Tumor: updated guide to oncological surgery centers

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RReceiving a cancer diagnosis causes panic not only because it suddenly puts into doubt the possibility of one’s future or a healthy future. The aspect of organizing treatment, choosing the oncologist and the hospital in which to be followed and possibly operate generates further stress which can influence the success of the therapies. That’s why the Italian Patients’ Oncology Network (ROPI) presented the new edition of. today to the Ministry of Health “Where do I get treatment?”, the updated guide of oncology surgery centers.
Breast cancer prevention: the tests to be done

Tumor: and now Where do I get treatment? How to choose the right hospital

For choose the oncology center there are some to turn to and put your life in your hands objective criteria. The number of oncological surgeries represents one of the most reliable indicators of healthcare facilities. The new data highlights one 16% reduction in places of care where a ‘below threshold’ volume is performed of surgical operations against tumors. In the new map already online was also taken into consideration European OECI certificationassigned to structures where there is a quality care path.

Tumor: the importance of associations

Having qualified people at your side to guide you in the right direction of treatment is essential after the diagnosis of cancer. This is the precious work of the associations that deal with cancer patients. «For those who find themselves facing oncological disease for the first time, which is so traumatizing from a psychological and social point of view, the importance of making a conscious choice regarding the hospital structure to which to entrust one’s health is evident – ​​he explains Bianchini Simonetta, president of For You Donna Odv –. As an association we are in daily contact with patients who ask us where it is best for them to be treated, even if the choice is then conditioned by the economic and logistical aspects that people have to face. But it is of absolute importance to have a tool that, based on objective criteria, can guide patients in this choice.”

Accompany patients by the hand with competence and affection who has been diagnosed with cancer is the principle on which it is also based Libellule Insieme ETS Foundation. Why, “Together we win. The dramatic moments that accompany the course of the disease are overcome. We start again, life continues and can be better than before.” as the founder, Doctor, says Paola Martinoni, breast surgeon, expert in first and second level diagnostics for the prevention of breast cancer, for years dedicated to the follow-up of cancer patients and their physical and psychological support. «We are dedicated to 360° rebirth of cancer patients offering them a individual guided tour. Each patient can count on the professionalism of our doctors and on a complete recovery and rebirth program. On a Organized personalized follow up in close contact with the hospital of origin, but also on the psychological support essential to overcome the period of oncological treatment.”

The map of the centers

Oncology surgery: almost half of hospitals do too little of it

According to data presented today by the Ministry of Health in the new edition of “Where do I get treatment?”, the updated guide of oncology surgery centers, in Italy approximately 46% of hospitals perform ‘sub-threshold’ oncological surgery. It means that about half of the hospitals perform little oncological surgery, and therefore have little experience. For the breast cancer, for example, the threshold value is 150 operations per year. It means that below this number the center is not able to offer the same safety and quality of outcomes as centers with interventions above the expected threshold.

Tumors and treatment certification: only in 13 Italian hospitals

Furthermore, only in 13 Italian facilities is there a treatment path whose quality is certified by OECI (Organization of European Cancer Institutes). However, there is one positive fact: from 2017 to 2022 the number of ‘below threshold’ hospitals reduced by over 16%, going from 5,670 to 4,747. At the same time, there was a reduction in the volumes of oncological surgery operations in ‘below threshold’ hospitals: from 57,419 operations in 2017 (29% of total operations) to 47,230 in 2022 (23% of total operations).

What is the OECI ‘stamp’

The new updated map “Where do I get treatment?” was developed starting from the data of the last one Agenas National Outcomes Program. It is based on two criteria: in addition to exceeding the surgical volume threshold – which scientific evidence associates with the best outcomes – those hospitals within which there is a treatment path whose quality is certified with the OECI ‘stamp’ are mentioned.

A fundamental help for those with cancer

«Like every year, our map aims to help patients and their loved ones find your way around the healthcare facilities that carry out oncological surgery – explains Stefania Gori, President of ROPI and of AIGOM (Italian Association of Multidisciplinary Oncology Groups) –. This year we have added a further piece, that relating to the care pathway, aware that quantitative data alone is not sufficient to give a correct and complete indication of the quality of a hospital”.

Breast cancer: “expert” hospitals on the rise

«The new map confirms the decreasing trend of interventions in ‘below threshold’ structures and, consequently, a increase in volumes of oncological surgery operations in ‘above threshold’ hospitals: from 143,469 interventions in 2017 (71% of total interventions) to 160,919 in 2022 (77% of total interventions)”, he declares Fabrizio Nicolis, ROPI advisor and project coordinator. The data relating to the breast cancer surgerywhere we are witnessing a trend in reduction in the number of ‘below threshold’ hospitals: from 521 in 2017 to 313 in 2022 (-40%).

On the other hand, a increase in the volumes of operations performed in ‘above threshold’ hospitals‘: from 45,656 in 2017 (74% of total interventions) to 53,653 in 2022 (84% of total interventions).

In the North more “above threshold” hospitals

«However, the North-South gradient remains unchanged, with the North in which the majority of the Regions have ‘above threshold’ hospitals for all 17 pathologies considered, and the South in which only 3 regions (Puglia, Campania and Sicily) cover all pathologies”, he underlines Nicolis.

Data on the quality of the care pathway

For those with cancer, the quality of the care path is also of fundamental importance for the success of the therapies. «We realized that to help patients and citizens choose the place of treatment not only on the basis of the number of oncological surgeries, but also with the best quality of care, verified by a third party, i.e. OECI», underlines Gori.

«The OECI accreditation certification is in fact the photograph of the actual implementation of the qualitative and qualitative standards envisaged by the Quality Program by an oncology institute – they explain Giovanni Apolone, president of OECI, and Claudio Lombardo, general manager of OECI –. Although OECI verifies the progress of the improvement plan over time, which generally follows certification, the quality of care provided is the result of a continuous innovation process connected to the exploitation of research results”.

How important post-operative care is

The importance of the quality of care pathways is also confirmed Massimo Carlini, president of Italian Society of Surgery (SIC): «The decrease in complications and mortality also depends on quality of postoperative carewhich is more closely related to some specific characteristics of the hospital, rather than to the number of operations performed.

Some operations require specifications intraoperative skills and in this case the volume of the surgeon predominates, while others may require important and complex treatments during the postoperative course and then the volume of the hospital predominates. However, after improved outcomes in high-volume centers, poorer outcomes may also result when a given center reaches its limit. In our country, considering that the number of beds, intensive care doctors, surgeons and specialized nurses is reduced, this second aspect is very important. In any case, complex centralized surgical procedures should be available in centers well distributed throughout the national territory.”

Surgical experience is also important for melanoma

«In the last 12/13 years, melanoma therapy has radically changed thanks to innovative drugs, leading to recoveries in the case of patients suffering from metastatic melanoma going from 5% to 55% – he explains Antonella Romanini, president ofAssociation Against Melanoma (ACM) –. The surgical part, although not presenting particular technical difficulties, however involves theidentification and removal of the sentinel lymph nodewhich requires a learning curve of at least 50 cases and the execution of at least 50 cases/year and that an expert pathologist. Therefore, it is important that the entire diagnostic-therapeutic path guarantees high levels of efficiency, which are the basis for improving the survival of these patients.”

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