This paper presents the main results of Colombian cancer patients’ quality of life measurement and effectively shows the affected dimensions for the portion of the population affected by cancer, and the effect social conditions or specific aspects of the disease has on said measurement. These results are imperative for the development of public policy since the dimensions most affected have, historically, not been considered for the established health plans aimed towards the population with cancer. Furthermore, these elements have not been contemplated when designing public policy whatsoever.
Amongst the most relevant results, the study found women had the worse perceived quality of life, making the findings even more impactful since breast cancer, according to the data presented by La Cuenta de Alto Costo, is the most prevalent type of cancer with 43,846 affected patients in 2016(10); by evaluating indicators that allow for an opportune care and diagnosis of the disease early detection is now more likely and continuous promotion and prevention from within the health care system, however, the results found in the study show the strategies developed have not resulted in an improvement in quality of life. Moreover, the results clearly show a socioeconomic quantifiable impact as consequence to the worsening of these patients’ quality of life, and hence an opportunity to develop public policy that would widely aid the health-illness process.
Like so, the study shows that cancer, denominated in Colombia as a catastrophic disease based on the technic complexity of its treatment, the high cost of treatment, and the low cost-effectiveness of intervention (11), generates a lower perceived quality of life amongst patients with a lower education and/or advanced stages of the diseases, thus showing the need for, not only, integrated care, but, psychosocial support for the handling of the diseases. This is highly relevant as the Colombian health care system vouches for equity between regimes and access and global coverages.
Results found in both EORTC and EQ5D3L scales show the most affected dimension is the emotional function, with an emphasis in anxiety and depression, which is the most neglected in the Colombian health system’s appropriate response. As a highlight, economic difficulties among the surveyed patients has the worse value in the foreseen outcomes for the symptoms dimension, a situation which is aggravated when the Colombian health care has total pathology coverage and therefore raises the need for specified studies with the purpose of determining to the highest degree the perceived financial toxicity, especially since it has different contexts, from spending out of pocket to the perceived financial ruin, because this study can only place it as the main affectation.
There have also been several studies conducted in Colombia, as is one by Bermudez and associates (12), where the quality of life was evaluated by using questionnaire QLQ-C30, conducted in cancer patients members of an institution in Bucaramanga, ratify the findings of the study since the disease was more prevalent in women with an average age of 60.89. Likewise, general results of the investigation found a measurement of 60 +/- 9.3 (CI 95% 57.01–62.99), compared to this study which found a general measurement of 66.05 (CI 95% 63.78–68.32), which are insignificant differences, and thus providing levity for the study which furthers details with a nation-wide sample.
Likewise, the results from the study concord in frequency and commitment in the perception of a worse quality of life for breast cancer patients with one conducted by Salas and associates in Antioquia(13), which was focused on evaluating the quality of life for breast cancer patients through the WHOQOL–100 scale, and providing results that showed women with the disease have a lower general scale as well as for the physical, psychological and social scales, hence ratifying the need for strategies centered around the patients rather than just providing health services.
One of the limitations of the investigation was the impossibility of using a questionnaire specially designed for the Colombian population, possibly causing an oversight of certain dimension that would otherwise be vital for the sociocultural context for Colombian patients. However, questionnaire EORTC QLQ-C30 was implemented based on the validation conducted in Colombia by Finck(14), where the scale was valued among the general population of age (18 years or older) for Colombia’s main cities (Medellín, Barranquilla, Bogotá, Cali, Pereira, Cartagena and Manizales), getting a response from approximately 1000 people.
The results of the validation in the general population show a higher measure for quality of life compared to the European population with a 77.1 and starting from said measurement the effect of cancer is put into context as the quality of life decreased in more than 10 points for the Colombian population. Further comparisons with the other evaluated scales in the general population confirm the deterioration caused by this pathology since the scales for the physical function, functional role, emotional function, cognitive function, and social function for the general population are above 87, while for cancer patients it does not reach 75, being the functional role the highest with 74.3.
In the other hand, the symptom scale for the study showed that insomnia 47.22 and financial difficulties 56.94 are the worse graded by the patient, while for the general population was fatigue, but that did not reach even 15 points, and the score given by sick patients did not drop from 13 points, this being diarrhea.
It is worth noting that it is possible that within this investigation there is not a significative sample for socioeconomic status since cancer patients from a higher status to 5 do not seek support from organizations such as charitable foundations, however, considering that this part of the population does not represent even 10% of the general population, the data presented in this analysis allow focus towards public policy that would tend to the all citizens.
The use of this measurements allows for keeping up with cancer patients as well as the evaluation of this strategies, by using evaluation instruments for quality of life and PRO as the ones used in this investigation.