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Curtit E, Bellanger MM, Nerich V, Hequet D, Frenel JS, Cristeau O, Rouzier R. Genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in France: a cost-effectiveness analysis. Front Oncol 2023; 13:1191943. [PMID: 37427133 PMCID: PMC10327821 DOI: 10.3389/fonc.2023.1191943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Chemotherapy (CT) is commonly used as an adjuvant treatment for women with early breast cancer (BC). However, not all patients benefit from CT, while all are exposed to its short- and long-term toxicity. The Oncotype DX® test assesses cancer-related gene expression to estimate the risk of BC recurrence and predict the benefit of chemotherapy. The aim of this study was to estimate, from the French National Health Insurance (NHI) perspective, the cost-effectiveness of the Oncotype DX® test compared to standard of care (SoC; involving clinicopathological risk assessment only) among women with early, hormone receptor-positive, human epidermal growth factor receptor 2-negative BC considered at high clinicopathological risk of recurrence. Methods Clinical outcomes and costs were estimated over a lifetime horizon based on a two-component model that comprised a short-term decision tree representing the adjuvant treatment choice guided by the therapeutic decision support strategy (Oncotype DX® test or SoC) and a Markov model to capture long-term outcomes. Results In the base case, the Oncotype DX® test reduced CT use by 55.2% and resulted in 0.337 incremental quality-adjusted life-years gained and cost savings of €3,412 per patient, compared with SoC. Being more effective and less costly than SoC, Oncotype DX® testing was the dominant strategy. Discussion Widespread implementation of Oncotype DX® testing would improve patient care, provide equitable access to more personalized medicine, and bring cost savings to the health system.
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Affiliation(s)
- Elsa Curtit
- University of Franche-Comté, University Hospital of Besançon J. Minjoz, INSERM, EFS UMR 1098, Besançon, France
| | - Martine Marie Bellanger
- UMR CNRS6051, Ecole des Hautes Etudes en Santé Publique - School of Public Health (EHESP), University of Rennes, Rennes, France
| | - Virginie Nerich
- Department of Pharmacy, University Hospital of Besançon, France; INSERM, EFS-BFC, UMR 1098, University of Franche-Comté, Besançon, France
| | - Delphine Hequet
- Institut Bourdonnais, Clinique Saint Jean de Dieu, Paris, France
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Metsälä E, Kivistik S, Straume K, Marmy L, Jorge JAP, Strom B. Breast cancer patients' experiences on their individual care pathway: A qualitative study. Radiography (Lond) 2022; 28:697-703. [PMID: 35738048 DOI: 10.1016/j.radi.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/07/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Radiographers must be aware of the needs and expectations of women to be able to involve them in the decision making on their own care pathway. The purpose of the study is to describe experiences of women with breast cancer in their individual care pathway. METHODS Data was collected with qualitative open-ended online questionnaires via national breast cancer patient organizations in four countries. The subjects were women who had completed their breast cancer treatments at a maximum of six months before responding. Data was analysed using thematic analysis. RESULTS Women responding to the survey questionnaire (N = 14) reported 11 main meaningful events in their care pathways. According to respondents, being well informed about the treatment process, a smooth flow of the care process, being treated individually and having a properly organized follow-up were the most important aspects for the optimal breast cancer care pathway. CONCLUSIONS The subjects perceived their breast cancer care pathways somewhat differently from the way the pathways are usually described from the health care organizations' viewpoint. In different stages of their individual breast cancer care pathway, positive and less positive experiences of women were somewhat similar, yet contrasting. IMPLICATIONS FOR PRACTICE In addition to general forms of support, targeted interventions should be planned to improve the quality of breast cancer care specific to different stages of the treatment process. The findings can be used to promote education for radiographers and other cancer care staff, as well as to develop patient-centred breast cancer care.
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Affiliation(s)
- E Metsälä
- Metropolia University of Applied Sciences, Myllypurontie 1, PO BOX 4000 00079, Finland.
| | - S Kivistik
- Tartu Healthcare College, Department of Radiography and Biomedical Laboratory Science, Nooruse 5, 50411, Tartu, Estonia.
| | - K Straume
- Avdeling for kreftbehandling og medisinsk fysikk, Haukeland Universitetssjukehus, Post Office Box 1400, N-5021 Bergen, Norway.
| | - L Marmy
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Av. de Beaumont 21, 1011 Lausanne Switzerland.
| | - J A P Jorge
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Av. de Beaumont 21, 1011 Lausanne Switzerland.
| | - B Strom
- Western Norway University of Applied Sciences, Faculty of Health and Social Science, Inndalsveien 28, 5063 Bergen, Norway.
