Assessing clinical networks through evidence: an empirical analysis of the effectiveness of cancer networks in improving patients’ quality of care and survival

Oncology networks are widespread and widely recognized by professionals and policymakers as a valuable model for promoting multidisciplinary care and its continuity to improve patient care in terms of appropriateness, equity and outcomes. However, empirical evidence on whether cancer networks improve patient health outcomes is lacking. In our study, we evaluated whether patients treated in Italy’s oldest oncology network (Piedmont region) receive higher quality care and have better survival rates than patients treated in the same region but outside the network and managed according to usual care. A longitudinal cohort study of individuals aged 18 years or older residing in Piedmont with a new diagnosis of cancer of the rectum, colon, bladder, stomach or ovaries between 2010 and 2019 and admitted for curative surgery was analysed. Outcomes included quality indicators, selected based on the international guidelines for each tumour, and survival. Analyses were performed using Administrative health data systematically collected at the regional level were analysed with multivariable logistic models. From 2010 to 2019, the proportion of patients treated within the network increased for all malignancies, with wide variations based on tumour type. Overall, the adoption of clinical guidelines, interval times between diagnosis and treatment, and 90-day and 1-year survival displayed better results among patients managed within the network (e.g., 1-year mortality adjusted odds ratio for rectal cancer: 0·73, 95%CI 0·61–0·88; colon cancer: 0·62, 0·55–0·70; stomach cancer: 0·69, 0·56–0·85). Empirical evaluation of the effectiveness of cancer networks on health outcomes is challenging, as it depends on a wide variety of factors that are difficult to control for in real-world settings. Our study empirically investigates a large sample of patients treated for common cancers over ten years. Overall, we found a positive association between network patient management with quality of care indicators and survival. • Longitudinal cohort study that measures the impact of a regional managed cancer network on process and patients’ outcomes over a 10-year time period • Patients treated within the Piedmont oncology network show better outcomes in terms of survival, clinical appropriateness and shortened time intervals between pre- and post-intervention stages compared to patients accessing the usual care pathway • The penetration of the oncology network culture in the healthcare system is generally a slow process