Centralisation and high-volume centres
Concentrating complex cancer surgery and rare cancer care in fewer hospitals that do a lot of it. Hospitals and surgeons that perform an operation often have fewer deaths and complications, so patients may travel further but do better.
The volume-outcome relationship is among the most robust findings in health services research: mortality after oesophagectomy, pancreatectomy, cystectomy and complex hepatobiliary surgery is roughly halved in high-volume centres, and the Netherlands, Denmark and parts of the UK have mandated minimum volumes. The same logic applies to sarcoma, paediatric cancers, CAR-T and allogeneic transplant, which are delivered only in accredited centres. Costs are travel burden, inequity for rural patients and loss of local skills, which telemedicine, hub-and-spoke networks and shared care (systemic therapy locally, surgery centrally) try to mitigate.