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Metsälä E, Schroderus-Salo T, Straume K, Strom B, Marmy L, Øynes M, Pires Jorge JA, Randle L, Kivistik S. The Factors for Success and Lack of Success in the Breast Cancer Patient Care Pathway: A Qualitative Study From the Health Care Staff Perspective. Eur J Breast Health 2022; 18:222-228. [DOI: 10.4274/ejbh.galenos.2022.2022-3-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/03/2022] [Indexed: 12/01/2022]
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[Episode-based bundled payment model: evaluation of medical costs for early operable breast cancer]. Bull Cancer 2021; 108:1091-1100. [PMID: 34657725 DOI: 10.1016/j.bulcan.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Episode-based bundled payment model is actually opposing to fee-for-service model, intending to incentivize coordinated care. The aims of these study were to determine episode-based costs for surgery in early breast cancer patients and to propose a payment model. METHODS OPTISOINS01 was a multicenter prospective study including early breast cancer patients from diagnosis to one-year follow up. Direct medical costs, quality and patient reported outcomes were collected. RESULTS Data from 604 patients were analyzed. Episode-based costs for surgery were higher in case of: planned radical surgery (OR=9,47 ; IC95 % [3,49-28,01]; P<0,001), hospitalization during more than one night (OR=6,73; IC95% [2,59-17,46]; P<0,001), home hospitalization (OR=11,07 ; IC95 % [3,01-173][3,01-54][3,01-543][3,01-54,33]; P<0,001) and re-hospitalization (OR=25,71 ; IC95 % [9,24-89,17; P<0,001). The average cost was 5 268 € [2 947-18 461] when a lumpectomy was planned and 7408 € [4 222-22 565] in case of radical mastectomy. Bootstrap method was applied for internal validation of the cost model showing the reliability of the model with an area under the curve of 0,83 (95 % CI [0,80-0,86]). Care quality and patient reported outcomes were not related to the costs. DISCUSSION This is the first report of episode-based costs for breast cancer surgery. An external validation will be necessary to validate our payment model.
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Mériade L, Rochette C. Integrated care pathway for breast cancer: A relational and geographical approach. Soc Sci Med 2020; 270:113658. [PMID: 33421916 DOI: 10.1016/j.socscimed.2020.113658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
This paper examines how to apply a spatial approach (relational and geographical) to care pathways for their better integration within their territories. Based on the case study of a senology department of a French Cancer Diagnosis, Treatment and Research Centre, we apply a mixed research methodology using qualitative data (synthesis documents, meeting minutes, in-depth interviews) and quantitative data relating to the mobility and geographical location of a cohort of 1798 patients treated in this centre. Our results show the inseparable nature of the relational dimension and the geographical approach to move towards greater integration of breast cancer care pathways. This inseparability is constructed from the proposal of a method for mapping the integrated care pathways in their territories. This method, applied to our case study, allows us to identify four main categories of pathways for the cohort of patients studied.
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Affiliation(s)
- Laurent Mériade
- CleRMa - Research Chair "Health and Territories" - IAE School of Management - Clermont Auvergne University, 11, boulevard Charles de Gaulle, 63000, Clermont-Ferrand, France.
| | - Corinne Rochette
- CleRMa - Research Chair "Health and Territories" - IAE School of Management - Clermont Auvergne University, 11, boulevard Charles de Gaulle, 63000, Clermont-Ferrand, France.
