Oncology: it is clinical complexity that is (re)shaping care pathways
Flexibility in care tailored to the individual patient, the integration of expertise and the promotion of the local area: these were the key themes of the debate organised by senior hospital oncologists
Therapeutic innovation, the availability of increasingly sophisticated diagnostic tools and the trend towards chronicity – and, in some cases, towards a cure – in many forms of cancer call for a re-evaluation of the organisational models of care. Such a reflection cannot ignore the local context – now a fundamental element of modern healthcare planning – but must begin with a practical question: whether local cancer care facilities are currently equipped to cope with the growing complexity of cancer.
Cipomo Day
This is one of the questions on which we have built the Cipomo Day 2026, a three-day event involving the most remote hospitals across the country’s three macro-regions – North, Centre and South – and entrusting those on the front line of care with the task of describing the opportunities and challenges of everyday clinical practice. The aim is to provide a snapshot of the current state of healthcare and, at the same time, to help shape the future of oncology.
The issue is not (or is no longer) simply a matter of transferring activities from hospitals to the local community. We need to understand which services can be provided in the various facilities, with what professional expertise, what technologies, and what access to innovative medicines and enabling diagnostic tests – which are now essential for guiding many treatment decisions. It is not enough to simply affirm the principle of localised care: we must create the conditions to ensure that this localisation translates into appropriate, safe and equitable care.
Overcoming the rigidity of career paths
In this context, it is necessary to move beyond a rigid view of cancer care pathways, which pre-determines that certain conditions should be treated at highly specialised centres and others at local facilities. The frequency or rarity of a cancer cannot, on its own, be the criterion for determining where a person should receive care. It is the clinical complexity, at the various stages of the disease, that guides organisational decisions.
The false dichotomy between ‘rare’ and ‘common’ cancers, and the patient’s actual needs. A rare cancer may require highly specialised expertise during the diagnostic phase or when determining the treatment strategy, but does not necessarily require the same level of care throughout the entire course of treatment. Similarly, a very common cancer may present clinical conditions that require the involvement of highly specialised centres. The model must therefore be tailored to the individual’s needs, allowing for the possibility of moving between different levels of care and returning to local care when clinical conditions permit.
