Transformation of Cancer Care during and after the COVID Pandemic, a point of no return. The Experience of Italy

S. Cascinu,G. Fasola,A. Ardizzoni,R. Tarricone,G. Numico,M. Annicchiarico,F. Puglisi,E. Listorti,P. Bossi,A. Torbica,V. Tozzi,M. Altini,H. Banks,P. Bordon,S. Ghislandi

doi:10.1016/j.jcpo.2021.100297

Abstract

Policymakers everywhere struggle to introduce therapeutic innovation while controlling costs, a particular challenge for the universal Italian National Healthcare System (SSN), which spends only 8.8% of GDP to care for one of the world’s oldest populations. Oncology provides a telling example, where innovation has dramatically improved care and survival, transforming cancer into a chronic condition. However, innovation has also increased therapy duration, adverse event management, and service demand. The SSN risks collapse unless centralized cancer planning changes gear, particularly with Covid-19 causing treatment delays, worsening patient prognosis and straining capacity. In view of the 750 billion Euro “Next Generation EU”, released by the European Union to relieve Member States hit by the pandemic, the SSN tapped a multidisciplinary research team to identify key strategies for equitable uptake of innovations in treatment and delivery, with emphasis on data-driven technological and managerial advancements – and lessons from Covid-19.

Highlights

The Covid-19 pandemic has highlighted health system inadequacies, and in Italy – hit hard and early by the pandemic – patients suffering from chronic conditions such as cancer were often left behind during the spring 2020 lockdown and show, or risk, worse outcomes [1,2,3]
Alternative care delivery scenarios employed during the Covid-19 pandemic showed that digital health, community and primary care should at least partially replace hospital services for cancer survivor follow-up and rehabilitation, coordinated at the intra-regional, interregional and national levels
Leveraging health data analysis – using patient stratification techniques supported by information technology (IT) and artificial intelligence (AI) - and full acti vation and exploitation of cancer networks can provide crucial in dications for integrating services and guaranteeing equal access to innovative specialty care while protecting fragile patients during the Covid-19 pandemic and, hopefully, when it is over

Summary

Introduction

The Covid-19 pandemic has highlighted health system inadequacies, and in Italy – hit hard and early by the pandemic – patients suffering from chronic conditions such as cancer were often left behind during the spring 2020 lockdown and show, or risk, worse outcomes [1,2,3]. The pandemic has provided a glimpse of new care delivery models that could positively impact oncology – and other – care, affording a preview of how changes in national cancer care planning and coordination currently under consideration (see Acknowledgements) might play out in a future, post-Covid world. Italy’s universal, National Healthcare System (SSN) provides an interesting case study to illustrate how national planning and in novations in care and delivery can both address disparities in access and improve quality of care for cancer patients as outlined in the problems and corrective actions described below, even when care is disrupted by waves of infections and lockdowns, in Italy as elsewhere. Clinicians must keep abreast of the latest clinical evidence and service delivery changes, complicating treatment decision, planning and follow-up processes [10]. The resulting difficulties in communication and care coordi nation highlighted the need to manage knowledge and service coordi nation differently, including through support from information technology (IT) and artificial intelligence (AI)

Stratification techniques to guide appropriate service provision

New delivery scenarios to be incentivized by new reimbursement schemes

Findings

Conclusions