Abstract Introduction Comprehensive palliative care is essential for improving the quality of life of women with breast and cervical cancer in Ethiopia, yet services remain poorly organized, largely inaccessible, and concentrated in the capital. While existing studies have quantified service gaps, the multi-level determinants enabling or hindering comprehensive care remain under-explored, particularly how these factors differ between urban and rural settings. Objective To explore the multi-level determinants of implementing comprehensive palliative care for women with breast and cervical cancer in Ethiopia. Methods An exploratory qualitative study was conducted from January to March 2025 in urban Addis Ababa and Sidama. Using purposive sampling with maximum variation, ninety-three participants including 37 women with breast or cervical cancer, 20 caregivers, and 36 key informants were recruited. Data were collected through open ended interview guides, transcribed verbatim, and analyzed using framework analysis guided by the Socio-Ecological Model. The analysis focused on identifying determinants at individual, interpersonal, community, organizational, and policy levels. ATLAS. ti V.09 was used to analyze the data. Findings Determinants of comprehensive palliative care access and quality emerged across five socio-ecological levels, with urban-rural variations. At the individual level, determinants included personal health literacy, assets, and financial resources. Patient resilience and health literacy enabled care, but outweighed by catastrophic out-of-pocket costs and misconceptions of cancer as a curse more pronounced in Sidama. At the interpersonal level, social support and family dynamics were critical. Supportive families enabled care, while family stigma and partner abandonment were major barriers with stigma more intense in Sidama. At the community level, social capital, community networks, and traditional structures served as determinants. Survivor-led groups, edirs, and religious leaders enabled support, yet their impact was constrained by resource deficits. Sidama relied on informal support. Cervical cancer patients experienced stigma rooted in sexually transmitted infection leading to social exclusion, whereas breast cancer patientsâ stigma was linked to fears of contagion and visible disfigurement. At the organizational level, access to healthcare services, resource allocation, and organizational culture were dominant determinants. Specialized cancer centers and community based health insurance enabled access, but systemic undervaluation of comprehensive palliative care, opioid shortages, lack of trained staff, and broken referral systems were barriers, worse in Sidama. At the policy level, governance, regulations, and health system financing were the overarching determinants. A national guideline exists but lacks rural implementation guidance, and is undermined by restrictive opioid regulations and absence of palliative care in professional curricula. Conclusion Determinants of comprehensive palliative care exist across all levels but are systematically undermined by organizational and policy barriers. Community-based organizations and traditional structures show promise but require sustainable funding. Policy reform, opioid access liberalization, curriculum integration, and decentralized community-based service models are needed to ensure equitable, and comprehensive palliative care.
Purpose: Automated scripts and workflows have been implemented in clinics to streamline the planning process, improving efficiency and consistency. However, standardized scripts often lack adaptability for patient-specific scenarios, requiring considerable effort to modify for non-standard cases. To address this, we present an interactive large language model (LLM)âdriven approach for flexible workflow automation across radiation oncology tasks. This work presents a proof-of-concept agentic LLM integration that enables flexible, natural-language automation across a broad set of radiotherapy (RT) workflow operations. Methods: An LLM-based assistant system was integrated into the MIM software platform. It includes a recursive MIM workflow, an agentic orchestrator, and coordinated agents: an LLM Consultant for selecting relevant functions, a code generator that compiles executable Java extensions, a Quality Checker for independent verification, and a Knowledge Accumulator that captures and stores valuable insights such as coding patterns, errors, and user preferences. The system uses a prompt-based approach with continuous learning from both successful executions and error corrections to enhance accuracy and adaptability. Its generalizability was validated using 57 realistic simple queries, robustness through repeatability and failure-rate testing, and overall performance through four complex examples addressing advanced clinical tasks across various stages of the adaptive RT workflow. Results: The system effectively replicated standard clinical workflows with high adaptability and flexibility. Early queries required extensive function library accumulation, while later ones mainly reused existing functions. Its multi-agent architecture enabled robust error recovery, with automatic correction loops reducing failure rates from 1% to near zero. Average execution time per query was 13â14 s. All complex examples were successfully implemented in MIM, supporting interactive use, dynamic workflow customization, and straightforward execution. Conclusion: By integrating an interactive AI assistant, the novel LLM-powered tool provides crucial workflow flexibility alongside automationâreducing workflow rigidity, enhancing efficiency, and promising a paradigm shift toward dynamic, patient-specific treatment planning and data management.
