SHORT COMMUNICATION

Establishment of the Campania Oncology Network (Rete Oncologica

Campana, ROC): a paradigm shift in oncological care and real world research
in the Campania region
E. Coppola1
y , I. De Santo2y , A. Luongo1 , P. Rocco1 , F. Ciardiello3 , S. Pignata1 , A. Crispo1 , E. Celentano1 , A. M. Grimaldi2 ,
F. Schiavone4 , R. Saviano1 , A. Bastone4 , G. Porciello1 , F. Caraglia3 , D. D’Errico1z & V. De Falco3z
1
Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Naples; 2Azienda Ospedaliera di Rilievo Nazionale San Pio, Benevento; 3Azienda Ospedaliera Universitaria Luigi
Vanvitelli, Naples; 4Università degli Studi di Napoli Parthenope, Naples, Italy

Available online xxx

The effective management of cancer patients necessitates a robust organizational framework to facilitate timely
diagnosis and treatment. This paper examines the development and impact of the Campania Oncology Network
(Rete Oncologica Campana, ROC) in tackling critical challenges in cancer care throughout the Campania region in
southern Italy. Established to address high cancer mortality rates and systemic inefficiencies, the ROC integrates
various health care facilities, including specialized multidisciplinary oncology groups, local health authorities, and
general practitioners, promoting a collaborative approach to patient management. Since its initiation in 2016,
further enhanced by the launch of a digital platform in 2018, the ROC has streamlined patient pathways by
reducing care fragmentation and diagnostic delays, ensuring the integration of home care services and access to
innovative diagnostic testing. This paper presents findings from the ROC digital platform (a real world database that
compiles data from w95 000 patients) demonstrating the ROC’s pivotal role in generating evidence-based clinical
guidelines and enhancing health care quality. By facilitating the systematic implementation of multidisciplinary care
and longitudinal monitoring of patient outcomes, the ROC has significantly expanded its capacity to manage new
cancer cases, showcasing the effectiveness of a well-organized oncology network in improving patient care
outcomes. These insights emphasize the critical need for strategic health care models to address regional disparities
in cancer care management effectively.
Key words: oncology network, cancer care, multidisciplinary oncology groups, digital health platform, real world data

Managing cancer patients requires an organized system for Health Services (Agenzia Nazionale per i Servizi Sanitari
timely diagnosis and treatment. A strong oncological Regionali, AGENAS) highlighted the inefficiency of the
network coordinates oncology centers, community health Campania Oncology Network (Rete Oncologica Campana,
facilities, and home care services to support patients ROC), prompting reform.4 This paper discusses the devel-
throughout their journey. In Italy, the health system is opment of the ROC model and its digital platform, showing
regionally managed. The Campania region, with 6 million how it improved cancer care by introducing a multidisci-
residents and 33 000 new cancer cases annually,1 faces plinary approach and reducing fragmentation of care.
challenges such as high cancer mortality and patient
mobility for care.2 Factors include limited prevention efforts THE CREATION OF THE ROC AND ITS CURRENT
and socioeconomic issues such as low income and high ORGANIZATION
unemployment.3 In 2018, the National Agency for Regional The Campania region established the ROC in September
2016 to ensure equitable access to treatments, diagnostics,
*Correspondence to: Dr Elisabetta Coppola, Istituto Nazionale Tumori IRCCS and integrated care, aiming to reduce mortality. The ROC
Fondazione G Pascale, SC Oncologia Clinica Sperimentale Uro-ginecologica,
Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, NA 80131, Italy. operates as a comprehensive cancer care network (CCCN),
Tel: þ39 08117770689 including specialized multidisciplinary oncology reference
E-mail: [email protected] (E. Coppola). centers (Centri II livello o Centri Oncologici di Riferimento
y
Co-first authors. Polispecialistici, CORP), and regional reference centers with
z
Co-last authors. specific activities in the oncology field (Centri di Riferimento
2949-8201/© 2025 The Author(s). Published by Elsevier Ltd on behalf of
European Society for Medical Oncology. This is an open access article under the Regionali con attività specifica in campo oncologico,
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). CORPUS) and seven local health authorities (Aziende

Volume 8 - Issue C - 2025 https://doi.org/10.1016/j.esmorw.2025.100126 1

ESMO Real World Data and Digital Oncology E. Coppola et al.

