Desenlaces económicos sobre fragmentación en la atención de pacientes con cáncer de mama y estómago en el régimen contributivo en Colombia
ilustraciones, graficas, mapas
- Autores:
-
Rozo Agudelo, Nicolás
- Tipo de recurso:
- Fecha de publicación:
- 2022
- Institución:
- Universidad Nacional de Colombia
- Repositorio:
- Universidad Nacional de Colombia
- Idioma:
- spa
- OAI Identifier:
- oai:repositorio.unal.edu.co:unal/81823
- Palabra clave:
- 610 - Medicina y salud::614 - Medicina Forense; incidencia de lesiones, heridas, enfermedades; medicina preventiva pública
Atención al Paciente
Patient Care
Costo de Enfermedad
Cost of Illness
Neoplasias de la Mama
Neoplasias gástricas
Continuidad de la Atención al Paciente
Breast cancer
Stomach cancer
Delivery of health Care
- Rights
- openAccess
- License
- Atribución-NoComercial-SinDerivadas 4.0 Internacional
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Desenlaces económicos sobre fragmentación en la atención de pacientes con cáncer de mama y estómago en el régimen contributivo en Colombia |
| dc.title.translated.eng.fl_str_mv |
Economic outcomes about healthcare fragmentation in breast and stomach cancer patients in contributive regimen, Colombia |
| title |
Desenlaces económicos sobre fragmentación en la atención de pacientes con cáncer de mama y estómago en el régimen contributivo en Colombia |
| spellingShingle |
Desenlaces económicos sobre fragmentación en la atención de pacientes con cáncer de mama y estómago en el régimen contributivo en Colombia 610 - Medicina y salud::614 - Medicina Forense; incidencia de lesiones, heridas, enfermedades; medicina preventiva pública Atención al Paciente Patient Care Costo de Enfermedad Cost of Illness Neoplasias de la Mama Neoplasias gástricas Continuidad de la Atención al Paciente Breast cancer Stomach cancer Delivery of health Care |
| title_short |
Desenlaces económicos sobre fragmentación en la atención de pacientes con cáncer de mama y estómago en el régimen contributivo en Colombia |
| title_full |
Desenlaces económicos sobre fragmentación en la atención de pacientes con cáncer de mama y estómago en el régimen contributivo en Colombia |
| title_fullStr |
Desenlaces económicos sobre fragmentación en la atención de pacientes con cáncer de mama y estómago en el régimen contributivo en Colombia |
| title_full_unstemmed |
Desenlaces económicos sobre fragmentación en la atención de pacientes con cáncer de mama y estómago en el régimen contributivo en Colombia |
| title_sort |
Desenlaces económicos sobre fragmentación en la atención de pacientes con cáncer de mama y estómago en el régimen contributivo en Colombia |
| dc.creator.fl_str_mv |
Rozo Agudelo, Nicolás |
| dc.contributor.advisor.none.fl_str_mv |
Sanchez Pedraza, Ricardo Buitrago Gutierrez, Giancarlo |
| dc.contributor.author.none.fl_str_mv |
Rozo Agudelo, Nicolás |
| dc.subject.ddc.spa.fl_str_mv |
610 - Medicina y salud::614 - Medicina Forense; incidencia de lesiones, heridas, enfermedades; medicina preventiva pública |
| topic |
610 - Medicina y salud::614 - Medicina Forense; incidencia de lesiones, heridas, enfermedades; medicina preventiva pública Atención al Paciente Patient Care Costo de Enfermedad Cost of Illness Neoplasias de la Mama Neoplasias gástricas Continuidad de la Atención al Paciente Breast cancer Stomach cancer Delivery of health Care |
| dc.subject.other.none.fl_str_mv |
Atención al Paciente Patient Care Costo de Enfermedad Cost of Illness |
| dc.subject.proposal.spa.fl_str_mv |
Neoplasias de la Mama Neoplasias gástricas Continuidad de la Atención al Paciente |
| dc.subject.proposal.eng.fl_str_mv |
Breast cancer Stomach cancer Delivery of health Care |
| description |
ilustraciones, graficas, mapas |
| publishDate |
2022 |
| dc.date.accessioned.none.fl_str_mv |
2022-08-09T17:01:30Z |
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2022-08-09T17:01:30Z |
| dc.date.issued.none.fl_str_mv |
2022 |
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Trabajo de grado - Maestría |
