Complexity around the Colombian Childhood Cancer Law: Requirements for its Evaluation



Palabras clave:

Evaluation of Health Programs and Projects, neoplasms, public policy


Introduction: The complexity of health problems such as childhood cancer poses challenges in health care and in the evaluation of interventions. This situation is aggravated if policy makers and decision makers assume that a healthcare system works in a delimited environment with defined rules. The approach to childhood cancer in Colombia required the promulgation of a law to contribute to the reduction of mortality from this cause with implications for nursing. This study characterized its complex nature, evidenced the potential implications in its evaluation and proposed an evaluation scheme. Methods: Documentary research with related information available between the years 2010 and 2020. Bowen's guidelines for the analysis of the information were followed, the categories included were relevant actors, context, components, organizational levels involved and results. Results: The analysis of the problem made visible the influence of the social determinants of health, the interaction of multiple actors in various scenarios and a high degree of uncertainty in a complex health system. The response is a complex intervention with multiple components and actors involved at different levels to achieve the proposed results. Conclusion: Evaluating this intervention implies context-sensitive approaches, a clear definition of the problem and identification of the underlying theory necessary to achieve the expected results; Establishing its evaluability provides important inputs to reorient its scope and its transferability.


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Ren HM, Liao MQ, Tan SX, Cheng C, Zhu S, Zheng L, et al. Global, Regional, and National Burden of Cancer in Children Younger Than 5 Years, 1990-2019: Analysis of the Global Burden of Disease Study 2019. Front Public Health. 2022 Jun 21;10. doi: 10.3389/fpubh.2022.910641.

Fondo Colombiano de Enfermedades de Alto Costo. Situación del cáncer en la población pediátrica atendida en el SGSSS de Colombia 2018. 2018. Available from:

Denburg A, Cuadrado C, Alexis C, Klussmann FA, Zamora JCB, Bodkyn C, et al. Improving childhood cancer care in Latin America and the Caribbean: a PAHO Childhood Cancer Working Group position statement. Lancet Oncol. 2017;18(6):709-11. doi: 10.1016/S1470-2045(17)30325-X.

Atun R, Bhakta N, Denburg A, Frazier AL, Friedrich P, Gupta S, et al. Sustainable care for children with cancer: a Lancet Oncology Commission. Lancet Oncol. 2020;21(4):e185-224. doi: 10.1016/S1470-2045(20)30022-X.

Huber E, Kleinknecht‐Dolf M, Kugler C, Spirig R. Patient‐related complexity of nursing care in acute care hospitals – an updated concept. Scand J Caring Sci. 2021 Mar 22;35(1):178-95. doi: 10.1111/scs.12833.

Gürcan M, Atay Turan S. Examining the expectations of healing care environment of hospitalized children with cancer based on Watson’s theory of human caring. J Adv Nurs. 2021 Aug 18; 77(8):3472-82. doi: 10.1111/jan.14934.

Bhakta N, Force LM, Allemani C, Atun R, Bray F, Coleman MP, et al. Childhood cancer burden: a review of global estimates. Lancet Oncol. 2019;20(1):e42-53. doi: 10.1016/S1470-2045(18)30761-7

Petrie S, Peters P. Untangling complexity as a health determinant. Health Science Inquiry. 2020 Aug 10;11(1):131-5.

Pawson R. Evidence-based policy: A realist perspective. London: SAGE; 2006.

Borghi J, Ismail S, Hollway J, Kim RE, Sturmberg J, Brown G, et al. Viewing the global health system as a complex adaptive system – implications for research and practice. F1000Res. 2022 Oct 7;11:1147.

Shiell A, Hawe P, Gold L. Complex interventions or complex systems? Implications for health economic evaluation. BMJ. 2008;336(7656):1281-3. doi:

Craig P, Dieppe P, Macintyre S, Mitchie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: The new Medical Research Council guidance. BMJ. 2008;337(7676):979-83. doi:

Ley 1384/2010, del 19 de abril. Ley Sandra Ceballos, por la cual se establecen las acciones para la atención integral del cáncer en Colombia. Diario Oficial. (19 de abril de 2010). Available from:

Kayesa NK, Shung-King M. The role of document analysis in health policy analysis studies in low and middle-income countries: Lessons for HPA researchers from a qualitative systematic review. Health Policy Open. 2021 Dec;2:100024.

Bowen G. Document Analysis as a Qualitative Research Method. Qualitative Research Journal. 2009;9(2):27-40.

VERBI Software. MAXQDA. Berlin; 2020.

Morgan H. Conducting a Qualitative Document Analysis. The Qualitative Report. 2022. Available from:

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for Reporting Qualitative Research. Academic Medicine. 2014 Sep;89(9):1245-51. doi: 10.1097/ACM.0000000000000388

Proyecto de ley 94. Gaceta del Congreso Colombia; 2007. Disponible en

Proyecto de Ley 312. Colombia; 2008. Available from:

Ley 1388/2010. Por el derecho a la vida de los niños con cáncer en Colombia. (26 de mayo de 2010). Available from: 1388 DE 2010.pdf

Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350. Available from:

Holvoet N, Van Esbroeck D, Inberg L, Popelier L, Peeters B, Verhofstadt E. To evaluate or not: Evaluability study of 40 interventions of Belgian development cooperation. Eval Program Plann. 2018 Apr;67:189-99.

Gilmore B. Realist evaluations in low- And middle-income countries: reflections and recommendations from the experiences of a foreign researcher. BMJ Glob Health. 2019;4(5).

Gupta S, Rivera-Luna R, Ribeiro RC, Howard SC. Pediatric Oncology as the Next Global Child Health Priority: The Need for National Childhood Cancer Strategies in Low- and Middle-Income Countries. PLoS Med. 2014;11(6):1-5. doi: 10.1371/journal.pmed.1001656.

De Oliveira Chaves M, Pereira Ribeiro G, Aguiar Amorim K. The role of the nurse in caring for the child with cancer: integration review. Hospice and Palliative Medicine International Journal. 2018 Jul 31;2(4). doi: 10.15406/hpmij.2018.02.00096.

Bretschneider PJ, Cirilli S, Jones T, Lynch S, Wilson NA. Document Review as a Qualitative Research Data Collection Method for Teacher Research. London: SAGE; 2017.




Cómo citar

Arias Quijano, N. L., & de Salazar, L. (2023). Complexity around the Colombian Childhood Cancer Law: Requirements for its Evaluation. Revista De Investigación De La Universidad Norbert Wiener, 12(1), a0021.