A Capacity for the ROC to take charge over the years

25 603
20 106
17 139
Patient intake (n)

8548
3973
89
2018 2019 2020 2021 2022 2023

Years

B
Breast
Breast
Colon-rectum
Colon-rectum
Lung Lung
Bladder Prostate
Prostate Bladder
Melanoma Melanoma
Head-neck Thyroid
Hepatocellular
carcinoma Head-neck
Patient intake (n)

Patient intake (n)

Pancreas Kidney
Kidney Hepatocellular
carcinoma
Stomach-
esophageal Pancreas

Endometrial Stomach-
esophageal
Thyroid Endometrial

Ovarian Ovarian

Central nervous system Central nervous system

Cervix-vulva Cervix-vulva

Testicle Sarcomas

Sarcomas Testicle

Cholangiocarcinoma Cholangiocarcinoma

Mesothelioma Mesothelioma

0 1000 2000 3000 4000 5000 6000 0 1000 2000 3000 4000 5000 6000
Patients (n) Patients (n)

Cancer incidence 2022 ROC 2022 Cancer incidence 2023 ROC 2023

Figure 1. (A) The patient intake of the Campania Oncology Network (ROC) from 2018 to 2023. (B) The patient intake of the ROC in 2022 and 2023 by multidis-
ciplinary oncological group (GOM) compared with annual regional cancer-specific incidence. The regional incidence estimates for 20 solid neoplasms have been
considered excluding non-melanoma skin cancers, uveal melanoma, and neuroendocrine tumors, as these are not included in the regional cancer incidence rates.

Sanitarie Locali, ASLs). Each center created cancer-specific patients (3.3%) were referred to GOMs via the ROC plat-
multidisciplinary oncological groups (Gruppi Oncologici form by their MMGs, with this proportion steadily
Multidisciplinari, GOMs) responsible for patient care, and increasing. This model helps prevent diagnostic and thera-
clinical decisions based on regional diagnostic and thera- peutic delays, known risk factors for poor cancer out-
peutic guidelines (Percorsi Diagnostici Terapeutici Assis- comes,7 as patients are managed within 7 days.
tenziali, PDTAs),5 affecting w90% of the cancer population,
along with three pathway PDTAs and 11 technical docu-
ments. The ROC promotes multidisciplinary care, which has The ROC digital platform: a tool for monitoring clinical and
been shown to improve treatment outcomes,6 and the assistance activities and a source of real world data
continuity of care through connections among GOMs, The ROC platform is a centralized modular web-based sys-
general practitioners (medici di medicina generale, MMGs), tem used across all hospitals within the ROC, designed to
and ASLs. From September 2023 to September 2024, 974 optimize referral for newly diagnosed oncology cases to

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E. Coppola et al. ESMO Real World Data and Digital Oncology

continuity of care for cancer patients, especially those who

are not self-sufficient and/or who are unable to travel for
treatment. In addition, the ROC platform facilitates the
2023 pathway for patients with hereditaryefamilial cancers, and
Patient intake (n)

