AGENAS, the National Agency for Regional Health Services, has recently published the outcome of the fifth national survey on the state of implementation of the Regional Oncology Networks (ROR), designed to improve the care of cancer patients. The purpose of the ROR is to create a connection between the different structures that deal with the diagnosis and care of these patients, but also between the different professionals that revolve around the treatment path of cancer patients. Here is what emerged from the investigation and why, especially when it comes to tumors, the multidisciplinary team appears to have a significant impact on the outcome of the treatment process.
The results of the monitoring
The data just published concerns the services provided during 2022. The monitoring was carried out through a questionnaire made available by AGENAS and compiled directly by the Regions and Autonomous Provinces, the results of which were integrated with those of three indicators relating to seven of the main oncological pathologies: breast cancer, colon cancer, rectal cancer, lung cancer, prostate cancer, ovarian cancer and uterine cancer. The three indicators concern the capacity to take care of the individual regional networks (i.e. the percentage of patients resident in a certain region and hospitalized, following a diagnosis of cancer, within structures that are part of the ROR), l the escape index outside the region or autonomous province (i.e. the percentage of hospitalizations in ROR facilities which however are outside the region or autonomous province of residence of the patient), and the waiting times, measured as the percentage of hospitalizations in ROR facilities within 30 days from the booking date.
Based on these criteria, the regional networks of Tuscany, Emilia-Romagna, Piedmont/Valle d’Aosta (which are part of a single network), Veneto and Liguria were found to be highly performing. Lombardy, Lazio and Friuli Venezia Giulia instead have some centers of excellence that at least partially meet regional needs, but with an effectiveness at network level that still needs to be improved. AGENAS also highlights the progress of the regional networks of Campania, Puglia, Sicily, Marche, and the two autonomous provinces of Trento and Bolzano, where the reorganization efforts are giving good results. Finally, the regional networks of Calabria, Molise, Sardinia, Umbria, Basilicata and Abruzzo still show a high escape rate, and are therefore still not sufficiently effective.
PDTA and multidisciplinary teams: the two pillars of ROR
Among the critical issues of oncology that were found in the past, Sabino De Placido, head of the Medical Oncology department at the Federico II Polyclinic Hospital in Naples, who spoke during the presentation of the AGENAS data, cites the lack of coordination in the integration of the different skills professionals and discontinuity of care: “The turning point regarding the quality of care and assistance – explained De Placido during the event presenting the results – was marked by the implementation of the oncology network”. Which, he continues, includes various entities, including oncology centres, local health authorities, doctors in the area, diagnostic centres, reference centers for assistance, research and training. And the two founding pillars of this reality, according to De Placido, were the creation of the Diagnostic Therapeutic Assistance Pathways (PDTA) and the Multidisciplinary Oncology Groups. The latter, abbreviated as GOM, are made up of a core team made up of oncologists, surgeons and radiotherapists, and also enjoy collaboration with many other professionals, including biologists, genetics experts, nutritionists, psychologists, anatomopathologists, nurses.
The work of the GOMs is marked by very specific rhythms, which naturally vary based on the type of pathology and therapeutic path. “A fundamental point – underlined De Placido – is that the taking charge is synchronous”. That is, that the patient begins their treatment journey with the entire multidisciplinary team from the very first stages following the diagnosis.
by Dario Rubino
Effects of multidisciplinary management
Several scientific studies demonstrate the benefits that patients can derive from this type of approach. A meta-analysis, i.e. the analysis of several studies already present in the literature, published in 2021 in Frontiers in Oncology, shows for example an increase in the survival rate of 16% for those patients suffering from head and neck cancer who were taken care of by multidisciplinary teams. However, the same trend had not been observed in two studies that had specifically taken into consideration patients affected by this type of tumor at stage four, for whom management by multidisciplinary teams had not determined statistically significant effects on survival.
Another one meta-analysis, published this year in JTO Clinical and Research Reports, shows that the multidisciplinary team can have an important impact on the outcome of the treatment process even for patients suffering from lung cancer, and in particular non-small-cell lung cancer. cells (NSCLC, non-small-cell lung cancer). The analysis took into consideration a total of 22 previously published studies, showing that patients suffering from this type of neoplasm and cared for by a multidisciplinary team have a proportional reduction in mortality equal to 40%, and also a treatment time on average shorter than patients who were not part of the group taken care of by the multidisciplinary team.