Open access
Advanced Radiotherapy Techniques
Advances in Oncology and Radiotherapy
Artificial Intelligence in Healthcare and Education
Knowledge is power. Updates in any field are essential to know for oneâs professional growth in life. In Medical science, scientist and clinicians have to be updated on recent developments. Continuing Medical Education (CME) is one of the ways to update. Different programs like CME, seminars, webinars, symposiums, Continuous Professional Development (CPD), etc., are conducted from time to time. When multiple people come to one platform for sharing their knowledge with experience with other delegates, it takes the form of a conference. After attending the conference, clinicians not only improve their knowledge but also get credit points. Various state medical councils in India have made mandatory requirements of credit points for medical registration renewal. Not only in India but also many other countries have made it mandatory.[1-3] Before the COVID-19 pandemic, many organizations and groups organized conferences in offline or physical modes but after the pandemic, most CMEs, seminars, and conferences are being conducted and converted from offline to online mode.[4] After around a 2 to 2.5 years of gap, the government has permitted offline conferences but now doctors incline to attend in online mode because online conference participation does not have distance, health issues, or cost like factors. They can attend their duties simultaneously and saves commuting times also.[5] Many of us attended the CME or conferences during the pre-pandemic and post-pandemic eras. We also thought of conducting a conference in a hybrid mode. We hence write what is required to arrange a basic conference successfully. Last year we organized one national level conference. We share our experience of how to arrange a conference, which can help all to understand the basics behind arranging one such event successfully. Concept: We discuss what you should have in your mind the thinking about organizing the Conference. Before going full throttle, better to conduct an all-India feedback among faculty members and post-graduate students to decide the theme of the conference and sessions for pre-conference workshops. Then, the organizers can shortlist the best theme. A reward also needs to be given to the winner who suggested the best theme during the conference because arranging a conference is a tedious thing. The planning takes a long-time and needs full concentration for many days to months.[6] Plan: Once you have a concept in mind, you can start planning for the conference. Finalizing the mode of the conference is a key thing nowadays (Online/Offline/Hybrid). Making a checklist serves a lot. Note down everything from beginning to end including the smallest to biggest things in your list. This list keeps on upgrading till the last day. We suggest that you have to think about what you expected as a delegate or participant from the organizer in any of the past conferences that you attended. Take advice from your senior faculties as well as juniors from the same as well as other departments to conduct the conference. The date of the conference is a separate entity. Choose the date after a minimum of 6 months, so you can get enough time for preparation. Most of the conferences are held on weekends and it is around 2-3 days. Select the date as per your convenience but weekends are suggested to get a good number of participants/delegates. Also, while finalizing a date, we check the availability of the auditoriums, clashing of any other programs, examinations, festivals, etc.[2] Committee: Organizing a conference is complete teamwork. Start preparing the team, which is known as the organizing team. The team should have a chairperson, organizing secretary, advisor, and other committee members. Chairperson and organizing secretary are key persons and to ease their work you have to appoint their deputy too. This will help in smoothening things during their absence of them. Choose the person in a particular committee based on the skills they are good at. Like good conversation, skilled in computer and internet work, good managerial skills, well in decorative things and many more. Arrangements of accommodation, travel, hospitality, etc., can be preferably given to the male members of the department. Scientific committee work should be given to the senior members of the team. The Finance committee looks after the financial aspects, audits, budgeting, etc., After the organizing committee builds up, the real work begins.[7,8] Funds: Whenever any event is organized, the first and biggest challenge is finance. Funds are needed for purchase, rent, gift/prize, mementos/honorarium for speakers, helpers/labor, travel costs, online platform costs, etc., You can get a sponsorship from the companies (who have a stake in the topic being discussed), from management, and also from registration of the delegates. Making a good budget for the conference goes a long way in the successful management of funds. Keep more than 15% or more funds for miscellaneous or contingency plans, because you will have things that you have not planned earlier.