Integrating early cancer care into one pathway: Comparison across Denmark, the Netherlands and Italy

Extant cancer-specific frameworks have advanced our understanding of policies and initiatives aimed at strengthening early diagnosis and integrated supportive care. Complementing these contributions, this study examines the organisational and inter-organisational mechanisms through which health literacy, early detection, early diagnosis and early treatment are connected into an early cancer care pathway across different healthcare systems.

We identified three case studies (Denmark, the Netherlands and Italy) based on a variety of contexts and challenges in addressing strategies of integration in early cancer care. We adopted a multilevel conceptual framework to identify different dimensions of integration implemented in the early cancer care phases. This analysis was supported by a comprehensive desk review of institutional documents, reports, scientific literature and interviews with key informants from the selected countries.

The application of a detailed conceptual model allowed us to understand the dimensions of integration implemented and their possible interaction in the three analysed cases. We found that structural integration is adopted for cross-cutting infrastructures and that process integration is followed for patient pathways and cancer networks, whereas health literacy is approached through interpersonal integration.

The ever-increasing complexity of cancer care, along with the number and diversity of stakeholders involved, has led policymakers and managers to implement integration strategies, yet comprehensive intervention strategies aimed at governing and managing the entire pathway are still lacking.