{"entity":{"id":"idea-acc-hub-spoke-national-networks","kind":"idea","name":"National hub-and-spoke cancer networks with defined referral tiers","aka":[],"tldr":"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.","summary":"Low- and middle-income countries often 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.","asOf":"2026-09-08","links":[{"label":"Tata Memorial Centre","url":"https://tmc.gov.in/"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["tata-memorial"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-global-access","b-care-fragmentation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","test":"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","actor":"policy","cost":"large","horizonYears":5},"route":"/ideas/idea-acc-hub-spoke-national-networks/","neighbours":{"institution":[{"id":"tata-memorial","kind":"institution","name":"Tata Memorial Centre","route":"/institutions/tata-memorial/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"}]}}