Our study moves from the consideration that prevalence of cancer patients is increasing due to the introduction of novel treatments such as immunotherapy or targeted agents, thus generating greater demand in oncology activities. But at the same time, literature and scientific society reports tell us that the population of medical oncologists is increasingly ageing and it is also struggling in the context of a general shortage of healthcare professionals and resources.
It is therefore necessary to timely plan future supplies for medical oncology. In this context the aim of our study was to estimate first what is the medical oncology workload generated by any new cancer patient referred to our oncology department over the following two years.
What were your methods?
This is a retrospective single institution study conducted at the Oncology Department of the University Hospital of Udine in Italy. Our institution is referenced for the oncology care of an entire Italian region. We used an accountability software to retrieve data on the number and type of oncology clinical episodes generated by any new patient referred for first consultation between January 2012 and December 2017. Patients without a second clinical episode within twelve months were excluded. The mean number of activities generated was calculated for treatment visits, follow-up visits, reassessments, hospitalisations, unplanned presentations and in-patient oncology advices.
What did you find?
We have analysed a total of 8,748 new cancer patients that generated more than 98,000 clinical episodes. Basically, any new cancer patient generates a considerable amount of clinical episodes over the two years following first consultation with a substantial difference on the basis of the clinical setting they were taken on charge, namely if they entered the system in a follow-up setting, in the adjuvant setting or in an advanced disease setting.
Indeed, the major source of oncology activity is due to the adjuvant treatment of breast cancer patients even though the highest number of episodes is caused by patients coming for first consultation in an advanced disease setting. The mean number of episodes generated by patients taken on charge in the follow-up setting is about three episodes over two years. This number rises to ten activities in the adjuvant setting and it becomes about 17 in the advanced setting. Moreover, we have also presented this data by type of clinical activity and also by cancer type.
For the future we are trying to estimate the workload generated by immunotherapy compared to conventional chemotherapy or the one generated in modern times compared to past years.
Finally, let me say that our data mining was made possible by a structural system of electronic medical records that has innovatively been conceived by our department many years ago.
What are you concluding from these results?
In conclusion, the amount of clinical activities generated in the following two years by any new cancer patient is considerable and it is highest for patients taken on charge in the advanced disease setting. To our knowledge this study, along with other few preliminary data, such as the one published by Dr Gianpiero Fasola in 2012, is the only modern original record that tries to estimate oncology workloads. With our study we want to highlight that the first step towards planning future reorganisation of sustainable medical oncology is to be able to quantify the historical load of activity faced by oncology departments and possibly forecasting future needs.
I think that cancer care sustainability should not only be conceived as a problem related to the cost of drugs and issues about the budget of the department. Indeed, due to the growing prevalence of cancer and human resources shortages, future supplies should be projected on the basis of a better knowledge of processes and workloads related to cancer care.