[8] Session and speaker finalization: For good participation and interest generation, a good theme (ideally a current topic) is essential. That will determine the topics for sessions. Selection of speakers, if possible, should have a mix of international, national, and local level speakers from that field. Avoid repeating or intersecting topics in the same type of session in your conference that you read or attend in the near past. Inviting the speakers on appropriate topics is also important. If the speakers are not comfortable with the topic, either you have to choose the topic or you have to shuffle the topics and speakers too. Sometimes all the speakers may not be available for all day or slot timings of conferences. Arrange the sessions as per the convenience of the speakers, but in a manner that the logical flow is maintained.[9] Registration fees and their category: Registration fee is one of the ways to decrease the requirements of external funds. This will support reducing the financial burden of a conference, but it also comes with its share of challenges. You have to set the fees, which are appropriate to cover a certain proportion of expenses but should not be too high to discourage participation. You can set the slab of the fees in three ways: early bird registration (least fees), normal registration (moderate), and spot registration (higher fees) as per the key dates. Another one is fees for consultant/faculty, student/resident, paramedical staff, and member/non-member category type. Variations in these fees structure will help you to get good enthusiastic delegates for the conference. Opening a new bank account in the name of the conference helps you to manage all the expense accountability records in one place. The GST bills, PAN cards of the bank account, etc., are necessary for smooth transactions and auditing purposes. Taking the help of a chartered accountant is necessary for financial guidance.[9] Applying for credit points in medical council: Many medical councils are encouraging associations to organize CME and CPD for clinician knowledge upgradation. They support CME by approving the credit points to delegates, which are also of interest to delegates. Appropriate efforts should be taken well beforehand to get your conference approved for credit points. You have to fulfill the criteria for the credit point as per the individual medical council requirements. For details, you have to visit and read the guidelines of the individual medical councilâs website. The approval of credit points needs finance. The amount may vary based on credit points approved and also upon the number of delegates that have registered for the conference.[2] First announcement and brochure: Next step is information to the target delegates about the event. You can prepare the first announcement pamphlet if your complete brochure needs more time to design. The first announcement gives the first impression about the events. It is usually a teaser. So, reveal only a few interesting aspects of the conference here. It should be attractive, and informative as well as should make delegates eager to know full details of events. A new logo on the name/theme of the conference gives a unique identity. After finalizing the speakers, schedule, registration fees, and brochure design, distribution of the brochure to all stakeholders should be done. A unique e-mail ID with the name of the conference should be made which should be used for the conversation and queries related to conference matters. Give complete information regarding your key dates, registration methods, registration fees, and their categories, speakers, sessions, contact details (of organizing secretary), etc., in a brochure that can make delegates clear about your events. You can also keep details of some nearby tourist places to visit in the brochures.[7] It is worthwhile to conduct some quiz or online assignment for postgraduates and senior residents in online mode related to theme of the conference to keep them reminded of the upcoming conference. Advertisement with an invitation: First announcement or final brochure should be distributed to the medical fraternity and important dignitaries of the institute. You cannot get good numbers of delegates at your conference without reaching them. Before social networking platforms, it was difficult to reach the delegates personally but now it is relatively easy to reach people. Post a brochure on various social networking platforms and groups to spread information about your events in other medical fraternities. A humble invitation message with the brochure attracts the delegates to attend the events. Stationary printing: Apart from the information brochure, many more things are there you may have to print. Banners, delegates, speakers, and resource personâs badges with the string, each category certificates, various informative sign boards, note pads with the name of events, and many more things required to be printed. Venue arrangements: If you are organizing a virtual conference, not much worry about the venue is there, but if you are organizing a physical or hybrid conference, you have to take specific caution about the venue. The size of the hall or auditorium, registration area, welcome kit distribution area, a place for parking, stall for exhibition, poster/oral presentation hall, a dedicated area for breakfast/tea and lunch, dedicated seating arrangement for guests and speakers, and many other things have to be kept in mind. You have to manage all the things without making hurdles to other workplaces of the institute and also have to satisfy the delegates.