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Prades J, Trama A, Casali PG, Emile JF, Gaspar N, Janavicius R, Jančiauskienė R, Karjalainen S, Kopeckova K, Pylkkänen L, Svoboda M, Borras JM. Is rare cancer care organized at national health system level? Multiple case study in six EU countries. Eur J Public Health 2022; 32:852-857. [PMID: 36374643 PMCID: PMC9713415 DOI: 10.1093/eurpub/ckac166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND As a system of European Reference Networks (ERNs) emerges, the differences in quality of care for patients with rare cancers may increase at national level. We aimed to elucidate the processes and healthcare planning principles through which the reference centres (RCs) for rare cancers are embedded in national health systems. METHODS We used a multiple case-study design based on the experiences of Czechia, Finland, France, Italy, Lithuania and Spain. Using sarcoma as an example of rare cancer, 52 semi-structured interviews were conducted during on-site visits, including a multidisciplinary group of professionals, Ministry of Health professionals, patient representatives and European policymakers. RESULTS The comparative analysis showed substantial heterogeneity in the processes for formalizing RCs' status and in their levels of integration in the different health systems, but two models (centre-based and the network-based) can be envisaged at national level. RCs for rare cancers were legally established only in France and Spain. Expert clinicians cooperate in a structured way, using network mechanisms, in France and Italy, and these countries, plus Finland and Lithuania, had a referral system to facilitate patients' access from non-expert centres to RCs. Seven key healthcare planning principles in instituting RCs at the national level were identified. CONCLUSIONS The conditions governing patient access to treatment centres-whether RCs or not-are decided at the national level. It is advisable to progressively align the European and national levels so that the RCs that participate in the ERNs also play a significant role at the national level.
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Affiliation(s)
- Joan Prades
- Catalonian Cancer Strategy, Department of Health, Barcelona, Spain
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona (UB), Barcelona, Spain
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo G Casali
- Medical Oncology Unit 2, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
- Oncology and Haemato-Oncology Department, University of Milan, Milan, Italy
| | - Jean-Francois Emile
- Research Unit EA4340, Versailles University, Paris-Saclay University, Boulogne, France
- Pathology Department, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne, France
| | - Nathalie Gaspar
- Département de cancérologie de l'enfant et l'adolescent, Gustave-Roussy cancer campus, 114, rue Edouard Vaillant, 94800 Villejuif, France
| | - Ramunas Janavicius
- Department of Human and Medical Genetics, Vilnius University Faculty of Medicine, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Hematology, Oncology and Transfusion Medicine Center, Hereditary Cancer Center, Vilnius, Lithuania
- State Research Institute Innovative Medicine Center, Vilnius, Lithuania
| | - Rasa Jančiauskienė
- Department of Oncology and Hematology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Katerina Kopeckova
- Department of Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
- University Hospital Motol, Prague, Czech Republic
| | - Liisa Pylkkänen
- Finnish Medicines Agency Fimea, Helsinki, Uusimaa, Finland
- Department of Oncology, University of Turku, Turku, Finland
| | - Marek Svoboda
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Josep M Borras
- Catalonian Cancer Strategy, Department of Health, Barcelona, Spain
- Department of Clinical Sciences, Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
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Nannini S, Penel N, Bompas E, Willaume T, Kurtz JE, Gantzer J. Shortening the Time Interval for the Referral of Patients With Soft Tissue Sarcoma to Expert Centers Using Mobile Health: Retrospective Study. JMIR Mhealth Uhealth 2022; 10:e40718. [PMID: 36350680 PMCID: PMC9685503 DOI: 10.2196/40718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/17/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND According to guidelines, all patients with sarcoma must be managed from initial diagnosis at expert sarcoma centers. However, in everyday practice, the time interval to an expert center visit can be long, which delays presentation to an expert multidisciplinary tumor board and increases the risk of inappropriate management, negatively