Collaborations in cancer care: contemporary approach toward comprehensive cancer networks

This thesis entitled ‘Collaborations in cancer care – contemporary approach toward comprehensive cancer networks’ aims to explore and optimize collaborations in transmural cancer care, first by examining the role of time intervals to treatment and second by establishing and advancing referrals, mainly focused on two cancer (sub)types; colorectal liver metastases and glioblastoma. The timing of glioblastoma treatment varies considerably in clinical practice. Regarding to neurosurgery, with current decision-making, initial presentation at the outpatient clinic, higher preoperative performance status, and smaller tumor volume are risk factors for delayed neurosurgery. The timing of glioblastoma surgery may be associated with postoperative performance improvements and survival. Timely glioblastoma surgery appears to have a favorable impact on survival in patients with tumor volumes greater than 50 mL or seizure as the only preoperative symptom. Regarding to (chemo)radiotherapy, larger extent of resection, university affiliation, and more recent year of treatment are risk factors for delayed start of this treatment. Regarding to adjuvant chemotherapy, higher postoperative performance status is a risk factor for delayed initiation of adjuvant chemotherapy. Therefore, patients should undergo neurosurgery as soon as feasible, with a maximum acceptable time interval of 4 weeks after careful patient’s triage, and radiotherapy should neither be forced nor delayed, but rather start timely as soon as the patient has recovered from surgery. Complex cancer care is increasingly concentrated in specialized and academic hospitals. The extent of concentration of care varies between cancer pathways, with rare tumors more likely to be already concentrated. With concentration of care, patients are referred between hospitals. The current lack of digital access to medical records across hospitals leads to loss of patient information in the majority of oncological referrals. In addition, the distribution of care among multiple hospitals impedes between-hospital consultation, resulting in undertreatment, delayed referrals and initiation of treatment, and needless referrals. Improvement of patient information exchange and referral management by telehealth innovations could contribute to optimize oncological referrals. Digital consultation of multidisciplinary expert or triage panels are feasible approaches to provide non-specialized hospitals with tumor-specific expertise for appropriate referral management. Collaboration between healthcare providers among hospitals in regional cancer networks could contribute to the continuity of transmural oncological care.