Cancer Services Research Articles

Are National Breast and Cervical Cancer Early Detection Program Recipients Providing Services in Counties Heavily Burdened by Breast and Cervical Cancer?

Alignment of National Breast and Cervical Cancer Early Detection Program (NBCCEDP) clinical services with the spatial distribution of breast and cervical cancer burden is essential to maximizing programmatic impact and addressing cancer disparities. This study identified spatial clustering of breast and cervical cancer burden scores and assessed whether and to what extent NBCCEDP clinical services were associated with clusters for the 5-year period, 2015-2019. We examined burden scores for spatial clustering using Local Indicators of Spatial Association (LISA) tests in GeoDA. We then used t-tests to compare the NBCCEDP 5-year average percentage of eligible women served clinical breast and cervical cancer services between hotspot (high burden) and coolspot clusters. There was statistically significant spatial clustering in the pattern of breast and cervical cancer burden scores across counties, with hotspot clusters mostly observed in the Southern region, Idaho and Nevada. For both breast and cervical cancer, higher percentages of eligible women received breast and cervical cancer clinical services in coolspot clusters compared to hotspot clusters during each year from 2015-2019. NBCCEDP clinical services can help reduce breast and cervical cancer burden. Yet, during 2015-2019, increased service delivery was not aligned with the spatial distribution of counties with greater breast and cervical cancer burdens. NBCCEDP recipients may improve their impact on breast and cervical cancer burden by prioritizing and consistently increasing service delivery in cancer burden hotspot clusters if they have not already maximized their resources in these areas.

Inequalities in the recovery of colorectal cancer services during the COVID-19 pandemic: a national population-based study.

Evidence is lacking on whether there were inequalities in the recovery of colorectal cancer (CRC) services within the English National Health Service (NHS) following the COVID-19 pandemic. The aim of this study was to evaluate recovery according to patient age and socioeconomic status. Using routinely collected data, CRC patients diagnosed and treated in the English NHS were identified for two timeframes: the 'initial pandemic period' (April-June 2020) and the 'pandemic period' (April 2020-March 2022). Poisson models evaluated changes in numbers of diagnoses, major resections, adjuvant chemotherapy and neoadjuvant radiotherapy use for each timeframe, relative to the equivalent pre-pandemic timeframe (April-June 2019 and April 2018-March 2020, respectively), stratified by age and socioeconomic status. Tumour stage at presentation was evaluated over time. Substantial deficits in diagnoses, major resections and adjuvant chemotherapy were identified in the initial pandemic period, whilst the use of neoadjuvant radiotherapy increased. Overall, these deficits recovered. Patients outside screening age, and in the most deprived group, had greater deficits in diagnoses and major resections. There was no evidence of stage migration by June 2021. CRC services showed recovery to baseline during the pandemic. However, evident inequalities must be addressed in ongoing recovery efforts. Long-term outcomes will fully establish the impact of the pandemic on CRC patients.

Attitudes of women towards screening, prevention and treatment of cervical cancer in Namibia.

Cervical cancer is among the top causes of cancer-related deaths among women globally. The aim of the study was to assess the attitudes of women of reproductive age towards cervical cancer services in the Otjozondjupa region, Namibia. The setting of this study was the Otjozondjupa region, one of the 14 regions of Namibia. A quantitative, cross-sectional, descriptive study was used. The data were collected with a questionnaire from a stratified sample of 381 out of the 37066 study population of women of reproductive age across four districts of the region. Descriptive data analysis was performed using Statistical Package for Social Science version 25. The findings revealed that most respondents (83.1%) had an overall neutral attitude towards the screening, prevention, and treatment of cervical cancer; they were not concerned about the risk of cervical cancer and would not practice health-seeking behaviours regarding cervical cancer services. The respondents were indifferent with regard to prevention, screening, and management services for cervical cancer, implying that they would not use available cervical cancer services. Attitudes of women of reproductive age towards cervical cancer services were highlighted. Subsequently, an educational programme for nurses to enhance the utilisation of cervical cancer services among women of reproductive age in the Otjozondjupa region, Namibia, was developed. Guidelines were developed to facilitate the implementation and evaluation of the educational programme activities to enhance the utilisation of cervical cancer screening services among women of reproductive age.

The Impact of Specialist Care on Teenage and Young Adult Patient-Reported Outcomes in England: A BRIGHTLIGHT Study.

