Integrated cancer care – next steps in best practice

Multidisciplinary, integrated care for cancer patients is more important than ever in a changed global landscape, with all countries experiencing periods of extensive lockdowns due to COVID-19. The need for improved communication often done in a virtual setting, adaptations to roles and responsibilities with considerations of more happening at a local level, and a need for heightened reassurance of safety, quality and consistent care have shifted the care model.

Defining integrated care

Integrated care is an over-arching term that captures various methods and models that facilitate improvements in patient experience through more streamlined coordination and continuity of care.¹

Integrated care involves the entire health care system, across all services — community (including preventative health measures), primary, secondary, tertiary (and quaternary) with the aim to achieve good health outcomes and to efficiently deliver a high quality of healthcare.^2,3

Active patient involvement is crucial for good integrated care, and an integrated system must deliver customised services to patients, with the object of having them at the centre of care rather than the services providing that care.4 Integrative care processes must be highly organised to provide consistency.²

The role of an integrated care model in the treatment of cancer

Cancer care is multifaceted as patients often require care and treatment outside of, and in addition to the cancer. Care may need to include many treatment modalities including several different specialists, surgery, chemotherapy, radiation therapy and support services such as rehabilitation for physical strength, and management of the often-complex emotional issues that arise with such a diagnosis.

In addition to the cancer, many patients often have pre-existing health conditions, and these may be exacerbated from the cancer and/or treatment and need careful management.

Primary health care providers play a vital role in helping patients access timely, appropriate cancer care. General practitioners provide comprehensive ongoing care and connect the community with the rest of the healthcare sector.5,6 Upwards of 85% of cancers are diagnosed following symptomatic presentation to a primary-care provider.⁶

Integrated cancer care in a post-pandemic world

There will be an urgent need for new models of care to address more complex cancer cases due to the impact of ongoing national lockdowns.

Global statistics are showing an increase in complex cancer with more patients presenting with metastatic disease due to delayed diagnosis and treatment.^7-9

Patients presenting with later-stage disease often require more treatment than early-stage disease, and a multidisciplinary, integrated approach to complex cancer cases is critical for optimising patient outcomes.¹⁰

Coordination is at the centre of the integrated model –

• ensuring continuity of care is integrated with the patient’s needs- both physically and emotionally
• integration of primary into secondary care
• integrating all treatment modalities and team members
• allied health – which may include internal or external providers
• health promotion and secondary prevention (particularly relevant for effective survivorship).

The benefits of integrative care are broad reaching

Integrated cancer care contributes to improved experiences for people affected by cancer and all their healthcare providers. It also impacts the delivery of value-based health care and improved health and cancer outcomes.^10,11

The results of a recent systematic review and meta-analysis indicate that integrated care showed both significant reduction in costs and improvement in outcomes compared with usual care, especially in studies with a follow-up period over a year.¹

1. Rocks S et al. Eur J Health Econ 2020; 21: 1211–1221.
2. Australian Government. Productivity Commission. 5-year productivity review, Supporting paper no. 5: Integrated care, 2017. Available at: pc.gov.au/inquiries/completed/productivity-review/report/productivity-review-supporting5.pdf. Accessed on: 18/01/22.
3. Integrated Care Models: an overview. WHO: Regional centre for Europe. 2016. Available at: euro.who.int/__data/assets/pdf_file/0005/322475/Integrated-care-models-overview.pdf. Accessed on: 18/01/22.
4. Hughes G, et al. Milbank Quarterly 2020; 98(2):446-492
5. Strengthening the frontline: How primary health care helps health systems adapt during the COVID-19 pandemic. Organisation for Economic Co-operation and Development. 2021. Available at: oecd.org/coronavirus/policy-responses/strengthening-the-frontline-how-primary-health-care-helps-health-systems-adapt-during-the-covid-19-pandemic-9a5ae6da/. Accessed on: 18/01/22.
6. Nunez C et al. Modifiable lifestyle factors and cancer risk: An Evidence Check rapid review brokered by the Sax Institute for the Cancer Institute NSW, 2018. Available at: cancer.nsw.gov.au/how-we-help/reports-and-publications/modifiable-lifestyle-factors-and-cancer-risk. Accessed on: 18/01/22.
7. Maringe C, et al. Lancet 2020; 21(8):P1023-1034.
8. Gurney J, et al. Lancet Reg Health – W Pac 2021; 10:100127.
9. Cancer screening and COVID-19 in Australia 2020. Available at: https://www.aihw.gov.au/reports/cancer-screening/cancer-screening-and-covid-19-in-australia/contents/how-has-covid-19-affected-australias-cancer-screening-programs. Accessed on: 18/01/22.
10. Beradi R, et al. Cancer Manag Res 2020; 12:9363-9374.
11. Selby P, et al. American Society of Clinical Oncology Educational Book. 2019; 39:332-340.