The Colombian Medical Oncologists Workforce

As a result of population aging, the absolute number of new cancer cases will increase in Colombia during the next decades from about 101,893 per year in 2018 (excluding nonmelanoma skin cancer) to about 136,246 per year in 2040, still with an average annual percentage change of −1.5%.1 The country shows an epidemiologic transition with breast and prostate cancers as leading causes of cancer incidence and mortality, and a mortality reduction from infection and tobacco-associated cancers such as those from the cervix, liver, stomach, larynx, esophagus, and lung.2,3 However, the latter remain highly prevalent and, with a few exceptions, population-based survival shows a relative reduction for most types of cancer and with significant differences when compared with high-income countries.4 Despite the reduced survival, the 5-year prevalence for all cancer types was 466.4 per 100,000 in 2018 corresponding to approximately 230,726 prevalent cases.1 The relative reduction in survival may indicate scarce progress in cancer early detection or proper timely treatment. In this regard, some analyses show a variable number of visits to the oncologist depending upon the stage of the disease, with higher rates at the beginning of treatment (particularly if neoadjuvant protocols are used), lower rates among survivors with controlled disease, and higher rates again toward the end of life.5 Thus, a high proportion of advanced cases at diagnosis, as may be the case in Colombia,6 would require greater oncologist time to meet the demand. In addition to cancer incidence and stage at diagnosis, technologies used for cancer treatment also determine the demand of medical oncology. Currently target and immune therapies represent the highest investment in research and development by pharmaceutical companies,7 thus inducing permanent licensing of new oncology drugs and delivery of associated knowledge, which demands careful analysis by the medical oncologist workforce. Moreover, new technologies lead to relevant changes in oncology practice; for instance, trastuzumab combined with cytotoxic drugs for the management of HER2-positive breast cancer patients (approximately 20% of cases) reduces relapse in 50% of cases and increases survival rates.8 Furthermore, the addition of trastuzumab increases treatment adverse effects and modifies the treatment schedule from approximately 8 to 27 sessions during the first year of treatment compared to chemotherapy alone.5 Similarly, systemic therapy combined with other treatment modalities, such as in the case of neoadjuvant and adjuvant protocols or concomitant chemo-radiation, the administration of several lines of treatment, and consolidation with bone marrow transplantation, have also shown better disease control and longer survival for different types of cancer, thus resulting in increased medical oncologist time for cancer care. All factors described challenge the planning and supply of medical oncologist workforce, a situation critical to middle-income countries where better access to new cancer care technologies might take place, but the availability of resources to harmonize technology development with cancer care delivery is not a common situation. Hence, in this article, we review supply and demand of the medical oncologist workforce in Colombia using accredited sources of information and international standards.