Many people diagnosed with cancer in Southern Italy will travel to other regions in the country for treatment, often because they are unaware of cancer expertise available locally.1 2 To address this issue in Apulia, the regional cancer network launched 18 oncology orientation cancer centres in 2019.3 4 These centres, located in or near hospitals, are staffed by multidisciplinary teams that can coordinate diagnostic tests, develop care plans and refer people to appropriate specialists in Apulia.1 3 4 By January 2021, the centres had supported more than 10,000 people with cancer.1
In Italy, regional governments are responsible for the organisation and delivery of cancer care.5 People can choose any provider within the public health system for their care, including those in other regions.
Many people with cancer in Southern Italy travel to other regions for treatment, which can disrupt their lives and increase costs for transportation and accommodation.1 Some may need to travel to access the right care; for example, treatment for rare cancers may only be offered by national centres of excellence in other regions. However, others may seek treatment elsewhere because they are unaware of the resources and expertise available locally.1 6 This was often the case in Apulia, where people needed more support in identifying an appropriate specialist in the region.
In 2019, the Apulian Oncology Network (Rete Oncologica Pugliese) launched 18 oncology orientation cancer centres (centri orientamenti oncologici, COrOs) across the region.3 4 7 These centres were set up to coordinate care, reduce delays in diagnosis and treatment, and increase the number of people treated locally.1 6 The COrOs are located in or near hospitals, close to oncology departments.3 4 People can self-refer or be referred by a healthcare professional when a cancer diagnosis is suspected.1 3 4 6
The centres are staffed by multidisciplinary teams comprising oncologists, nurses, data managers, administrative staff, social workers, psycho-oncologists and volunteers.1 3 4 The oncologist leads the diagnostic process and liaises with the team to assess the needs and preferences of each person with cancer.6 Based on this information, the team develops a personalised care plan and makes a referral to an appropriate cancer centre in Apulia.1
Each person registered with a COrO is assigned a case manager, often a nurse, who coordinates care and acts as the main point of contact.1 3 4 People typically remain in contact with the COrO team throughout their care journey.
What has it achieved?
Apulia’s regional health authority (Agenzia Regionale Strategica per la Salute ed il Sociale, AReSS) is collecting data on the impact of the COrOs using a standardised set of indicators, which cover:
- organisational elements (e.g. the location of the COrO, composition of the care team and presence of electronic booking systems)
- care activity (e.g. the number of people registered with the COrOs and patient satisfaction).1
The COrO initiative has been recognised by The European Breast Cancer Coalition (Europa Donna), which awarded its Cancer Policy Award to the Apulian region in 2019 and 2020.7 8
COrOs were a vital resource for people with cancer during the first wave of the COVID-19 pandemic, when access to hospitals and other specialist services was limited.1 Between January 2020 and January 2021, the centres supported 10,688 people.1
AReSS plans to conduct a full audit of the COrO network by the end of 2021.1 This audit will examine whether the COrOs are operating as designed and improving care for people with cancer in Apulia.
- A video about the COrOs (in Italian)
Dr Mariangela Ciccarese, Rete Oncologica Pugliese (Apulian Oncology Network): firstname.lastname@example.org
- Ciccarese M. 2021. Interview with Catherine Hodge at The Health Policy Partnership [written correspondence]. 31/08/21
- Agenzia Nazionale per i Servizi Sanitari Regionali. 2019. Programma Nazionale Esiti Edizione 2019. Rome: Ministero della Salute
- DDG AReSS Puglia. 2020. n. 230/2019 presa d'atto del regolamento dei Centri di Orientamento Oncologico (COrO) della Rete Oncologica Pugliese (R.O.P) e loro istituzione. Available here: https://www.sanita.puglia.it/web/aress [accessed: September 2021]
- DGR Regione Puglia. 2020. Revisione identificazione dei Centri di Orientamento Oncologico (COrO) della Rete Oncologica Pugliese (R.O.P) n.1103 [Updated 17/07/20]. Available here: https://trasparenza.regione.puglia.it/provvedimenti/provvedimenti-della-giunta-regionale/135100
- Ferré F, Giulio de Belvis A, Valerio L, et al. 2014. Italy: Health system review. Brussels: European Observatory on Health Systems and Policies
- Ciccarese M, Leo S, Surico G, et al. 2020. Oncology Orientation Cancer Center (CORO): The functional structure to reduce sanitary migration - An Apulian experience. Tumori Journal 106(25): 204
- Regione Puglia. 2020. Cancer Policy Award: Premiato il presidente Emilano per l'attivazione in Puglia dei CORO, Centri di Orientamento Oncologico. Available here: https://www.sanita.puglia.it/documents/45631926/112785949/Cancer+policy+award/264b2f8e-c6b6-4748-bf8a-1392b07c74f1
- Gorgoni G. 2021. Personal communication by email: 11/05/21