affecting local tumor control and prognosis. The advent of mobile health offers an easy way to facilitate communication and cooperation between general health care providers (eg, general practitioners and radiologists) and sarcomas experts. We developed a mobile app (Sar'Connect) based on the algorithm designed by radiologists from the French Sarcoma Group. Through a small number of easy-to-answer questions, Sar'Connect provides personalized advice for the management of patients and contact information for the closest expert center. OBJECTIVE This retrospective study is the first to assess this mobile app's potential benefits in reducing the time interval for patient referral to an expert center according to the initial clinical characteristics of the soft tissue tumor. METHODS From May to December 2021, we extracted tumor mass data for 78 patients discussed by the multidisciplinary tumor boards at 3 centers of the French Sarcoma Group. We applied the Sar'Connect algorithm to these data and estimated the time interval between the first medical description of the soft tissue mass and the referral to expert center. We then compared this estimated time interval with the observed time interval. RESULTS We found that the use of Sar'Connect could potentially shorten the time interval to an expert center by approximately 7.5 months (P<.001). Moreover, for half (31/60, 52%) of the patients with a malignant soft tissue tumor, Sar'Connect could have avoided inappropriate management outside of the reference center. We did not identify a significant determinant for shortening the time interval for referral. CONCLUSIONS Overall, promoting the use of a simple mobile app is an innovative and straightforward means to potentially accelerate both the referral and management of patients with soft tissue sarcoma at expert centers.
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Affiliation(s)
- Simon Nannini
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute, Strasbourg, France
| | - Nicolas Penel
- Department of Medical Oncology, Center Oscar Lambret, Lille University, Lille, France
| | - Emmanuelle Bompas
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nancy, France
| | - Thibault Willaume
- Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute, Strasbourg, France
| | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute, Strasbourg, France
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Fayet Y, Chevreau C, Decanter G, Dalban C, Meeus P, Carrère S, Haddag-Miliani L, Le Loarer F, Causeret S, Orbach D, Kind M, Le Nail LR, Ferron G, Labrosse H, Chaigneau L, Bertucci F, Ruzic JC, Le Brun Ly V, Farsi F, Bompas E, Noal S, Vozy A, Ducoulombier A, Bonnet C, Chabaud S, Ducimetière F, Tlemsani C, Ropars M, Collard O, Michelin P, Gantzer J, Dubray-Longeras P, Rios M, Soibinet P, Le Cesne A, Duffaud F, Karanian M, Gouin F, Tétreau R, Honoré C, Coindre JM, Ray-Coquard I, Bonvalot S, Blay JY. No Geographical Inequalities in Survival for Sarcoma Patients in France: A Reference Networks' Outcome? Cancers (Basel) 2022; 14:2620. [PMID: 35681600 PMCID: PMC9179906 DOI: 10.3390/cancers14112620] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 12/02/2022] Open
Abstract
The national reference network NETSARC+ provides remote access to specialized diagnosis and the Multidisciplinary Tumour Board (MTB) to improve the management and survival of sarcoma patients in France. The IGéAS research program aims to assess the potential of this innovative organization to address geographical inequalities in cancer management. Using the IGéAS cohort built from the nationwide NETSARC+ database, the individual, clinical, and geographical determinants of the 3-year overall survival of sarcoma patients in France were analyzed. The survival analysis was focused on patients diagnosed in 2013 (n = 2281) to ensure sufficient hindsight to collect patient follow-up. Our study included patients with bone (16.8%), soft-tissue (69%), and visceral (14.2%) sarcomas, with a median age of 61.8 years. The overall survival was not associated with geographical variables after adjustment for individual and clinical factors. The lower survival in precarious population districts [HR 1.23, 95% CI 1.02 to 1.48] in comparison to wealthy metropolitan areas (HR = 1) found in univariable analysis was due to the worst clinical presentation at diagnosis of patients. The place of residence had no impact on sarcoma patients' survival, in the context of the national organization driven by the reference network. Following previous findings, this suggests the ability of this organization to go through geographical barriers usually impeding the optimal management of cancer patients.