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Investigating the healthcare pathway through patients' experience and profiles: implications for breast cancer healthcare providers. BMC Health Serv Res 2020; 20:735. [PMID: 32781993 PMCID: PMC7422593 DOI: 10.1186/s12913-020-05569-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/23/2020] [Indexed: 12/03/2022] Open
Abstract
Background Healthcare systems are facing many changes. Particularly, patients are more engaged in the care process. The medical perspective of the process is insufficient to provide patients with high quality care and service personalisation. This research presents an attempt to complete this medical perspective through an experiential perspective, especially for chronic diseases such as cancer. We investigated patients’ experiences and profiles to reach a deeper understanding of their needs and expectations when they confront the disease. The objectives of this research were to model the key stages underling the patient pathway and to identify the challenging touch points of the interactions between patients and healthcare providers. Bringing together findings of patient experience, pathway, and profiles would help all the stakeholders involved to develop better practices for the healthcare process. Methods A qualitative observational nethnography on a French specialized forum for breast cancer patients “les Impatientes” was conducted. A total of 967 reviews were collected over a complete year period from all over France. Thematic and lexicometric content analysis were performed according to the experience dimensions, the pathway stages and touch points, as well as the patients’ profiles. Results Data analysis shows that the healthcare pathway experienced by the patients is built around three stages. The discovery stage is closely related to the emotional dimension regarding the patient and physician relationship. The examination stage is characterized by a more technical and informational needs for the types of treatments. The follow-up and survivorship stage illustrates the patients’ need to assess the treatments’ effectiveness and the quality of the follow-up. Moreover, three profiles of patients were identified. The newcomers, the altruists and the autonomous are characterized by different attitudes depending on the stage of the healthcare pathway they were living. Conclusions Our research presents an original modelling of the patient pathway and profiles beyond the medical process. It gives practical tracks to improve the healthcare pathway. Patients expect healthcare providers to integrate and strengthen several challenging touch points in order to create satisfactory patient experiences and high quality service.
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Ferrier C, Thebaut C, Levy P, Baffert S, Asselain B, Rouzier R, Hequet D. Absenteeism and indirect costs during the year following the diagnosis of an operable breast cancer: A prospective multicentric cohort study. J Gynecol Obstet Hum Reprod 2020; 50:101871. [PMID: 32673814 DOI: 10.1016/j.jogoh.2020.101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diseases consequence on individual work as much as consequences of being absent from work are matters of interest for decision makers. METHODS We analyzed lengths of absenteeism and related indirect costs for patients with a paid activity in the year following the diagnosis of early stage breast cancer, in the prospective OPTISOINS01 cohort. Both human capital and friction costs approach were considered for the valuation of lost working days (LWD). For the analysis, the friction period was estimated from recent French data. The statistical analysis included simple and multiple linear regression to search for the determinants of absenteeism and indirect costs. RESULTS 93 % of the patients had at least one period of sick leave, with on average 2 period and 186 days of sick leave. 24 % of the patients had a part-time resumption after their sick leave periods, during 114 days on average (i.e. 41 LWD). Estimated indirect costs were 22,722.00 € and 7,724.00 € per patient, respectively for the human capital and the friction cost approach. In the multiple linear regression model, factors associated with absenteeism were: the invasive nature of the tumor (p = .043), a mastectomy (p = .038), a surgery revision (p = .002), a chemotherapy (p = .027), being a manager (p = .025) or a craftsman (p = .005). CONCLUSION Breast cancer lead to important lengths of absenteeism in the year following the diagnosis, but almost all patients were able to return to work. Using the friction cost or the human capital approach in the analysis led to an important gap in the results, highlighting the importance of considering both for such studies.
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Affiliation(s)
- Clement Ferrier
- Curie Institute, Surgical Oncology Department, Saint-Cloud, France.
