In Puerto Rico, colorectal cancer (CRC) stands as the leading cause of cancer-related mortality, presenting a formidable challenge to healthcare providers, particularly oncologists who manage patients burdened with multiple chronic conditions (MCC). The island’s unique socio-cultural landscape, combined with systemic healthcare complexities, compounds the difficulties faced when delivering comprehensive cancer care. A recent qualitative inquiry delves deeply into these challenges, shedding light on the intricate interplay between social determinants, healthcare infrastructure, and clinical decision-making in this vulnerable population.
Puerto Rico’s healthcare system, while providing broad access through various insurance schemes, is hampered by bureaucratic intricacies that complicate timely diagnosis and treatment implementation. Oncologists describe the pre-authorization processes required for procedures and chemotherapy regimens as significant administrative hurdles, especially for elderly patients. These administrative demands often delay critical interventions, thereby potentially compromising patient outcomes. The navigation through insurance requirements is exacerbated by inadequate patient support systems, leaving older adults especially vulnerable to lapses in care continuity.
At the heart of these obstacles is the fragmentation in care coordination. Patients with CRC and MCC frequently necessitate consultations across multiple specialties, encompassing oncology, gastroenterology, endocrinology, cardiology, and more. Yet, the communication channels among providers remain rudimentary and reliant on phone calls or physical notes carried by patients themselves, rather than integrated electronic health records or collaborative platforms. This disjointed communication contributes to redundancies, omissions, and delays in essential treatments, posing a significant barrier to quality care.
Beyond systemic inefficiencies, socio-economic factors play a pivotal role in shaping patient experiences. The research highlights the profound influence of social determinants of health on treatment trajectories and prognoses. Many patients lack robust social support networks, which are vital for ensuring adherence to complex oncological and chronic disease management plans. Issues such as transportation deficits, limited local access to specialized care services, and financial constraints further hinder consistent outpatient follow-up and timely interventions.
Moreover, oncologists face intricate challenges in the context of treatment decision-making. The presence of multiple chronic conditions necessitates a careful balancing act to tailor oncologic therapies without exacerbating comorbidities. Physicians must weigh the risks of intensive chemotherapeutic regimens against potential decompensation of chronic illnesses such as diabetes or cardiovascular disease. In many cases, this results in altered or attenuated treatment plans, underscoring the need for personalized approaches grounded in holistic patient assessment.
Crucially, the cultural nuances intrinsic to the Hispanic population in Puerto Rico influence clinical dynamics. Language barriers, health literacy levels, and culturally specific beliefs about illness and treatment profoundly impact patient-provider interactions. Effective communication requires not only linguistic competence but also cultural sensitivity to build trust and facilitate shared decision-making. Oncologists recognize the necessity for tailored educational resources and counseling strategies that resonate with patients’ values and social contexts.
Survivorship and end-of-life care emerged as another domain fraught with challenges. As patients with CRC and MCC transition from active treatment phases to palliative or hospice care, the coordination among oncologists, primary care providers, and family caregivers becomes critical. The study underscores gaps in advanced care planning and symptom management support, which are compounded by caregivers’ limited availability and expertise. Enhancing integration across the continuum of care could alleviate patient suffering and improve quality of life during these vulnerable stages.
Significantly, the study’s methodology involved in-depth semi-structured interviews conducted in Spanish with nine oncologists deeply engaged in CRC care across Puerto Rico. This qualitative approach allowed researchers to capture rich, contextualized insights into the realities of clinical practice on the island. Data saturation was achieved, indicating a comprehensive exploration of shared themes and unique challenges from the perspective of experienced providers. This linguistic and cultural alignment in data collection ensured authenticity and relevance of findings.
In addressing these complex challenges, the oncologists interviewed advocate for systemic reforms that incorporate culturally attuned, multidisciplinary care models. Strengthening social support infrastructures, streamlining bureaucratic hurdles, and adopting interoperable health information technologies are seen as critical measures. Equally important is training healthcare professionals in cultural competence and chronic disease management tailored to the Hispanic elderly demographics predominant in Puerto Rico.