Purpose: In England, health care policy promotes specialized age-appropriate cancer services for teenagers and young adults (TYA), for those aged 13-24 years at diagnosis. Specialist Principal Treatment Centers (PTCs) provide enhanced age-specific care for TYA, although many still receive all or some of their care in adult or children's cancer services. Our aim was to determine the patient-reported outcomes associated with TYA-PTC based care. Methods: We conducted a multicenter cohort study, recruiting 1114 TYA aged 13-24 years at diagnosis. Data collection involved a bespoke survey at 6,12,18, 24, and 36 months after diagnosis. Confounder adjusted analyses of perceived social support, illness perception, anxiety and depression, and health status, compared patients receiving NO-TYA-PTC care with those receiving ALL-TYA-PTC and SOME-TYA-PTC care. Results: Eight hundred and thirty completed the first survey. There was no difference in perceived social support, anxiety, or depression between the three categories of care. Significantly higher illness perception was observed in the ALL-TYA-PTC and SOME-TYA-PTC group compared to the NO-TYA-PTC group, (adjusted difference in mean (ADM) score on Brief Illness Perception scale 2.28 (95% confidence intervals [CI] 0.48-4.09) and 2.93 [1.27-4.59], respectively, p = 0.002). Similarly, health status was significantly better in the NO-TYA-PTC (ALL-TYA-PTC: ADM -0.011 [95%CI -0.046 to 0.024] and SOME-TYA-PTC: -0.054 [-0.086 to -0.023]; p = 0.006). Conclusion: The reason for the difference in perceived health status is unclear. TYA who accessed a TYA-PTC (all or some care) had higher perceived illness. This may reflect greater education and promotion of self-care by health care professionals in TYA units.

Creating safer cancer care with ethnic minority patients: A qualitative analysis of the experiences of cancer service staff

AbstractIntroductionEffective consumer engagement practices can enhance patient safety. This is important for consumers from ethnic minority backgrounds who are exposed to increased risk of patient safety events. Using the Systems Engineering Initiative for Patient Safety model, this study explored staff experiences of creating opportunities for engagement with consumers from ethnic minority backgrounds to contribute to their cancer care safety.MethodA qualitative study was conducted using semistructured interviews with cancer service staff from four cancer services across two states in Australia. Purposive sampling was used to recruit healthcare staff from a diverse range of professions. Data were analysed using the Framework Analysis method.ResultsFifty‐four interviews were conducted with healthcare staff. Analysis of the qualitative interview data identified enablers and associated challenges that contributed to creating a shared understanding between consumers and staff of the information, processes, expectations and problems arising in care. Enablers and challenges are reported in relation to four themes: (1) co‐creating safety through shared understanding of care processes; (2) tools and technologies support planned communication; (3) organisational policy levers exist but lack implementation in direct care and (4) formal tasks incorporate consumer engagement more readily than informal interactions.ConclusionThe availability of infrastructure and resources to support communication with consumers from ethnic minority backgrounds was limited to specific tasks across the cancer care continuum. Strategies implemented by health services to foster effective communication during formal interactions now require expansion to support and create conditions for effective consumer engagement during informal and everyday care tasks. The use of innovative language support tools and cultural considerations are required at the service and system level to support consumer engagement in all types of care interactions.Public and Patient InvolvementThe study was embedded within a larger project that included a consumer investigator and was guided by a consumer advisory group (CAG). These consumer team members have lived experience of cancer and are from diverse ethnic backgrounds. CAG members provided feedback on the draft interview guide and participant information for this study.

Sharing Colorectal Cancer Follow-Up Using an E-Care Plan Between Cancer Services and Primary Health Care.

High quality, long term follow-up care for cancer patients needs to be coordinated, comprehensive and tailored to the diverse needs of patients. This study implemented shared follow-up care using an interactive e-care plan that provided a collaborative space to schedule and share goals, tasks and information and support the monitoring of care. Qualitative results identified good relational coordination. Increasing communication from the cancer service is important.

Impact of COVID-19 on cancer incidence, presentation, diagnosis, treatment and survival in Northern Ireland.