| | - Clémence Thebaut
- Department of Economics, Université Paris-Dauphine, PSL Research University, LEDa[LEGOS], Paris, France
| | - Pierre Levy
- Department of Economics, Université Paris-Dauphine, PSL Research University, LEDa[LEGOS], Paris, France
| | | | - Bernard Asselain
- Department of Biostatistics, Curie Institute, Saint-Cloud, France
| | - Roman Rouzier
- Curie Institute, Surgical Oncology Department, Saint-Cloud, France
| | - Delphine Hequet
- Curie Institute, Surgical Oncology Department, Saint-Cloud, France
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Bertucci F, Le Corroller-Soriano AG, Monneur A, Fluzin S, Viens P, Maraninchi D, Goncalves A. [E-health and "Cancer outside the hospital walls", Big Data and artificial intelligence]. Bull Cancer 2019; 107:102-112. [PMID: 31543271 DOI: 10.1016/j.bulcan.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/15/2019] [Accepted: 07/04/2019] [Indexed: 12/25/2022]
Abstract
To heal otherwise in oncology has become an imperative of Public Health and an economic imperative in France. Patients can therefore receive live most of their care outside of hospital with more ambulatory care. This ambulatory shift will benefit from the digital revolution and the development of digital health or e-health. Cancer research will also benefit with Big Data and artificial intelligence, which gather and analyze a huge amount of data. In this synthesis, we describe the different e-health tools and their potential impacts in oncology, at the levels of education and information of patients and caregivers, prevention, screening and diagnosis, treatment, follow-up, and research. A few randomized studies have already demonstrated clinical benefits. Large Big Data projects such as ConSoRe and Health Data Hub have been launched in France. We also discuss the issues and limitations of "cancer outside the hospital walls and e-health" from the point of view of patients, health care professionals, health facilities and government. This new organization will have to provide remote support "outside the walls" with care and follow-up of quality, continuous and prolonged in total safety and equity. Ongoing and future randomized clinical trials will need to definitively demonstrate areas of interest, advantages and drawbacks not only for patients, but also for caregivers, health facilities and governments.
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Affiliation(s)
- François Bertucci
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France.
| | - Anne-Gaëlle Le Corroller-Soriano
- Aix-Marseille université, SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, Inserm UMR912, 13009 Marseille, France
| | - Audrey Monneur
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France
| | - Sylvain Fluzin
- Institut Paoli-Calmettes, direction du système d'information et de l'organisation, 13009 Marseille, France
| | - Patrice Viens
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
| | - Dominique Maraninchi
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
| | - Anthony Goncalves
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
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Héquet D, Huchon C, Soilly AL, Asselain B, Berseneff H, Trichot C, Combes A, Alves K, Nguyen T, Rouzier R, Baffert S. Direct medical and non-medical costs of a one-year care pathway for early operable breast cancer: Results of a French multicenter prospective study. PLoS One 2019; 14:e0210917. [PMID: 31291250 PMCID: PMC6619952 DOI: 10.1371/journal.pone.0210917] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/07/2019] [Indexed: 01/12/2023] Open
Abstract
Introduction The organization of health care for breast cancer (BC) constitutes a public health challenge to ensure quality of care, while also controlling expenditure. Few studies have assessed the global care pathway of early BC patients, including a description of direct medical costs and their determinants. The aims of this multicenter prospective study were to describe care pathways of BC patients in a geographic territory and to calculate the global direct costs of early stage BC during the first year following diagnosis. Methods OPTISOINS01 was a multicenter, prospective, observational study including early BC patients from diagnosis to one-year follow-up. Direct medical costs (in-hospital and out-of-hospital costs, supportive care costs) and direct non-medical costs (transportation and sick leave costs) were calculated by using a cost-of-illness analysis based on a bottom-up approach. Resources consumed were recorded in situ for each patient, using a prospective direct observation method. Results Data from 604 patients were analyzed. Median direct medical costs of 1 year of management after diagnosis in operable BC patients were €12,250. Factors independently associated with higher direct medical costs were: diagnosis on the basis of clinical signs, invasive cancer, lymph node involvement and conventional hospitalization for surgery. Median sick leave costs were €8,841 per patient and per year. Chemotherapy was an independent determinant of sick leave costs (€3,687/patient/year without chemotherapy versus €10,706 with chemotherapy). Forty percent (n = 242) of patients declared additional personal expenditure of €614/patient/year. No drivers of these costs were identified. Conclusion Initial stage of disease and the treatments administered were the main drivers of direct medical costs. Direct non-medical costs essentially consisted of sick leave costs, accounting for one-half of direct medical costs for working patients. Out-of-pocket expenditure had a limited impact on the household.
