Leon

Local Health System

• The assessment found a lack of standardisation, homogeneous regulations, unifying criteria and protocols as well as siloed care models and programmes/efforts.

Multidisciplinary Teams and Work Safety

• Multidisciplinary cancer care (surgery, palliative care, radiotherapy, chemotherapy and nuclear medicine) in Leon was hindered for various reasons including lack of regulation, limited human resources and poor coordination.

Management and Information System and Database

• Decisions and contracts for healthcare needs were agreed annually at the state Ministry of Health. This centralised decision-making model imposed constraints and restricted the participation of local stakeholders.
• Reimbursement mechanisms and purchasing policies (particularly after the pandemic) increased shortages of some cancer drugs.
• Healthcare registries were unspecific, fragmented and federally dependent, limiting their decision-making potential.
• Cancer was often detected late due to lack of training in early diagnosis and an inefficient referral system from the primary level.

Quality Assurance

• The data revealed limited compliance with standardised treatment protocols in surgical oncology, chemotherapy, radiotherapy and pathology.
• Standardised guidelines for the management of specific cancers were lacking.

Financing and affordability

• At city level, decision-making and resource allocation capabilities were limited.
• Scarce financial resources led to insufficient financial coverage for patients, out-of-pocket expenses and even treatment discontinuation.

Human Resources

• The needs assessment identified long lead times between requests for personnel and their effective assignment.
• Professionalisation was lacking in some cancer support areas.
• Medical physicists and technicians were lacking, as were support staff in recovery areas for complex surgeries and oncology nurses.
• The human resources problems were exaggerated by a shortage of continuous training programmes.
• Specialised professionals faced non-competitive salaries and lack of incentives.

Pathology

• Pathology units were held back by inadequate infrastructure and facilities that did not meet required standards.
• Quality assurance in the pre-analytical and post-analytical processes was limited.
• Pathology reports lacked homogenisation.
• Not all centres had the supplies for immunohistochemistry tests required for oncologic-hematologic cases.

Clinical Laboratory

• Cancer was absent from the list of services provided by public laboratories. Demand was higher than capacity and oncology patients often faced delays in diagnosis.

Radiology

• Quality control protocols existed. However, as a result of high workloads, these may not have been fully carried out.
• Image storage systems were not available, which hindered quality control for mammography.
• Development of interventional radiology for cancer care was slow.

Nuclear Medicine

• Not all oncology care specialists were up to date on the availability of nuclear medicine resources that could benefit their cancer patients.

Systemic Treatment

• Few centres offered full cancer services accessible to the city population (only by coverage).
• The referral system contained several barriers to effective bone marrow transplantation.
• Staff administering cancer medicines lacked safety training.

Radiotherapy

• Supply and demand for radiotherapy services were misaligned.
• There were limitations in equipment (particularly brachytherapy) and qualified human resources personnel (especially medical physicists and technicians).
• Not all institutions had a quality assurance programme in radiotherapy, and there was no culture of process safety in radiotherapy.

Paediatric Cancer

• Various sociodemographic factors affected paediatric cancer outcomes.
• Specialised services were lacking for some less common paediatric cancer services.

Oncology Surgery

• There was no quality assurance programme for oncological surgery.
• A high proportion of new cancer cases reached a very late stage, which reduced surgical options.

Palliative Care

• Not all hospitals had palliative care services, trained personnel or infrastructure.
• Appropriate medicines were often unavailable for adequate symptom control.

Patient Navigation and Community Access

• There were several barriers to timely diagnosis and adequate treatment, including misinformation, lack of awareness and lack of education about treatment.
• Patients received insufficient information regarding their rights and available services and treatment.