Improving equity in access to early diagnosis of cancer: implementation research in different healthcare systems of Latin America.

Healthcare fragmentation is a main cause for delay in cancer diagnosis and treatment, contributing to high and steadily increasing mortality rates in Latin America(LA), particularly among disadvantaged populations.

Building on Equity-LA I (GA223123) and II (GA305197), this research focuses on integrated care interventions, which have proven effective at improving early diagnosis of cancer, mostly in HIC, and are also promoted by national cancer plans in LA, but limitedly implemented or evaluated.

The objective is to evaluate the contextual effectiveness of scaling-up a multicomponent integrated care intervention to improve early diagnosis of frequent cancers in healthcare networks of Chile, Colombia and Ecuador. Method: This participatory, interdisciplinary and mix-methods implementation research is two-pronged: a) a quasiexperimental design (controlled before and after) with an intervention and a control healthcare network; b) a case study design.

Focussing on the most vulnerable socioeconomic population, it develops in four phases: 1) analysis of delays,
related factors and contextual barriers to early diagnosis (base-line); 2) adaptation and scaling-up of the intervention (PC training, fast-track referral pathway and patient information, adapting available ICT tools) in real life; 3) intra-country evaluation of intervention; 4) cross-country analysis.

ICT tools will be also adopted in research activities as needed in a Covid-19 on-going or post- pandemic context. Relevance: EquityCancer-LA contributes to H2020 call objectives advancing cancer control policies by generating: 1) robust evidence on contextual effectiveness and costs-effectiveness of an affordable, tailored intervention to reduce diagnostic delays; and a validated strategy for its large-scale implementation in LA and LMICs; 2) novel data on delays and key barriers and facilitators to early diagnosis and inequalities in access; 3) e-tools
to improve clinical practice and research on early diagnosis.

Cancer early diagnosis, integrated care, implementation research, equity in access, Latin America, vulnerable populations, cancer control, quasi-experimental study, primary care training, IT tools.