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Affiliation(s)
- Delphine Héquet
- Department of Surgical Oncology, Institut Curie, St Cloud, France
- * E-mail:
| | - Cyrille Huchon
- Department of Gynecology, Poissy-St Germain hospital, Poissy, France
| | - Anne-Laure Soilly
- Health Economics Department, CHU Dijon Bourgogne, Délégation à la Recherche Clinique et à l’Innovation, USMR, Dijon, France
| | | | | | - Caroline Trichot
- Department of Gynecology, Antoine Béclère Hospital, Clamart, France
| | - Aline Combes
- Department of Gynecology, André Mignot Hospital, Versailles, France
| | - Karine Alves
- Department of Gynecology, Argenteuil Hospital, Argenteuil, France
| | - Thuy Nguyen
- Department of Gynecology, Louis Mourier Hospital, Colombes, France
| | - Roman Rouzier
- Department of Surgical Oncology, Institut Curie, St Cloud, France
| | - Sandrine Baffert
- Health Economics Department, Institut Curie, Paris, France/CEMKA-EVAL, Bourg-La-Reine, France
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Cariou A, Rouzier R, Baffert S, Soilly AL, Hequet D. Multidimensional impact of breast cancer screening: Results of the multicenter prospective optisoins01 study. PLoS One 2018; 13:e0202385. [PMID: 30138470 PMCID: PMC6107193 DOI: 10.1371/journal.pone.0202385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/02/2018] [Indexed: 12/01/2022] Open
Abstract
Breast cancer (BC) screening has been developed to detect earlier stage tumors associated with better prognosis. The aim of study was to evaluate the impact of BC screening on therapeutic management of patients with first operable BC, and on costs, patients’ needs, and working life. OPTISOINS01 was a multicenter, prospective observational study which aimed to identify the main care pathway of early BC. Among patients aged from 50 to 74 years-old, 2 groups were defined: the “Clinical signs” group and the "Screening" group (national organized screening and individual screening). We compared between these 2 groups: locoregional and systemic treatments, direct medical and non-medical costs from a National Health Insurance perspective, patients’ needs assessed by the validated SCNS-BR8 “breast cancer” module of the SCNS-SF34 supportive care needs survey and the duration of sick leave. The “Clinical signs” group included 89 patients, while the”Screening” group included 290 patients. More axillary lymph node dissections and radical breast surgery were performed in the “Clinical signs”. The rate of adjuvant chemotherapy was dramatically higher in the “Clinical signs” group. The median direct medical costs of the “Screening” group were €11,860 (€3,643-€41,030) per year and per patient, much lower than in the “Clinical signs” group (€14,940; €5,317-€41,070). Finally, needs specifically assessed by the SCNS-BR8 questionnaire were significantly higher for the postoperative and post-adjuvant periods in the “Clinical signs” group. This study highlighted the benefit of BC screening in terms of reduced therapies and positive impact on work and social life.
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Affiliation(s)
- Amélie Cariou
- Department of Surgical Oncology, Institut Curie, Saint-Cloud, France
| | - Roman Rouzier
- Department of Surgical Oncology, Institut Curie, Saint-Cloud, France
- Inserm U900 –Bioinformatics, Biostatistics, Epidemiology and Computational Systems, Cancer Biology, Institut Curie, Saint-Cloud, France
| | | | - Anne-Laure Soilly
- Health Economics, Bourgogne Franche-Comté University, EA 7467, Dijon, France
| | - Delphine Hequet
- Department of Surgical Oncology, Institut Curie, Saint-Cloud, France
- Inserm U900 –Bioinformatics, Biostatistics, Epidemiology and Computational Systems, Cancer Biology, Institut Curie, Saint-Cloud, France
- * E-mail:
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Arfi A, Baffert S, Soilly AL, Huchon C, Reyal F, Asselain B, Neffati S, Rouzier R, Héquet D. Determinants of return at work of breast cancer patients: results from the OPTISOINS01 French prospective study. BMJ Open 2018; 8:e020276. [PMID: 29776920 PMCID: PMC5961575 DOI: 10.1136/bmjopen-2017-020276] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Return to work (RTW) after breast cancer (BC) is still a new field of research. The factors determining shorter sick leave duration of patients with BC have not been clearly identified. The aim of this study was to describe work during BC treatment and to identify factors associated with sick leave duration. MATERIALS AND METHODS An observational, prospective, multicentre study was conducted among women with operable BC. A logbook was given to all working patients to record sociodemographic and work-related data over a 1-year period. RESULTS Work-related data after BC were available for 178 patients (60%). The median age at diagnosis was 50 years (27-77), 87.9% of patients had an invasive form of BC and 25.3% a lymph node involvement. 25.9% had a radical surgery and 24.2% had an axillary dissection. Radiotherapy was performed in 90.9% of patients and chemotherapy in 48.1%. Sick leave was prescribed for 165 patients (92.7%) for a median of 155 days. On univariate analysis, invasive BC (p=0.025), lymph node involvement (p=0.005), radical surgery (p=0.025), axillary dissection (p=0.004), chemotherapy (p<0.001), personal income <€1900/month (p=0.03) and not having received the patient information booklet on RTW (p=0.047) were found to be associated with a longer duration of sick leave. On multivariate analysis, chemotherapy was found to be associated with longer sick leave (OR: 3.5; 95% CI 1.6 to 7.9; p=0.002). The cost of sick leave to French National Health Insurance was fourfold higher in the case of chemotherapy (p<0.001). CONCLUSION Advanced disease and chemotherapy are major factors that influence sick leave duration during the management of BC. TRIAL REGISTRATION NUMBER NCT02813317.
