Main Article Content



We analyze the impact of the COVID-19 pandemic on oncology service demand in a middle-income country with universal health coverage.


We collected data from January 1st-2017, to December 31th-2021 at a reference center in Bogotá-Colombia regarding first-time consultations of cross-cutting services (clinical oncology, hematology, palliative care, radiation oncology); specialized multidisciplinary units (breast, prostate, lung, stomach); inpatient and outpatient systemic therapy; radiotherapy; oncology surgery; and bone marrow transplant. In addition, a descriptive time series analysis was performed, estimating monthly percent change and endemic channels.


Starting the confinement (April 2020), a general decrease in service demand was observed (R: -14.9% to -90.0%), with an additional but lower reduction in August 2020 coinciding with the first pandemic wave (R: -11.3% to -70.0%). Follow-up visits and ambulatory treatment showed no consistent reductions. New patients’ consultations for cross-cutting services had a speedy recovery (1 month), but clinical oncology, specialized units, and in-hospital treatment resumed more slowly. Only breast and stomach cancer showed a sustained reduction in early-stage disease. Women and older patients had a more significant reduction in service demand.


Despite no changes in service supply, the confinement induced a significant reduction in service demand. Variations by cancer type, service type, and population demographics deserve careful consideration for a suitable response to the emergency. The speedy recovery and the absence of a significant decrease during subsequent waves of the pandemic suggest patient resiliency and a lower impact than expected in middle-income settings in the presence of universal health insurance.

Maria Zuluaga, Centro Javeriano de Oncología - Hospital Universitario San Ignacio


Maria Camila Luna, Centro Javeriano de Oncología - Hospital Universitario San Ignacio


Natallie Jurado, Departamento Medicina Interna – Hospital Universitario San Ignacio


Beatriz Soto-Cala, Facultad de Medicina – Pontificia Universidad Javeriana

Julio César Solano, Centro Javeriano de Oncología - Hospital Universitario San Ignacio


Ricardo Sánchez-Forero, Centro Javeriano de Oncología - Hospital Universitario San Ignacio


Raúl Murillo, Centro Javeriano de Oncología - Hospital Universitario San Ignacio


Zuluaga, M., Luna, M. C., Jurado, N., Soto-Cala, B., Solano, J. C., Sánchez-Forero, R., & Murillo, R. (2023). The impact of the COVID-19 pandemic on the oncology services demand in a middle-income setting with universal health insurance. Colombia Medica, 53(1), e2065115. (Original work published November 4, 2022)

World Health Organization. WHO Coronavirus (COVID-19) Dashboard With Vaccination Data [Internet]. 2021 [cited 2021 Aug 2]. Available from:

Lee AWM, Xu Z-Y, Lin L, Xu J, Yang J, Lee E, et al. Advocacy to provide good quality oncology services during the COVID-19 pandemic- Actions at 3-levels. Radiother Oncol. 2020;149:25-9. PMid:32389755 PMCid:PMC7205699

Lancet Oncology T. COVID-19: global consequences for oncology. Lancet Oncol. 2020;21(4):467.

Ueda M, Martins R, Hendrie PC, McDonnell T, Crews JR, Wong TL, et al. Managing Cancer Care During the COVID-19 Pandemic: Agility and Collaboration Toward a Common Goal. J Natl Compr Cancer Netw. 2020 April 1;18(4):366-9. PMid:32197238

Ranganathan P, Sengar MD, Chinnaswamy G, Khattry ND, Badwe MS RA, Gandhi Regional I, et al. Impact of COVID-19 on cancer care in India: a cohort study. Artic Lancet Oncol. 2021;22(7):970-6.

Degeling K, Baxter NNN, Emery J, Jenkins MAA, Franchini F, Gibbs P, et al. An inverse stage-shift model to estimate the excess mortality and health economic impact of delayed access to cancer services due to the COVID-19 pandemic. Asia Pac J Clin Oncol. 2021 August 1;17(4):359-67. PMid:33567163 PMCid:PMC8014813

Sud A, Torr B, Jones MEE, Broggio J, Scott S, Loveday C, et al. Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study. Artic Lancet Oncol. 2020;21:1035-79.

Patt D, Gordan L, Diaz M, Okon T, Grady L, Harmison M, et al. Impact of COVID-19 on Cancer Care: How the Pandemic Is Delaying Cancer Diagnosis and Treatment for American Seniors. JCO Clin Cancer Informatics. 2020 Nov 30;4:1059-71. PMid:33253013 PMCid:PMC7713534

Cancer Australia. National and jurisdictional data on the impact of COVID-19 on medical services and procedures in Australia: Breast, colorectal, lung, prostate and skin cancers. Surry Hills; 2020.

Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020 March 1;21(3):335-7.

