Despite encouraging progress, outcomes for cancer patients are still patchy and inequalities are apparent even across Europe.1-3 Integrated cancer care, bringing together primary care and hospital care and forming closer links between institutions, can improve the quality of care and outcomes for patients.4 This chapter summarizes approaches to improving integration between primary care and hospital services and between hospitals and other cancer services through cancer networks.
Integrating primary care with oncology and other hospital care teams
A high standard of primary care is key to the entire path of a cancer patient: from early diagnosis to the support of survivors or to terminal care. Increasingly, treatments can be delivered without hospital admissions.4 Early diagnosis improves clinical outcomes and may reduce overall service costs.5-8 Low public awareness of symptoms that may indicate cancer, and negative beliefs about cancer outcomes, contribute to delayed presentation, advanced stage and lower survival. Nationally coordinated, multi-component public awareness campaigns can positively influence cancer outcomes.9
Danish investigators have studied generic and disease-specific issues underlying delay in diagnosis. They have characterized the potential for adverse consequences from gatekeeper practices in primary care, the prevalence of cancer alarm symptoms, the impact on patients' confidence in their GP, and comparisons in the international benchmarking programmes. Their work has underpinned consensus statements such as the Aarhus statement on improving design and reporting studies on early cancer diagnosis.10 In 2007, having recognized the lack of progress in the previous decade, the Danish government launched a new diagnostic strategy, the key components of which were that a diagnostic suspicion of cancer should be dealt with as an acute condition, with only medically necessary delays. Multidisciplinary working groups were established to describe the ideal clinical pathway for cancer types, with clear maximum acceptable waiting times and GP access to diagnostic investigations. Preliminary results are encouraging.11
Integrated cancer services can strengthen both vertical links between primary, secondary, tertiary and social care services for patients with cancer and horizontal links between cancer services and other hospital specialties, including diagnostic services, across all medical specialities. Comorbidities in oncology patients require that their management be shared with professionals in other specialties, e.g. cardiology, respiratory medicine, gastroenterology and especially geriatrics. On the other hand, in a cancer patient acute complications of the cancer itself or complications of its treatment may require urgent or emergency care: this highlights the need for close integration of cancer services with critical care services and with acute medical and surgical services (Figure 13.1).
Model for integrated cancer care.
Health informatics and telemedicine solutions can now be deployed within integrated healthcare models to effectively link all relevant electronic patient records and the datasets contained with them. Optimal information flow can ensure excellence in cancer care ...