The COVID-19 pandemic had a major impact on cancer patients and services but has been difficult to quantify. We examined how the entire cancer pathway-from incidence, presentation, diagnosis, stage, treatment and survival-was affected in Northern Ireland during April-December 2020 compared to equivalent 2018-2019 periods using retrospective, observational cancer registry data from the Northern Ireland Cancer Registry (NICR). There were 6748 cancer cases in April-December 2020 and an average 7724 patients in April-December 2018-2019. Incident cases decreased by 13% (almost 1000). Significant differences were found across age cohorts and deprivation quintiles, with reductions greatest for younger people (<55 years; 19% decrease) and less deprived (22% decrease). A higher proportion had emergency admission (16%-to-20%) with lower proportions diagnosed pathologically (85%-to-83%). There was a significant stage shift, with lower proportions of early stage (29%-to-25%) and higher late-stage (21%-to-23%). Lower proportions received surgery (41%-to-38%) and radiotherapy (24%-to-22%) with a higher proportion not receiving treatment (29%-to-33%). One-year observed-survival decreased from 73.7% to 69.8% and 1-year net-survival decreased from 76.1% to 72.9%, with differences driven by five tumours; Lung (40.3%-to-35.0%), Head-and-Neck (77.4%-to-68.4%), Oesophageal (53.5%-to-42.3%), Lymphoma (81.1%-to-75.2%) and Uterine cancer (87.4%-to-80.4%). Our study reveals profound adverse impact of COVID-19 on the entire cancer patient pathway, with 13% fewer cases, greater emergency admissions and significant stage-shift from early to more advanced-stage disease. There was major treatment impact with lower rates of surgery and radiotherapy and higher proportions receiving no treatment. There were significant reductions in 1-year survival. Our study will support service recovery and protect cancer services in future pandemics or disruptions.

Understanding experiences of cognitive decline and cognitive assessment from the perspectives of people with glioma and their caregivers: A qualitative interview study

BackgroundDespite the impact of cognitive decline during brain cancer care, implementing routine cognitive assessment can be challenging. Effective implementation of cognitive assessment necessitates an understanding of implementation from the patient perspective. However, little is known about how people with glioma and their caregivers experience cognitive changes, assessment and support. ObjectiveTo understand the lived experiences of changes in cognition for people with glioma and their caregivers including experiences of: i) perceived or objectively measured cognitive decline (or absence of decline); ii) cognitive assessment following diagnosis, and; iii) met and unmet cognition-related supportive care needs. DesignSemi-structured qualitative telephone interviews were conducted with people with gliomas and support persons and analysed using reflexive thematic analysis. Setting(s)Two Australian cancer services Participants18 people with glioma and caregivers MethodsSemi-structured qualitative telephone interviews were conducted with people with gliomas and caregivers and analysed using reflexive thematic analysis. ResultsPeople with glioma (n = 5) and caregivers (n = 13) completed interviews. Four themes were identified: Cognition needs to be considered within the context of glioma diagnosis and treatment; concerns about cognition were initially subordinate to survival but become important; there are challenges identifying and communicating about people with gliomas’ changes in cognition; cognition-related supportive care can be helpful but challenging for people with glioma and caregivers to identify and access. ConclusionsChanges to cognition can have considerable impacts of people with glioma and their caregivers which may be overshadowed by treatment and survival. A multi-disciplinary approach to timely cognitive screening, structured referral pathways, and communication with caregivers may provide opportunities for support. Registrationn/a Tweetable abstractIdentifying cognitive changes in people with glioma is important and challenging. A multidisciplinary approach and inclusion of care coordination and caregivers can help.

Abstract PR01: Implementation of a real-time AI-guided navigation service for pancreas cancer

