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Bourlon MT, Remolina-Bonilla YA, Acosta-Medina AA, Saldivar-Oviedo BI, Perez-Silva A, Martinez-Ibarra N, Castro-Alonso FJ, Martín-Aguilar AE, Rivera-Rivera S, Mota-Rivero F, Pérez-Pérez P, Díaz-Alvarado MG, Ruiz-Morales JM, Campos-Gómez S, Martinez-Cannon BA, Lam ET, Sobrevilla-Moreno N. Impact of healthcare inequities on survival in Mexican patients with metastatic renal cell carcinoma. Front Oncol 2023; 13:1229016. [PMID: 38044992 PMCID: PMC10693405 DOI: 10.3389/fonc.2023.1229016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/22/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction The survival of patients with metastatic renal cell carcinoma (mRCC) has improved dramatically due to novel systemic treatments. However, mRCC mortality continues to rise in Latin America. Methods A retrospective, multicenter study of patients diagnosed with mRCC between 2010-2018 in Mexico City was conducted. The aim of the study was to evaluate the impact of healthcare insurance on access to treatment and survival in patients with mRCC. Results Among 924 patients, 55.4%, 42.6%, and 1.9% had no insurance (NI), social security, (SS) and private insurance (PI), respectively. De novo metastatic disease was more common in NI patients (70.9%) compared to SS (47.2%) and PI (55.6%) patients (p<0.001). According to IMDC Prognostic Index, 20.2% were classified as favorable, 49% as intermediate, and 30.8% as poor-risk disease. Access to systemic treatment differed by healthcare insurance: 36.1%, 99.5%, and 100% for the NI, SS, and PI patients, respectively (p<0.001). NI patients received fewer lines of treatment, with 24.8% receiving only one line of treatment (p<0.001). Median overall survival (OS) was 13.9 months for NI, 98.9 months for SS, and 147.6 months for NI patients (p<0.001). In multivariate analysis, NI status, brain metastases, sarcomatoid features, bone metastases, no treatment were significantly associated with worse OS. Conclusion OS in mRCC was affected by insurance availability in this resource-limited cohort of Mexican patients. These results underscore the need for effective strategies to achieve equitable healthcare access in an era of effective, yet costly systemic treatments.
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Affiliation(s)
- Maria T. Bourlon
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Yuly A. Remolina-Bonilla
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Aldo A. Acosta-Medina
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bruno I. Saldivar-Oviedo
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Antonio Perez-Silva
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Nayeli Martinez-Ibarra
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Francisco Javier Castro-Alonso
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ana E. Martín-Aguilar
- Department of Medical Oncology, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Samuel Rivera-Rivera
- Department of Medical Oncology, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Fernando Mota-Rivero
- Department of Medical Oncology, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Perla Pérez-Pérez
- Department of Medical Oncology, Centro Médico Nacional 20 Noviembre, Mexico City, Mexico
| | - María G. Díaz-Alvarado
- Department of Medical Oncology, Centro Médico Nacional 20 Noviembre, Mexico City, Mexico
| | | | - Saúl Campos-Gómez
- Statal Oncologic Center, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico
| | | | - Elaine T. Lam
- Department of Hematology and Medical Oncology, University of Colorado Cancer Center, Aurora, CO, United States
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Arrieta O, Zatarain-Barrón ZL, Cardona AF, Corrales L, Martin C, Cuello M. Uniting Latin America Through Research: How Regional Research Can Strengthen Local Policies, Networking, and Outcomes for Patients With Lung Cancer. Am Soc Clin Oncol Educ Book 2022; 42:1-7. [PMID: 35503985 DOI: 10.1200/edbk_349951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer represents a considerable global health threat, leading the list in terms of cancer-related deaths worldwide. An important proportion of lung cancer cases occur within Latin America, and current projections show that over the next decade, the number of deaths due to lung cancer will double in the region, underscoring the need to implement evidence-based interventions to improve outcomes. Several challenges have limited the progress in lung cancer research in Latin America for many years, though recently the surge of multidisciplinary, transnational, and transcultural research groups have overcome many of these limitations. The increase in region-specific knowledge has improved cancer care in the area, providing clinicians with a specific demographic and molecular profile for Hispanic patients with lung cancer; as a result, the implementation of precision oncology has benefited from a profound knowledge of the patient profile. Nonetheless, there are still challenges to improve research in Latin America, including stabilizing funding sources to continue independent research, supporting mentoring programs and an early immersion in clinical research for early career fellows, and overcoming barriers for publishing.