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Affiliation(s)
- Yohan Fayet
- EMS Team–Human and Social Sciences Department, Centre Léon Bérard, 69008 Lyon, France
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, 69008 Lyon, France
| | | | - Gauthier Decanter
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France;
| | - Cécile Dalban
- Department of Clinical Research and Innovation, Centre Léon Bérard, 69008 Lyon, France; (C.D.); (S.C.)
| | - Pierre Meeus
- Department of Surgery, Centre Léon Bérard, 69008 Lyon, France; (P.M.); (F.G.)
| | - Sébastien Carrère
- Institut de Recherche en Cancérologie Montpellier, INSERM U1194, 34000 Montpellier, France;
| | - Leila Haddag-Miliani
- Service D’imagerie Diagnostique, Institut Gustave Roussy, 94800 Villejuif, France;
| | - François Le Loarer
- Department of Pathology, Institut Bergonié, 33000 Bordeaux, France; (F.L.L.); (J.-M.C.)
| | | | - Daniel Orbach
- Centre Oncologie SIREDO (Soins, Innovation et Recherche en Oncologie de l’Enfant, de l’aDOlescents et de L’adulte Jeune), Institut Curie, Université de Recherche Paris Sciences et Lettres, 75005 Paris, France;
| | - Michelle Kind
- Radiologue, Département D’imagerie Médicale, Institut Bergonié, 33000 Bordeaux, France;
| | - Louis-Romée Le Nail
- Department of Orthopaedic Surgery, CHU de Tours, Faculté de Médecine, Université de Tours, 37000 Tours, France;
| | - Gwenaël Ferron
- INSERM CRCT19 ONCO-SARC (Sarcoma Oncogenesis), Institut Claudius Regaud-Institut Universitaire du Cancer, 31000 Toulouse, France;
| | - Hélène Labrosse
- CRLCC Léon Berard, Oncology Regional Network ONCO-AURA, 69008 Lyon, France; (H.L.); (F.F.)
| | - Loïc Chaigneau
- Department of Medical Oncology, CHRU Jean Minjoz, 25000 Besançon, France;
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France;
| | | | | | - Fadila Farsi
- CRLCC Léon Berard, Oncology Regional Network ONCO-AURA, 69008 Lyon, France; (H.L.); (F.F.)
| | | | - Sabine Noal
- UCP Sarcome, Centre François Baclesse, 14000 Caen, France;
| | - Aurore Vozy
- Department of Medical Oncology, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), CLIP(2) Galilée, Sorbonne University, 75013 Paris, France;
| | | | - Clément Bonnet
- Service d’Oncologie Médicale Hôpital Saint Louis, 75010 Paris, France;
| | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Centre Léon Bérard, 69008 Lyon, France; (C.D.); (S.C.)
| | | | - Camille Tlemsani
- Service d’Oncologie Médicale, Hôpital Cochin, Institut du Cancer Paris CARPEM, Université de Paris, APHP Centre, 75014 Paris, France;
- INSERM U1016-CNRS UMR8104, Institut Cochin, Institut du Cancer Paris CARPEM, Université de Paris, APHP Centre, 75014 Paris, France
| | - Mickaël Ropars
- Orthopaedic and Trauma Department, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France;
| | - Olivier Collard
- Département d’Oncologie Médicale, Hôpital Privé de la Loire, 42100 Saint-Etienne, France;
| | - Paul Michelin
- Service D’imagerie Médicale, CHU Hopitaux de Rouen-Hopital Charles Nicolle, 76000 Rouen, France;
| | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France;
| | | | - Maria Rios
- Department of Medical Oncology, Cancer Institute of Lorraine-Alexis Vautrin, 54500 Vandoeuvre Les Nancy, France;
| | - Pauline Soibinet
- Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, 51000 Reims, France;
| | - Axel Le Cesne
- Medical Oncology, Insitut Gustave Roussy, 94800 Villejuif, France;
| | - Florence Duffaud
- Department of Medical Oncology, CHU La Timone and Aix-Marseille Université (AMU), 13005 Marseille, France;
| | - Marie Karanian
- Department of Pathology, Lyon University Hospital, 69008 Lyon, France;
| | - François Gouin
- Department of Surgery, Centre Léon Bérard, 69008 Lyon, France; (P.M.); (F.G.)
