Yohan Fayet1,2, Raphaël Tétreau3, Charles Honoré4, Louis-Romée Le Nail5, Cécile Dalban6, François Gouin7, Sylvain Causeret8, Sophie Piperno-Neumann9, Simone Mathoulin-Pelissier10,11, Marie Karanian12, Antoine Italiano13, Loïc Chaigneau14, Justine Gantzer15, François Bertucci16, Mickael Ropars17, Esma Saada-Bouzid18, Abel Cordoba19, Jean-Christophe Ruzic20, Sharmini Varatharajah21, Françoise Ducimetière22, Sylvie Chabaud6, Pascale Dubray-Longeras23, Fabrice Fiorenza24, Sixtine De Percin25, Céleste Lebbé26, Pauline Soibinet27, Paul Michelin28, Maria Rios29, Fadila Farsi30, Nicolas Penel31, Emmanuelle Bompas32, Florence Duffaud33, Christine Chevreau34, Axel Le Cesne35, Jean-Yves Blay36, François Le Loarer37, Isabelle Ray-Coquard22,38. 1. Equipe EMS - Département de Sciences Humaines et Sociales, Centre Léon Bérard, F-69008, Lyon, France. yohan.fayet@lyon.unicancer.fr. 2. Univ Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne, France. yohan.fayet@lyon.unicancer.fr. 3. Medical Imaging Center, Institut du Cancer, Montpellier, France. 4. Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France. 5. Department of Orthopaedic Surgery, CHU de Tours, Faculte de médecine, Université de Tours, Tours, France. 6. Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France. 7. Department of Surgery, Centre Léon Bérard, Lyon, France. 8. Department of Surgery, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France. 9. Department of Medical Oncology, Institut Curie, Paris, France. 10. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000, Bordeaux, France. 11. Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonié, F-33000, Bordeaux, France. 12. Department of Pathology, Lyon University Hospital, Lyon, France. 13. Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France. 14. Department of Medical Oncology, CHRU Jean Minjoz, Besançon, France. 15. Department of Medical Oncology, ICANS, Strasbourg, France. 16. Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France. 17. Orthopaedic and trauma department, Rennes1 University Pontchaillou University Hospital, Rennes, France. 18. Medical Oncology Department, University Côte d'Azur, Centre Antoine Lacassagne, Nice, France. 19. Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France. 20. Department of Orthopaedic Surgery, Réunion University Hospital, St-Pierre, France. 21. Surgery Department, Centre François Baclesse, F-14000, Caen, France. 22. Equipe EMS, Centre Léon Bérard, F-69008, Lyon, France. 23. Oncology Department, Centre Jean Perrin, F-63011, Clermont-Ferrand, France. 24. Department of Orthopedics Traumatology, CHU de Dupuytren, F-87042, Limoges, France. 25. Medical Oncology Department, Hôpital Cochin; AP-HP, Cancer Research for PErsonalized Medicine (CARPEM); Paris University, Paris, France. 26. AP-HP Dermatology Department, Saint-Louis Hospital, INSERM U976, Université de Paris Diderot, Paris, France. 27. Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France. 28. Department of Radiology and Medical Imaging, CHU-hôpitaux de Rouen, Rouen, France. 29. Department of Medical Oncology, Cancer Institute of Lorraine, Alexis Vautrin, Vandoeuvre Les Nancy, France. 30. CRLCC Léon Berard - Lyon, Oncology Regional Network ONCO-AURA, Lyon, France. 31. Lille University Medical School and Centre Oscar Lambret, Lille, France. 32. Medical Oncology Department, ICO, Saint Herblain, Pays de la Loire, France. 33. Department of Medical Oncology, CHU La Timone and Aix-Marseille Université (AMU), Marseille, France. 34. Department of Medical Oncology, ICR IUCT- Oncopole Toulouse, Toulouse, France. 35. Medical Oncology, Insitut Gustave Roussy, Villejuif, Ile-de-France, France. 36. Departement of Medical Oncology, Centre Léon Bérard, Université de Lyon and Unicancer Paris, Lyon, France. 37. Department of Pathology, Institut Bergonié, Bordeaux, France. 38. Department of Medical Oncology, Centre Leon Berard, Lyon, Rhône-Alpes, France.
