Case Studies

Cancer care pathways often require complex, multispecialty coordination and long-term management. Since the 1990s, clinical networks have emerged internationally as a strategic response to these challenges, particularly in oncology. The fragmented nature of cancer care – characterized by inconsistent access, variable quality and disconnected services – called for system-level solutions to promote integration, equity and continuity.

In this context, the Piedmont Region of Italy established the Rete Oncologica Piemontese (ROP), a regional cancer network designed to coordinate services, improve accessibility, standardize care and strengthen multidisciplinary management across providers. Founded in 2001, the ROP aimed to enhance clinical governance and patient-centred care by coordinating cancer diagnosis, treatment and follow-up across the region. Its structure is based on three main components:

• Reception and service centres (Centro Accoglienza e Servizi – CAS): Patient entry points managing access, scheduling and administrative support.
• Interdisciplinary care groups (Gruppo Interdisciplinare Cure – GIC): Multidisciplinary teams developing shared treatment plans.
• Integrated care pathways (ICPs): Standardized clinical procedures ensuring consistent, evidence-based care.

The initiative was regionally led, backed by public institutions and clinical leaders, and strongly supported by oncology departments from the outset. Training programs and shared protocols helped align providers. CAS units were established within oncology departments and staffed by multidisciplinary teams of nurses, oncologists and administrators, while GICs brought professionals from different specialties together for collaborative treatment planning. To encourage adherence to network processes, regional incentives were introduced, including higher reimbursement rates and CME credits for GIC participation.

Over time, ROP evolved through regulatory reforms and structural adjustments, gradually transitioning from shared to centralized governance. In 2021, a Central Coordination Authority was established, with designated leaders overseeing both hospital and community care. By then, the network had matured into a structured system with wide stakeholder support.

The ROP developed through four phases: formation (1998–2010), stability (2010–2016), routinization (2016–2019) and extension (2020 onward). Initial resistance – particularly from specialists concerned about loss of autonomy – was gradually overcome through evidence-based multidisciplinary care, shared training and clear leadership. The appointment of a full-time scientific director and dedicated funding helped institutionalize the model while CAS and GICs were progressively rolled out across the region. Between 2010 and 2019, data from more than 200 000 cancer patients showed that access to the network more than doubled (from 35.3% to 73.3%), while CAS and GIC participation increased from 9.4% to 43.7%. Variability in access across geographic areas and cancer types declined, indicating greater equity. Uptake was higher among younger and healthier patients, with differences also observed by education level and cancer site. The ROP improved collaboration, reducing unnecessary variation and enhancing professional identity. However, disparities in access among the elderly and those with complex conditions remained a concern, partly due to administrative and organizational limitations in integrating comorbid care. Despite these challenges, ROP was widely seen as a success in embedding a culture of multidisciplinary collaboration, contributing to better continuity of care and reducing fragmentation. Its model has since inspired replication efforts elsewhere in Italy.

Enablers included strong leadership, integrated ICT infrastructure, dedicated funding and clear incentives. The founder’s credibility among clinicians and ability to secure institutional support were critical during the formation phase. The appointment of a full-time scientific director further aligned clinical priorities and consolidated the network’s vision. The network’s web portal, logo and visual identity also fostered a sense of ownership among professionals. Training programs, CME credits and higher reimbursement for GIC consultations incentivized participation, while managerial tools such as audits, shared indicators and strategic planning ensured accountability and alignment. Cross-node collaboration through staff exchanges and shared educational events reinforced cohesion.

Barriers included administrative complexities and fragmented financial flows, which limited recognition of multidisciplinary work, particularly when GIC meetings occurred during hospitalization. Elderly patients and those with comorbidities often had lower access, due partly to different clinical entry points and partly to limited standardization of geriatric oncology pathways. Generational turnover also posed a risk, as younger professionals often lacked the historical commitment to ROP’s founding principles.

The ROP significantly contributed to achieving key health system goals. It improved equity by reducing geographic disparities in cancer care access, and promoted people-centredness through personalized, multidisciplinary management. Efficiency was enhanced by reducing duplication, unnecessary referrals and treatment variability. Integration between hospitals and territorial services strengthened the continuum of care. The network’s structure allowed for better allocation of resources, reducing reliance on central hospitals for standard care and increasing the role of community-based services. By standardizing clinical pathways and fostering shared professional identity, ROP supported quality and safety improvements. ROP also influenced policy at the national level, offering a blueprint for other regional cancer networks and aligning with EU and national priorities on cancer care integration.

Lessons learned: The ROP demonstrates that clinical networks can evolve into powerful policy tools when supported by visionary leadership, professional alignment and institutional commitment. Multidisciplinary collaboration, if properly incentivized and governed, enhances continuity and quality of care. However, networks require long-term investment, adaptive governance and strategies to retain institutional memory across leadership transitions. While digital infrastructure and incentives help promote standardization, attention must be given to vulnerable populations such as the elderly or multi-morbid patients, whose care needs may not align neatly with standardized pathways. Administrative and financial mechanisms must be adapted to recognize team-based care across settings. The success of the ROP lies in its progressive development: informal beginnings solidified through formal structures, responsive leadership, and iterative adaptation. It highlights the value of gradual institutionalization, local flexibility and embedded professional engagement in sustaining impactful healthcare networks.