Abstract Patient navigation aims to overcome access barriers and optimize care delivery, but navigators cannot identify pre-diagnosed patients using traditional methods, hindering navigation efficacy. We observed care gaps among patients identified at our institution with suspected pancreatic cancer during January 2023: among 67 patients with new pancreas cancer, only 36% underwent biopsy with 22 days between radiology and biopsy; and 30% were seen by an outpatient oncologist with 32 days between radiology and visit. We sought to improve patient care outcomes through daily prospective AI-guided identification and navigation of patients with radiographic findings suspicious for pancreas cancer. In June 2023, we implemented an AI-guided daily workflow using the following steps: 1) at 24-hour intervals, an NLP model reviewed abdominal imaging reports and flagged reports containing language suspicious for pancreatic cancer; 2) a trained coordinator and GI oncologist validated reports with new masses and sent such reports to a GI navigator, and 3) the navigator facilitated appointments for proper follow-up, including GI services, the multi-disciplinary tumor board, and clinical trial coordinator. During June 2023, the model identified 69 patients with suspicion for new pancreas cancer. 19% were immediately eligible for navigation and scheduled for follow-up within our institution with an average of 8 days between report and navigation - 77% saw an outpatient oncologist with an average of 17.5 days between report and visit, 69% underwent biopsy with an average of 4.5 days between report and biopsy, and 54% were seen at multidisciplinary pancreatic cancer tumor board (pcTB) with an average of 16 days between report and pcTB. Furthermore, of these, we were able to enroll 4 patients to clinical trials and 5 accruals to biospecimen studies during this one-month period. 2 of these accruals were to the P-1000 study, which has been open at our institution for the last 2 years with a 0.5 per month accrual rate. Of the 81% who were not immediately eligible for navigation, 23% were already established with an oncologist in our system, 23% sought care elsewhere, 23% were not eligible for or did not desire further workup, and 30% were still undergoing in-patient workup. We show that an AI-guided workflow can transform referral patterns of pre-diagnosed pancreatic cancer patients, creating a new access stream for navigators to intervene much earlier in a patient’s continuum of cancer care with resultant improvement in healthcare delivery, evidenced by an average of 4.5 days between imaging and biopsy and 17.5 days between imaging and outpatient oncology visit, compared to our traditional cancer care approach with averages of 22 and 32 days, respectively. Furthermore, we have rapidly accelerated pancreas cancer clinical trial enrollment and biospecimen accrual at our institution since implementation of this workflow with 4 patients enrolled and 5 biospecimen accruals in a month alone. We are now working to expand this innovative framework across additional cancer types. Citation Format: Kristen M. John, Joseph Tenner, Yuddy Franco, Rolando Croocks, Melissa Perez, Tara McEvoy, Tiffany Zavadsky, Kristen Beyer, Rita Mercieca, Sandeep Nadella, Anthony Carvino, Matthew Barish, Daniel A. King. Implementation of a real-time AI-guided navigation service for pancreas cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr PR01.

Decline in Cancer Diagnoses during the ‘Zero COVID’ Policy in Hong Kong: Indirect Spillover Impact of the COVID-19 Pandemic

AimsDespite a largely successful ‘zero COVID’ policy in 2020, the COVID-19 pandemic disrupted routine cancer services in the city of Hong Kong. The aims of this study were to examine the trends in cancer incidence before and during the COVID-19 pandemic and estimate missed cancer diagnoses. Materials and methodsWe used population-based data from the Hong Kong Cancer Registry 1983–2020 to examine the trends of age- and sex-standardised cancer incidence before and during the COVID-19 pandemic. We applied: (i) the annual average percentage change (AAPC) calculated using the Joinpoint regression model and (ii) the autoregressive integrated moving average (ARIMA) model to forecast cancer incidence rates in 2020. Missed cancer diagnoses in 2020 were estimated by comparing forecasted incidence rates to reported rates. A subgroup analysis was conducted by sex, age and cancer site. ResultsThe cancer incidence in Hong Kong declined by 4.4% from 2019 to 2020 (male 8.1%; female 1.1%) compared with the long-term AAPC of 0.5% from 2005 to 2019 (95% confidence interval 0.3, 0.7). The gap between the reported and forecasted incidence for 2020 ranged from 5.1 to 5.7% (male 8.5%, 9.8%; female 2.3%, 3.5%). We estimated 1525–1596 missed cancer diagnoses (ARIMA estimate –98, 3148; AAPC 514, 1729) in 2020. Most missed diagnoses were in males (ARIMA 1361 [327, 2394]; AAPC 1401 [1353, 1460]), with an estimated 479–557 missed cases of colorectal cancer (ARIMA 112, 837; AAPC 518, 597) and 256–352 missed cases of prostate cancer (AAPC 231, 280; ARIMA 110, 594). ConclusionThe incidence of new cancer diagnoses declined in 2020 contrary to the long-term increase over the previous decades. Significantly lower diagnoses than expected were observed in males, particularly for colorectal and prostate cancers. Fewer reported cancer cases indicate missed diagnoses and could lead to delayed treatment that could impact future health outcomes.