83% serves as the sole prescriptive tool for innovative

testsdsuch as oncogenic testing in breast cancerdensuring
equitable access to these critical services, also for patients
coming from the periphery of the region. Overall, ADI is the
most requested service (n ¼ 13 566), followed by hereditary
2022
cancer screenings (n ¼ 5328) and oncogenic tests for breast
64%
cancer (n ¼ 1127). Finally, the ROC supports clinical
research by facilitating patient eligibility assessments for
0 5000 10 000 15 000 20 000 25 000 30 000 experimental trials, including phase I studies. A clinical trials
Years
service has been integrated into the platform to streamline
this process. Patients requiring evaluation for experimental
Campania incidence ROC therapies are referred to other cancer-specific GOMs, where
Figure 2. The patient intake of the Campania Oncology Network (ROC) their clinical features are reviewed for eligibility within 5
compared with annual regional cancer incidence in 2022 and 2023. The days. If the patient does not meet the inclusion criteria, the
regional incidence estimates for 20 solid neoplasms have been considered request is redirected within the network for consideration
excluding non-melanoma skin cancers, uveal melanoma, and neuroendocrine
tumors, as these are not included in the regional cancer incidence rates. under alternative protocols or standard care from other
GOMs. If the patient is potentially eligible, a screening
cancer-specific GOMs, intake, therapeutic decision-making, consultation is scheduled within 5 days by the case
and service coordination throughout the patient’s journey. manager.
The GOM pathway starts with patient referral by MMGs or The ROC platform includes >95 000 patients across 664
health care professionals, followed by intake by a cancer- GOMs, enabling periodic monitoring of data on quantita-
specific GOM. The ROC platform allows health care pro- tive, economic, diagnostic, and therapeutic factors affecting
fessionals to access a registry of hospitals affiliated with care. Patient data, except for demographics (linked to the
GOMs, with the choice based on factors including patient regional registry), are entered by case managers into the
preference and proximity. Once a GOM is selected, the case appropriate sections of the patient’s record or by attaching
managerda health care professional within the GOM relevant medical reports. Data can be extracted in aggre-
responsible for patient pathways within the ROCdinte- gate (e.g. total patients managed)dthis approach was
grates the patient into a multidisciplinary discussion in employed in the present article. As a source of real world
which the GOM makes a diagnostic and therapeutic deci- data (RWD), the platform can generate real world evidence,
sion. This process concludes with the creation of a detailed enhancing clinical guidelines and research with a large
GOM report, uploaded to the ROC platform, formally clos- sample size for robust statistical analysis.
ing the patient’s case file. The report includes the GOM’s Based on these considerations, in November 2022, the
findings, and recommendations including treatment options ONCOCAMP research protocol was developed as a
such as surgery, oncologic treatment, radiotherapy, and retrospectiveeprospective, observational, multicenter
follow-up. After this, each hospital uses its internal software study to record data from the ROC platform, monitor ROC
to manage the patient’s journey. Additionally, the ROC performance, and create a registry of patients within the
platform provides many services promoting comprehensive ROC. Approved by all local ethical committees, ONCOCAMP
patient care and integration between hospital and com- aims to enhance the appropriateness, effectiveness, and
munity services. Among these, hospital-at-home care safety of diagnostic and therapeutic pathways, clinical
(Assistenza Domiciliare Integrata, ADI) is crucial to ensure strategies, and procedures. RWD from the ROC platform

Table 1. Evolution of the ValPeROC project from phase I to V

Phase of the Periods ROC cancer Cancer-specific GOM Cancer type Sample of ROC
project monitored centers for each patients
involved in the cancer center involved, n
project, n involved in the project, n
I 6 months 3 3 Lung, ovarian, and colon 89
II 6 months 5 4 Lung, ovarian, colon, and prostate 227
III 6 months 7 5 Lung, ovarian, colon, prostate, and bladder 515
IV 6 months 7 5 Lung, ovarian, colon, prostate, and bladder 512
Va 12 months 9 6 Lung, ovarian, colon, prostate bladder, and 674
breast
GOM, Gruppi Oncologici Multidisciplinari; ROC, Rete Oncologica Campana.
a
In phase V (specifically from September 2022 to October 2023), the analysis also involved four accredited nursing homes.

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ESMO Real World Data and Digital Oncology E. Coppola et al.

50.0 45.1
38.8
40.0 3.6

30.0 26.3
21.7

%
20.0 13.8
10.7
10.0 6.8

0.0
Family MMG ASL physician Private specialist
doctor
Phase IV Phase V
Figure 3. Type and percentage of health care professionals who suggest the Campania Oncology Network (ROC) path (from phase IV to V) of the ValPeROC project.
ASL, local health authority; MMG, general practitioner.

