Transforming Cancer Care: Rethinking Pathways, People, and Moving Beyond Hospital-Centric Models

This doctoral dissertation aims to analyze oncology patient pathways from different perspectives. The oncology patient is a complex patient who is often multi-pathological and whose care needs do not end in the hospital pathway of diagnosis and treatment. The SARS-CoV2 pandemic has accelerated the shift in the care setting from hospital to primary care and home. In this thesis, several networks and trials are analyzed that aim to bring care closer to the patient and identify the best and most appropriate setting for different clinical care needs. The introduction provides a brief overview of performance evaluation systems, particularly performance evaluation in health care. Performance evaluation involves different dimensions, and different systems use different dimensions. However, patients move within pathways that are structured between different levels of care and involve functional integration between different settings. Performance evaluation has therefore shifted to analyzing the patient pathway, not just individual performance. The two leading causes of mortality in Europe are circulatory diseases and cancer. Management of the cancer patient requires coordinated care across health care settings, multidisciplinary teams of professionals and performance evaluation systems that can measure this care. Therefore, the cancer patient pathway has been evaluated, from the organization of services to the evaluation of patients. The thesis comprises three chapter. The first chapter is a scoping review analyzing home-based oncology care through the lens of patient and caregiver experiences, guided by the Picker Principles of Person-Centered Care. In the second chapter, data from the Sant ’Anna School’s performance measurement system identify the best-performing areas in breast cancer care. Best practices from these areas are shared with regional networks using the "learning from excellence" methodology. In the third chapter is examinate broader cancer patient management through three Italian case studies on relocating oncology care and establishing regional oncology networks (CCCNs), focusing on the “Casa della Salute” as a community-centered care hub. This thesis aims to provide evidence on the use of integrated pathway assessment and the learning from excellence approach to improve outcomes for patients with breast cancer. It also contributes to filling the gap in the literature related to the evaluation of oncology healthcare services according to the patient-centered care paradigm.