Background: in 2022, cancer was the second cause of death in Europe (247.5/100000 deaths), and in Italy (218.7/100000 deaths), where new diagnoses were estimated to be around 375000 in 2024. Campania region established in September 2016 the Campania Oncology Network (ROC) to define standardized diagnostic and therapeutic pathways (PDTAs). These include health care setting, fair access and appropriateness of hospitals, and territory integration through meetings of experts from disease-specific multidisciplinary oncological group (GOMs). The Pathway Evaluation of ROC project (“Valutazione Percorso della ROC” - ValPeROC) aims to appraise clinical and economic performance of ROC over time.
Objectives: to assess how patients’ care quality may affect overall survival (OS) we investigated the relationship of diagnostic delays and repeated clinical exams across two phases (Pre-GOM and GOM) on OS.
Methods: unique data from 1909 cancer patients (cancer sites: bladder, breast, colon, lung, ovary, and prostate) from four ValPeROC surveys were included in the analysis. Two phases were taken into account: 1)“Pre-GOM” phase (from the date of first symptom appearance or incidental–occasional finding- or screening exam to the first GOM meeting date); 2)“GOM” phase, from the first GOM meeting date to the date of therapeutic decision (surgery, adjuvant therapy, immunotherapy, etc.); the Pre-GOM delay was calculated as the difference between the two dates and split into <1.5 and ≥1.5 months; the number of PDTA-standard exams was available from lists of  the Pre-GOM and GOM phases. The proportion of total repeatead exams was assessed by matching the complete lists of the two phases. The OS analysis at 2 years was performed on 735 subjects with available data, from the first GOM meeting to the date of death, or the follow-up date. The time-to-event was studied in relation to the Pre-GOM delay, alone and together with the number of PDTA exams, cancer site, age, and the proportion of repeated total exams, in a subsample of cancer patients, through univariate and multivariable survival models.
Results: in Pre-GOM and GOM phases, the median delay in days was 71.5 (IQR: 28.7, 139) and 26 (IQR: 2, 49); mean number of PDTA-standard exams was 1.4 (SD: 1.5) in Pre-GOM and 0.8 in GOM (SD: 1.4). The median  number of total exams was 5 in Pre-GOM and 4 in GOM; the mean proportion of repeated total exams was 17.6% (SD: 29.7%).
There were 241 deaths among 735 individuals, with an OS rate of 67.2% at two years. Patients with ≥1.5 months of Pre-GOM diagnostic delay had a lower OS rate compared to <1.5 months  (60.5% vs 67.9%); however, no significant differences in OS emerged  (p = 0.12, n = 575), even after adjusting for cancer site, age, PDTA-standard and proportion of repeated exams.
Conclusions: ValPeROC is the first project in Southern Italy studying the quality of  cancer patient care. Information on clinical, diagnostic and therapeutic variables should be further investigated.