[10] Food arrangement: Food variety and quality play one the major attractions for the delegates. A not too heavy breakfast, a working lunch, tea at least twice, and sometimes dinners or banquets needs to arranged in the conference. Food arrangements should be verified and confirmed at least before one day of events. Food items should reach to specific place a minimum of 30 minutes before the schedule which can give time to caterers to decorate and serve food on time. 2-3 designated persons should be moved around to take care of guests and speakers during the break and food time. A spread and portion size should be meticulously planned, taking into account the palate of all regions of people and also taking into account local flavors. Adequate time should be allotted to the dining time because a lot of interaction between people takes place at this time.[7] Audio/Visual planning: Audio-visual facility is one major area that needs to focus on properly, especially when you are organizing virtual or hybrid events. Good resolution of the speakerâs PowerPoint slides, clear voice with good audio transmission quality, good network connection for online delegates, and live interaction between online and offline delegates and speakers. A professional team needs to handle all these things. A dry run needs to be done a day or two before the actual event.[11] For virtual conference presentations, participants can be encouraged to share their recorded video presentations to address Internet-related issues and time management during presentation. Stage rehearsal: Stage etiquette and performance are also important. The selection of a master of ceremony, and script writing is an integral part. Coordination between anchors and other stage managers needs to be smoothened. Lamp lighting and inauguration ceremony should be rehearsed at least 2-3 times before the event which can make everyone confident on the event days. Welcoming the guest and speakers, anchoring the whole event, facilitating, and felicitation guests and speakers before and after sessions, delivering bouquets, mementos, and certificates to guests and speakers, and vote of thanks and the valedictory session should be finalized earlier. Rehearsals can make the whole event will go smoothly on the main day.[12] Abstract submission and result notification: One of the corollary events that take place in paper and poster presentations. The organizing team can call for papers and include them in competitions. Various institutes and places clinicians and students want to share their research work with others via conference. Organizers invite abstracts for the papers, posters, or both before the conference. Dates of submission, result notification, and paper/poster submission dates for presentation have to be announced well in advance with the brochure. The scientific committee and judges have to be decided beforehand for the abstract selection/rejection and judging the paper/poster presentation in the events. On the final day, the place/mode of presentation and AV aids need to be arranged. Format and criteria for judging need to be established well in advance.[11,13] Registration verification: In the information brochure, the link for registration and payment is given. But verification of the registration information with the account statement should be done to avoid financial problems in the future. You have to dedicate 1-2 persons for verifying those details and give confirmation to the delegates about registration via email, phone call, or message. You can set autoreply in the registration form or email but still you have to check it once to avoid any future problems. Miscellaneous: The day before the conference is usually very hectic. All last-moment preparations, checks, etc., go on. Preparing the delegates, speakers, and resource personsâ badges, welcome kit/folder preparation, sign board/banner sticking, stage arrangements, decoration of the venue, and other things going on. Have a good sleep at night.[6] On the day of the conference: On the day of the event all members have to do what they have been assigned. No work is small or less. Organizing committees have a big task to organize and all members have to fulfill their roles either in their work on stage or anywhere else. If each member does their best, no one can stop your event to be successful. Spot registration facility: People assigned to the registration counter should arrive early along with all delegate bags, batches, and signature/attendance forms. Turnout should be impressive as they are the face of the event. Some organizer keeps the spot registration facility. You can keep it but we suggest, donât keep it unless a lot of spots are vacant because it is extra work, starting from registration to certificate distribution.[9] If you have in-house speakers, you do not have to worry about being on time session starting. If your speakers are coming only for session time, try to take confirmation and arrange transportation before the session time. They should reach the venue at least 30 minutes prior, so they can get time to ready for the sessions. You have to schedule the questionâanswer session at the end of each lecture or session. But try to manage the time limit to avoid delay for the next lecture or session.[7] Conducting an Oral/Poster session: If in your conference, you inviting the abstract for either paper, posters, or both, you have to arrange the time slot with the venue for the presentation. You also have to coordinate with the participants about their time slots and share links for presentations. You have to invite the judges for judging the presentation. After completion of the presentation, have to collect the scores from judges and compile them for prize announcements.