also has potential for identifying prognostic factors and GOM through the ROC platform has increased from 13.8%
health determinants specific to the Campania population. (phase IV) to 21.7% (phase V) (Figure 3). Moreover, pre-
Figure 1A shows a steady increase in patient intake from liminary data indicate that the ROC has significantly reduced
2018 to 2023, measured by the annual number of patients diagnostic times, highlighting the positive impact of estab-
evaluated by a GOM. Focusing on 2022 and 2023, there was lishing a regional network on key prognostic factors, such as
an increase in patient intake numbers by the GOMs for all diagnostic and therapeutic timelines.
the cancer types with a specific PDTA, with a high propor-
tion of new cases discussed in a multidisciplinary team CONCLUSIONS
compared with expected regional incidence (Figure 1B). The This paper highlights how an efficient regional network can
proportion of cases diagnosed and discussed within the improve cancer care in a population of 6 million with sig-
GOMs continues to rise as the network improves and all nificant sociodemographic challenges. We discussed the
facilities, including those in peripheral areas, become ROC’s evolution and its increased capacity for managing
interconnected. cancer patients through a multidisciplinary approach,
Figure 2 shows the overall statistically significant increase demonstrating the model’s effectiveness. A key goal of the
in patient intake compared with the cancer incidence in the ROC is to ensure each patient is discussed in a specific GOM
region for 2022 and 2023 (from 64% to 83%, respectively, at diagnosis. The establishment of a unified digital platform
P < 0.05). has facilitated the integrated application of multidisciplinary
The number of cases extracted from the ROC platform care across the Campania region, enabling ongoing perfor-
and discussed within the GOM should not replace incidence mance monitoring. The growing volume of data collected
estimates, as some may be prevalent cases needing further has the potential to generate scientific evidence to improve
examination. However, this metric is a valuable indicator of patient management. ONCOCAMP contributes by creating a
the ROC’s effectiveness in managing cancer care. Comparing registry to analyze various aspects of oncology care in the
these figures with regional incidence helps assess the ROC’s region. In conclusion, the ROC and its digital platform
progress over time. represent a major advancement in cancer care, promoting
One of the first experiences in monitoring both the better management, teamwork, and research, while offer-
clinical and economic performance of the ROC is repre- ing a model that could be applied in other regions facing
sented by the evaluation of the ROC pathway (Valutazione similar challenges.
Percorso ROC, ValPeROC) multicenter project.8 The project
has developed key performance indicators to measure the ACKNOWLEDGEMENTS
multidisciplinary approach; adherence to PDTAs (in terms of
The medical doctors, specialists, and case managers who
continuity, timeliness, and adequacy of health care services,
made this path possible are acknowledged.
overcoming territorial disparities and achieving service
standardization); and resource utilization (i.e. number and
FUNDING
types of appropriate and inappropriate diagnostic tests).
The project involves periodic surveys tracking diagnostic, The research leading to these results has received funding
therapeutic, sociodemographic, and clinical data to identify from The ContInuum of CarE through the ROC (CICERO
potential risk factors. Over time, the number of both ROC project) under grant Pfizer #73575621.
cancer centers and cancer-specific GOMs has increased,
along with the data collection (Table 1). The last two phases DISCLOSURE
also focused on the engagement of MMGs and other health SP reports consulting fees from AZ, and research funding
care professionals in referring patients to the ROC network. from Clovis Oncology, GSK, Merck Sharp & Dohme, Roche,
The percentage of MMGs referring patients directly to a and Novartis. FC reports advisory board work for Merck,

4 https://doi.org/10.1016/j.esmorw.2025.100126 Volume 8 - Issue C - 2025

E. Coppola et al. ESMO Real World Data and Digital Oncology

Roche, Amgen, Bayer, Servier, Symphogen, and Pfizer, and 4. AGENAS. Italian National Agency for Regional Healthcare Services.
research funding from Roche, Merck, Amgen, Bayer, and Quarta Indagine Nazionale sullo stato di attuazione delle R.O.R.
2021. Available at https://www.agenas.gov.it/comunicazione/primo-
Ipsen. All other authors have declared no conflicts of piano/1920-reti-oncologiche-rapporto-def-2021-su-dati-2020. Accessed
interests. November 19, 2024.
5. De Placido S, Bracale U, Pacelli R, et al. A new strategy for a high tumour
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