Comparative analysis of breast cancer care models and patient journeys across six European countries: implications for the Austrian healthcare system

The increasing prevalence of breast cancer is straining hospital-centred healthcare systems worldwide, including Austria’s. This study examined breast cancer care models across six European countries to identify alternative approaches for improving resource use and care delivery in Austria and other hospital-centred countries. A mixed-methods approach combined a scoping review with expert consultations (n=17) across Austria, Germany, Denmark, Sweden, the Netherlands, and Belgium. The analysis mapped breast cancer patient journeys through five phases from diagnosis to follow-up care and compared healthcare infrastructures, service provision, and professional roles across different care settings. Expert consultations were conducted through online meetings (n=11) and written responses (n=6), with at least two experts from each country representing diverse professional backgrounds. Three care models were identified: (1) Centralised Specialist Model with accredited centres and strict volume requirements (Austria, Denmark, Belgium); (2) Decentralised Model utilising certified hospitals with national quality standards (Germany); and (3) Network-based Model combining specialist centres with regional facilities (Netherlands, Sweden). The models showed significant differences in surgical settings, with Sweden performing procedures exclusively in outpatient settings, while Austria and Germany relied on inpatient care. Care coordination mechanisms varied substantially, from Sweden’s mandatory contact nurses to Germany’s strong outpatient oncologist networks. All models maintained quality through regulation and accreditation but differed significantly in their approach to accessibility, cross-sectoral coordination, and resource allocation. Findings indicate opportunities for hospital-centred healthcare systems to optimise cancer care through strategic integration of centralised and network-based elements. Success factors include addressing workforce shortages, particularly among specialised nurses, enhancing data integration, and strengthening cross-sectoral coordination. Implementing hybrid care models that combine centralised expertise with distributed service delivery could significantly improve both the efficiency and accessibility of breast cancer care across different healthcare systems, while accounting for specific national contexts and existing infrastructures.