About this section
This section of the toolkit describes how cancer care networks and network models of care can be used to enhance access to care.
Cancer care networks
Equitable distribution of care and efficiency of delivery is impacted by how cancer services are organized between and within cancer centres. Multidisciplinary clinics and cancer care networks are becoming more prevalent in Canada and internationally and help to improve the efficient organization of resources and delivery of person-centred care.
Often focused on a single disease site, multidisciplinary cancer clinics are typically located at a single centre and bring together clinicians from multiple specialities, including allied health, with a focus on providing the full complement of care and services. Multidisciplinary disease site clinics focus on person-centred care and enable all team members to work to their full scope of practice.
Identifying the best cancer network models
Patients benefit from the wide range of clinical expertise available at the centre, however the lack of coordination can negatively affect patients. The traditional model of care is structured around a single specialty (e.g., medical or radiation oncology, surgery, etc.) and can result in patients having to return for multiple cancer centre visits and a duplication of consultations. This can lead to a general sense that “my care team doesn’t seem to be working together.” This lack of coordination disproportionately affects people impacted by social determinants of health.1
Cancer networks can take many forms; however, they are commonly organized for a specific disease site and connect two or more centres that share clinical expertise, resources, and services. Networks provide a structure for staff to work more closely across jurisdictions, institutions, and professional boundaries. They are often organized as centres of excellence or have expertise centralized at one centre with access shared across several centres in an area.
Organizing specialized care in this way helps support the flow of expertise and best practice and improves the quality of and access to care for patients, including those who require coordination of care across various settings.2 This type of coordination can be particularly useful when care is coordinated in rural and remote areas or across provincial and territorial boundaries.
Patient navigation is a critical component of cancer networks
Network models of care help patients to access care faster. A staff member is responsible for helping patients navigate through multiple appointments and for ensuring they receive the necessary care in a timely manner. Patient navigators promote a holistic, person-centred approach to care and are shown to improve patient satisfaction when compared to models where no navigation support is provided.3
Together with partners and the cancer community, the Partnership worked to identify network and clinic models that have the potential to enhance access to specialized services for patients regardless of where they live. These include network models and multidisciplinary clinics, along with voluntary, unstructured approaches such as communities of practice and information networks.
Evidence collected from a rapid review by McMaster Health Forum and input on existing best practices were used to identify models that have the potential to be scaled and spread across jurisdictions.
Explore this section for models and examples of approaches for jurisdictional implementation.
Scalable and spreadable models
Models of care with potential for scale and spread across jurisdictions were identified using evidence from a rapid synthesis by McMaster Health Forum and existing best practices.
- Andermann A. Taking action on the social determinants of health in clinical practice: a framework for health professionals. CMAJ. 2016;188(17-18):E474-E483.
- Riley-Behringer M, Davis MM, Werner JJ, Fagnan LJ, Stange KC. The evolving collaborative relationship between Practice-based Research Networks (PBRNs) and clinical and translational science awardees (CTSAs). J Clin Transl Sci. 2017;1(5):301-309.
- Stone CJL, Vaid HM, Selvam R, Ashworth A, Robinson A, Digby GC. Multidisciplinary clinics in lung cancer care: A systematic review. Clin Lung Cancer. 2018;19(4):323-330.e3.
- Brown BB, Patel C, McInnes E, Mays N, Young J, Haines M. The effectiveness of clinical networks in improving quality of care and patient outcomes: a systematic review of quantitative and qualitative studies. BMC Health Serv Res. 2016;16(1).
- Hunter RM, Davie C, Rudd A, et al. Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: A comparative effectiveness before and after model. PLoS One. 2013;8(8):e70420.
- Reeders J, Ashoka Menon V, Mani A, George M. Clinical profiles and survival outcomes of patients with well-differentiated neuroendocrine tumors at a health network in new South Wales, Australia: Retrospective study. JMIR Cancer. 2019;5(2):e12849.
- Tremblay D, Touati N, Roberge D, et al. Understanding cancer networks better to implement them more effectively: a mixed methods multi-case study. Implement Sci. 2016;11(1):39.
- Labbe C, Martel S, Fournier B, Saint-Pierre C. P1.15-13 wait times for diagnosis and treatment of lung cancer across the province of Quebec, Canada. J Thorac Oncol. 2018;13(10):S615-S616.
- Ministère de la Santé et des Services sociaux. Cadre de référence pour la mise en place de réseaux par siège tumoral. Accessed December 2, 2021. https://publications.msss.gouv.qc.ca/msss/document-002357
- Canadian Hospice Palliative Care Association. Innovative Models of Integrated Hospice Palliative Care, the Way Forward Initiative: An Integrated Palliative Approach to Care.; 2013. Accessed November 24, 2021. http://www.hpcintegration.ca/media/40546/TWF-innovative-models-report-Eng-webfinal-2.pdf
- Sedgewick JR, Ali A, Badea A, Carr T, Groot G. Service providers’ perceptions of support needs for Indigenous cancer patients in Saskatchewan: a needs assessment. BMC Health Serv. Res. 2021;21(1)
- Ontario Health (Cancer Care Ontario). Complex Malignant Hematology Models of Care: Recommendations for Changes in the Roles and Composition of the Multidisciplinary Team and the Setting of Care to Improve Access for Patients in Ontario – March 2017. Accessed December 2, 2021. https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/43051%5d