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Affiliation(s)
- Alexandra Arfi
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, Paris, France
| | | | - Anne-Laure Soilly
- Health Economics Department, Bourgogne Franche-Comté University, Dijon, France
| | - Cyrille Huchon
- Department of Obstetrics and Gynecology, Hôpital de Poissy-St Germain, Paris, France
- Equipe d’Accueil 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles-Saint-Quentin, Paris, France
| | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, Paris, France
- Residual Tumor and Response to Treatment Lab, Translational Research Department, Institut Curie, Paris, France
| | - Bernard Asselain
- Department of Biostatistics, Institut Curie-Centre René Huguenin, Saint-Cloud, France
| | - Souhir Neffati
- Clinical Research and Innovation Department, Sponsorship Division, Institut Curie, Saint-Cloud, France
| | - Roman Rouzier
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, Paris, France
- Inserm U900 – Bioinformatics, Biostatistics, Epidemiology and Computational Systems. Cancer Biology, René-Huguenin hospital, Institut Curie, Saint-Cloud, France
| | - Delphine Héquet
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, Paris, France
- Inserm U900 – Bioinformatics, Biostatistics, Epidemiology and Computational Systems. Cancer Biology, René-Huguenin hospital, Institut Curie, Saint-Cloud, France
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Mazari FAK, Sharma N, Reid D, Horgan K. The need for triple assessment and predictors for diagnosis of breast cancer in patients <40 years of age. Clin Radiol 2018; 73:758.e19-758.e25. [PMID: 29731127 DOI: 10.1016/j.crad.2018.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
AIM To assess the safety of selective use of triple assessment with omission of radiological assessment proposed in patients <40-years old. MATERIALS AND METHODS Data were collected retrospectively for all patients seen in the one-stop breast clinic between January 2014 and August 2015. Demographics, symptoms, diagnostics, and treatment details were recorded. Subgroup and logistic regression analysis was performed to identify predictors for breast cancer. RESULTS Of the 3,305 patients included, 95.6% (n=3,161) were first-time referrals. 57.6% (n=1,903) had a breast lump, and 4% (n=133) had a high-risk family history; 75.6% (n=2,499) underwent imaging and 16.7% (n=552) underwent a biopsy. The median age was 29 years (interquartile range [IQR]=25-34). Breast cancer was diagnosed in 29 cases (0.88%) and 3.2% (n=105) had surgery. Median referral-to-diagnosis time was 13 days (IQR=9-14) and referral-to-surgery time was 44 days (IQR=34-95). Patients with breast cancer were significantly older (33 versus 28 years, p=0.016). All patients were first-time referrals. Most patients had a breast lump with low suspicion on clinical examination and breast cancer identified on imaging. Time-to-diagnosis (12 versus 14 days, p=0.017) and time-to-surgery (37 versus 67 days, p=0.012) was significantly shorter in the breast cancer group. Comparative older age (odds ratio [OR]=1.08, 95% confidence interval [CI]: 1.01-1.15) and breast lump (OR=11.43,95% CI: 2.72-48.07) were the only significant predictors of cancer on uni/multivariate regression. CONCLUSIONS Triple assessment is also the best practice for all patients in the younger age group. This cohort should not be treated any differently regarding one-stop clinic infrastructure as the cancers detected were not clinically malignant. Missed cancers in this age group would have significant personal, clinical, and legal consequences.