[7] Last-moment hurdles: All events may have been completed without any hurdles. Even those hurdles will make our events more memorable for us. Some accidental events like speaker illness, late supply of material, electricity and Internet problems, some environmental/weather-related situations, and other things can create problems at the last moment, think about those during the event planning to avoid trouble on the event day.[7] Untoward incidents on the event day: Sometimes it may fail or fall even after perfect arrangements and rehearsal. Donât panic on the event day, even after some mismanagement. Try to make it normal to maintain your team membersâ morale for successful event completion. Collecting the attendance and feedback from offline and online delegates: To engage the delegates with sessions, speakers can ask the question to delegates during the session. Organizers can take attendance on a paper sheet for physical delegates while collecting online feedback responses from all delegates to be sure of attendance. You can improve your event management, after evaluating the delegates and guest feedback.[7] After the completion of all lectures and valedictory sessions, the conference is almost complete. Delegates will leave the venue, but this is not the end of your work. You also have a lot of work which is known as post-conference work. Post-conference work: The certificate is proof of attendance for delegates and participants. In a physical conference, you can distribute the certificate at the end of the last session but for the virtual or hybrid conference, you have to send the delegates, speakers, and participants certificates to their email id. If you donât have good IT support, you will suffer to distribute them. you also have to announce the prize winnersâ names and distribute certificates with prize gifts, if you had the slot for poster/paper presentations. You also have to return the material to the supplier in the same condition which you received. Complete the task as per your checklist to avoid any troubles in the future.[14] After completion of the above work, prepare the list and make the brief reports of the conference. You have to prepare the reports with the delegate list as per the requirement of institutional management, state medical council, National Medical council, and other regulatory body requirements with their suggested formats. You also have to send the thanks email/letter to the speakers, sponsors, and institutional management team to support you and your team in organizing the event. Keep all the reports records along with the event photographs, videos, speakers/delegatesâ testimonials, presentations of lectures, feedback forms, etc. Future conference planning: After organizing one successful event, you can get a good experience for the future. You can plan the next event after a month, a year, or at your You can improve your work after evaluating feedback We that this will help all future event organizers to organize the conference. We are not to cover all the of organizing in one but we important things. from event is a new So, start from one day you will be successful in the future. support and sponsorship of interest are no of
Oscar Tapera, Greta Dreyer, Anna Mary Nyakabau, Webster Kadzatsa ¡ 6 authors
BACKGROUND: Cervical cancer treatment and care remains limited in Zimbabwe despite the growing burden of the disease among women. This study was aimed at investigating strategies to address barriers in accessing treatment and care by women with cervical cancer in Harare, Zimbabwe. METHODS: A qualitative inquiry was conducted to generate evidence for this study. Eighty-four (84) participants were purposively selected for interviews and participation in focus group discussions. The participants were selected from cervical cancer patients, caregivers of cervical cancer patients, health workers involved in the care of cervical cancer patients as well as relevant policy makers in the Ministry of Health and Child Care. Participants were selected in such as a way as to ensure different of characteristics to obtain diverse perspectives about the issues under study. Discussion and interview guides were used as data collection tools and discussions/interviews were audio-recorded, transcribed and translated into English. Inductive thematic analysis was conducted using Dedoose software. RESULTS: Salient sub-themes that emerged in the study at the individual patient level were: provision of free or subsidized services, provision of transport to treating health facilities and provision of accommodation to patients undergoing treatment. At the societal level, the sub-themes were: strengthening of health education in communities and training of health workers and community engagement. Salient sub-themes from the national health system level were: establishment of more screening and treatment health facilities, increasing the capacities of existing facilities, decentralization of some services, building of multidisciplinary teams of health workers, development and rolling out of standardized guidelines and reformation of Acquired Immunodeficiency Virus (AIDS) levy into a fund that would finance priority disease areas. CONCLUSION: This study revealed some noteworthy strategies to improve access to cervical cancer treatment and care in low-income settings. Improved domestic investments in health systems and reforming health policies underpinned on strong political are recommended.
