Catalan cancer strategy Barcelona, Catalonia, Spain.
Catalonian Cancer Strategy, Department of Health, Barcelona, Spain & University of Barcelona (IDIBELL)| Catalonian Cancer Strategy, Spain.
J Cancer Policy. 2022 Jun;32:100334. doi: 10.1016/j.jcpo.2022.100334. Epub 2022 Apr 28.
Centralisation of cancer surgery is a commonly applied healthcare strategy worldwide. This study aimed to detail the design of centralisation policies, to shed light on the implications of such policies in real practice and to describe the different perspectives taken to deal with difficulties that emerged, taking pancreatic cancer as an example of a complex cancer disease requiring surgery.
A scoping review was conducted using the MEDLINE database. We systematically searched for eligible studies published between January 2000 and December 2018.
In the 33 included studies, centralisation of pancreatic cancer surgery was implemented through three different models: designated hospitals, definition of minimum volumes per provider, and/or recommendations included in protocols and national guidelines. The presence of highly advanced technology and infrastructures, the availability of extensive service coverage and advanced care processes based on expert multidisciplinary teams, and higher caseloads were identified as key components of centralisation policy.
Centralisation models for pancreatic cancer surgery showed that having expert centres where the care process is comprehensively guided is a foundational policy approach. External quality assessment and the accreditation of centres and professionals performing complex surgical procedures are levers that may positively impact the effectiveness of the measure. POLICY SUMMARY: while we found different experiences and three models of centralisation, all of them were guided by the will to positively impact on pancreatic cancer patients' access to expert care. Clinical research might be able to make progress in the coming years and perhaps contribute to reversing a critical situation of high mortality and growing incidence. However, policymakers must optimise health system responses considering current resources, as suggested by the recommendations proposed in the framework of the EU initiative Bratislava Statement for pancreatic cancer care.
癌症手术的集中化是全球范围内广泛应用的医疗保健策略。本研究旨在详细说明集中化政策的设计，阐明这些政策在实际实践中的影响，并描述为应对出现的困难而采取的不同观点，以胰腺癌为例，探讨需要手术的复杂癌症疾病。
使用 MEDLINE 数据库进行范围综述。我们系统地检索了 2000 年 1 月至 2018 年 12 月期间发表的合格研究。
在纳入的 33 项研究中，胰腺癌手术的集中化通过三种不同的模式实现：指定医院、每个提供者的最低容量定义，和/或纳入协议和国家指南中的建议。先进技术和基础设施的存在、广泛的服务覆盖范围和基于专家多学科团队的先进护理流程，以及更高的病例量被确定为集中化政策的关键组成部分。
胰腺癌手术的集中化模式表明，拥有专家中心，全面指导护理过程是一项基础政策。外部质量评估和对执行复杂手术程序的中心和专业人员的认证是可能对该措施的有效性产生积极影响的杠杆。政策总结：虽然我们发现了不同的经验和三种集中化模式，但所有这些模式都是为了积极影响胰腺癌患者获得专家护理的机会。临床研究在未来几年可能会取得进展，并可能有助于扭转高死亡率和发病率不断上升的危急局面。然而，政策制定者必须根据欧盟倡议布拉迪斯拉发声明中提出的建议，优化卫生系统的应对措施，考虑到当前的资源。
