Scaling access to gynecologic oncology care: a network-based framework

Access to gynecologic oncology care varies substantially across health care systems and is influenced by organizational, geographic, workforce, and referral network factors that extend beyond the availability of specialized services. Using Brazil as an illustrative case of a large middle-income country with a mixed public-private health system, we performed a narrative policy and health-systems analysis, integrating evidence from global cancer surgery, gynecologic oncology, health-system organization, and international models of cancer care delivery. The objective was to examine access to gynecologic oncology from a health-systems perspective and to develop a conceptual framework describing the organizational dimensions of access that may be applicable across diverse health care settings. The literature was examined to identify recurrent concepts related to the organization of gynecologic oncology care. These concepts were grouped into broader themes and progressively consolidated into the nine domains of the Brazilian-informed Gynecologic Oncology Access and Sustainability Framework: burden, geography, organization, workforce, quality, financing, education, digital integration, and sustainability. Building on the Global Cancer Surgery framework, we also propose an expanded model that considers safe, equitable, timely, and networked care as complementary dimensions of access. To support the interpretation of the proposed framework, we developed the Gynecologic Oncology Network Maturity Framework, a conceptual framework for network organizational development, together with a scalable four-tier model linking local services, regional cancer units, specialized referral hubs, and centers of excellence. The Brazilian-informed Gynecologic Oncology Access and Sustainability Framework is intended as a conceptual model to support the description, discussion, and planning of gynecologic oncology networks. The Gynecologic Oncology Network Maturity Framework is proposed as a conceptual framework for describing network organizational development and requires prospective validation before benchmarking applications. Together, these frameworks should be interpreted as a foundation for future empirical evaluation, refinement, and implementation across different health-system contexts.