ideasIdea
National hub-and-spoke cancer networks with defined referral tiers
Instead of one overwhelmed national cancer hospital, organise care in tiers: district hospitals diagnose and give simple treatment, regional centres give chemotherapy and surgery, and the hub handles radiotherapy and complex cases.
Many LMICs have a single national cancer institute that patients travel days to reach, with everything else undefined. Formal networks with tiered service specifications, referral criteria, shared protocols, and a common minimum dataset (the Tata Memorial National Cancer Grid in India is the largest example) spread capacity, shorten travel, and make quality auditable. The design choices are which services sit at which tier and how the money follows the patient.
Hypothesis
Regions organised into a formal tiered network will reduce median distance travelled for chemotherapy by more than half and increase the proportion of patients completing planned curative treatment by at least 15 percentage points within five years.
Rationale
The National Cancer Grid grew to more than 300 centres and demonstrates protocol harmonisation and pooled procurement at scale; stroke and trauma networks show the same logic in other conditions.
What would test it
Compare two regions in one country, one with a funded network and one without, on stage at diagnosis, time to treatment, completion rates, and travel burden over three years.
Maturity
being tested at scale
Who has to act
policy
Cost to try
Large (over $50M)
Years to first evidence
5
Bottlenecks it attacks
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.