Emerging technologies such as telemedicine offer promising avenues to mitigate some access barriers. Remote consultations could circumvent transportation limitations and offer continuity amid fragmented local services. However, for these technologies to be effective, infrastructure improvements and digital literacy initiatives are essential to bridge the technological divide often experienced by older adults in underserved communities.
The intersectionality of cancer care and chronic disease management in this context highlights the imperative for integrated clinical protocols. Oncologists must extend beyond tumor-centric frameworks to incorporate comprehensive assessments of comorbid conditions, functional status, and psychosocial factors. This paradigm shift aligns with global trends towards precision medicine augmented by social determinants-informed care planning, ensuring treatments align not only with genomic or tumor markers but also with patient lifestyles and capacities.
Furthermore, improving inter-provider communication demands investment in health information systems capable of seamless data exchange. The reliance on manual message passing via patients is outdated and prone to error. Electronic health records customized for multidisciplinary oncology care could support synchronized interventions and real-time updates, fostering a cohesive team-based approach to patient management.
Culturally sensitive survivorship programs must also be prioritized. These programs should address physical rehabilitation, psychological support, nutritional counseling, and comorbidity monitoring in a manner respectful of cultural beliefs and language preferences. Engaging community health workers or patient navigators familiar with local customs could enhance uptake and adherence to survivorship care plans.
The study also implicitly calls attention to healthcare policy implications. Policymakers in Puerto Rico must consider strategies to reduce administrative barriers and incentivize integrated care networks. Allocating resources to local centers with specialized CRC services can diminish geographic disparities and relieve pressure on tertiary care hospitals. Health insurance reforms facilitating streamlined approvals and patient-centered funding models could expedite access to needed therapies.
Ultimately, this research underscores the multidimensional nature of oncologic care in Puerto Rico’s Hispanic elder population with CRC and MCC. It illuminates how clinical, social, systemic, and cultural factors intertwine to influence outcomes. Addressing these barriers necessitates collaborative efforts spanning clinical innovation, social policy, and community engagement. Only through such comprehensive approaches can the quality of cancer care be elevated and disparities diminished.
The findings contribute valuable insights for oncologists, healthcare administrators, and researchers aiming to refine cancer care delivery in similar socio-economic and cultural settings worldwide. By embracing culturally informed, coordinated, and patient-centered approaches, healthcare systems can better serve complex patient populations facing intersecting medical and social challenges.
As Puerto Rico grapples with its CRC burden amidst a backdrop of chronic diseases, this study offers a blueprint for transformation. Enhancing care pathways, reducing systemic fragmentation, and fostering culturally competent practices hold promise to improve survival and quality of life for this vulnerable community. The ultimate goal is a healthcare environment where patients with CRC and MCC receive not only effective treatments but also dignified, compassionate care attuned to their unique circumstances.
Subject of Research: Challenges in oncological care for Hispanic patients with colorectal cancer and multiple chronic conditions in Puerto Rico.
Article Title: Challenges oncologists face when caring for hispanics living in puerto rico with colorectal cancer and multiple chronic conditions
Article References:
Castañeda-Avila, M.A., Latoni-Guillermety, D., Sabatino, M. et al. Challenges oncologists face when caring for hispanics living in puerto rico with colorectal cancer and multiple chronic conditions. BMC Cancer 25, 898 (2025). https://doi.org/10.1186/s12885-025-14271-0
Image Credits: Scienmag.com
DOI: https://doi.org/10.1186/s12885-025-14271-0
Tags: administrative hurdles in oncologycancer mortality among Puerto Rican Hispanicscare coordination in cancer treatmentfragmented care in oncologyhealthcare disparities in Puerto Ricohealthcare infrastructure issuesinsurance navigation difficultiesmultiple chronic conditions in cancer careoncologists treating Hispanic patientspatient support systems for elderlyPuerto Rico colorectal cancer challengessocial determinants of health in Puerto Rico