Outcome and barriers to cervical cancer screening amongst human immunodeficiency virus-positive women attending Aminu Kano Teaching Hospital, Kano State, Nigeria

Sub-Saharan Africa carries the overwhelming share of the global burden of human immunodeficiency virus (HIV) infection and of HIV-associated cervical cancer. Screening is an effective strategy for the prevention, early diagnosis and prompt management of cervical precancerous lesions among HIV-positive women. This study assessed the outcome and barriers to cervical cancer screening among HIV-positive women attending Aminu Kano Teaching Hospital, Kano. Using a cross sectional study design, a pro forma was used to collect data and screen 740 HIV-positive women. Screening was done using visual inspection with acetic acid and Lugol’s iodine and the data were analysed using SPSS version 24.0. The age of the patients ranged from 25 to 49 years with a mean age of 30.7 ± 2.4 years. Majority (n=698; 94.3%) were  30 years and married (n=592; 80.0%). Almost half (n=362; 48.9%) had secondary level of education and many (n=520; 70.3%) were unemployed. A few (n=42; 5.7%) had positive results on visual inspection with acetic acid and a lesser proportion (n=26; 3.5%) had positive screening results on visual inspection with Lugol’s iodine. Lack of awareness of screening services for cervical cancer was found to be a barrier to cervical cancer screening and treatment among two-thirds (n=565; 76.4%) of the patients while a substantial proportion (n=592; 80.0%) reported that their personal belief which was strengthened by their religion prevented them from accessing cervical cancer screening services. Also, two-thirds (n=493; 66.6%) agreed that their culture which considers cervical screening a taboo was a barrier to screening. There is a need for targeted and enhanced education with counselling to optimize the uptake of screening for cervical cancer among HIV-positive women in HIV treatment centers. The generated data can guide in the provision of evidence-based policy and decision-making.

The impact of transportation mode, socioeconomic deprivation and rurality on travel times to radiotherapy and surgical services for patients with prostate cancer: A national population-based evaluation

BackgroundThe distances that patients have to travel can influence their access to cancer treatment. We investigated the determinants of travel time, separately for journeys by car and public transport, to centres providing radical surgery or radiotherapy for prostate cancer. MethodsUsing national cancer registry records linked to administrative hospital data, we identified patients who had radical surgery or radiotherapy for prostate cancer between January 2017 and December 2018 in the English National Health Service. Estimated travel times from the patients’ residential area to the nearest specialist surgical or radiotherapy centre were estimated for journeys by car and by public transport. ResultsWe included 13,186 men who had surgery and 26,581 who had radiotherapy. Estimated travel times by public transport (74.4 mins for surgery and 69.4 mins for radiotherapy) were more than twice as long as by car (33.4 mins and 29.1mins, respectively). Patients living in more socially deprived neighbourhoods in rural areas had the longest travel times to the nearest cancer treatment centres by car (62.0 mins for surgery and 52.1 mins for radiotherapy). Conversely patients living in more affluent neighbourhoods in urban conurbations had the shortest (18.7 mins for surgery and 17.9 mins for radiotherapy). ConclusionTravel times to cancer centres vary widely according to mode of transport, socioeconomic deprivation, and rurality. Policies changing the geographical configuration of cancer services should consider the impact on the expected travel times both by car and by public transport to avoid enhancing existing inequalities in access to treatment and patient outcomes.

Dealing with digital paralysis: Surviving a cyberattack in a National Cancer center

