New approach to implement cancer patients care: The ValPeROC experience from an Italian oncology network

Objective: Primary goal of the Oncology Campania Network (ROC) was to reduce cancer delay and care fragmentation through the establishment of cancer-specific Multidisciplinary Oncologic Groups (GOM) and therapeutic and diagnostic assistance paths (PDTA). Methods: five Cancer Centers of the ROC, with their own cancer specific GOM were selected. In our analysis we have focused on four neoplasms: lung, colon, ovarian and prostate cancers. The median time for pre-GOM and GOM Times were calculated for each tumor site. Univariate and Multivariate logistic regressions were performed to individuate risk factors for pre-GOM and GOM Time. Results: Significant differences were observed for prostate cancer compared to other patients either for pre-GOM or GOM Times. Significant risks were found for ovarian and prostate cancer in pre-GOM time and for prostate cancer in GOM-Time. Conclusions: This experience will produce knowledge and data to guide decision-making and to manage more effectively the challenges of fighting cancer in Campania region. The ValPeROC study evaluates, for the first time, the ROC activity, through the analysis of key performance indices. Pre-GOM and GOM Time represent the quality of the entire regional health system and are useful to define models which can evaluate the performance of the ROC over time.研究目标：坎帕尼亚肿瘤网络（Oncology Campania Network，ROC）的核心目标为，通过建立肿瘤专科多学科团队（Multidisciplinary Oncologic Groups，GOM）以及治疗与诊断援助路径（therapeutic and diagnostic assistance paths，PDTA），降低癌症诊疗延误与医疗照护碎片化问题。研究方法：选取ROC旗下5家配备专属肿瘤专科GOM的癌症中心作为研究对象。本分析聚焦肺癌、结肠癌、卵巢癌及前列腺癌四类肿瘤。针对每类瘤种，计算其GOM组建前（pre-GOM）与GOM组建后的中位耗时。采用单因素及多因素logistic回归分析，识别pre-GOM耗时与GOM耗时的危险因素。研究结果：相较于其他瘤种患者，前列腺癌患者的GOM组建前耗时与GOM组建后耗时均存在显著差异。pre-GOM耗时的显著危险因素见于卵巢癌与前列腺癌患者，而GOM耗时的显著危险因素则见于前列腺癌患者。研究结论：本研究积累的知识与数据可为临床决策提供指导，更有效地应对坎帕尼亚地区的癌症防控挑战。ValPeROC研究首次通过关键绩效指标分析，评估了ROC的运行情况。GOM组建前耗时与GOM组建后耗时可反映整个区域医疗体系的服务质量，且有助于构建可长期评估ROC运行绩效的模型。