Integrated cancer care – next steps in best practice
With changes experienced to the healthcare system during the COVID-19 global pandemic, multidisciplinary, integrated care for cancer patients is more important than ever.1-5 Like many aspects of life, the pandemic impacted cancer care across multiple areas, including a greater reliance on online consultation, and disruptions around how healthcare workers could perform their roles and responsibilities.5 For patients and carers alike, particular importance centered around having the confidence that continual ongoing treatment would occur.5
Integrated care
Integrated care is a general overarching term used to describe the various methods and models that facilitate the improvement of the patient treatment experience by enhancing coordination and continuity of care.6,7 By using relevant areas of the healthcare system, integrated care aims to achieve the best outcomes possible for each patient, especially for older more vulnerable patients.7-9 Active patient involvement is crucial for good integrated care, and an integrated system must aim to deliver customised services to patients and have them at the centre of care rather than the services providing that care.7,10 To be more effective, integrative care should have clear governance and accountability.7
The role of an integrated care model in the treatment of cancer
Cancer care is multifaceted – that is, patients often require a number of support services during the their treatment journey.11 Care often requires many treatment modalities including:
- specialists
- surgery
- chemotherapy
- radiation therapy
- support services such as rehabilitation for physical strength, and
- management of the often-complex emotional issues that arise with such a diagnosis.11,12
In addition to having cancer, many patients often have pre-existing health conditions, and these also need to be carefully managed and not neglected during treatment.13
Primary health care providers also play a vital role in helping patients access timely and appropriate cancer care.13 General practitioners provide comprehensive ongoing care and connect the community with the rest of the healthcare sector.14,15 Upwards of 85% of cancers are diagnosed following symptomatic presentation to a primary-care provider.15
Integrated cancer care in a post-pandemic world
Global statistics suggest there is a rising trend in increasing complex cancer cases; with more patients presenting with metastatic disease due to delayed diagnosis and treatment.18,19 Hence a multidisciplinary, integrated approach to complex cancer cases is critical for optimising patient outcomes.19
Coordination is at the centre of the integrated model – especially:
- ensuring continuity of care is integrated with the patient’s needs, both physically and emotionally20
- a more seamless transition of primary into secondary care21
- allied health – which may include internal or external providers22
- health promotion and secondary prevention (particularly relevant for effective survivorship).23
The benefits of integrative care are broad reaching
Integrated cancer care may contribute to improved experiences for people affected by cancer and all their healthcare providers.24 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.25
Disclaimer
Any medical procedure or treatment involving the use of radiation carries risks, including skin irritation and associated pain. Before proceeding with treatment, you should discuss the risks and benefits of the treatment with an appropriately qualified health practitioner. Individual treatment outcomes and experiences will vary.
- University of Oxford. Blavatnik School of Government (webpage]. COVID-19 Government response tracker. Last updated Feb 2023 [ cited Jan. 2024]. Access from: https://www.bsg.ox.ac.uk/research/covid-19-government-response-tracker
- BBC News. Conronavirus: The worl in lockdown in maps and charts (webpage). Lats updated April 2020 (cited Jan. 2024). Access from: https://www.bbc.com/news/world-52103747
- Moynihan R., et al. BMJ Open. 2021; 11(3): e045343.
- Milch V., 2021, et al. Med J Aust. 2021; 215(10): 479–484.
- Edge, R., et al. PLoS One. 2021; 16(9): e0257420.
- Rocks S et al. Eur J Health Econ 2020; 21: 1211–1221.
- 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.
- 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.
- Australian Government. Cancer Australia [website]. Complementary therapies. Updated 2024 [cited Jan. 2024]. Access: https://www.canceraustralia.gov.au/impacted-cancer/treatment/complementary-therapies
- Hughes G, et al. Milbank Quarterly 2020; 98(2):446-492
- Cancer Council Australia [website]. Examples of multidisciplinary care teams. Updated 2024 [cited Jan. 2024]. Access: https://www.canceraustralia.gov.au/clinicians-hub/multidisciplinary-care/all-about-multidisciplinary-care/multidisciplinary-care-team/case-studies-advanced-disease
- Cancer Council Australia [website]. Emotions and cancer. Updated Nov. 2022 [cited Jan. 2024]. Access: https://www.cancer.org.au/assets/pdf/emotions-and-cancer-booklet
- Sarfati, D et al. A Cancer J Clin. 2016; 66(4):337-50.
- 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.
- NSW Government. Cancer Institute NSW [webpage]. Working with primary care. Last updated 2018. (cited Jan 2024). Access from: https://www.cancer.nsw.gov.au/what-we-do/working-with-primary-care
- Maringe C, et al. Lancet 2020; 21(8):P1023-1034.
- Gurney J, et al. Lancet Reg Health – W Pac 2021; 10:100127.
- Sung, H et al. A Cancer J Clin. 2021;71(3):209-249
- Beradi R, et al. Cancer Manag Res 2020; 12:9363-9374.
- Aubin M., et al. Ann Fam Med. 2021;19(2):117-125
- Collaco N, et al. Support Care Cancer. 2024; 32(2): 120.
- Australian Government. Cancer Australia [website]. Multidisciplinary care. Updated 2024 [cited Sept. 2023]. Access: https://www.canceraustralia.gov.au/clinicians-hub/multidisciplinary-care/all-about-multidisciplinary-care
- Loomans krrop, HA & Umar, A. NPJ Precis Oncol. 201928:3:3.
- Selby P, et al. American Society of Clinical Oncology Educational Book. 2019; 39:332-340.
- Selby, et al. Eur J Health Econ. 2020; 21(8): 1211–1221.