Access to cancer care in Colombia, a middle-income country with universal health coverage

In this paper, we present the most currently available data on real access to high quality diagnostic and curative and palliative care in Colombia, a middle income country with relatively recent large healthcare reforms. We will focus on cancer types with a good average prognosis when detected and treated adequately and which are prioritized in national policies and cancer plans: cancers of the breast, cervix, prostate, colorectum and childhood cancers. These cancers have a quite poor prognosis compared to high-income countries. We find that, despite having achieved an almost "universal health coverage", Colombia suffers serious problems in accessibility to preventative, diagnostic and treatment services for patients with cancer. People living in poverty have lower real access to all types of care, but other problems are due to lack of health literacy, beliefs and knowledge. Much can be gained by early detection, the advanced stages at diagnosis of many cancers can be avoided by increasing awareness amongst both the general public and health care professionals. Delays in diagnosis and treatment can be reduced, changes in legislation and bureaucratic processes, and increases in trained human resources and equipment is needed. The economic impact of getting a cancer diagnosis to patients and their families is understudied but seems to be substantial, as well as studies on quality of life of cancer patients and survivors - providing ample room for improvement.