Public-data territorial prioritization of oncology access inequity in Colombia.

BACKGROUND: Subnational cancer planning often proceeds without comparable public measures of potential access to diagnosis and treatment. We developed a reproducible public-data approach to identify Colombian municipalities for oncology-access review. METHODS: We conducted an observational study using public administrative and geospatial data mapped to a minimum common model. The 2023 file covered 1122 municipalities. The Territorial Oncology Access Priority Index (TOAPI) was defined as a municipality-level prioritization score combining expected need, geographic barriers, social vulnerability, service supply, installed capacity, and workforce availability, supported by service-registry subgroups, DIRAC radiotherapy records, oncology-specific workforce profiles, and road-network routing. RESULTS: TOAPI classified 225 municipalities as high priority, 449 as medium priority, and 448 as low priority. High-priority municipalities had longer routed travel times to the nearest oncology service (149.0 vs 43.3 min) and greater distance to the nearest public radiotherapy center (82.0 vs 44.3 km). Rankings were stable in sensitivity analyses, and the transferable core closely matched the Colombia-enriched version. Mortality and department-level incidence did not align positively with TOAPI; access-oriented checks were more consistent with its intended review role. CONCLUSION: TOAPI is best read as a territorial oncology-access review tool, not as an incidence estimator, mortality-prediction tool, or direct measure of clinical quality. POLICY SUMMARY: Health systems can use this approach to prioritize where referral-network review, diagnostic expansion, workforce planning, transport support, and local access audits should begin.