Analysing the implementation and transferability of an enhanced care pathway integrating systematic supportive cancer care and patient-partner support for people living with anal cancer: Protocol for a mixed-methods study in two French cancer centres

BACKGROUND: Supportive cancer care (SCC) is essential for comprehensive oncology care. It addresses treatment-related adverse effects, reduces long-term sequelae and improves patients' quality of life. Patient-partner (PP) programmes positively impact psychological well-being, patient empowerment and supportive care. Nevertheless, access to SCC remains inconsistent, fragmented and unequally distributed, while PPs are rarely integrated into routine cancer care pathways. Anal cancer is a predominantly localised cancer with high survival rates. Treatment is associated with acute toxicity and often severe long-term sequelae. This interventional public health research study aims to implement and evaluate an innovative enhanced care pathway combining systematic SCC and structured PP support for all individuals diagnosed with anal cancer living in France. The study will assess the intervention's clinical, organisational, and social effects, and will identify the conditions required for its long-term sustainability and transferability. METHODS AND DESIGN: This is a longitudinal mixed-methods case study conducted in two French Comprehensive Cancer Centres. The intervention entails introducing a systematic, coordinated, and repeated SCC offer together with a structured PP support programme for all patients diagnosed with anal cancer and over 12 months following diagnosis. One centre will implement the enhanced care pathway, while the other will initially provide standard care before progressively adopting the intervention during the transferability phase. Quantitative data will include patient-reported outcomes, clinical information and implementation indicators. Qualitative data exploring implementation processes, organisational changes and contextual determinants, will be collected through observations, semi-structured interviews, focus groups and PP activity logs. DISCUSSION: The study's results will provide essential scientific knowledge on the implementation of programmes providing equitable SCC and PP support access to people living with anal cancer. Specifically, by combining implementation research, participatory approaches and mixed-methods evaluation, the project aims to identify the organisational conditions for the sustainable implementation of such programmes for this population, and their successful transferability to other populations living with cancer and to other healthcare settings.