Our territorial-based model of care for oncological (TOC) patients includes outpatient clinics, located closer to the patients home, in three Community Hospitals; since July 2016, this model of care has been implemented; in fact, similar clinical activities have been established in a health center, named “Casa della Salute” (CdS)in an area without community hospitals, thus completing the oncological service throughout the whole Province of Piacenza. The oncological outpatients management in the province of Piacenza is allocated in dedicated areas within the three Community Hospitals, and within aCdS.
Oncological activities are performed by oncologists and by specialized nurses who travel from the City Hospital of Piacenza to the peripheral hospitals and to the CdS. This model provides the same modality of care of those of the referral hospital for cancer patients since they are managed by the same specialists (oncologists and specialized nurses).
In this model, the patient with cancer is managed in the outpatient service in one of the nearest Community Hospitals and CdS; the oncologists take care of all the treatments: the drugs are scheduled with a specific computer program, according to the same computerized model in place to the referral oncology department, Hospital of Piacenza All anticancer therapies are prepared at the Antiblastic Drug of the referral Hospital, Unità Farmaci Antiblastici (UFA), where all the treatment schedules are registered and memorized so that traceability of the administered therapies is ensured. The dedicated area for oncologic management in the community hospital and in the CdS is similar to an outpatient clinic where medical services are offered by oncology nurses and by oncologists.
The oncologic activities performed in the community hospitals and in the CdS are:
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Patient’s clinical evaluation, non-invasive diagnostic tests (blood tests, electrocardiogram, ultrasound (US)of chest-abdomen and soft tissues);
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Diagnostic-therapeutic us-guided procedures (fine needle aspiration-biopsy, paracentesis, thoracentesis).
All the cases treated at the CdS and in the community hospitals are collegially discussed with the Oncological medical and nursing staff of the oncology department, of the referral Piacenza Hospital in order to share therapeutic choices and to increases the possibility of offering these patients experimental clinical trials. For diagnostic techniques and surgical treatment, not available in peripheral hospitals, cancer patients are sent to the central referral hospital, after diagnosis and they are evaluated by the multidisciplinary oncology group and after a surgical treatment they can come back for medical treatments near their residence. The referral physicians inform the patients that can chose the site of medical treatment: closer to their residence or at the referral city hospital. In addition each patient was free to choose to continue his/her treatment in the TOC program or to be taken care of the city hospital.
The primary end-points of this study are the kms saved with treatment closer to patient’s home and the average travel times gained with this organization evaluated calculating the distance from the residence of patients to the outpatient setting closer to their home, compared with the distance to reach the oncology unit of the referral hospital, using Google Maps. Secondary endpoints are 1) the reduction of need of caregivers to drive patients to reach the nearest outpatient setting, compared to the need of caregivers to reach the central hospital of Piacenza, 2) the rate of satisfaction with treatment nearest the residence of patients analyzed with dedicated questionnaire that used a 5 items Likert-type scale ranging from “not at all satisfied/ completely disagree” to “very satisfied/strongly agree”[14]. This questionnaire was administered after two months of treatment and at the end of the planned therapy.
For the present study, we have analyzed all the files containing schedules of patients managed in the Community Hospitals and in the CdS; all files have been electronically recorded at the UFA of the Local Health Authority of Piacenza, and contain clinical data of cancer patients such as sex, age, type of cancer, stage, type and line of treatments. For this research we focused on intravenous, intramuscular and target therapies delivered closed to patient’s home.
Patient’s personal data, residence, site of primary disease, histology, stage of disease and detailed information about the therapy administered, i.e. route of administration (intravenous, intramuscolar), line of treatment (neoadjuvant, adjuvant, treatment for metastatic disease), type of anticancer drugs (chemotherapy, immunotherapy, hormones,...) have been collected in these files and analyzed.
Here we report data of oncologic patients treated closer to their home from January 2, 2021 to June 30, 2022.
Statistical analysis
Quantitative variables were described by median and interquartile range (IQR) and qualitative variables were described by absolute and percentage frequencies. Normality was checked for all continuous variables. Comparisons of covariates were conducted using Mann Whitney test for continuous variables (distance and time). All analyses were performed using RStudio version 3.6.0 statistical software with two-sided significance tests and a 5% significance level.