As cancer cases in Saudi Arabia are projected to double by 2040, the Kingdom’s healthcare system faces mounting pressure to abandon outdated, fragmented models of oncology care. Dr Russell Hales, Chief of Centres of Excellence at Johns Hopkins Aramco Healthcare, sets out the clinical and structural case for a precision-driven, patient-centred approach – and why the old ways must be consigned to history.
Imagine walking into the reception area of a cancer care centre and feeling like you just walked into an Apple Store. A receptionist holding a tablet computer greets you at the entrance and books you in for your appointment. Moments later, you are sitting with one of the four oncology sub-specialists who collaborate as a team. You will meet one-on-one with them that day to discuss the comprehensive treatment plan they have drawn up to help you beat the disease.
For a cancer patient, this is surely a compelling vision of how cancer care should work: quite simply, it puts the patient first. Unfortunately, in most parts of the world, modern cancer care is built on an outdated model that places the needs of the healthcare system above the needs of patients. This results in a fragmented care journey that does not serve patients well. Yet precision oncology and Saudi Arabia’s Vision 2030 demand that the needs of patients, not the healthcare system, are put first. It is important to leukaemia these influences given the expected trajectory of cancer rates in the Kingdom.
The scale of the challenge
Around 28,000 new cancer cases are reported in Saudi Arabia every year, split roughly equally between women and men, figures from the World Health Organization show. Breast and colorectal cancer are the most frequently diagnosed, followed by thyroid cancer, Non-Hodgkin lymphoma, and leukaemia. Unfortunately, cancer rates in the Kingdom are expected to soar in the coming years, with one forecast predicting that cases will double between 2020 and 2040.
Through the Health Sector Transformation Program set out in Vision 2030, the Kingdom has already taken significant steps to prepare for significantly higher levels of cancer and other non-communicable diseases. Among other things, the transformation program calls for improving the quality of care and patients’ quality of life. This is a challenge, albeit a welcome one, for healthcare providers in an era where cancer care has grown much more complex with the nuances of precision medicine.
From linear pathways to precision oncology
The cancer care journey of the past was relatively linear because diagnostic and treatment options were limited. A patient presented with symptoms, underwent tests, and got a diagnosis. They underwent staging to determine how large their cancer was and whether it had spread to other parts of their body. Then they were treated based on “stage”: surgery for early-stage disease; chemotherapy for more advanced disease. The linear model of oncology care is based on a one-disease, one-treatment system, with care organised around departments focused on a particular specialty such as surgery, medical oncology, or radiation oncology.
Today, screening is helping to catch cancer before patients have symptoms. A patient diagnosed with cancer can now benefit from the wonders of genetic analysis, whereby the DNA in their tumour is examined for clues about how it might respond to particular treatments. Huge leaps forward in the fields of immunotherapy and targeted therapy have vastly expanded the available treatment options. Blood-based DNA markers can not only predict which therapies are most likely to work but also detect the effectiveness of therapy before changes are seen on imaging.
We have now entered the era of precision oncology where treatment is more personalised to the patient than ever. By its very nature, oncology care delivery cannot function effectively under the old, fragmented model that focuses on the system rather than the patient. The patient must be front and centre of all our efforts, from early detection to diagnosis, treatment, and survivorship. This is, in essence, the Centre of Excellence model.
Putting the patient at the centre of care
Fragmented care focuses on specialties instead of patients and creates inefficiencies that burden the patient as well as the provider. Patients might be subjected unnecessarily to the same tests several times if their physicians are not collaborating in real time or if medical records and alerts systems are not integrated. Patients might be scheduled to attend multiple appointments with different specialists in different departments on different days. This approach may have worked in the past when the cancer care journey was relatively linear.
But it does not work in today’s era of complex cancer care, because it forces patients to travel back and forth to the hospital on several occasions, taking time off work and away from their families. Importantly, fragmented care can leave patients with limited, conflicting information about the status of their health and their treatment, leading to lower satisfaction. And most importantly of all, fragmented care is likely to extend the time between diagnosis and initiation of treatment, creating a serious risk that the patient’s cancer will progress in the interim.
The old ways need to be consigned to history once and for all and replaced with a patient-centred care model. For healthcare providers, this necessitates a fundamental rethinking of how every department, service, and member of staff involved in cancer care can better interact with one another to ensure patients are put first. Here are a couple of ideas.
Multidisciplinary clinics are the new model for care whereby departments are replaced by specialist “disease teams.” This means that a cancer patient can see all relevant specialists during a single visit – consultants from medical oncology, radiation oncology, pathology, and surgery, perhaps. They no longer need to visit the four consultants separately – maybe on four different days over the course of a month, depending on the doctors’ schedules – which has always been a wasteful and time-consuming process.
A single “patient navigator,” typically a nurse, can chaperone a patient from the beginning to the end of their care journey. This gives a patient and their family a single point of contact for coordinating hospital visits, obtaining tests, providing education about treatment options, and demystifying medical jargon, among other things. Without a patient navigator, the administrative and educational burden falls on the physician and the patient, whose relationship should instead be fully focused on core care needs.
Patient satisfaction with cancer care has been linked to enhanced health-related quality of life, in part because a happy patient is more likely to abide by the recommendations of their care team. Conversely, if patients are not satisfied with their care, their health-related quality of life can decline. They become less likely to comply with the recommendations of their care team, which can frustrate the effective management of their disease and may impact survival.
It is unlikely that every cancer care provider in Saudi Arabia will model its reception area on an Apple Store, as appealing as that vision may seem. But if care providers embrace the patient-first mindset, create specialist disease teams, and generally show willingness to give up the old ways – as we are doing at my hospital – then patients across the Kingdom will be better served, and they will stand a better chance of beating cancer.
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9068518
https://pmc.ncbi.nlm.nih.gov/articles/PMC5891359
https://gco.iarc.who.int/media/globocan/factsheets/populations/682-saudi-arabia-fact-sheet.pdf
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00084-1/fulltext