Carla J. Chibwesha, Leeya F. Pinder, Agnes Musonda, Kombatende Sikombe ¡ 11 authors
Introduction: By 2030 cancer will kill one million Africans each year. Women will bear the heaviest burden, as cancers of the breast and cervix are the most common malignancies and causes of cancer-related death in the African region. National-level data that map the status of women's cancer control services are needed to inform strategies for implementing platforms for the early detection and treatment of these âpriorityâ cancers. Methods: Using mixed-methods, we assessed available services for breast and cervical cancer detection and treatment at all provincial hospitals, the national referral hospital, and the national cancer treatment center in Zambia. Results: A system for cervical cancer prevention using visual inspection with acetic acid (VIA) and ablation/excision of precancerous lesions has been established at the provincial level. The potential for mammography, clinical breast examination, diagnostic ultrasound and biopsy exist at the provincial level, albeit on a much smaller scale. Breast wedge resections and mastectomy can be performed in provinces where general surgeons are located; however, breast conserving and reconstructive surgery are not available. Invasive cancers are generally referred to University Teaching Hospital in Lusaka, where services for radiation, chemotherapy and hormonal therapy are available but overburdened. Pathology services nationwide are woefully inadequate. Discussion: The assessment revealed a critical need for centrally coordinated, but decentralized, public service platforms for women's cancer control. Efforts are underway, through multiple stakeholders, to implement recommendations related to training healthcare workers who can provide advanced diagnostic and therapeutic services, improving pathology services, and innovative financing for these initiatives.
Many cancer centers reach out to their elected officials by meeting with them on Capitol Hill and inviting them to tour their institutions. But few go as far as the Ohio State University Comprehensive Cancer Center (OSUCCC). At this National Cancer Institute-designated center based in Columbus, Ohio, elected officials and their staffs take on the roles of patients, researchers, or healthcare providers to gain a more personalized understanding of the importance of translational research and its impact on patient care. âAt the end of their visit, we have roundtable discussions, and the feedback is always, âwe never knew how complex cancer care and research isâ,â says Jennifer Carlson, director of government relations for OSUCCC. As further proof of the program's success, legislators discussing cancer-related legislation at government hearings have referred to their participation in Project Cancer Education and the knowledge they gained from it, Carlson notes. âThis hands-on program literally takes policymakers from the bench to the bedside and helps them understand some of the challenges we face,â she says, adding that it also helps illustrate some of the lost opportunities that can occur with lack of government investment or support of medical research and care. Because Project Cancer Education has been so successful in Ohio, OSUCCC Director Michael Caligiuri, MD, who was recently elected president of the Association of American Cancer Institutes (AACI), proposed making it available to member centers across the country. The program is âthe cornerstone of our advocacy efforts this year,â he notes. âWe have had amazing success in seeing important anticancer legislation move forward in Ohio because of the impact Project Cancer Education has had on our elected officials,â Dr. Caligiuri says. âWe are asking the community of American cancer centers through the AACI to implement this best practice at their centers because it will help to justify the greater investment in cancer research and make our elected officials and staff aware of why our cause is such an urgent one.â Participants in Project Cancer Education learn about the challenges of cancer care through role-playing scenarios. Carlson is chairing the committee within the AACI that is developing a toolkit based on her center's existing collateral materials for all member centers to refine and adopt to fit their specific needs. They plan to have the materials available this spring. Additionally, they are working with the National Cancer Institute to roll out a similar program for congressional committee staffers who are based in Washington, DC. The toolkits will include different âtracks,â such as a patient scenario or a researcher scenario. The program can range from 2 hours, geared mainly toward the elected officials, to a half-day or full day, which is designed for their staff members. Participants also receive graduation certificates and pose for a photograph, which is later E-mailed to them to reinforce the program's messages. The program that supported your research has been eliminated because of federal budget cuts. Your second- and third-year budgets have been zeroed out. The institutional review board determined that you did not plan to have enough research nurses for your proposed phase 1 study. Wait 6 months and try again. Due to cuts in federal funding line for your grant, your budget has been reduced by 30% for the next 3 years. Visits to cancer care and research facilities allow participants to see the intricacies of discovery and treatment firsthand. Participants encounter positive results too, such as, âThe drug you developed is ready to come to market and is expected to bring in large profits to the university during its patent lifetime. The new science building on campus will be named in your honor.â In the patient scenario, some of the challenges participants learn about are lack of insurance coverage for clinical-trial patient-care costs, the importance of proper insurance authorization for specific treatments, and the intensive recovery that occurs with an allogeneic marrow transplant for acute myeloid leukemia. In some cases, policymakers get a chance to talk with patients participating in clinical trials who are living proof of research's value, Carlson notes. She is confident that cancer centers across the country will find the program beneficial. âBy partnering with our elected officials, we can take cancer care to the next level,â she says. The Ohio legislative cancer education program, Project Cancer Education, is set to roll out nationwide. The program gives elected officials a chance to walk in the shoes of researchers and patients. Legislators and their staffs experience firsthand the challenges faced by cancer centers. Cancer centers will receive toolkits from AACI to help tailor their own programs.