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info:eu-repo/semantics/masterThesis |
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info:eu-repo/semantics/acceptedVersion |
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Text |
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http://purl.org/redcol/resource_type/TM |
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https://repositorio.unal.edu.co/handle/unal/81823 |
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Universidad Nacional de Colombia |
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Repositorio Institucional Universidad Nacional de Colombia |
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https://repositorio.unal.edu.co/ |
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https://repositorio.unal.edu.co/handle/unal/81823 https://repositorio.unal.edu.co/ |
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Universidad Nacional de Colombia Repositorio Institucional Universidad Nacional de Colombia |
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RedCol LaReferencia |
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GLOBOCAN. The Global Cancer Observatory - All cancers. Int Agency Res Cancer - WHO [Internet]. 2020;419:199–200. Available from: https://gco.iarc.fr/today/home Whiteman DC, Wilson LF. The fractions of cancer attributable to modifiable factors: A global review. Cancer Epidemiol [Internet]. 2016;44:203–21. Available from: http://dx.doi.org/10.1016/j.canep.2016.06.013 Onyango P. Genomics and cancer. Curr Opin Oncol. 2002;14(1):79–85. Weaver SJ, Jacobsen PB. Cancer care coordination: Opportunities for healthcare delivery research. Transl Behav Med. 2018;8(3):503–8. Data I, Method L. Globocan Colombia 2018. 2018;380:1–2. The Global Cancer Observatory. GLOBOCAN 2020: International Agency Research on Cancer. 2020;509:1–2. Raphael MJ, Biagi JJ, Kong W, Mates M, Booth CM, Mackillop WJ. The relationship between time to initiation of adjuvant chemotherapy and survival in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2016;160(1):17–28. Soyfer V, Geva R, Michelson M, Inbar M, Shacham-Shmueli E, Corn BW. The impact of overall radiotherapy treatment time and delay in initiation of radiotherapy on local control and distant metastases in gastric cancer. Radiat Oncol. 2014;9(1):1–5. Montenegro H, Holder R, Ramagem C, Urrutia S, Griffith T, Cruz M, et al. Combating health care fragmentation through integrated health services delivery networks. Int J Integr Care [Internet]. 2011;11(Suppl):e100. Available from: http://new.paho.org/hq/index.php?option=com_content&task=view&id=6183&Itemid=3553 Justiniano CF, Xu Z, Becerra AZ, Aquina CT, Boodry CI, Swanger A, et al. Long-term Deleterious Impact of Surgeon Care Fragmentation After Colorectal Surgery on Survival: Continuity of Care Continues to Count. Dis Colon Rectum. 2017;60(11):1147–54. Murcia E, Aguilera J, Wiesner C, Pardo C. Oncology services supply in Colombia. Colomb Med. 2018;49(1):89–96. Varol U, Kucukzeybek Y, Alacacioglu A, Somali I, Altun Z, Aktas S, et al. BRCA genes: BRCA 1 and BRCA 2. J BUON. 2018;23(4):862–6. Camilo V, Sugiyama T, Touati E. Pathogenesis of Helicobacter pylori infection. Helicobacter. 2017;22:1–6. Harbeck N, Gnant M. Breast cancer. Lancet [Internet]. 2017;389(10074):1134–50. Available from: http://dx.doi.org/10.1016/S0140-6736(16)31891-8 Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet [Internet]. 2020;396(10251):635–48. Available from: http://dx.doi.org/10.1016/S0140-6736(20)31288-5 Matikas A, Foukakis T, Swain S, Bergh J. Avoiding over- And undertreatment in patients with resected node-positive breast cancer with the use of gene expression signatures: are we there yet? Ann Oncol. 2019;30(7):1044–50. Perou CM, Sørile T, Eisen MB, Van De Rijn M, Jeffrey SS, Ress CA, et al. Molecular portraits of human breast tumours. Nature. 2000;406(6797):747–52. Correa P. Gastric Cancer. Overview. Gastroenterol Clin North Am [Internet]. 