[Hospital-territory integration: the case of the Territorial Oncology Center of the ASL 04 of Teramo].

In recent years, proximity of care has taken on a fundamental role in oncological management, improving the humanization and accessibility of treatments. The model of decentralizing oncological care from hospitals to local areas has been supported by national and international healthcare policies, such as the National Cancer Plan 2023-2027 and Ministerial Decree No. 77/2022. The aim of this work is to assess the impact of a hospital-territory integration pathway started by the G. Mazzini Hospital in Teramo, considering both the quality of the services offered and the economic implications for the National Health Service. The integration was achieved through the creation of a territorial oncology center, which provides care through a team of professionals working under the "migrant unit" model. This model focuses on chronic patients and long-term survivors, reducing waiting times and improving access to services. It has alleviated hospital overcrowding, improved organizational efficiency, treatment quality, and the psychological well-being of patients, which was measured using specific quality of life (QoL) questionnaires and financial toxicity assessments. From 1st January 2024 until 31 December 2024 the center managed approximately 3,000 visits, easing the hospital workload by rationalizing space and human resources, and improving access to treatments. An analysis of financial toxicity showed improved cost management, with a significant reduction in the cost per service, dropping from 30 euros in 2021 to about 17 euros in 2024 (-43%). The reorganization also helped reduce hospitalizations by optimizing care settings. Patient satisfaction was high, both in terms of service quality and stress reduction, thanks to a less crowded and more welcoming environment. Decentralization reduced the burden on hospital departments, improved efficiency and patient satisfaction, and lowered costs. The experience suggests that this model could be implemented and scaled in other regional healthcare systems to further enhance overall efficiency.