| | - Raphaël Tétreau
- Medical Imaging Center, Institut du Cancer, 34000 Montpellier, France;
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy, Villejuif 94800, France;
| | - Jean-Michel Coindre
- Department of Pathology, Institut Bergonié, 33000 Bordeaux, France; (F.L.L.); (J.-M.C.)
| | | | - Sylvie Bonvalot
- Department of Surgical Oncology, Institut Curie, Université Paris Sciences et Lettres, 75005 Paris, France;
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon University, 69008 Lyon, France;
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van der Graaf W, Tesselaar M, McVeigh T, Oyen W, Fröhling S. Biology-Guided Precision Medicine in Rare Cancers: Lessons from Sarcomas and Neuroendocrine Tumours. Semin Cancer Biol 2022; 84:228-241. [DOI: 10.1016/j.semcancer.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
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Vats K, Spafford M, Groot G, Graham P, Banerjee T, Deobald R, Osmond A. Moving towards the optimization of diagnosis for patients with sarcoma: A 10-year review of externally consulted sarcoma cases in a general anatomical pathology service. Ann Diagn Pathol 2022; 60:151958. [DOI: 10.1016/j.anndiagpath.2022.151958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
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Mojsak D, Dębczyński M, Kuklińska B, Mróz RM. Ewing's Sarcoma in a 58-Year-Old Man: Oncological Diagnosis in the Time of COVID-19. CLINICAL CANCER INVESTIGATION JOURNAL 2022. [DOI: 10.51847/rqquqpcuny] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Honoré C, Drovetti G, Geraud A, Epaillard N, Garcia GCTE, Colomba E, Matias M, Majer M, Ammari S, Khettab M, Hervé R, Mir O, Ducreux M, Gustin P. [Intercontinental Multidisciplinary Oncology Videoconferencing between the South Pacific and the French mainland: Results after one year and 323 cases of rare or complex cancers discussed]. Bull Cancer 2021; 108:1077-1084. [PMID: 34802717 DOI: 10.1016/j.bulcan.2021.09.008] [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: 06/03/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Overseas France represents 18 % of French territory and is home to 4 % of its population for whom there is unequal treatment in the field of rare/complex cancer. AIM To report our experience of intercontinental multidisciplinary videoconferencing between the French mainland and Pacific territories. METHODS Every other friday, three centers located in Papeete, Nouméa and Paris-Villejuif connected between 6:30 AM and 8:00 AM GMT to discuss cases of rare/complex cancers. RESULTS Between November 2019 and December 2020, 323 presentations implicating 233 patients involved sarcoma (n=93), digestive pathology (n=60), neuroendocrine tumors (n=35), urology (n=24), gynecology (n=24), neurology (n=16), thyroid pathology (n=14), dermatology (n=14), senology (n=11), hematology (n=11), ENT pathology (n=10), pathology thoracic (n=10) and pediatrics (n=1). Of the 233 patients, 134 (57.5 %) living in New Caledonia and 99 (42.5 %) in French Polynesia, 117 (50.5 %) had metastatic disease. 39 patients (16.7 %) were transferred to French mainland (EVASAN), for surgery (n=25), vectorized radiotherapy (n=7), biopsy (n=5), chemotherapy (n=1) or inclusion in a clinical trial (n=1). 195 patients (83.7 %) were treated at home, 15 (6.4 %) are still awaiting a decision and 4 (1.7 %) lost to follow-up. CONCLUSION The use of videoconferencing to discuss rare/complex cancer cases was effective in guaranteeing French overseas population access to innovative therapies and clinical trials, limiting the need for intercontinental transfer to 16.7 %.
