Puschel Klaus, Arancibia Victor, Rioseco Andrea, Paz Sarah, Soto María Gabriela, Martinez Javiera, Faundez Marcela, Acevedo Francisco, Di Biase Felipe, Emery Jon, León Augusto, Are Chandrakanth, Thompson Beti
Department of Family and Community Medicine, Pontificia Universidad Catolica De Chile School of Medicine, Santiago, Chile
Center for Cancer Prevention and Control (CECAN), Santiago, Chile.
BMJ Open. 2025 Aug 10;15(8):e097015. doi: 10.1136/bmjopen-2024-097015.
The rapid growth in the cancer survivor population in Chile and Latin America raises new challenges in addressing their care needs. This study assesses the health status and compares the quality of care and quality of life in cancer survivors at a primary care network and a private cancer centre in Santiago, Chile.
Retrospective cohort study.
Three primary care clinics and one cancer centre in Chile.
All breast and colorectal cancer patients identified from a primary care retrospective cohort of 61 174 were followed from 2018 to 2023 and compared with an equivalent sample of patients from a university cancer centre identified during the same period.
Quality of care was assessed based on American Cancer Society standards, while quality of life was measured using the EuroQol 5 Dimensions-5 Levels survey instrument.
A total of 420 cancer survivors participated in the study; 208 from primary care and 212 from the cancer centre. All participants received substandard care. Patients in primary care had lower educational levels and higher rates of comorbidity. They reported a lower quality of life score (72.22 vs 78.43, p<0.001), a higher prevalence of chronic pain (37.02% vs 25.6%, p=0.016) and more severe mental health symptoms (19.89% vs 10.05%, p=0.03). Differences in educational level and cancer stage at diagnosis explained the observed disparities in chronic pain and mental health disorders between the two populations. Primary care patients received more psychosocial care (OR=2.29; 95% CI: 1.55 to 3.39), cardiovascular assessment (OR=2.66; 95% CI:2.17 to 3.26) and psychosocial evaluations (OR: 9.07; 95% CI:4.75 to 17.32).
Cancer survivors face a significant disease burden and receive substandard care in Chile. As the primary source of care for this population, primary care is challenged to better integrate with speciality care to develop an effective shared care model for cancer survivors.
智利和拉丁美洲癌症幸存者人数的快速增长给满足他们的护理需求带来了新挑战。本研究评估了智利圣地亚哥一个初级保健网络和一个私立癌症中心中癌症幸存者的健康状况，并比较了他们的护理质量和生活质量。
回顾性队列研究。
智利的三家初级保健诊所和一家癌症中心。
从61174人的初级保健回顾性队列中确定的所有乳腺癌和结直肠癌患者在2018年至2023年期间接受随访，并与同期在大学癌症中心确定的同等患者样本进行比较。
根据美国癌症协会标准评估护理质量，使用欧洲五维健康量表-5级调查问卷测量生活质量。
共有420名癌症幸存者参与了研究；208名来自初级保健机构，212名来自癌症中心。所有参与者均接受了不合格的护理。初级保健机构的患者教育水平较低，合并症发生率较高。他们报告的生活质量得分较低（72.22对78.43，p<0.001），慢性疼痛患病率较高（37.02%对25.6%，p=0.016），心理健康症状更严重（19.89%对10.05%，p=0.03）。诊断时的教育水平和癌症分期差异解释了这两个人群在慢性疼痛和精神健康障碍方面观察到的差异。初级保健患者接受了更多的心理社会护理（比值比=2.29；95%置信区间：1.55至3.39）、心血管评估（比值比=2.66；置信区间：2.17至3.26）和心理社会评估（比值比：9.07；95%置信区间：4.75至17.32）。
在智利，癌症幸存者面临着重大的疾病负担，且接受的护理不合格。作为这一人群的主要护理来源，初级保健面临着更好地与专科护理相结合，为癌症幸存者制定有效的共享护理模式的挑战。
