Italian Oncology at the Crossroads: Between Hospital Bed Cuts and the Need for a Transition to Integrated Community-Based Simultaneous Care.

BACKGROUND

In Italy, public health investments have not kept pace with the rising demand for cancer care. Hospitalization costs are increasing, and length of stay (LOS) remains a critical metric for hospital efficiency and care quality.

METHODS

An ecological study analyzed hospital discharge records of patients admitted to "Policlinico Tor Vergata" (Rome, Italy) in 2022. Associations between cancer types and key variables influencing inpatient care were analyzed using logistic regression models (AOR; 95% CI), along with discharge patterns.

RESULTS

Among 14,451 ordinary hospitalizations, cancer diagnoses accounted for 16.4%, with blood cancers as the largest subgroup (20.1%). LOS outliers (5%) contributed to 11,342 excess hospitalization days. Blood cancers were associated with prolonged LOS (2.031; 1.499-2.753), while blood (2.368; 1.911-2.933), gastric (2.216; 1.603-3.062), and bladder cancers (2.661; 2.133-3.319) had a higher infection risk. Patients with bladder cancers were more likely to be ≥65 years old (2.661; 2.133-3.319). Secondary diagnoses were more likely to occur in gastric cancer types (1.637; 1.486-1.802). A discharge analysis revealed that 46.8% of cancer patients were discharged home without activation of home care services, and only 0.2% received home care activation. Cancer patients were more likely to be discharged home (2.150; 1.911-2.418) while awaiting completion of diagnostic or therapeutic processes.

CONCLUSIONS

Our findings highlight the significant variability in hospitalization patterns across cancer types and the inadequacy of current discharge planning processes. The burden of prolonged LOS highlights the unsustainability of current care models. An urgent transition toward integrated, community-based simultaneous care models is needed to reduce healthcare costs, prevent prolonged hospitalizations, and improve outcomes, particularly for vulnerable elderly patients.