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Affiliation(s)
- Charles Honoré
- Gustave Roussy, Département d'Anesthésie Chirurgie et Interventionnel (DACI), département d'Anesthésie, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Gustave Roussy, service de chirurgie viscérale oncologique, 114, rue Edouard Vaillant, 94805 Villejuif, France.
| | - Gianmaria Drovetti
- Clinique Kuindo-Magnin, Département d'oncologie, 5, rue Contre-Amiral Joseph du Bouzet Nouville, 98800 Nouméa, Nouvelle-Calédonie, France
| | - Arthur Geraud
- Gustave Roussy, Département de médicine oncologique (DMO), 114, rue Edouard Vaillant, 94805 Villejuif, France; Gustave Roussy, Département d'Innovation thérapeutique et d'essais précoces (DITEP), 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Nicolas Epaillard
- Centre Hospitalier de Polynésie Française, Département d'oncologie, avenue du Général de Gaulle, 98713 Pirae, Polynésie Française, France
| | - Gabriel C T E Garcia
- Gustave Roussy, Département de radiologie, 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Emeline Colomba
- Gustave Roussy, Département de médicine oncologique (DMO), 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Margarida Matias
- Clinique Kuindo-Magnin, Département d'oncologie, 5, rue Contre-Amiral Joseph du Bouzet Nouville, 98800 Nouméa, Nouvelle-Calédonie, France; Gustave Roussy, Département de médicine oncologique (DMO), 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Michael Majer
- Gustave Roussy, Département de radiologie, 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Samy Ammari
- Gustave Roussy, Département de radiologie, 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Mohamed Khettab
- Gustave Roussy, Département de médicine oncologique (DMO), 114, rue Edouard Vaillant, 94805 Villejuif, France; CHU de La Réunion, service hématologie-oncologie, 97, avenue du Président Mitterrand, 97448 Saint-Pierre, La Réunion, France; Université de La Réunion, 15, avenue René Cassin, 97715 Sainte-Clotilde, La Réunion, France
| | - Robert Hervé
- Centre Hospitalier de Polynésie Française, Département d'oncologie, avenue du Général de Gaulle, 98713 Pirae, Polynésie Française, France
| | - Olivier Mir
- Gustave Roussy, département Interdisciplinaire d'organisation des Parcours Patients (DIOPP), 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Michel Ducreux
- Gustave Roussy, Département de médicine oncologique (DMO), 114, rue Edouard Vaillant, 94805 Villejuif, France; Université Paris-Saclay, 3, rue Joliot Curie, 91190 Gif-sur-Yvette, France
| | - Pierre Gustin
- Centre Hospitalier de Polynésie Française, Département de Radiothérapie, avenue du Général de Gaulle, 98713 Pirae, Polynésie Française, France
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Nannini S, Gantzer J, Tetreau R, Blay JY, Kurtz JE. [Sar'connect a mobile app to enhance soft-tissue sarcoma patients' referral to expert centers]. Bull Cancer 2021; 108:1181-1183. [PMID: 34756597 DOI: 10.1016/j.bulcan.2021.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/18/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Simon Nannini
- Institut de cancérologie Strasbourg Europe, service d'oncologie médicale, 67200 Strasbourg, France.
| | - Justine Gantzer
- Institut de cancérologie Strasbourg Europe, service d'oncologie médicale, 67200 Strasbourg, France
| | - Raphaël Tetreau
- Institut du cancer, centre d'imagerie médicale, 34298 Montpellier, France
| | - Jean-Yves Blay
- Centre Léon-Bernard, université Claude-Bernard Lyon I, service d'oncologie médicale, 69008 Lyon, France
| | - Jean-Emmanuel Kurtz
- Institut de cancérologie Strasbourg Europe, service d'oncologie médicale, 67200 Strasbourg, France
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Sritart H, Tuntiwong K, Miyazaki H, Taertulakarn S. Disparities in Healthcare Services and Spatial Assessments of Mobile Health Clinics in the Border Regions of Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10782. [PMID: 34682527 PMCID: PMC8535297 DOI: 10.3390/ijerph182010782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 01/21/2023]
Abstract
Reducing the disparities in healthcare access is one of the important goals in healthcare services and is significant for national health. However, measuring the complexity of access in truly underserved areas is the critical step in designing and implementing healthcare policy to improve those services and to provide additional support. Even though there are methods and tools for modeling healthcare accessibility, the context of data is challenging to interpret at the local level for targeted program implementation due to its complexity. Therefore, the purpose of this study is to develop a concise and context-specific methodology for assessing disparities for a remote province in Thailand to assist in the development and expansion of the efficient use of additional mobile health clinics. We applied the geographic information system (GIS) methodology with the travel time-based approach to visualize and analyze the concealed information of spatial data in the finer analysis resolution of the study area, which was located in the border region of the country, Ubon Ratchathani, to identify the regional differences in healthcare allocation. Our results highlight the significantly inadequate level of accessibility to healthcare services in the regions. We found that over 253,000 of the population lived more than half an hour away from a hospital. Moreover, the relationships of the vulnerable residents and underserved regions across the province are underlined in the study and substantially discussed in terms of expansion of mobile health delivery to embrace the barrier of travel duration to reach healthcare facilities. Accordingly, this research study addresses regional disparities and provides valuable references for governmental authorities and health planners in healthcare strategy design and intervention to minimize the inequalities in healthcare services.