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Affiliation(s)
- F A K Mazari
- Leeds Breast Unit, Leeds Teaching Hospitals NHS Trust, UK.
| | - N Sharma
- Leeds Breast Unit, Leeds Teaching Hospitals NHS Trust, UK
| | - D Reid
- Leeds Breast Unit, Leeds Teaching Hospitals NHS Trust, UK
| | - K Horgan
- Leeds Breast Unit, Leeds Teaching Hospitals NHS Trust, UK
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Héquet D, Pouget N, Seror J, Huchon C, Robain M, Brédart A, Baffert S, Rouzier R. Physician-to-physician communication in breast cancer care coordination. Bull Cancer 2017; 104:690-693. [PMID: 28602384 DOI: 10.1016/j.bulcan.2017.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/28/2017] [Accepted: 04/28/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Delphine Héquet
- Centre René-Huguenin, institut Curie, département d'oncologie chirurgicale, 35, rue Dailly, 92210 Saint-Cloud, France; Centre René-Huguenin, institut Curie, Inserm U900 - cancer et génome : bioinformatique, biostatistiques et épidémiologie, 35, rue Dailly, 92210 Saint-Cloud, France; Université Paris-Sud, Gustave Roussy, école doctorale de cancérologie 418, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
| | - Nicolas Pouget
- Centre René-Huguenin, institut Curie, département d'oncologie chirurgicale, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Julien Seror
- Centre René-Huguenin, institut Curie, département d'oncologie chirurgicale, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Cyrille Huchon
- Hôpital de Poissy-Saint-Germain, département de gynecologie, 10, rue du Champ-Gaillard, 78300 Poissy, France
| | - Mathieu Robain
- Institut Curie, Santé publique, 26, rue d'Ulm, 75005 Paris, France
| | - Anne Brédart
- Institut Curie, département interdisciplinaire de soins de support, 26, rue d'Ulm, 75248 Paris cedex 05, France; Université Paris-Descartes, LPPS EA 4057, 71, avenue Édouard-Vaillant, 92774 Boulogne-Billancourt cedex, France
| | - Sandrine Baffert
- Centre d'études et d'innovation en santé, Fondation A. de Rothschild, 25, rue Manin, 75940 Paris cedex 19, France
| | - Roman Rouzier
- Centre René-Huguenin, institut Curie, département d'oncologie chirurgicale, 35, rue Dailly, 92210 Saint-Cloud, France; Centre René-Huguenin, institut Curie, Inserm U900 - cancer et génome : bioinformatique, biostatistiques et épidémiologie, 35, rue Dailly, 92210 Saint-Cloud, France
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14
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Héquet D, Huchon C, Baffert S, Alran S, Reyal F, Nguyen T, Combes A, Trichot C, Alves K, Berseneff H, Rouzier R. Preoperative clinical pathway of breast cancer patients: determinants of compliance with EUSOMA quality indicators. Br J Cancer 2017; 116:1394-1401. [PMID: 28441385 PMCID: PMC5520093 DOI: 10.1038/bjc.2017.114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 12/23/2022] Open
Abstract
Background: The European Society of Breast Cancer Specialists (EUSOMA) has defined quality indicators for breast cancer (BC). The aim of this study was to describe the preoperative clinical pathway of breast cancer patients and evaluate the determinants of compliance with EUSOMA quality indicators in the Optisoins01 cohort. Methods: Optisoins01 is a prospective, multicentric study. Data from operable BC patients were collected, including results from before surgery to 1 year follow-up. Seven preoperative EUSOMA quality indicators were compared with the clinical pathways Optisoins01. Results: Six hundred and four patients were included. European Society of Breast Cancer Specialists targets were reached for indicator 1 (completeness of clinical and imaging diagnostic work-up), 3 (preoperative definitive diagnosis) and 5 (waiting time). For indicator 8 (multidisciplinary discussion), the minimum standard of 90% of the patients was reached only in general hospitals and comprehensive cancer centres. Having more than 1 medical examination within the centre was associated with an increased waiting time for surgery, whereas it was reduced by having an outpatient breast biopsy. The comprehensive cancer centre type was the only parameter associated with the other quality indicators. Conclusions: European Society of Breast Cancer Specialists quality indicators are a useful tool to evaluate care organisations. This study highlights the need for a standardised and coordinated preoperative clinical pathway.
