Cancer patients' survival following the reference centre model implementation

This paper performs a survival analysis of cancer patients in Portugal, assessing the impact of the creation of oncology Reference Centres (RCs). RCs are a highly specialized healthcare delivery centre, focused on addressing specific health conditions, such as cancer, and delivering best-in-class treatment. Oncology RCs have been officially recognized in Portugal since 2016, following the European Directive 2011/24/EU, and were a National Health System objective during the Economic Stabilization Program. In a context of financial resources scarcity, information about the efficacy of the investments made in RCs is crucial for decision-making concerning funds allocation.

In Portugal, cancer accounts for one in every four deaths. It is the leading cause of death before the age of 70, being the second cause for all ages nationwide. Considering this, the paper presents a survival analysis comparing cancer patients who had at least one hospital episode (i.e., have been “referred”) or all episodes in an RC, to patients who had no hospital episode in an RC. Four cancer types, which have seen the recognition of oncology RCs in Portugal and for which data was made available, were considered: hepatobiliary, pancreatic, sarcomas and oesophageal. For each cancer type, survival curves were estimated using the Kaplan–Meier methodology, and hazard ratios were estimated using multivariate Extended Cox models. Covariates such as sex of the patient, age at diagnosis, number of surgeries, number of infections, cumulative length of stay, severity, were also included.

The results obtained support the implementation and encourage the further extension of the RC model for oncology in Portugal, as cancer patients treated in an oncology RC, overall, demonstrated a better survival probability when compared to patients who had no episode in an RC. These results are clearer for hepatobiliary and pancreatic cancer, but also visible for sarcomas and oesophageal cancer.

Click here to go to the paper by Manuel Melo Mateus, Margarida Catalão‑Lopes, Rui Portugal.