National Keynote

Maria Sala, MD, MPH, PhD

Maria Sala, MD, MPH, PhD is a specialist in Preventive Medicine and Public Health and serves as Head of the Epidemiology and Evaluation Department and Director of Quality at Hospital del Mar, Barcelona. She also coordinates the Epidemiology and Evaluation Research Group at the Hospital del Mar Research Institute (HMRI). She holds Master's degrees in Biomedical Research Methodology and Healthcare Management from the Universitat Autònoma de Barcelona (UAB). She is Associate Professor at the Universitat Pompeu Fabra (UPF) and has extensive experience in teaching, research supervision, and mentoring of healthcare professionals. Her research focuses on cancer epidemiology, health services evaluation, and survivorship care, particularly in breast cancer screening and long-term breast cancer outcomes. She is a member of the Spanish research network RICAPPS (Research Network on Chronicity, Primary Care and Health Promotion). Her work has contributed significantly to advancing evidence-based survivorship care and the integration of epidemiological research into healthcare quality improvement. 

Multimorbidity and care trajectories among Long-Term Breast Cancer Survivors: Lessons from the SURBCAN Project

Advances in breast cancer diagnosis and treatment have led to a growing population of long-term breast cancer survivors. In Spain, where breast cancer is the most common cancer among women, increasing survival rates have shifted the focus from acute cancer care to the long-term management of survivorship, including the challenges posed by comorbidity and multimorbidity. Understanding how these women use healthcare services and how their care needs evolve over time is essential for developing effective, patient-centered follow-up models. This keynote will present the main findings of the SURBCAN (SUrvival Breast CANcer) project, a multicenter study conducted within the RICAPPS network using real-world data from five Spanish regions. The project included 6,512 women who had survived breast cancer for at least five years and 12,816 age-matched women without a history of breast cancer. By combining epidemiological methods, analyses of electronic health records, multimorbidity clustering techniques, healthcare utilization studies, and innovative data-mining approaches to characterize care trajectories, SURBCAN provides a comprehensive picture of survivorship care in Spain. Results show that long-term breast cancer survivors make greater use of both primary and specialist healthcare services than women without breast cancer, although service utilization gradually decreases with increasing time since diagnosis. Adherence to follow-up recommendations also declines over time and appears potentially suboptimal among both younger and older survivors. Importantly, the study identified five distinct multimorbidity patterns, each associated with different healthcare needs and service-use profiles. More than 80% of survivors presented multimorbidity, highlighting its central role in survivorship care. A particularly novel contribution of SURBCAN is the application of data-mining techniques to visualize and characterize healthcare trajectories. These analyses reveal substantial heterogeneity in the pathways followed by survivors and demonstrate how multimorbidity influences both patterns of care and long-term outcomes. Interestingly, women with multimorbidity showed higher adherence to follow-up recommendations, suggesting that more frequent contact with healthcare services may facilitate surveillance and continuity of care. The findings underline the need to move beyond disease-centered follow-up models and towards integrated approaches that consider multimorbidity, patient complexity, and coordinated care between primary and specialist services. By providing robust real-world evidence on healthcare utilization, adherence, and survivorship trajectories, SURBCAN offers valuable insights to inform future clinical guidelines, healthcare planning, and the organization of survivorship care for the growing population of long-term breast cancer survivors.