[Influence of geographic barriers and care pathways on radiotherapy treatment and survival of breast cancer patients.].

Evidence on outcome-volume relation and resource shortage are forcing the oncology department towards concentrating of cancer care in large specialized centres. We report a study on radiotherapy for breast cancer patients in Umbria, Italy, where geographic barriers reduced appropriate radiotherapy for patients with a travel burden as low as >40 minutes and the under-treatment was associated with low survival probabilities. The creation of additional radiotherapy centres (i.e. decentralization) improved appropriate care. However, evidence pointed also to a role of access to the oncology service through rural surgical centres in determining suboptimal treatment and health outcomes. We introduced radiotherapy in breast cancer patients as an instance of the complexity of cancer care. The oncology network is actively introduced in Italian health services as a tool to face problems of equity, quality of care and effective use of available resources. Meaningful information on care process and outcomes will be central to set cancer control strategies within the network and to assess the network results. Cancer registries can contribute to network effectiveness providing surveillance and evaluation data.