Centralizing specialized oncological procedures at experienced centers is of crucial importance. This is demonstrated by the results of a previously unpublished nationwide Czech study linking data from the National Cancer Registry with health insurance records.
The analysis covered 1,414 adult patients with early-stage (I–II) pancreatic cancer diagnosed between 2017 and 2023 who underwent surgery to remove the tumor. In hospitals performing fewer than 17 pancreatic resections annually, the 90-day postoperative mortality rate was 12%, whereas at centers with higher procedure volumes, it was 4.9%.
This disparity persisted even after adjusting for factors such as patient age and sex, comorbidities, tumor stage, and pre-operative treatment. Statistical analysis revealed that the risk of death within 90 days of surgery was approximately 2.5 times higher in hospitals with lower procedure volumes.
The findings indicate that, for technically demanding surgical procedures, concentrating care at experienced centers can be critically important. However, this does not imply that the entire subsequent course of a cancer patient's care must automatically take place at a specialized center.
According to experts from the Czech Technical University (CTU), it is therefore equally important to determine which aspects of care must truly be delivered at the center and which can be safely provided closer to the patient's home. "We should not centralize the patient, but rather the specific aspect of their care where centralization demonstrably yields higher quality," summarizes Associate Professor Aleš Tichopád, head of a research group at FBMI.
The center should play a crucial role as soon as there is a reasonable suspicion of a serious oncological disease. Well-coordinated diagnostics and the rapid involvement of necessary specialists can shorten the path to diagnosis and the initiation of treatment. It is precisely at this stage that a specialized center can help the patient gain valuable time.
Conversely, once treatment has begun and stabilized, or during remission, part of the care for suitable patients can be shifted to the local region—for instance, through regular check-ups, long-term monitoring, delegated prescribing where feasible, or other activities that do not require a highly specialized center.
Decision-making must take into account not only the diagnosis itself but also the patient's age and overall condition, prognosis, treatment options, preferences, and willingness to undergo intensive therapy.
The patient's own perspective is also important. A person who has been helped by the center during a critical phase of the illness may naturally place great trust in it and wish to remain under its care. From a systemic standpoint, however, keeping every stabilized patient in a highly specialized center for the long term may not always be optimal.
Communication and patient navigation are therefore key, and trained care coordinators should assist with these processes. Patients must understand why certain aspects of their care are being shifted closer to home and that this move does not imply a drop in quality or a loss of contact with the specialized center.
Overcrowded centers place a heavy burden on doctors and nurses, leaving less time for patients who genuinely require their specialized expertise. Consequently, overly broad centralization can lead to the inefficient use of the centers' limited capacity.
CTU therefore utilizes data on actual patient care pathways and artificial intelligence methods to identify ways to better organize care. By analyzing vast amounts of anonymized data, it is possible to track the routes patients take through the healthcare system, the care they received, and the resulting outcomes. These methods allow for the comparison of various care organization models to determine at which stages a patient should be treated in a specialized center and when part of their care can be safely provided closer to home.
The goal of centralization is not simply to channel as many patients as possible into the center. Success lies in ensuring the patient receives the right expertise at the right time while preserving the center's capacity for those moments when it is truly needed.
Translated by Google Translate