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Health Services and Patient-Centered Outcomes Research

(P 219) RETROPERITONEAL SARCOMA: HEALTH SYSTEM BARRIERS AND THE RATIONALE FOR A SPECIALIZED SARCOMA UNIT

    Author(s)

  • Juliana Restrepo, MD, MSc (she/her/hers)

    Surgical oncologist
    Fundación Colombiana de Cancerología Clínica Vida, Clínica Astorga
    Medellín, Antioquia, Colombia

    • Co-Author(s)

  • CE

    Claudia Echeverri, MD

    Surgical Oncologist
    Fundación Colombiana de Cancerología Clínica Vida
    Medellin, Antioquia, Colombia

  • FS

    Felipe Solorzano, MD

    Surgical Oncologist
    Fundación Colombiana de Cancerología Clínica Vida
    Medellin, Antioquia, Colombia

  • JB

    Jorge Bernal, MD

    Surgical Oncologist
    Fundación Colombiana de Cancerología Clínica Vida
    Medellin, Antioquia, Colombia

  • Hernán Camilo Luna Hurtado, MD

    General Surgeon
    Fundación Colombiana de Cancerología Clínica Vida
    Medellin, Antioquia, Colombia

  • SR

    Santiago Rojas, MD

    Surgical Oncologist
    Fundación Colombiana de Cancerología Clínica Vida, Hospital San Vicente Fundación
    Medellin, Antioquia, Colombia

  • LH

    Laura Herrera, MD

    Medical doctor
    Fundación Colombiana de Cancerología Clínica Vida
    Medellin, Antioquia, Colombia

  • DL

    Daniela Lara, MD

    Medical doctor
    Fundación Colombiana de Cancerología Clínica Vida
    Medellin, Antioquia, Colombia

Objective: Colombia's fragmented healthcare system, due to economic and geographic inequities, significantly impedes sarcoma patient care. We analyzed health system-dependent variables affecting retroperitoneal sarcoma patients, proposing a specialized sarcoma unit to address these challenges.

Methods: Descriptive retrospective analysis of patients surgically treated for retroperitoneal sarcoma at Fundación Colombiana de Cancerología Clínica Vida, Medellín, Colombia (2016-2025). Descriptive statistics presented qualitative (frequencies) and quantitative variables (medians, interquartile ranges [IQR]). Wilcoxon test compared median follow-up and diagnosis-to-surgery days across health insurance regimens. Kruskal-Wallis test compared these medians across insurance companies. p< 0.05 significant.

Results: Seventy-four retroperitoneal sarcoma patients underwent surgery; 47 (63.5%) were women with a median age of 61 [IQR: 26-85] years. Most (75.6%) resided in the Medellín metropolitan area, and 22.9% had a subsidized health insurance regimen. Patients were from 5 different insurance companies and used a median of 3 [IQR: 2-4] imaging providers and 2 [IQR: 1-2] pathology providers. Of 69 patients, 24% lacked presurgical biopsy; 4% were by laparotomy and 1.3% by laparoscopy. Ten (13.5%) had prior non-oncological surgery at a non-oncological institution. Median days from diagnosis to oncological surgery were 65 [IQR: 9-189] higher in subsidized vs. contributory regimens and non-metropolitan vs. metropolitan residents. Median follow-up was 24 [IQR: 11-47] and it was shorter in subsidized vs. contributory regimens and non-metropolitan vs. metropolitan residents. Treatment and follow-up times varied according to insurance companies.

Conclusion: The fragmented healthcare system of Colombia, driven by insurer-led provider changes, causes significant sarcoma care barriers and delays. Establishing a specialized sarcoma unit in Medellín would consolidate diagnosis, treatment, and follow-up. The proposal aims to overcome fragmentation, ensure consistent expertise access, and improve outcomes for these rare tumors.