Rethinking cancer care pathways

How a systems approach can streamline specialist healthcare

Illustration of four people using electronic devices to connect

Cancer care providers around the world are facing complex challenges. Rising demand cannot be satisfied due to limited resources.

Scientific breakthroughs in diagnostics and therapies offer improved outcomes but adopting these within existing healthcare systems is stretching already underfunded budgets. Improving access to care remains a universal issue, affecting rich and poor countries alike.

Some sector leaders believe that the only way to overcome such challenges is to adopt a systems approach: that is, rather than adjusting individual parts of the system, rethinking holistically how cancer services are provided. As in most sectors, Covid-19 exposed serious limitations in healthcare, but a systems approach offers opportunities not only to address these but to improve service overall.

“Organisational leaders, clinicians, administrators, managers, and local politicians are coming together in a way that I’ve not experienced before,” says Raj Jain, Chair of NHS Cheshire and Merseyside, which serves 2.7m people in north-west England. A long-standing advocate of a systems approach, Jain emphasizes a need to alleviate the pressure on resources.

Addressing demand at local level

For a single organisation, the answer might be simply to increase resources. From a systems perspective, however, the optimum solution is to reduce demand by lowering the number of people who require care. This means investing in cancer prevention by supporting healthier lifestyles and educating people about their cancer risks, measures that are in the best interests of potential patients, as well as the system itself, Jain points out.

Alongside prevention, providers need to focus on early detection, which, when successful, means patients require less resource-intensive treatment. In Britain, more than one-third of cancer cases are discovered through emergency department visits. “That’s absolutely a system failure,” suggests Jain. Varying detection rates are closely linked to social inequality, with people from disadvantaged groups more likely to present with later-stage cancers — a key reason, Jain argues, for healthcare systems to be locally structured, reflecting local needs.

A data-based approach

The key to the systems approach is putting patients first. “I look at this through the lens of, ‘What would the patient and their family want?’” says Jain. “That’s not necessarily the same as what a healthcare professional has in their control.”

This mindset can drive new ways of working; for instance, by bringing together different services – and tapping a wider range of high-quality data sources – at each stage of a patient’s care journey. Using this broader base of knowledge can bring greater insight and precision to sensitive decisions, such as whether to use chemotherapy, with a measurable impact on patients’ quality of life.

By pooling data from across the system, healthcare professionals are able to predict and mitigate demand for care. NHS Cheshire and Merseyside has developed Combined Intelligence for Population Health Action CIPHA), a system that “brings together previously disconnected and disparate data sources to identify individuals who have greater risk factors,” Jain explains. The value of such an approach to cancer care is clear.

One healthcare system, working together

If sharing data across the sector improves outcomes, by extension, care providers, local authorities, not-for-profits and industry working together more closely can offer a new range of benefits for all.

“That’s the new C word for us,” affirms Jain: “Collaboration, collaboration, collaboration.” Data-sharing allows providers to learn from one another, drawing on expertise and knowledge across both academia and industry. Jain firmly believes industry partnerships can add huge value, as long as care providers ensure cultural fit and alignment on long-term goals: “I absolutely believe that industry’s expertise, know-how, talent, technologies — and sometimes balance sheets — can be better leveraged to enable us to develop better services.”

A systems-based approach could add value on a global scale, argues Jain. “If demand continues to grow, I’m not sure that there’s any economy around the world that will be able to afford cancer care in the way it should be delivered, or deliver on other priorities around healthcare,” he reflects.

“How we measure value is the key question for me,” says Jain. “Ultimately, the systems approach is not about money, but about patients.”