BACKGROUND: Changing patterns of patient referral, decreasing payments for service provision, confusing network participation and reimbursement, as well as challenges to autonomous clinical decision-making jeopardize the traditional role of the oncologist in delivering cancer care. The cancer patient also may be at risk with unproven cancer delivery systems that displace the oncologist as decision-maker and care provider. The authors have constructed a model that preserves the oncologist's clinical and financial autonomy while meeting marketplace demands for improved access, decreasing costs and preserved quality of care. METHODS: During a 4-year period, a group of private practice medical oncologists initiated a formal business plan to evaluate marketplace needs, then designed and implemented a novel cancer care delivery model. The model required reconfiguring the practice into an integrated Joint Commission on Accreditation of Healthcare Organizations-certified cancer service corporation, providing medical, radiation, and gynecologic oncology. Palliative care, pain management, psychologic, and nutritional services were instituted as well as the vertical integration of home health and hospice care. Clinical pathways and treatment protocols were designed to enhance patient care and facilitate cost-of-care projections in designated populations using a cancer incidence forecasting model. Outcomes analysis are performed as part of ongoing continuous quality improvement, which continues to change this health care delivery system. RESULTS: In the 3 years since implementation of the model, the practice has increased from 16 to 24 physicians, and the number of offices has increased from 12 to 17. Patient encounters, both new and established, have doubled. Cost of services, specifically hospitalization, have been reduced by 50%. Clinical research referrals have increased 300%. Physician compensation has improved >20%. CONCLUSIONS: The model created a low cost, high value provider not burdened by allocated overhead. Decentralized care enhanced community access, which improved patient compliance, enhanced patient satisfaction, decreased hospitalization, and thereby decreased cost. The horizontal structure permited the flexibility for varied purchaser products and politically sensitive physician and hospital provider panels. Consensus-based protocol and pathway determination achieved maximum physician participation, which preserved clinical and financial autonomy, decreased variance, and facilitated clinical research.
The evolution of radiotherapy in Denmark is traced from its early inception in 1896 to the first three radium centres in 1913-1914, the establishment of which caused a roar of protests among the surgeons of that time. Private initiative pioneered the Radium Foundation which raised money for radium and financed erection of new buildings for the three centres in the 1930's. Radiotherapy became a separate speciality in 1950. The early 1960s saw the introduction of megavoltage therapy and the first promising results from chemotherapeutic management of solid tumors. The consequent referral of patients to centres for non-surgical therapy created a need for two new centres (Aalborg and Herlev) and called for a gradual closing down of decentralized low-voltage treatment at county level. However, the decentralization of health care in 1970 partly reversed this trend and some patients were therefore referred for decentralized treatment at major county hospitals. Such treatment mainly consisted of adjuvant or palliative chemotherapy, though in a few countries palliative therapy was supported by low-voltage therapy. In 1987 the medical speciality of radiotherapy was officially renamed oncology.