Geographic access as a modifiable determinant of cancer care: perspectives on hub-and-spoke oncology networks, travel burden and time toxicity.

Geographic access affects whether cancer care can be delivered and sustained across increasingly specialized health systems. Centralization is often necessary for services such as major cancer surgery, advanced radiotherapy, cellular therapy, and early-phase trials, where outcomes depend on concentrated expertise and infrastructure. Yet much of cancer care involves repeated contacts for services such as systemic therapy, monitoring, supportive care, and survivorship follow-up, for which proximity remains important. This narrative review examines hub-and-spoke oncology networks as a way of organizing these different functions across sites, with attention to shared governance, digital interoperability, patient navigation, and decentralized trial elements. It also considers how geographic equity can be assessed using measures of spatial access, treatment delivery, and patient time burden. The aim is to propose, on the basis of a targeted narrative synthesis, a practical framework for thinking about regional oncology organization in Spain and in comparable health systems that can be tested, adapted, and refined using local data.