IntroductionCyberattacks represent a growing threat for healthcare delivery globally. We assess the impact and implications of a cyberattack on a cancer center in Ireland. MethodsOn May 14th 2021 (day 0) Cork University Hospital (CUH) Cancer Center was involved in the first national healthcare ransomware attack in Ireland. Contingency plans were only present in laboratory services who had previously experienced information technology (IT) failures. No hospital cyberattack emergency plan was in place. Departmental logs of activity for 120 days after the attack were reviewed and compared with historical activity records. Daily sample deficits (routine daily number of samples analyzed – number of samples analyzed during cyberattack) were calculated. Categorical variables are reported as median and range. Qualitative data were collected via reflective essays and interviews with key stakeholders from affected departments in CUH. ResultsOn day 0, all IT systems were shut down. Radiotherapy (RT) treatment and cancer surgeries stopped, outpatient activity fell by 50%. hematology, biochemistry and radiology capacity fell by 90% (daily sample deficit (DSD) 2700 samples), 75% (DSD 2250 samples), and 90% (100% mammography/PET scan) respectively. Histopathology reporting times doubled (7 to 15 days). Radiotherapy (RT) was interrupted for 113 patients in CUH. The median treatment gap duration was six days for category 1 patients and 10 for the remaining patients. Partner organizations paused all IT links with CUH. Outsourcing of radiology and radiotherapy commenced, alternative communication networks and national conference calls in RT and Clinical Trials were established. By day 28 Email communication was restored. By day 210 reporting and data storage backlogs were cleared and over 2000 computers were checked/replaced. ConclusionCyberattacks have rapid, profound and protracted impacts. While laboratory and diagnostic deficits were readily quantified, the impact of disrupted/delayed care on patient outcomes is less readily quantifiable. Cyberawareness and cyberattack plans need to be embedded in healthcare. Policy SummaryCyberattacks pose significant challenges for healthcare systems, impacting patient care, clinical outcomes, and staff wellbeing. This study provides a comprehensive review of the impact of the Conti ransomware attack on cancer services in Cork University Hospital (CUH), the first cyberattack on a national health service. Our study highlights the widespread disruption caused by a cyberattack including shutdown of information technology (IT) services, marked reduction in outpatient activity, temporary cessation of essential services such as radiation therapy. We provide a framework for other institutions for mitigating the impact of a cyberattack, underscoring the need for a cyberpreparedness plan similar to those made for natural disasters and the profound legacy of a cyberattack on patient care.

Susceptibility to cancer misinformation: Predictors of false belief and false memory formation

AbstractPrevious research has shown that people sometimes come to believe in misinformation presented in the form of fake news, and even form false memories for the fabricated events described. This study aimed to investigate the effects of analytical reasoning, attitudes to complementary and alternative medicine, bullshit receptivity, and previous experience with cancer on the formation of false memory and false belief for cancer related misinformation. Participants (N = 466) were exposed to four fake news stories and four true news stories relating to cancer treatment and services. Male gender, low analytical reasoning, receptivity to bullshit, and endorsement of complementary and alternative medicine were all significant predictors of belief in cancer misinformation, while participants with poor analytical reasoning or higher receptivity to bullshit reported more false memories for fake news stories. These results indicate that reflexive, intuitive thinking styles contribute to susceptibility to cancer misinformation, suggesting a potential target for public health interventions.

Psychosocial Experiences in an Australian Rural Cancer Service: Mixed-Method Insights into Psychological Distress and Psychosocial Service Barriers

Purpose. To examine psychosocial and well-being concerns throughout the cancer experience, from prediagnosis to survivorship. Whilst most oncology research focuses on patients, the role and experiences of families and caregivers are increasingly recognised as a core component of health service delivery. Moreover, research suggests that geography is an important consideration, with evidence of rural inequities in health service provision and access. Aims. (i) To examine the unique patient and caregiver experiences of rural people in three rural cancer treatment centres in New South Wales (NSW) and (ii) to examine the barriers to rural patients and caregivers accessing psycho-oncological support in NSW. Methods. A convergent parallel mixed-method evaluation of the psychosocial experiences of rural patients and caregivers accessing cancer services through three health services in rural NSW was undertaken (N = 125). Measures of psychological distress as well as quantitative and qualitative barriers data were collected. Results. Approximately, one-third of the participants reported moderate to severe distress. Patients and caregivers reported systemic, intrapersonal, interpersonal, and pandemic-specific barriers in accessing quality psychosocial healthcare. Conclusions. These results suggest that cancer patients and caregivers in rural NSW may experience elevated levels of psychological distress and barriers in accessing psychosocial care. The combination of high psychological need for patients and caregivers with reduced availability of psychosocial support services has substantial implications for psychological wellbeing and service provision. Underdetection of psychosocial need and a lack of support services pose a significant challenge for rural people with cancer and for those who care for them; this must be an urgent priority for quality improvement and equitable healthcare provision.

Collaborative governance in integrated healthcare networks: insights from the cancer program in Québec (Canada)

