Data that drives decisions

The impact of the pandemic on the healthcare system is indisputable, as the slowdown in the response to non-COVID-19 diseases is leading to an increase in unmet healthcare demand. This represents a significant imbalance between patient needs and the responsiveness of healthcare resources, requiring optimization and the search for all kinds of efficiencies to rebalance the two parameters. While this impact has significant consequences for all pathologies, for some, such as cancer, it is of particular relevance and concern: the high and numerous variability of pathologies within the cancer concept, which is curable in a significant proportion of cases if detected early, and is often silent in its early stages, offering multiple therapeutic opportunities that must be well managed and organized, high prevalence, and no less social sensitivity toward it. Cancer, in general and crude terms, since each type has its "complex history," is a clear example of the need to trigger the Venturi effect in order to increase the system's responsiveness. And this must be done from the healthcare process, which includes everything from suspicion to diagnosis, and from this to therapeutic alternatives, leading to continuity of care in post-treatment follow-up. The critical point undoubtedly lies in detecting patients with suspected cancer and accelerating the diagnostic process, as it is reasonable to assume that once the patient is on the healthcare system's radar, in one queue or another, the appropriate solutions are delivered more efficiently. The truth is that it is difficult to know exactly how many patients may have been affected. As a guide, if we consider that approximately 280,000 patients are diagnosed, at an average of 23,000 per month, in the first months of the pandemic alone, nearly 50,000 patients remained undiagnosed. The months of halting screening programs, among other issues, will have led to an increase in this figure. The objective must therefore be to adapt the responsiveness of healthcare processes to the reality of demand, which, at present, is not quantified. The Agreement of the Interterritorial Council of the National Health System of February 24, 2021, on the COVID-19 pandemic and cancer prevention and control, briefly points out the following causes: the suspension of the aforementioned population screening programs, more difficult access to primary care and hospital care resources, longer access times for testing, and changes in attitudes and willingness to seek healthcare services. The objective must therefore be to adapt the responsiveness of healthcare processes to the reality of demand, which, at present, is not quantified. It is the result of the demand generated annually, plus the unresolved demand, adjusted for deaths and other parameters. Because statistics allow us to approximate the incidence of diseases for a given population with relative precision. What this entails: Understanding the healthcare demand that approximates the real number of patients awaiting diagnosis, and even more so those without suspected disease, by time of cancer and by region. The impact, as we have seen in the studies we have been conducting, is heterogeneous. The absence of a national population-based cancer registry makes it difficult to determine the true incidence and requires more or less accurate estimates. The variability in the incidence of different types of cancer according to different sources is proof of this. While the Spanish Society of Medical Oncology (SEOM) expects 277,394 cancer patients in 2021 (source: Spanish Network of Cancer Registries), the Spanish Association Against Cancer (AECC) expects the expected incidence to be 281,478. Understanding the activity actually carried out during the impact of the pandemic, also by type of cancer and region: screening programs, hospital morbidity, consultations and diagnostic tests, compared with their historical data, biopsy activity, and mortality. To approximate, through estimates, the average processing times per patient used throughout the care process. This will allow us to determine the volume of activity required for each of the cancer care processes to standardize efficient cancer care, emphasizing strategies and actions to reduce underdiagnosis, such as screening programs. To analyze the resolving capacity of available resources based on scenarios of the evolving impact of the pandemic that continue to reduce the capacity to respond to non-COVID-19 pathologies. This will establish their response margin and the differential from what is needed. To determine the necessary resources based on scenarios that maximize the venturi effect, that is, the optimization of resources and processes, and that consider, among other issues: diagnostic and therapeutic technology alternatives, pharmacotherapy, professional, organizational, and structural aspects, and the evolution of the pandemic. For example, screening technology will determine the degree of success in detections and the speed at which tests are performed. Furthermore, the collapse of operating rooms due to delays in all non-COVID-19 pathologies is leading to the promotion of alternative therapies, where evidence so warrants. This analytical process appears essential to achieve, at least, a recovery to the pre-pandemic situation. It also enables organizational decision-making to achieve the venturi effect of increasing the system's response with the available and possible capacity. New Medical Economics, May 7, 2021 Antonio Burgueño Jerez