2013;42(2):211–7. Available from: http://dx.doi.org/10.1016/j.gtc.2013.01.002 McLaughlin SA. Surgical Management of the Breast. Breast Conservation Therapy and Mastectomy. Surg Clin North Am [Internet]. 2013;93(2):411–28. Available from: http://dx.doi.org/10.1016/j.suc.2012.12.006 Park YM, Cho E, Kang HY, Kim JM. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: A systematic review and metaanalysis. Surg Endosc. 2011;25(8):2666–77. van der Wielen N, Straatman J, Daams F, Rosati R, Parise P, Weitz J, et al. Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial. Gastric Cancer [Internet]. 2021;24(1):258–71. Available from: https://doi.org/10.1007/s10120-020-01109-w Gennari A, André F, Barrios CH, Cortés J, de Azambuja E, DeMichele A, et al. ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer ☆. Ann Oncol. 2021;32(12):1475–95. Cunningham D, Allum WH, Stenning SP. Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer. N Engl J Med. 2006;3355(1):11–20. MacDonald JS, Smalley SR. Chemoradiotherapy after surgery compared with surgery aline for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345(10):725–30. WHO/Europe | Health systems [Internet]. [cited 2022 Mar 29]. Available from: https://www.euro.who.int/en/health-topics/Health-systems Panamericana de la Salud OPS O. Conceptos, Opciones de Politica y Hoja de Ruta para su Implementacion en las Americas. Sun X, Tang W, Ye T, Zhang Y, Wen B, Zhang L. Integrated care: A comprehensive bibliometric analysis and literature review. Int J Integr Care. 2014;14(2):1–12. Brigham R. Frandsen P, Karen E. Joynt, MD M, James B. Rebitzer P, and Ashish K. Jha, MD M. Care Fragmentation, Quality, and Cost Among Chronically Ill Patients. Am J Manag Care [Internet]. 2015;21(May 2015 5):355–62. Available from: http://www.ajmc.com/journals/issue/2015/2015-vol21-n5/Care-Fragmentation-Quality-Costs-Among-Chronically-Ill-Patients Skolarus TA, Zhang Y, Hollenbeck BK. Understanding fragmentation of prostate cancer survivorship care: Implications for cost and quality. Cancer. 2012;118(11):2837–45. Fishman PA, Hornbrook MC, Ritzwoller DP, O’Keeffe-Rosetti MC, Lafata JE, Salloum RG. The challenge of conducting comparative effectiveness research in cancer: The impact of a fragmented US health-care system. J Natl Cancer Inst - Monogr. 2013;(46):99–105. Ehrenstein V, Nielsen H, Pedersen AB, Johnsen SP, Pedersen L. Clinical epidemiology in the era of big data: New opportunities, familiar challenges. Clin Epidemiol. 2017;9:245–50. Booth CM, Tannock IF. Randomised controlled trials and population-based observational research: Partners in the evolution of medical evidence. Br J Cancer. 2014;110(3):551–5. Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Peteresen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLoS Med. 2015;12(10):1–22. Checklists - STROBE [Internet]. [cited 2022 Mar 29]. Available from: https://www.strobe-statement.org/checklists/ Meyer A-M, Olshan AF, Green L. Big Data for Population-Based Cancer Research. N C Med J [Internet]. 2014;75(4):265–9. Available from: file:///C:/Users/Carla Carolina/Desktop/Artigos para acrescentar na qualificação/The impact of birth weight on cardiovascular disease risk in the.pdf Sistema de Información de Cáncer en Colombia [Internet]. [cited 2022 Apr 27]. Available from: https://www.infocancer.co/portal/#!/filtro_incidencia/ Gaviria Uribe, Alejandro; Wiesner Ceballos, Carolina; De Vries, Esther; Acosta Peñaloza, Jesus Antonio; Pérez Acevedo JJ. Anuario Estadístico. Instituto de Cancerología-ESE Colombia. 2013. Salud M de. Registro Especial de Prestadores de Servicios de Salud - REPS [Internet]. Available from: https://prestadores.minsalud.gov.co/habilitacion/ Costo C de A. Situación del cáncer de la población atendida en el SGSSS en Colombia. 2015. Ministerio de Salud y Protección Social. Estudio de la suficiencia y de los mecanismos de ajuste de riesgo para el cálculo de la Unidad de Pago por Capitación para garantizar el Plan Obligatorio de Salud en el año 2007. Ministerio de Salud y Protección Social. 