Context: The challenge of modernizing health services delivery for cancer patients and their loved ones involves moving towards integrated network-based practices. While initiatives at different levels of healthcare systems contribute to this movement, further efforts are needed to maintain and extend gains to adapt to the complex and fast-changing cancer environment. A collaborative governance regime, understood as a form of capacity building for joint action across boundaries, represents a promising way to improve and sustain integrated care.&#x0D; Objective: This presentation reports insights from providers and users of health services gained from the experience in operationalizing an integrated network-of-networks in the context of a national cancer program in Quebec (Canada). &#x0D; Methods: Methods: Insights are drawn from a larger multiple case study that took place from 2018 to 2021. Participants (n=39) are knowledgeable informants on how “mandated” integration structures and processes support collaboration among the various components of the network. Documents (n=45) related to network governance and integrated practices are also included. The data collection guide and analysis based on qualitative interpretive description are framed on the Collaborative Governance framework to capture critical dimensions in the integration process. These include clear mission, common and shared definition of complex problems and potential solutions, and identification of common values to support motivation, engagement and capacity for joint action.&#x0D; Results: We report on three main tensions related to integration in the cancer network that suggest strategies for enhancing collaborative governance: &#x0D; The first tension emerges as some participants perceive “mandated integration” within a “prescribed collaborative work” as a constraint that undermines previous collaborative work at local level. This tension leads to unresolved controversies within and between actor groups, weakening the mechanisms of collaborative governance. &#x0D; The second tension is a principle-to-practice divide around engaging people affected by cancer in network governance. Despite widespread motivation, participation at the local level varies according to managers' willingness and skill in creating open and inclusive processes where evidence-based medical practice and lived patient experience can be assembled. This tension is seen to contribute to a poor consideration of patient perspectives during the highly volatile period of decision-making during the COVID-19 pandemic.&#x0D; The third tension involves the hierarchy of cancer services promoted in the national cancer program and the standardization of practices. Organizing the network-of- networks by cancer specialization involves creating trajectories by type of cancer and their navigation according to established standards of practice and quality considerations. The consequent redistribution of human and financial resources, and revised ownership of care process creates perceived asymmetries between cancer network professionals and centers and controversies that hinder integrated practices. &#x0D; Conclusion: Despite favorable starting conditions from the national cancer program and its central leadership promoting collaborative governance, tensions that emerge through the pursuit of network integration limit the transition to a more collaborative regime. Taking the time to work out these tensions as integration proceeds appears essential to arrive at a governance model that is appropriate and acceptable for all network members.

"Establishing a Multi-disciplinary Adult Oncology Unit at Muhimbili National Hospital: Lessons Learned, Challenges, and Opportunities Amidst Tanzania's Growing Cancer Burden"

The escalating cancer burden, particularly in low- and middle-income countries such as Tanzania, necessitates innovative strategies. One strategy is to increase access to cancer services through the establishment of treatment in existing referral hospitals that offer multidisciplinary care, as was the case in the opening of the adult oncology unit at Muhimbili National Hospital (MNH) in Tanzania. A comprehensive facility assessment served as the foundation for this expansion, encompassing assessments of the spatial requirements of human resources, equipment, and drug availability. Aiming to ensure optimal resource allocation and effective implementation by capitalizing on existing systems. The main objective of opening the MNH adult oncology unit was to increase coverage and accessibility to comprehensive cancer care services. This initiative has substantially improved patient outcomes, with reduced wait times for oncology care initiation, facilitating seamless care coordination that capitalizes on multidisciplinary treatment planning. The unit has provided benefits to MNH by fostering collaborative efforts, serving as a revenue generation point, and expanding care that aligns with institutional goals. Nonetheless, challenges persist, including space constraints and an inadequate number of trained human resources for oncology care. The successful establishment of the MNH's adult oncology unit exemplifies the significance of stakeholder engagement, adaptability, and collaboration. A comprehensive approach that emphasizes workforce development, community awareness, and infrastructure enhancement offers promise in confronting Tanzania's mounting cancer burden.

A Review of Policies to Reduce Waiting Times for Health Services across OECD Countries

Waiting times for health services are a significant policy issue in most OECD countries, where improving the experience and patient satisfaction with the health system is a key objective. Waiting times in publicly-funded systems arise from the imbalance between demand for and supply of health services. This study reviews policies aimed at reducing waiting times in OECD countries across different health services: specialist consultations and elective treatments; consultations with primary care providers; cancer care; and mental health services. A policy questionnaire was sent by the OECD in May 2019. For each area it asked information on a) policies, its objectives and actions, b) the extent to which they were regularly evaluated or assessed, and c) main results of the evaluation. 33 countries provided at least a partial response, with 24 countries providing detailed information about the policies, which are reviewed in this study. Our key findings are as follows. Countries often start by specifying maximum waiting times across a range of services, which can be used as a guarantee for patients and/or targets for providers. Policies for elective care include improving demand management by prioritising patients on the list, and improving coordination between primary and secondary care. For primary care, policies focus on increasing the supply of general practitioners and advanced practice nurses, and encouraging the use of new technologies (e.g. teleconsultations). For cancer care, countries have developed national strategies to ensure timely access to diagnosis and treatment, including fast-track pathways, which rationalise and coordinate different types of cancer services, facilitated by dedicated capacity. Policies for mental health focus on better meeting demand through increased volume or scope with, in some cases, targets driving better access. In summary, policymakers have several levers to reduce waiting times along the patient pathway to improve responsiveness and make health systems more people centred.