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Affiliation(s)
- Hiranya Sritart
- Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand;
| | - Kuson Tuntiwong
- School of Dentistry, King Mongkut’s Institute of Technology Ladkrabang, Bangkok 10520, Thailand;
| | - Hiroyuki Miyazaki
- Center for Spatial Information Science, Tokyo University, Chiba 277-8568, Japan;
| | - Somchat Taertulakarn
- Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand;
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Brisset C, Carton M, Chemin-Airiau C, Karanian M, Vérité C, Corradini N, Mascard E, Gouin F, Bonvalot S, Minard-Colin V, Fayard C, Pannier S, Blay JY, Le Nail LR, Le Loarer F, Brisse HJ, Chotel F, Pierron G, Tirode F, Defachelles AS, Toulmonde M, Orbach D. Locally aggressive rarely metastazing tumors and low-grade sarcoma in children, adolescents and young adults: The benefits of a national network. Eur J Surg Oncol 2021; 48:508-517. [PMID: 34561126 DOI: 10.1016/j.ejso.2021.09.006] [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: 07/01/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Complete surgical resection constitutes the mainstay of treatment for locally aggressive, rarely metastazing tumor and low-grade soft tissue sarcomas (LAS). Local relapse is the most common tumor event, especially in the presence of positive margins (R1 margins). The aims of this study are to assess the impact of the national network on patient care and to evaluate the role of immediate re-excision in children, adolescents and young adults with incompletely resected LAS. METHODS National retrospective multicenter study of all young patients (≤25 years) included in the Sarcoma "ConticaBase" treated for LAS between 2005 and 2017 for whom pathology/biology review was available via the national NETSARC + network. RESULTS A total of 96 patients were identified (median age: 16 years). Tumors were localized in 99% of cases (1 N+ tumor). With a median follow-up of 4.7 years (range: 0.1-11.9), eight local relapses and two distant metastases were observed. No patient died. Overall 5-year event-free survival (EFS) was 90.4% [95%CI, 84.3-97]. Five year EFS for R1 patients (n = 51) with (n = 24) and without (n = 27) immediate re-excision was 90.5% [95%CI, 78.8-100.0] and 80.3% [95%CI, 64.7-99.9], respectively (p = 0.34). The 37 patients directly treated in a reference center more commonly had a diagnostic biopsy (78% vs. 21%; p < 0.001), more complete surgery (R0: 65% vs. 14%; p < 0.001) and less commonly underwent re-excision (16% vs. 54%; p < 0.001). CONCLUSIONS This large series indicates that LAS are rare in young patients and have a favorable prognosis. Immediate management in reference centers is associated with better standard of care. The main tumor events are local relapses.
