The Bermuda model: Achieving world-class, equitable, and efficient cancer care in a small island nation.

Abstract

11080 Background: Bermuda is a small island nation that historically faced significant challenges in provision of local cancer care. Between 2000-2017, 100% of patients requiring radiation therapy (RT) had to travel abroad, causing prohibitive financial toxicity. In 2017, Bermuda Cancer and Health Centre (BCHC) evolved to deliver an integrated and comprehensive national cancer solution, including RT. The "Bermuda Model" represents a national approach to address critical gaps in cancer care by leveraging innovative partnership models to enable access, efficiency, health equity and international quality standards. Methods: We conducted a retrospective descriptive cohort study. Data for cancer incidence/outcomes were collected from the Bermuda National Tumour Registry; treatment/quality data and patient satisfaction surveys were collected from BCHC clinical records. Timeframes for travel reduction data were between 2015-2020. Outcomes measures included percentage of overseas referrals for RT and chemotherapy, international quality assurance, patient satisfaction scores from 2025, access measures such as interval from diagnosis to treatment, cancer-specific overseas insurance claims, and selected clinical outcomes, including early breast cancer detection and survival rates. Results: The Bermuda Model has eliminated the need for overseas RT, ensuring access for the 70-90% who previously went abroad and the remainder who went without. Through an international strategic partnership with Brigham and Women’s Hospital, high quality and consistent peer-review of radiation treatment plans by Harvard faculty specialists was ensured for 100% of all patients receiving RT at BCHC. Patient satisfaction rates for RT were 100% positive for multiple months in 2025. Between 2017-2019, Bermuda achieved excellent clinical outcomes including an 87% early detection rate for localized (Stage 1-2) breast cancer and a lower breast cancer mortality rate than either the USA or Europe. Care timelines were efficient; average time from diagnosis to first treatment was as low as 16 days in 2025. The model was associated with an approximately 24% reduction in cancer-specific overseas insurance claims between 2017-2020 ($6.2 million and $4.7 million respectively). Conclusions: The "Bermuda Model" demonstrates that with strategic investment and international partnerships, a small island nation can locally establish world-class, equitable, and efficient cancer care services. Eliminating overseas treatment, high satisfaction, and excellent outcomes evidence its success. The reduction in claims has been particularly impactful for Bermudian residents with government-level insurance, helping to advance, access-to-all cancer care. This model serves as a valuable blueprint for other small nations or isolated regions seeking to improve their delivery of cancer care.