Implementation of the Adult Oncology Unit at Muhimbili National Hospital (MNH)

The escalating cancer burden, particularly in low- and middle-income countries such as Tanzania, necessitates innovative strategies. One such strategy is increasing access to cancer services through the establishment of treatment in existing referral hospitals that offer multidisciplinary care, as was the case in the opening of the adult oncology unit at Muhimbili National Hospital (MNH) in Tanzania to address the burgeoning cancer crisis. A comprehensive facility assessment served as the foundation for this transformation, ensuring optimal resource allocation and effective implementation. The rising cancer burden in Tanzania is dominated by cervical, breast, and prostate cancers. However, reported figures might underestimate the issue due to the lack of a centralized national cancer registry and limited access to diagnostic and treatment facilities throughout the country. The MNH oncology unit's creation aimed to decentralize care from the Ocean Road Cancer Institute (ORCI); as the cancer burden increased over the years, the center was getting strained by demand. The MNH facility assessment encompassed assessments of spatial requirements for human resources, equipment, and drug availability. This unit adopts a multidisciplinary approach, enabling personalized treatment plans and collaborative decision-making, aimed at expanding capacity and promoting inter-departmental cooperation. A "train-the-trainer" model empowered nursing staff in chemotherapy administration, and pharmacist involvement ensured accurate medication management. This initiative has substantially improved patient outcomes, with reduced wait times for oncology care initiation, facilitating seamless care coordination that capitalizes on multidisciplinary treatment planning. The opening of the oncology unit has given benefits to MNH through fostering multidisciplinary collaboration, an increase in revenue generation, and the expansion of care that aligns with institutional goals. Nonetheless, challenges, including space constraints and an inadequate number of trained human resources for oncology care, persist. The successful establishment of MNH's adult oncology unit exemplifies stakeholder engagement, adaptability, and the significance of collaboration. A comprehensive approach, emphasizing workforce development, community awareness, and infrastructure enhancement, offers promise in confronting Tanzania's mounting cancer burden.

Addressing the gap in health economics data to support national cancer control plans in low- and middle-income countries: The Childhood Cancers Budgeting Rapidly to Incorporate Disadvantaged Groups for Equity (CC-BRIDGE) tool.

National cancer control plans (NCCPs) are complex public health programs that incorporate evidence-based cancer control strategies to improve health outcomes for all individuals in a country. Given the scope of NCCPs, small and vulnerable populations, such as patients with childhood cancer, are often missed. To support planning efforts, a rapid, modifiable tool was developed that estimates a context-specific national budget to fund pediatric cancer programs, provides 5-year scale-up scenarios, and calculates annual cost-effectiveness. The tool was codeveloped by teams of policymakers, clinicians, and public health advocates in Zimbabwe, Zambia, and Uganda. The 11 costing categories included real-world data, modeled data, and data from the literature. A base-case and three 5-year scale-up scenarios were created using modifiable inputs. The cost-effectiveness of the disability-adjusted life years averted was calculated. Results were compared with each country's projected gross domestic product per capita for 2022 through 2026. The number of patients/total budget for year 1 was 250/$1,109,366 for Zimbabwe, 280/$1,207,555 for Zambia, and 1000/$2,277,397 for Uganda. In year 5, these values were assumed to increase to 398/$5,545,445, 446/$4,926,150, and 1594/$9,059,331, respectively. Base-case cost per disability-adjusted life year averted/ratio to gross domestic product per capita for year 1, assuming 20% survival, was: $807/0.5 for Zimbabwe, $785/0.7 for Zambia, and $420/0.5 for Uganda. This costing tool provided a framework to forecast a budget for childhood-specific cancer services. By leveraging minimal primary data collection with existing secondary data, local teams obtained rapid results, ensuring that childhood cancer budgeting is not neglected once in every 5 to 6years of planning processes.