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Affiliation(s)
- Claire Brisset
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France; Sorbonne Université, Paris, France.
| | - Matthieu Carton
- Unit of Biometry, Institut Curie, DRCI, PSL Research University, Paris, France
| | | | - Marie Karanian
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - Cécile Vérité
- Department of Pediatric and Adolescent Hematology and Oncology, Pellegrin Hospital, Bordeaux, France
| | - Nadege Corradini
- Department of Pediatric and Adolescent Oncology, Centre Leon Berard, Lyon, France
| | - Eric Mascard
- Department of Orthopedic Surgery, Hôpital Necker-Enfants-Malades, Université de Paris, Paris, France
| | | | - Sylvie Bonvalot
- Department of Surgical Oncology, Institut Curie, Université Paris Sciences et Lettres, Paris, France
| | | | - Cindy Fayard
- Imaging Department, Oscar Lambret Centre, Lille, France
| | - Stéphanie Pannier
- Department of Orthopedic Surgery, Hôpital Necker-Enfants-Malades, Université de Paris, Paris, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Louis-Romée Le Nail
- Department of Orthopedic Surgery, CHRU de Tours, Faculté de Médecine de Tours, Université François Rabelais, Tours, France
| | - François Le Loarer
- Department of Biopathology, Institut Bergonié, Université de Bordeaux, Bordeaux, France
| | | | - Franck Chotel
- Department of Pediatric Orthopedic Surgery, Hôpital Femme Mere Enfant, Lyon, France
| | | | - Franck Tirode
- Department of Translational Research and Innovation, Centre Léon Bérard, Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Lyon, France
| | | | - Maud Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
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11
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Blay JY, Casali P, Bouvier C, Dehais C, Galloway I, Gietema J, Halámková J, Hindi N, Idbaih A, Kinloch E, Klümpen HJ, Kolarova T, Kopeckova K, Lovey J, Magalhaes M, Oselin K, Piperno-Neumann S, Ravnsbaek A, Rogasik M, Safwat A, Scheipl S, Seckl M, Taylor J, Temnyk M, Trama A, Urbonas M, Wartenberg M, Weinman A. European Reference Network for rare adult solid cancers, statement and integration to health care systems of member states: a position paper of the ERN EURACAN. ESMO Open 2021; 6:100174. [PMID: 34139485 PMCID: PMC8219752 DOI: 10.1016/j.esmoop.2021.100174] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- J-Y Blay
- Department of Medical Oncology, Centre Leon Berard & Centre de Recherche en Cancérologie de Lyon (CRCL) & Université Claude Bernard Lyon 1, Lyon, France.
| | - P Casali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - C Bouvier
- Neuroendocrine Cancer Unit, Royal Free Hospital, London, UK
| | - C Dehais
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - I Galloway
- Melanoma Patient Network Europe, OcuMel, Birmingham, UK
| | - J Gietema
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - J Halámková
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - N Hindi
- Institute of Biomedicine of Sevilla (IBIS, HUVR, CSIC, Universidad de Sevilla), Virgen, Virgen del Rocío University Hospital, Seville, Spain
| | - A Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | | | - H-J Klümpen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T Kolarova
- International Neuroendocrine Cancer Alliance, Boston, USA
| | - K Kopeckova
- Department of Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - J Lovey
- National Institute of Oncology, Budapest, Hungary
| | - M Magalhaes
- Oncology Department, Centro Hospitalar e Universitário Universitário do Porto, Porto, Portugal
| | - K Oselin
- Department of Chemotherapy, Clinic of Haematology and Oncology, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | | | - A Ravnsbaek
- Oncology Department, and Danish Centre for Particle Therapy, University Hospital, Aarhus, Denmark
| | - M Rogasik
- Research and Innovation Department, Centre Léon Bérard, Lyon, France
| | - A Safwat
- Oncology Department, and Danish Centre for Particle Therapy, University Hospital, Aarhus, Denmark
| | - S Scheipl
- Medical University of Graz, Graz, Austria
| | - M Seckl
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - J Taylor
- Thyroid Cancer Alliance, Rotterdam, The Netherlands
| | - M Temnyk
- Maria Skłodowska Curie Institute, Warsaw, Poland
| | - A Trama
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - M Urbonas
- Lithuanian University of Health Sciences, Department of Neurosurgery, Kaunas, Lithuania
| | | | - A Weinman
- EURORDIS-Rare Diseases Europe (European Patient Organisation for Rare Diseases)
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12
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Fayet Y, Tétreau R, Honoré C, Le Nail LR, Dalban C, Gouin F, Causeret S, Piperno-Neumann S, Mathoulin-Pelissier S, Karanian M, Italiano A, Chaigneau L, Gantzer J, Bertucci F, Ropars M, Saada-Bouzid E, Cordoba A, Ruzic JC, Varatharajah S, Ducimetière F, Chabaud S, Dubray-Longeras P, Fiorenza F, De Percin S, Lebbé C, Soibinet P, Michelin P, Rios M, Farsi F, Penel N, Bompas E, Duffaud F, Chevreau C, Le Cesne A, Blay JY, Le Loarer F, Ray-Coquard I. Determinants of the access to remote specialised services provided by national sarcoma reference centres. BMC Cancer 2021; 21:631. [PMID: 34049529 PMCID: PMC8164290 DOI: 10.1186/s12885-021-08393-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/19/2021] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
- Yohan Fayet
- 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.
