Commentary: Perceptions and needs of patients, caregivers and health professionals regarding an oncology community center: a qualitative study

Mitnik et al.'s (2025) timely study illuminates the human dimension of decentralizing cancer care through Oncology Community Centers (OCCs). Their qualitative exploration reveals a core tension: the clash between the undeniable benefits of geographical accessibility and the deep-seated psychological need for clinical security associated with large hospitals. As healthcare systems globally grapple with rural-urban disparities, this work exposes critical undercurrents-the proximity-security paradox and the untapped potential of General Practitioners (GPs)-that demand deeper consideration in OCC implementation. While Mitnik et al. first identified this tension, our commentary systematically conceptualizes it as the 'proximity-security paradox' and draws practical implications for design and policy. This commentary aims to: first, explore and conceptualize the 'proximity-security paradox' as a framework capturing the tension identified by Mitnik et al.; and second, discuss potential multilevel strategies-addressing both systemic integration and interpersonal dynamics-to resolve this paradox. This commentary extends the original study by not only conceptualizing the problem but also offering a synthesis for implementation, while highlighting systemic barriers (e.g., GP reimbursement models) critical for the sustainable success of OCCs. Moreover, we emphasize that such systemic strategies must be coupled with attention to interpersonal dynamics-such as trust-building and environmental familiarity-which are equally critical to resolving the paradox.The study powerfully captures the patient dilemma: while welcoming reduced travel burdens ("leave the house without 3.5h travel"), participants expressed profound anxiety about losing the perceived safety net of the hospital's "complete staff". This anxiety transcends logistics, tapping into a profound state of existential vulnerability well-documented in psycho-oncology (Lo et al., 2014). While Lo et al. focused on managing this vulnerability within the hospital setting, our commentary extends this by examining how decentralizing care inherently exacerbates this anxiety. This aligns with global patterns where patients prioritize perceived credibility over convenience (Bhatia et al., 2022), underscoring that trust requires deliberate design features within the OCC model, and cannot be assumed.To understand the mechanisms behind this trust deficit, we consider the cognitive biases underlying this trust deficit: patients' heuristic reliance on hospital size as a proxy for safety, a phenomenon noted in healthcare decision-making literature (Gigerenzer, G., & Gaissmaier, W. 2011), which is rooted in systemic fragmentation and lack of transparent outcome data. To address this trust deficit mechanistically, we suggest a potential intervention: the integration of real-time outcome dashboards at OCCs. We hypothesize that this could provide transparent quality metrics, thereby shifting patient focus from institutional size to evidence-based security. To clinically translate this concept, a pilot study could be designed to implement and evaluate patient education modules based on this dashboard data, with the goal of enhancing adherence by reducing existential anxiety. While Mitnik's hospital-affiliated OCC model represents a significant step forward, challenges to ensuring relational continuity remain. These strategies form an integrated model that leverages hospital resources while embedding community access and primary care, aiming to balance the proximity-security continuum. Beyond technological solutions, the integration of General Practitioners (GPs) presents a critical human-centric strategy to resolve the proximity-security paradox, by leveraging their unique position within the community to build trust and provide continuous care. (ii)The underutilization of GPs is not incidental but rooted in structural barriers, primarily reimbursement models that do not compensate for care coordination and training gaps in specialist cancer care. However, evidence from other systems offers clear solutions. 2) the adoption of minimum design standards for OCCs, developed through patient co-design workshops, which incorporate elements such as sound-absorbing materials for privacy, adjustable lighting, and residential-style furniture to create a physically and psychologically comfortable environment. Our proposed model (Figure 1) visualizes this necessary integration, positioning the 'homely' OCC environment as the foundational layer upon which both proximity and technological security are built, ensuring that accessibility does not come at the cost of patient-centeredness.Building upon the foundational qualitative insights of Mitnik et al. (2025), this commentary offers a novel conceptual and practical extension by introducing the 'proximity-security paradox' as a defining framework. Our proposed 'security-accessibility matrix' serves as a conceptual heuristic to guide decision-making by framing OCC design along two axes: proximity and security.At the clinical level, this matrix translates into care models that must strategically balance local access points (e.g., OCCs) with robust security layers (e.g., virtual specialist networks). A key operational challenge involves fostering trust and standardized practices across these diverse settings.At the policy level, validating and scaling such integrated models requires concomitant policy reforms. Future research must quantify the impact on hard outcomes like hospitalizations and cost-efficiency. This evidence is essential to inform critical policy changes, particularly in GP reimbursement models and funding for telehealth infrastructure, which are the true enablers for sustainable OCC implementation.In summary, whereas Mitnik et al. expertly documented stakeholder perceptions, our commentary provides a synthesizing framework and a forward-looking roadmap. We argue that resolving the proximity-security paradox is a sociocultural challenge requiring deliberate strategies to engineer trust, activate primary care networks, and design nurturing environments.We therefore recommend: to pilot and evaluate these integrated models within the context of national cancer control plans and global health security frameworks, such as those advocated by the WHO, to ensure that the decentralization of cancer care achieves its goal of equitable, accessible, and truly patient-centered security for all.