Integrated care – next steps in best practice

With countries around the world facing extensive lockdowns due to COVID-19, integrated care for cancer patients is more important than ever.

Disruption caused by the pandemic has shifted the global care model. There is now a focus on communication, particularly virtually. Roles and responsibilities are changing, with more happening locally. There’s a greater need for reassurance about the safety, quality and consistency of care.

These pressures have led many healthcare systems and providers to re-evaluate their care models and look at ways to drive efficiencies and improve patient experience and health outcomes.

Integrated care is a broad term to describe a more streamlined, coordinated and multidisciplinary approach to delivering high-quality healthcare efficiently. Integrated care involves the entire healthcare system working together seamlessly to improve patient experience and outcomes.1 This includes community (including preventative health measures), primary, secondary, tertiary (and quaternary), with the aim to achieve good health outcomes and to efficiently deliver a high quality of healthcare.^2,3

Active patient involvement is crucial for good integrated care. An integrated system must deliver services tailored to individual patient needs, with the patient at the centre of care rather than the services providing that care.4 Integrated care processes must be highly organised to provide consistency.²

Cancer care is multidisciplinary and multi-modal – from primary to quaternary healthcare.

Primary health care providers play a vital role in helping patients access timely, appropriate cancer care. GPs provide comprehensive ongoing care and connect the community with the rest of the healthcare sector.^5,6 Over 85% of cancers are diagnosed following symptomatic presentation to a primary-care provider.⁶

Cancer patients often require care and treatment outside of and in addition to their cancer. Care may need to include treatment modalities involving several different specialists, surgery, chemotherapy, and radiotherapy. Beyond medical care, support services such as rehabilitation for physical strength and wellbeing therapies to manage emotional and psychological issues that often come with a cancer diagnosis are also crucial to a patient’s experience and can affect outcomes.

On top of this, many patients have pre-existing health conditions that are often exacerbated by the cancer or its treatment. These cases need careful management, which can involve specialists and services outside of oncology.

All of these services working together with the patient as the focus requires good communication and organised processes to ensure the patient receives the right care – tailored to their needs – at the right time. This is what the integrated healthcare model aims to achieve.

There will be an urgent need for new models of care to address more complex cancer cases due to the impact of ongoing national lockdowns.

Global statistics are showing an increase in complex cancer with more patients presenting with metastatic disease due to delayed diagnosis and treatment.^7-9

Patients presenting with later-stage disease often require more treatment than early-stage disease, and a multidisciplinary, integrated approach to complex cancer cases is critical for optimising patient outcomes^.10

Coordination is at the centre of the integrated model:

• Ensuring continuity of care is integrated with the patient’s needs – both physically and emotionally
• Integration of primary into secondary care
• Integrating all treatment modalities and team members
• Allied health – which may include internal or external providers
• Health promotion and secondary prevention (particularly relevant for effective survivorship)

Integrated care contributes to improved experiences for people affected by cancer and all their healthcare providers. It also impacts the delivery of value-based health care and improved health and cancer outcomes.^10,11

The results of a recent systematic review and meta-analysis indicate that integrated care showed both cost efficiencies in delivery and improvement in outcomes compared with usual care, especially in studies with a follow-up period over a year.¹

GenesisCare is committed to adopting an integrated approach to cancer care and tailoring patient care to the individual’s needs has always been our priority. By collaborating across our centres and with partner hospitals, we facilitate end-to-end patient pathways, from rapid access diagnostics to the latest innovations in cancer care.

Our highly skilled teams include specialists dedicated to their discipline: oncologists, surgeons, radiotherapists, chemotherapy nurses, exercise medicine physiotherapists, wellbeing consultants from Penny Brohn UK, dietitians, speech and language therapists, physicists, nuclear medicine specialists and more.

We work dynamically with local partners, national organisations and global networks to deliver our unique approach to world-class cancer care.

References

1. Rocks S et al. Eur J Health Econ 2020; 21: 1211–1221.
2. Australian Government. Productivity Commission. 5-year productivity review, Supporting paper no. 5: Integrated care, 2017. Available at: pc.gov.au/inquiries/completed/productivity-review/report/productivity-review-supporting5.pdf. Accessed on: 18/01/22.
3. Integrated Care Models: an overview. WHO: Regional centre for Europe. 2016. Available at: euro.who.int/__data/assets/pdf_file/0005/322475/Integrated-care-models-overview.pdf. Accessed on: 18/01/22.
4. Hughes G, et al. Milbank Quarterly 2020; 98(2):446-492
5. Strengthening the frontline: How primary health care helps health systems adapt during the COVID-19 pandemic. Organisation for Economic Co-operation and Development. 2021. Available at: oecd.org/coronavirus/policy-responses/strengthening-the-frontline-how-primary-health-care-helps-health-systems-adapt-during-the-covid-19-pandemic-9a5ae6da/. Accessed on: 18/01/22.
6. Nunez C et al. Modifiable lifestyle factors and cancer risk: An Evidence Check rapid review brokered by the Sax Institute for the Cancer Institute NSW, 2018. Available at: cancer.nsw.gov.au/how-we-help/reports-and-publications/modifiable-lifestyle-factors-and-cancer-risk. Accessed on: 18/01/22.
7. Maringe C, et al. Lancet 2020; 21(8):P1023-1034.
8. Gurney J, et al. Lancet Reg Health – W Pac 2021; 10:100127.
9. Cancer screening and COVID-19 in Australia 2020. Available at: https://www.aihw.gov.au/reports/cancer-screening/cancer-screening-and-covid-19-in-australia/contents/how-has-covid-19-affected-australias-cancer-screening-programs. Accessed on: 18/01/22.
10. Beradi R, et al. Cancer Manag Res 2020; 12:9363-9374.
11. Selby P, et al. American Society of Clinical Oncology Educational Book. 2019; 39:332-340.