Determinants of the access to remote specialised services provided by national sarcoma reference centres

BMC Cancer

Céleste Lebbé¹  Fadila Farsi²  Jean-Yves Blay³  Sylvie Chabaud⁴  Cécile Dalban⁴  Pauline Soibinet⁵  Loïc Chaigneau⁶  Florence Duffaud⁷  Maria Rios⁸  Justine Gantzer⁹  Christine Chevreau^1,10  Antoine Italiano^1,11  Sophie Piperno-Neumann^1,12  François Bertucci^1,13  Louis-Romée Le Nail^1,14  Jean-Christophe Ruzic^1,15  Fabrice Fiorenza^1,16  François Le Loarer^1,17  Marie Karanian^1,18  Paul Michelin^1,19  Sylvain Causeret^2,20  François Gouin^2,21  Charles Honoré^2,22  Yohan Fayet^2,23  Françoise Ducimetière^2,24  Isabelle Ray-Coquard^2,25  Nicolas Penel^2,26  Raphaël Tétreau^2,27  Sixtine De Percin^2,28  Emmanuelle Bompas^2,29  Esma Saada-Bouzid^3,30  Axel Le Cesne^3,31  Pascale Dubray-Longeras^3,32  Mickael Ropars^3,33  Abel Cordoba^3,34  Sharmini Varatharajah^3,35  Simone Mathoulin-Pelissier^3,36 

[1] AP-HP Dermatology Department, Saint-Louis Hospital, INSERM U976, Université de Paris Diderot, Paris, France;CRLCC Léon Berard – Lyon, Oncology Regional Network ONCO-AURA, Lyon, France;Departement of Medical Oncology, Centre Léon Bérard, Université de Lyon and Unicancer Paris, Lyon, France;Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France;Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France;Department of Medical Oncology, CHRU Jean Minjoz, Besançon, France;Department of Medical Oncology, CHU La Timone and Aix-Marseille Université (AMU), Marseille, France;Department of Medical Oncology, Cancer Institute of Lorraine, Alexis Vautrin, Vandoeuvre Les Nancy, France;Department of Medical Oncology, ICANS, Strasbourg, France;Department of Medical Oncology, ICR IUCT- Oncopole Toulouse, Toulouse, France;Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France;Department of Medical Oncology, Institut Curie, Paris, France;Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France;Department of Orthopaedic Surgery, CHU de Tours, Faculte de médecine, Université de Tours, Tours, France;Department of Orthopaedic Surgery, Réunion University Hospital, St-Pierre, France;Department of Orthopedics Traumatology, CHU de Dupuytren, F-87042, Limoges, France;Department of Pathology, Institut Bergonié, Bordeaux, France;Department of Pathology, Lyon University Hospital, Lyon, France;Department of Radiology and Medical Imaging, CHU-hôpitaux de Rouen, Rouen, France;Department of Surgery, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France;Department of Surgery, Centre Léon Bérard, Lyon, France;Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France;Equipe EMS – Département de Sciences Humaines et Sociales, Centre Léon Bérard, F-69008, Lyon, France;Univ Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne, France;Equipe EMS, Centre Léon Bérard, F-69008, Lyon, France;Equipe EMS, Centre Léon Bérard, F-69008, Lyon, France;Department of Medical Oncology, Centre Leon Berard, Lyon, Rhône-Alpes, France;Lille University Medical School and Centre Oscar Lambret, Lille, France;Medical Imaging Center, Institut du Cancer, Montpellier, France;Medical Oncology Department, Hôpital Cochin; AP-HP, Cancer Research for PErsonalized Medicine (CARPEM); Paris University, Paris, France;Medical Oncology Department, ICO, Saint Herblain, Pays de la Loire, France;Medical Oncology Department, University Côte d’Azur, Centre Antoine Lacassagne, Nice, France;Medical Oncology, Insitut Gustave Roussy, Villejuif, Ile-de-France, France;Oncology Department, Centre Jean Perrin, F-63011, Clermont-Ferrand, France;Orthopaedic and trauma department, Rennes1 University Pontchaillou University Hospital, Rennes, France;Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France;Surgery Department, Centre François Baclesse, F-14000, Caen, France;Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000, Bordeaux, France;Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonié, F-33000, Bordeaux, France;

关键词: Cancer inequalities;    Spatial inequalities;    Reference networks;    Sarcoma;    Cancer care accessibility;    Rare cancers;   

DOI  :  10.1186/s12885-021-08393-4

来源: Springer

【 摘 要 】

BackgroundSpatial 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.MethodsUsing 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.ResultsSome 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.ConclusionsIn 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.

【 授权许可】

CC BY