2013. Elasticidad - Qué es, definición y significado | 2022 | Economipedia [Internet]. [cited 2022 May 9]. Available from: https://economipedia.com/definiciones/elasticidad.html Dawson JF. Testing and Interpreting Interaction Effects. Oxford Res Encycl Bus Manag. 2021;1–8. Pardoe I. Applied Regression Modeling: A Business Approach. Applied Regression Modeling: A Business Approach. 2012. Matsumoto K, Haga K, Kitazawa T, Seto K, Fujita S, Hasegawa T. Cost of illness of breast cancer in Japan: trends and future projections. BMC Res Notes. 2015;8(1):1–7. Haga K, Matsumoto K, Kitazawa T, Seto K, Fujita S, Hasegawa T. Cost of illness of the stomach cancer in Japan - A time trend and future projections. BMC Health Serv Res [Internet]. 2013;13(1):1. Available from: BMC Health Services Research Cortis LJ, Ward PR, McKinnon RA, Koczwara B. Integrated care in cancer: What is it, how is it used and where are the gaps? A textual narrative literature synthesis. Eur J Cancer Care (Engl). 2017;26(4):1–17. Kaye DR, Min HS, Norton EC, Ye Z, Li J, Dupree JM, et al. System-level health-care integration and the costs of cancer care across the disease continuum. J Oncol Pract. 2018;14(3):e149–57. Sardi A, Orozco-Urdaneta M, Velez-Mejia C, Perez-Bustos AH, Munoz-Zuluaga C, El-Sharkawy F, et al. Overcoming barriers in the implementation of programs for breast and cervical cancers in Cali, Colombia: A pilot model. J Glob Oncol. 2019;2019(5):1–9. Thrift AP, El-Serag HB. Burden of Gastric Cancer. Clin Gastroenterol Hepatol. 2020;18(3):534–42. Saldaña Espinel LE, Patiño Benavidez AF, Rozo Agudelo N, Gamboa Garay OA, Paneso Echeverry JE, Bernal Gutierrez M, et al. Estimating breast, stomach, and colorectal cancer incidence in Colombia through administrative database algorithms: A systematic review of literature and real-world data study. J Clin Oncol. 2021 May 20;39(15_suppl):e18810–e18810. Setoguchi S, Solomon DH, Glynn RJ, Cook EF, Levin R, Schneeweiss S. Agreement of diagnosis and its date for hematologic malignancies and solid tumors between medicare claims and cancer registry data. Cancer Causes Control. 2007;18(5):561–9. Ajrouche A, Estellat C, De Rycke Y, Tubach F. Evaluation of algorithms to identify incident cancer cases by using French health administrative databases. Pharmacoepidemiol Drug Saf. 2017;26(8):935–44. |
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Universidad Nacional de Colombia |
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Bogotá - Medicina - Maestría en Epidemiología Clínica |
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Facultad de Medicina |
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Bogotá, Colombia |
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Atribución-NoComercial-SinDerivadas 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Sanchez Pedraza, Ricardof55ddb76ec231ee228b45eed9de6033cBuitrago Gutierrez, Giancarlob504c94bfc22c8541225807419592087Rozo Agudelo, Nicolás50579483f954132b9352d74718348e9b2022-08-09T17:01:30Z2022-08-09T17:01:30Z2022https://repositorio.unal.edu.co/handle/unal/81823Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, graficas, mapasIntroducción: El cáncer de mamá y estomago son patologías de alta incidencia y mortalidad en Colombia. Para su tratamiento se requiere de los tres pilares del tratamiento: cirugía oncológica, quimioterapia y radioterapia. La falta de integración de los tres pilares puede llevar a la fragmentación de la atención en salud, esta investigación mide el impacto sobre los costos totales de atención. Métodos: Se realizó un estudio retrospectivo de cohortes de sujetos incluidos entre los años 2013 y 2015 y un seguimiento de 3 años. Los sujetos fueron identificados mediante algoritmos basados en el registro de servicios y códigos CIE-10 relacionados con los tipos de cáncer en estudio. La exposición fue la fragmentación definida como el número de IPS