Ward ZJ, Walbaum M, Walbaum B, Guzman MJ, Jara JJ de la, Nervi B, et al. Estimating the impact of the COVID-19 pandemic on diagnosis and survival of five cancers in Chile from 2020 to 2030: a simulation-based analysis. Lancet Oncol. 2021;0(0).

Garcia-Ramirez J, Nikoloski Z, Mossialos E. Inequality in healthcare use among older people in Colombia. Int J Equity Heal 2020 191. 2020 October 26;19(1):1-15. PMid:33100214 PMCid:PMC7646194

Guerrero R, Gallego AII, Becerril-Montekio V, Vásquez J. Sistema de salud de Colombia. Salud Publica Mex. 2011;53:s144-55. PMid:22328998

Centro Javeriano de Oncología [Internet]. [cited 2021 Aug 4]. Available from:

Corres G, Esteban A, García J, Zárate C. _. Vol. 8, Revista Ingeniería Industrial. 2009. 21-33 p.

American Joint Committee on Cancer. AJCC - Cancer Staging Manual 8th edition [Internet]. 2018 [cited 2021 Aug 22]. Available from:

National Cancer Institute - Division of Cancer Control and Population Sciences. Annual Percent Change (APC) and Confidence Interval - Joinpoint Help System [Internet]. [cited 2021 August 22]. Available from:

Gobierno de Colombia. Casos positivos de COVID-19 en Colombia | Datos Abiertos Colombia [Internet]. 2021 [cited 2021 Aug 22]. Available from:

Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol. 2020 August 1;21(8):1023-34.

Rosas TV, Cazap E, Delgado L, Ismael J, Bejarano S, Castro C, et al. Social Distancing and Economic Crisis During COVID-19 Pandemic Reduced Cancer Control in Latin America and Will Result in Increased Late-Stage Diagnoses and Expense. 2021 May 17;(7):694-703. PMid:33999696 PMCid:PMC8162975

Gutiérrez D, Martin G, Ñopo H. The Coronavirus and the Challenges for Women's Work in Latin America. UNDP Lat Am Caribb. 2020;(18):142-66.

Villamizar García-Herreros ME. Uso del tiempo libre de hombres y mujeres. Midiendo la inequidad. CEPAL, Mujer y desarrollo. 2011. 69 p.

Smith J. Overcoming the 'tyranny of the urgent': integrating gender into disease outbreak preparedness and response. 2019 May 4;27(2):355-69.

Dunatchik A, Gerson K, Glass J, Jacobs JA, Stritzel H. Gender, Parenting, and The Rise of Remote Work During the Pandemic: Implications for Domestic Inequality in the United States: 2021 March 19;35(2):194-205. PMid:35599685 PMCid:PMC9122150

Wenham C, Smith J, Morgan R. COVID-19: the gendered impacts of the outbreak. Lancet. 2020 March 14;395(10227):846-8.

Pinchoff J, Austrian K, Rajshekhar N, Abuya T, Kangwana B, Ochako R, et al. Gendered economic, social and health effects of the COVID-19 pandemic and mitigation policies in Kenya: evidence from a prospective cohort survey in Nairobi informal settlements. BMJ Open. 2021;11(3):42749. PMid:33658260 PMCid:PMC7931215

Hamilton AC, Donnelly DW, Loughrey MB, Turkington RC, Fox C, Fitzpatrick D, et al. Inequalities in the decline and recovery of pathological cancer diagnoses during the first six months of the COVID-19 pandemic: a population-based study. Br J Cancer 2021. 2021 July 1;1-8. PMid:34211120 PMCid:PMC8245662

Issaka RB, Feld LD, Kao J, Hegarty E, Snailer B, Kalra G, et al. Real-World Data on the Impact of COVID-19 on Endoscopic Procedural Delays. Clin Transl Gastroenterol. 2021 Jun 1;12(6):e00365. PMid:34060496 PMCid:PMC8162484

Turkington R, Lavery A, Donnelly D, Cairnduff V, McManus D, Coleman H. The Impact of the COVID-19 Pandemic on Barrett's Esophagus and Esophagogastric Cancer. Gastroenterology. 2021 May 1;160(6):2169-2171.e1. PMid:33513406 PMCid:PMC7837162

Obek C, Doganca T, Argun OB, Kural AR. Management of prostate cancer patients during COVID-19 pandemic. Prostate Cancer Prostatic Dis 2020 233. 2020 July 20;23(3):398-406. PMid:32690870 PMCid:PMC7371779

Herrera CA, Fernández P, Bhadelia A, Maza M. Anticipating the COVID-19-related surge in cancer care demand is urgent in Latin America and the Caribbean. Lancet Oncol. 2021 Sep;0(0).


Download data is not yet available.
Received 2021-12-06
Accepted 2022-10-24
Published 2023-05-04