriers to healthcare access: narratives of women with breast cancer in Colombia

Fundación Simmon

Papers

Barreras de acceso a los servicios de salud: narrativas de mujeres con cáncer de mama en Colombia Barriers to healthcare access: narratives of women with breast cancer in Colombia