Abstract
BACKGROUND: Spatial inequalities in cancer management have been evidenced by studies reporting lower quality of care or/and lower survival for patients living in remote or socially deprived areas. NETSARC+ is a national reference network implemented to improve the outcome of sarcoma patients in France since 2010, providing remote access to specialized diagnosis and Multidisciplinary Tumour Board (MTB). The IGéAS research program aims to assess the potential of this innovative organization, with remote management of cancers including rare tumours, to go through geographical barriers usually impeding the optimal management of cancer patients. METHODS: Using the nationwide NETSARC+ databases, the individual, clinical and geographical determinants of the access to sarcoma-specialized diagnosis and MTB were analysed. The IGéAS cohort (n = 20,590) includes all patients living in France with first sarcoma diagnosis between 2011 and 2014. Early access was defined as specialised review performed before 30 days of sampling and as first sarcoma MTB discussion performed before the first surgery. RESULTS: Some clinical populations are at highest risk of initial management without access to sarcoma specialized services, such as patients with non-GIST visceral sarcoma for diagnosis [OR 1.96, 95% CI 1.78 to 2.15] and MTB discussion [OR 3.56, 95% CI 3.16 to 4.01]. Social deprivation of the municipality is not associated with early access on NETSARC+ remote services. The quintile of patients furthest away from reference centres have lower chances of early access to specialized diagnosis [OR 1.18, 95% CI 1.06 to 1.31] and MTB discussion [OR 1.24, 95% CI 1.10 to 1.40] but this influence of the distance is slight in comparison with clinical factors and previous studies on the access to cancer-specialized facilities. CONCLUSIONS: In the context of national organization driven by reference network, distance to reference centres slightly alters the early access to sarcoma specialized services and social deprivation has no impact on it. The reference networks' organization, designed to improve the access to specialized services and the quality of cancer management, can be considered as an interesting device to reduce social and spatial inequalities in cancer management. The potential of this organization must be confirmed by further studies, including survival analysis.
BACKGROUND: Spatial inequalities in cancer management have been evidenced by studies reporting lower quality of care or/and lower survival for patients living in remote or socially deprived areas. NETSARC+ is a national reference network implemented to improve the outcome of sarcomapatients in France since 2010, providing remote access to specialized diagnosis and Multidisciplinary Tumour Board (MTB). The IGéAS research program aims to assess the potential of this innovative organization, with remote management of cancers including rare tumours, to go through geographical barriers usually impeding the optimal management of cancerpatients. METHODS: Using the nationwide NETSARC+ databases, the individual, clinical and geographical determinants of the access to sarcoma-specialized diagnosis and MTB were analysed. The IGéAS cohort (n = 20,590) includes all patients living in France with first sarcoma diagnosis between 2011 and 2014. Early access was defined as specialised review performed before 30 days of sampling and as first sarcoma MTB discussion performed before the first surgery. RESULTS: Some clinical populations are at highest risk of initial management without access to sarcoma specialized services, such as patients with non-GIST visceral sarcoma for diagnosis [OR 1.96, 95% CI 1.78 to 2.15] and MTB discussion [OR 3.56, 95% CI 3.16 to 4.01]. Social deprivation of the municipality is not associated with early access on NETSARC+ remote services. The quintile of patients furthest away from reference centres have lower chances of early access to specialized diagnosis [OR 1.18, 95% CI 1.06 to 1.31] and MTB discussion [OR 1.24, 95% CI 1.10 to 1.40] but this influence of the distance is slight in comparison with clinical factors and previous studies on the access to cancer-specialized facilities. CONCLUSIONS: In the context of national organization driven by reference network, distance to reference centres slightly alters the early access to sarcoma specialized services and social deprivation has no impact on it. The reference networks' organization, designed to improve the access to specialized services and the quality of cancer management, can be considered as an interesting device to reduce social and spatial inequalities in cancer management. The potential of this organization must be confirmed by further studies, including survival analysis.
Entities:
Keywords:
Cancer care accessibility; Cancer inequalities; Rare cancers; Reference networks; Sarcoma; Spatial inequalities
Authors: I Ray-Coquard; P Thiesse; D Ranchère-Vince; F Chauvin; J-Y Bobin; M-P Sunyach; J-P Carret; B Mongodin; P Marec-Bérard; T Philip; J-Y Blay Journal: Ann Oncol Date: 2004-02 Impact factor: 32.976
Authors: J-Y Blay; P Soibinet; N Penel; E Bompas; F Duffaud; E Stoeckle; O Mir; J Adam; C Chevreau; S Bonvalot; M Rios; P Kerbrat; D Cupissol; P Anract; F Gouin; J-E Kurtz; C Lebbe; N Isambert; F Bertucci; M Toumonde; A Thyss; S Piperno-Neumann; P Dubray-Longeras; P Meeus; F Ducimetière; A Giraud; J-M Coindre; I Ray-Coquard; A Italiano; A Le Cesne Journal: Ann Oncol Date: 2017-11-01 Impact factor: 32.976