Hub and spoke models in oncology: A scoping review.

Abstract

497 Background: Significant barriers to accessing specialized cancer care exist based on patients’ geography including longer travel times, transportation, and financial strain, often resulting in lower survival rates, clinical trial enrollment, and patient satisfaction. Conversely, there is a well-documented relationship between receipt of specialized care (e.g., subspecialist expertise, technology-intensive treatments/procedures, supportive care) and improved outcomes for cancer patients. “Hub and Spoke” models represent a promising approach to address this gap, extending care beyond specialized centers to rural or lower volume centers through a variety of methods. Methods: We conducted a scoping review using Arksey and O’Malley’s methodology to characterize design and implementation considerations for Hub and Spoke models in oncology, and to assess evidence quality using an adapted version of the Critical Appraisal Skills Programme checklists. We searched the oncology literature in PubMed, Embase, Scopus, CINAHL, Healthcare Administration Database, and Health & Medical Collection using a comprehensive list of search terms based on stems “oncology” and “Hub and Spoke”. Abstracts were independently reviewed by two team members prior to full text review. We abstracted data using a matrix derived from Proctor’s Implementation Model and the Consolidated Framework for Implementation Research. Results: Our initial search yielded 1708 studies. 143 full-text studies were assessed for eligibility. The 34 included articles described 29 distinct models. 15 models were cancer type-specific. Models were in North America (17), Europe (5), Australia/New Zealand (3), Africa (2), Asia (1), and South America (1). 12 models (41%) included a centralizing function: patient sharing, in which patients were physically routed to hub(s) versus spoke(s) depending on their needs. Models also included two decentralizing functions: extension of specialized hub services to spokes (12, 38%) or building spoke capacity to provide specialized care(21, 72%). Model outcomes included improved clinician knowledge, provision of guideline-concordant care, cost savings for patients, and reduced early mortality. We identified many themes related to implementation including the importance of shared digital infrastructure, personnel dedicated to care coordination, explicit role delineation, multistakeholder involvement, alignment with clinical guidelines, bidirectional communication, and standardization across sites. Conclusions: Findings establish Hub and Spoke models as a promising strategy to extend access to specialized cancer care and offer a framework to conceptualize model design and implementation. However, the existing literature lacks clarity on whether current interventions will be effective across settings, and more evidence on patient outcomes associated with Hub and Spoke models is needed.