Italian Oncology at the Crossroads: Between Hospital Bed Cuts and the Need for a Transition to Integrated Community-Based Simultaneous Care

TL;DR

Italy's oncology care is facing challenges due to hospital bed cuts and unsustainable care models, requiring a shift to community-based care to improve patient outcomes and reduce costs.

Contribution

The study emphasizes the need for integrated community-based care models to address unsustainable hospitalization patterns in oncology.

Findings

Blood cancers are associated with prolonged hospital stays and higher infection risks.

Only 0.2% of cancer patients received home care activation upon discharge.

Cancer patients are more likely to be discharged home while awaiting treatment completion.

Abstract

Although there is increasing demand for oncology care in Italy, recent public health policies have resulted in the reduction of over a thousand oncology beds over the past decade. Cancers are often treated as a single entity; however, they encompass a diverse range of conditions that require tailored healthcare approaches. Given the significant burden associated with prolonged hospital length of stay (LOS), particularly for certain types of cancer, this study highlights the poor sustainable nature of current care models and underscores the critical importance of effective discharge planning for cancer patients. As a potential solution, this study supports the urgent need for a transition toward integrated community-based simultaneous care models to reduce healthcare costs and improve patient outcomes, especially for vulnerable elderly patients.

Background: In Italy, public health investments have not kept pace with the rising demand for cancer care. Hospitalization costs are increasing, and length of stay (LOS) remains a critical metric for hospital efficiency and care quality. Methods: An ecological study analyzed hospital discharge records of patients admitted to “Policlinico Tor Vergata” (Rome, Italy) in 2022. Associations between cancer types and key variables influencing inpatient care were analyzed using logistic regression models (AOR; 95% CI), along with discharge patterns. Results: Among 14,451 ordinary hospitalizations, cancer diagnoses accounted for 16.4%, with blood cancers as the largest subgroup (20.1%). LOS outliers (5%) contributed to 11,342 excess hospitalization days. Blood cancers were associated with prolonged LOS (2.031; 1.499–2.753), while blood (2.368; 1.911–2.933), gastric (2.216; 1.603–3.062), and bladder cancers (2.661; 2.133–3.319) had a higher infection risk. Patients with bladder cancers were more likely to be ≥65 years old (2.661; 2.133–3.319). Secondary diagnoses were more likely to occur in gastric cancer types (1.637; 1.486–1.802). A discharge analysis revealed that 46.8% of cancer patients were discharged home without activation of home care services, and only 0.2% received home care activation. Cancer patients were more likely to be discharged home (2.150; 1.911–2.418) while awaiting completion of diagnostic or therapeutic processes. Conclusions: Our findings highlight the significant variability in hospitalization patterns across cancer types and the inadequacy of current discharge planning processes. The burden of prolonged LOS highlights the unsustainability of current care models. An urgent transition toward integrated, community-based simultaneous care models is needed to reduce healthcare costs, prevent prolonged hospitalizations, and improve outcomes, particularly for vulnerable elderly patients.

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