diferentes durante el primer año de supervivencia que conformaron la red de atención de los pacientes. El desenlace fue la suma los costos de todos los servicios pagados desde la vista del tercer pagador y se deflactaron a pesos del año 2021. Se estimó el impacto de la fragmentación sobre los costos con modelos multivariados de regresión lineal utilizando intervalos de confianza del 95% a partir de errores estándar robustos. Resultados: Se ensambló una cohorte para cada enfermedad (cáncer de mama: 13106, cáncer de estómago: 2434). La mediana de costos en cáncer de mama es $1.601.333 COP y en cáncer de estómago $2.947.926 COP. Por cada incremento en un punto porcentual del número de IPS en el primer año de supervivencia los costos aumentaron significativamente 2.18% (IC 95% 2.09 – 2.24) en cáncer de mama y 1.97% (IC 95% 1.82 – 2.12) en cáncer de estómago. Conclusión: La fragmentación de la atención en pacientes con cáncer de mama y estomago se asocia significativamente con un aumento en los costos. Se requieren múltiples esfuerzos para alcanzar la integralidad en la atención del paciente con cáncer. (Texto tomado de la fuente)Background: Breast and gastric cancer have high incidence and mortality in Colombia. Both types of cancer require three principal treatments: surgery, chemotherapy and radiotherapy. Lack of integration could lead to healthcare fragmentation, this investigation measures fragmentation impact on total cost. Methods: A retrospective cohort study included subjects from 2013 to 2015 and followed those patients for a period of 3 years. Subjects were identified by algorithms based on services and ICD – 10 codes related to the types of cancer. For measuring fragmentation, the count of providers during the first year of follow-up has been used. All cost was added and adjusted by inflation to 2021. Impact on cost were modeled with lineal robust regression. Results: Cohorts were assembled by cancer type (breast cancer: 13106, gastric cancer: 2434). Median follow up time was 3 years in both cohorts. The median cost in breast cancer was $1.601.333 and $2.947.926 in gastric cancer. The increase by one percentage point in the number of providers increases costs significantly 2.18% (CI 95% 2.09% – 2.24%) in breast cancer and 1.97% (CI 95% 1.82% – 2.12%) in gastric cancer. Conclusion: Healthcare fragmentation in breast and gastric cancer is associated with increase in total cost. Multiple efforts are required in order to reach healthcare integration in cancer care.MaestríaMagíster en Ciencias Epidemiología ClínicaAtención en salud86 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Maestría en Epidemiología ClínicaFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::614 - Medicina Forense; incidencia de lesiones, heridas, enfermedades; medicina preventiva públicaAtención al PacientePatient CareCosto de EnfermedadCost of IllnessNeoplasias de la MamaNeoplasias gástricasContinuidad de la Atención al PacienteBreast cancerStomach cancerDelivery of health CareDesenlaces económicos sobre fragmentación en la atención de pacientes con cáncer de mama y estómago en el régimen contributivo en ColombiaEconomic outcomes about healthcare fragmentation in breast and stomach cancer patients in contributive regimen, ColombiaTrabajo de grado - Maestríainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMRedColLaReferenciaGLOBOCAN. The Global Cancer Observatory - All cancers. Int Agency Res Cancer - WHO [Internet]. 2020;419:199–200. Available from: https://gco.iarc.fr/today/homeWhiteman DC, Wilson LF. The fractions of cancer attributable to modifiable factors: A global review. Cancer Epidemiol [Internet]. 2016;44:203–21. Available from: http://dx.doi.org/10.1016/j.canep.2016.06.013Onyango P. Genomics and cancer. Curr Opin Oncol. 2002;14(1):79–85.Weaver SJ, Jacobsen PB. Cancer care coordination: Opportunities for healthcare delivery research. Transl Behav Med. 2018;8(3):503–8.Data I, Method L. Globocan Colombia 2018. 