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Affiliation(s)
- Delphine Héquet
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, 35 Rue Dailly, 92210 Saint-Cloud, France.,Equipe d'Accueil 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles-Saint-Quentin, 2 av de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France.,School of Oncology, Paris-Sud University, ED418 Paris, France
| | - Cyrille Huchon
- Equipe d'Accueil 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles-Saint-Quentin, 2 av de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France.,Department of Obstetrics and Gynecology, Hôpital de Poissy-St Germain, 10 Rue du Champ Gaillard, 78300 Poissy, France
| | - Sandrine Baffert
- Center of studies and innovations in health, Fondation A. de Rothschild, 25 rue Manin, 75940 Paris, France
| | - Séverine Alran
- Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
| | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.,Residual Tumor and Response to Treatment Lab, Translational Research Department, Institut Curie, 75005, Paris, France.,UMR932 Immunity and Cancer, INSERM, Institut Curie, 75005 Paris, France
| | - Thuy Nguyen
- Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, 178 Rue des Renouillers, 92701 Colombes, France
| | - Alix Combes
- Department of Obstetrics and Gynecology, Hôpital André Mignot, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - Caroline Trichot
- Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, 157 Rue de la Porte de Trivaux, 92140 Clamart, France
| | - Karine Alves
- Department of Obstetrics and Gynecology, Hôpital Victor Dupouy, 95107 Argenteuil, France
| | - Hélène Berseneff
- Department of Obstetrics and Gynecology, Hôpital René Dubos, 6 Avenue de l'Île de France, 95300, Pontoise, France
| | - Roman Rouzier
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, 35 Rue Dailly, 92210 Saint-Cloud, France.,Equipe d'Accueil 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles-Saint-Quentin, 2 av de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France
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15
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Wintner LM, Sztankay M, Aaronson N, Bottomley A, Giesinger JM, Groenvold M, Petersen MA, van de Poll-Franse L, Velikova G, Verdonck-de Leeuw I, Holzner B. The use of EORTC measures in daily clinical practice-A synopsis of a newly developed manual. Eur J Cancer 2016; 68:73-81. [PMID: 27721057 DOI: 10.1016/j.ejca.2016.08.024] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 12/12/2022]
Abstract
Cancer has increasingly become a chronic condition and the routine collection of patient-reported outcomes (PROs) like quality of life is widely recommended for clinical practice. Nonetheless, the successful implementation of PROs is still a major challenge, although common barriers to and facilitators of their beneficial use are well known. To support health care professionals and other stakeholders in the implementation of the EORTC PRO measures, the EORTC Quality of Life Group provides guidance on issues considered important for their use in daily clinical practice. Herein, we present an outline of the newly developed "'Manual for the use of EORTC measures in daily clinical practice", covering the following issues: * a rationale for using EORTC measures in routine care *selection of EORTC measures, timing of assessments, scoring and presentation of results * aspects of a strategic implementation * electronic data assessment and telemonitoring, and * further use of EORTC measures and ethical considerations. Next to an extensive overview of currently available literature, the manual specifically focuses on knowledge about EORTC measures to give evidence-based recommendations whenever possible and to encourage readers and end-users of EORTC measures to contribute to further needed high-quality research. The manual will be accessible on the EORTC Quality of Life Group website's homepage and will be periodically updated to take into account any new knowledge due to medical, technical, regulatory and scientific advances.
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Affiliation(s)
- Lisa M Wintner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Monika Sztankay
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Neil Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
| | - Andrew Bottomley
- Quality of Life Department, EORTC Headquarters, Avenue E. Mounier 83, 1200, Brussels, Belgium.
| | - Johannes M Giesinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Mogens Groenvold
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
| | - Morten Aa Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
| | - Lonneke van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation, Gebouw Janssoenborch, Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands.
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, LS2 9JT, Leeds, UK.
| | - Irma Verdonck-de Leeuw
- Clinical Psychology, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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