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Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Andrés F Cardona
- Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Luis Corrales
- Clinical Oncology Department, Centro de Investigaciones y Manejo del Cancer, San Jose, Costa Rica
| | - Claudio Martin
- Thoracic Oncology Unit, Instituto Fleming, Buenos Aires, Argentina
| | - Mauricio Cuello
- Medical Oncology Department, Hospital de Clinica, Universidad de la Republica, Montevideo, Uruguay
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Libkind AN, Salekh AZS, Markusova VA, Rubwalter DA. The Publication Activities of Russian Scientists in the Field of Medicine and Healthcare in Comparison with World Trends (1993–2019). Autom Doc Math Linguist 2021. [DOI: 10.3103/s0005105521050022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Werutsky G, Barrios CH, Cardona AF, Albergaria A, Valencia A, Ferreira CG, Rolfo C, de Azambuja E, Rabinovich GA, Sposetti G, Arrieta O, Dienstmann R, Rebelatto TF, Denninghoff V, Aran V, Cazap E. Perspectives on emerging technologies, personalised medicine, and clinical research for cancer control in Latin America and the Caribbean. Lancet Oncol 2021; 22:e488-e500. [PMID: 34735818 DOI: 10.1016/s1470-2045(21)00523-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 12/23/2022]
Abstract
Challenges of health systems in Latin America and the Caribbean include accessibility, inequity, segmentation, and poverty. These challenges are similar in different countries of the region and transcend national borders. The increasing digital transformation of health care holds promise of more precise interventions, improved health outcomes, increased efficiency, and ultimately reduced health-care costs. In Latin America and the Caribbean, the adoption of digital health tools is in early stages and the quality of cancer registries, electronic health records, and structured databases are problematic. Cancer research and innovation in the region are limited due to inadequate academic resources and translational research is almost fully dependent on public funding. Regulatory complexity and extended timelines jeopardise the potential improvement in participation in international studies. Emerging technologies, artificial intelligence, big data, and cancer research represent an opportunity to address the health-care challenges in Latin America and the Caribbean collectively, by optimising national capacities, sharing and comparing best practices, and transferring scientific and technical capabilities.
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Affiliation(s)
- Gustavo Werutsky
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil; Oncology Department, Rio de Janeiro, Brazil
| | - Andres F Cardona
- Thoracic and Brain Tumor Unit, Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia; Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - André Albergaria
- Translational Research & Industry Partnerships Unit, Instituto de Inovação em Saúde (i3S), Porto, Portugal
| | - Alfonso Valencia
- Institución Catalana de Investigación y Estudios Avanzados (ICREA) and Barcelona Supercomputing Center, Barcelona, Spain
| | | | - Christian Rolfo
- Center for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Evandro de Azambuja
- Medical Oncology Department, Institut Jules Bordet and l'Université Libre de Bruxelles, Brussels, Belgium
| | - Gabriel A Rabinovich
- Laboratory of Immunopathology, Institute of Biology and Experimental Medicine, and School of Exact and Natural Sciences, University of Buenos Aires, Buenos Aires, Argentina
| | - Georgina Sposetti
- Instituto de Investigaciones Clinicas Mar del Plata, Buenos Aires, Argentina; Un Ensayo para Mi, Buenos Aires, Argentina
| | - Oscar Arrieta
- Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Rodrigo Dienstmann
- Oncoclínicas Precision Medicine and Big Data Initiative, Rio de Janeiro, Brazil
| | | | - Valeria Denninghoff
- University of Buenos Aires - National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Veronica Aran
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Eduardo Cazap
- Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
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