How redesigning cancer care pathways leads to better patient outcomes

The University Hospital of Rennes in France is taking a new approach to hospital treatment to improve patient care

Case study:

How redesigning cancer care pathways leads to better patient outcomes

The University Hospital of Rennes in France is taking a new approach to hospital treatment to improve patient care

Like so many hospitals around the world, CHU de Rennes – the University Hospital of Rennes in north-west France – has seen a significant rise in demand for cancer care in recent years. As part of the hospital’s attempt to manage this while battling resource constraints, the pneumology department has been working to reduce the hospitalization time of its lung-cancer patients during treatment.

Downside of success

“We have more and more patients with lung cancer,” explains Dr Hervé Léna. The fact that patients are surviving for longer is a sign of success: “We have more effective treatments, so patients are living longer, but they need continued treatment,” he confirms. A decade ago, a patient with stage-4 lung cancer would receive just four cycles of chemotherapy, each lasting a few weeks, before moving to second-line treatment. Now, advances in cancer treatments – including immunotherapy – can better control the cancer, with treatment lasting up to two years before second- or third-line treatment is needed.

This shift has had significant implications for the hospital. “We do not have enough places to treat all the patients the way we did four years ago,” explains Dr Léna. “When you have 10 treatment slots and 25 patients to see in a day, you must look at all possibilities.”

Putting the patient first

The hospital team set out to review its processes, gathering data on key metrics, including duration of treatment and hospitalization. From the start, Dr Léna and his team felt it essential to listen to patients’ opinions, so a survey of 76 patients – of whom 57% were receiving immunotherapy – was developed to explore patients’ experiences and preferences for treatment, related communication, emotional support, and accessibility.

“Not all patients think the same during their care,” Dr Léna points out. Nevertheless, immediately after a cancer diagnosis, patient priority is usually rapid access to the best treatment possible. Over time, quality of life becomes more important: patients want to minimize their time in hospital, while continuing to receive the best and most appropriate healthcare.

With an explicit steer from patients, the team focused on reducing hospitalization during treatment. The pneumology team redesigned their treatment programme, evaluating the patient’s condition via a phone call prior to an appointment. The team still, of course, evaluates the patient in person at the hospital.

“It’s very important that we can be confident in the things they tell us,” says Dr Léna. However, the additional step has significantly reduced the face-to-face time required. An advance prescription service, again using a nurse-led conversation a day before the visit to identify pharmacy requirements in advance, has also helped, by reducing waiting time in the hospital.

Less waiting around

The results have been impressive. From an original average visit time of four and a half hours, some immunotherapy patients now complete their visits within 90 minutes. “For patients who are treated for up to two years, coming every two or four weeks, this is a major improvement,” says Dr Léna.

In addition, the hospital has increased the time between visits – initially, a reaction to the pandemic. “We thought it was possible,” says Dr Léna, “but Covid made it real in a very short period of time”.

The pneumology department was supported throughout the initiative by MSD France. “What MSD did for us was critical,” says Dr Léna. That included gathering patients’ views and gaining an objective view of how the Rennes team operates. Having an external partner also helped the hospital team commit to the improvements in the face of competing priorities.

Leaning on technology

The hospital intends to further enhance patient experiences through developing its online systems. An integrated technology platform is essential, suggests Dr Léna. The hospital must integrate patient records into an online system, he argues, so any doctor can access an up-to-date record of the patient's treatment programme at any time.

As demand for cancer services rises, the work done by the pneumology department at CHU de Rennes is a powerful example of how hospitals can deliver enhanced patient experiences and more efficient services in harmony.