2018;380:1–2.The Global Cancer Observatory. GLOBOCAN 2020: International Agency Research on Cancer. 2020;509:1–2.Raphael MJ, Biagi JJ, Kong W, Mates M, Booth CM, Mackillop WJ. The relationship between time to initiation of adjuvant chemotherapy and survival in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2016;160(1):17–28.Soyfer V, Geva R, Michelson M, Inbar M, Shacham-Shmueli E, Corn BW. The impact of overall radiotherapy treatment time and delay in initiation of radiotherapy on local control and distant metastases in gastric cancer. Radiat Oncol. 2014;9(1):1–5.Montenegro H, Holder R, Ramagem C, Urrutia S, Griffith T, Cruz M, et al. Combating health care fragmentation through integrated health services delivery networks. Int J Integr Care [Internet]. 2011;11(Suppl):e100. Available from: http://new.paho.org/hq/index.php?option=com_content&task=view&id=6183&Itemid=3553Justiniano CF, Xu Z, Becerra AZ, Aquina CT, Boodry CI, Swanger A, et al. Long-term Deleterious Impact of Surgeon Care Fragmentation After Colorectal Surgery on Survival: Continuity of Care Continues to Count. Dis Colon Rectum. 2017;60(11):1147–54.Murcia E, Aguilera J, Wiesner C, Pardo C. Oncology services supply in Colombia. Colomb Med. 2018;49(1):89–96.Varol U, Kucukzeybek Y, Alacacioglu A, Somali I, Altun Z, Aktas S, et al. BRCA genes: BRCA 1 and BRCA 2. J BUON. 2018;23(4):862–6.Camilo V, Sugiyama T, Touati E. Pathogenesis of Helicobacter pylori infection. Helicobacter. 2017;22:1–6.Harbeck N, Gnant M. Breast cancer. Lancet [Internet]. 2017;389(10074):1134–50. Available from: http://dx.doi.org/10.1016/S0140-6736(16)31891-8Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet [Internet]. 2020;396(10251):635–48. Available from: http://dx.doi.org/10.1016/S0140-6736(20)31288-5Matikas A, Foukakis T, Swain S, Bergh J. Avoiding over- And undertreatment in patients with resected node-positive breast cancer with the use of gene expression signatures: are we there yet? Ann Oncol. 2019;30(7):1044–50.Perou CM, Sørile T, Eisen MB, Van De Rijn M, Jeffrey SS, Ress CA, et al. Molecular portraits of human breast tumours. Nature. 2000;406(6797):747–52.Correa P. Gastric Cancer. Overview. Gastroenterol Clin North Am [Internet]. 2013;42(2):211–7. Available from: http://dx.doi.org/10.1016/j.gtc.2013.01.002McLaughlin SA. Surgical Management of the Breast. Breast Conservation Therapy and Mastectomy. Surg Clin North Am [Internet]. 2013;93(2):411–28. Available from: http://dx.doi.org/10.1016/j.suc.2012.12.006Park YM, Cho E, Kang HY, Kim JM. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: A systematic review and metaanalysis. Surg Endosc. 2011;25(8):2666–77.van der Wielen N, Straatman J, Daams F, Rosati R, Parise P, Weitz J, et al. Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial. Gastric Cancer [Internet]. 2021;24(1):258–71. Available from: https://doi.org/10.1007/s10120-020-01109-wGennari A, André F, Barrios CH, Cortés J, de Azambuja E, DeMichele A, et al. 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Pharmacoepidemiol Drug Saf. 2017;26(8):935–44.Impacto de la fragmentación en la atención de pacientes con cáncer de mama y estomago en el régimen contributivo en ColombiaMinCienciasInvestigadoresPadres y familiasPúblico generalORIGINAL1013658836.2022.pdf1013658836.2022.pdfTesis de Maestría en Epidemiología Clínicaapplication/pdf69951785https://repositorio.unal.edu.co/bitstream/unal/81823/1/1013658836.2022.pdf814555e84dd3fdea35871bc48ab4b81eMD51LICENSElicense.txtlicense.txttext/plain; charset=utf-84074https://repositorio.unal.edu.co/bitstream/unal/81823/2/license.txt8153f7789df02f0a4c9e079953658ab2MD52THUMBNAIL1013658836.2022.pdf.jpg1013658836.2022.pdf.jpgGenerated Thumbnailimage/jpeg5689https://repositorio.unal.edu.co/bitstream/unal/81823/3/1013658836.2022.pdf.jpg34350fe6e75e54042b30d0a6fdd88c17MD53unal/81823oai:repositorio.unal.edu.co:unal/818232024-08-08 23:11:10.782Repositorio Institucional Universidad Nacional de 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