In Italy, around 46% of hospitals perform ‘sub-threshold’ oncological surgery, meaning they use the scalpel too few times. For breast cancer, for example, the threshold value is 150 operations per year. It means that below this number the center is not able to offer the same safety and quality of outcomes as centers with interventions above the expected threshold. Furthermore, only in 13 Italian facilities is there a treatment path whose quality is certified by OECI (Organisation of European Cancer Institutes).
Oncology care, strong disparities between Regions by Letizia Gabaglio 13 December 2023
However, there is one positive fact: from 2017 to 2022 the number of ‘below threshold’ hospitals reduced by over 16%, going from 5,670 to 4,747. At the same time, there was a reduction in the volumes of oncological surgery operations in ‘below threshold’ hospitals: from 57,419 operations in 2017 (29% of total operations) to 47,230 in 2022 (23% of total operations). The new updated map “Where do I get treatment?”, presented today by ROPI (Italian Patients’ Oncology Network) to the Ministry of Health and drawn up starting from the data of the latest National Outcomes Program of Agenas, is based on two criteria: in addition to exceeding the threshold of surgical volumes – which scientific evidence associates with the best outcomes – those hospitals within which there is a treatment path whose quality is certified with the OECI ‘stamp’.
Help patients orient themselves
“Like every year, our map aims to help patients and their loved ones to find their way around the healthcare facilities that carry out oncology surgery – he explains Stefania Gori, President of ROPI and of AIGOM (Italian Association of Multidisciplinary Oncology Groups) – . This year we have added a further piece, that relating to the care path, aware that quantitative data alone is not sufficient to give a correct and complete indication of the quality of a hospital”.
“The new map confirms the decreasing trend of interventions in ‘below threshold’ facilities and, consequently, an increase in the volumes of oncological surgery operations in ‘above threshold’ hospitals: from 143,469 operations in 2017 (71% of total operations) to 160,919 in 2022 (77% of total interventions)”, he declares Fabrizio Nicolis, ROPI advisor and project coordinator. The data relating to surgery for breast cancer are emblematic, where there is a decreasing trend in the number of hospitals ‘below the threshold’: from 521 in 2017 to 313 in 2022 (-40%). On the other hand, there was an increase in the volumes of operations performed in ‘above threshold’ hospitals: from 45,656 in 2017 (74% of total operations) to 53,653 in 2022 (84% of total operations). “However, the North-South gradient remains unchanged, with the North in which the majority of the Regions have ‘above threshold’ hospitals for all 17 pathologies considered, and the South in which only 3 regions (Puglia, Campania and Sicily) cover all pathologies”, underlines Nicolis.
There is a hospital ‘tailored’ for women, 367 facilities awarded with the pink sticker by Valeria Pini 30 November 2023
The certification
The OECI certification for the quality of the care path – The evaluations relating to the quality of the care path are also added to the numbers. “We realized that to help patients and citizens choose the place of treatment not only based on the number of oncological surgeries, but also with the best quality of care, verified by a third party, namely OECI”, underlines Gori .
“The OECI accreditation certification is in fact the photograph of the actual implementation of the qualitative and qualitative standards envisaged by the Quality Program by an oncology institute – they explain John Apollo, president of OECI, and Claudio Lombardo, general manager of OECI – . Although OECI verifies the progress of the Improvement Plan over time, which generally follows certification, the quality of care provided is the result of a continuous innovation process connected to the exploitation of research results”.
The care paths
The importance of the quality of care pathways is also confirmed Massimo Carlinipresident of the Italian Society of Surgery: “The decrease in complications and mortality also depends on the quality of postoperative care, which is more closely related to some specific characteristics of the hospital, rather than the number of operations performed. Some operations require specific skills intraoperative and in this case the volume of the surgeon predominates, while others may require important and complex treatments during the postoperative course and then the volume of the hospital predominates. Furthermore, after an improvement in results in high-volume centers, inferior results may also result when a given center reaches its limit. In our country, considering that the number of beds, intensive care doctors, surgeons and specialized nurses is reduced, this second aspect is very important. In any case, complex surgical procedures centralized services should be available in well-distributed centers throughout the national territory”.
The choice of structure
When you get sick it often becomes difficult to understand what to do. And an evaluation criterion therefore becomes important to guide the patient. “For those who find themselves facing an oncological disease for the first time, which is so traumatizing from a psychological and social point of view, the importance of making a conscious choice regarding the hospital structure to which to entrust one’s health is evident – he comments Simonetta Bianchinipresident of For You Donna Odv . As an association we are in daily contact with patients who ask us where it is best for them to be treated, even if the choice is then conditioned by the economic and logistical aspects that people have to face. But it is of absolute importance to have a tool that, based on objective criteria, can guide patients in this choice.”
To each their own mammogram by Tiziana Moriconi 19 January 2024
Not just surgery, but follow up
It is necessary to evaluate not only where to undergo surgery, if necessary, but also where to be followed throughout the treatment. “In the last 12/13 years, melanoma therapy has radically changed thanks to innovative drugs, leading to recoveries in the case of patients suffering from metastatic melanoma going from 5% to 55% – he explains Antonella Romaninipresident ofAssociation Against Melanoma. The surgical part, although not presenting particular technical difficulties, however involves the identification and removal of the sentinel lymph node, which requires a learning curve of at least 50 cases and the execution of at least 50 cases/year and that of an expert pathologist. Therefore, it is important that the entire diagnostic-therapeutic path guarantees high levels of efficiency, which are the basis for improving the survival of these patients.”