| | - Raphaël Tétreau
- Medical Imaging Center, Institut du Cancer, Montpellier, France
| | - Charles Honoré
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Louis-Romée Le Nail
- Department of Orthopaedic Surgery, CHU de Tours, Faculte de médecine, Université de Tours, Tours, France
| | - Cécile Dalban
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | | | - Sylvain Causeret
- Department of Surgery, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France
| | | | - Simone Mathoulin-Pelissier
- 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
| | - Marie Karanian
- Department of Pathology, Lyon University Hospital, Lyon, France
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France
| | - Loïc Chaigneau
- Department of Medical Oncology, CHRU Jean Minjoz, Besançon, France
| | | | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Mickael Ropars
- Orthopaedic and trauma department, Rennes1 University Pontchaillou University Hospital, Rennes, France
| | - Esma Saada-Bouzid
- Medical Oncology Department, University Côte d'Azur, Centre Antoine Lacassagne, Nice, France
| | - Abel Cordoba
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | | | | | | | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | | | - Fabrice Fiorenza
- Department of Orthopedics Traumatology, CHU de Dupuytren, F-87042, Limoges, France
| | - Sixtine De Percin
- Medical Oncology Department, Hôpital Cochin; AP-HP, Cancer Research for PErsonalized Medicine (CARPEM); Paris University, Paris, France
| | - Céleste Lebbé
- AP-HP Dermatology Department, Saint-Louis Hospital, INSERM U976, Université de Paris Diderot, Paris, France
| | - Pauline Soibinet
- Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
| | - Paul Michelin
- Department of Radiology and Medical Imaging, CHU-hôpitaux de Rouen, Rouen, France
| | - Maria Rios
- Department of Medical Oncology, Cancer Institute of Lorraine, Alexis Vautrin, Vandoeuvre Les Nancy, France
| | - Fadila Farsi
- CRLCC Léon Berard - Lyon, Oncology Regional Network ONCO-AURA, Lyon, France
| | - Nicolas Penel
- Lille University Medical School and Centre Oscar Lambret, Lille, France
| | - Emmanuelle Bompas
- Medical Oncology Department, ICO, Saint Herblain, Pays de la Loire, France
| | - Florence Duffaud
- Department of Medical Oncology, CHU La Timone and Aix-Marseille Université (AMU), Marseille, France
| | - Christine Chevreau
- Department of Medical Oncology, ICR IUCT- Oncopole Toulouse, Toulouse, France
| | - Axel Le Cesne
- Medical Oncology, Insitut Gustave Roussy, Villejuif, Ile-de-France, France
| | - Jean-Yves Blay
- Departement of Medical Oncology, Centre Léon Bérard, Université de Lyon and Unicancer Paris, Lyon, France
| | | | - Isabelle Ray-Coquard
- Equipe EMS, Centre Léon Bérard, F-69008, Lyon, France.,Department of Medical Oncology, Centre Leon Berard, Lyon, Rhône-Alpes, France
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13
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Alcindor T, Dumitra S, Albritton K, Thomas DM. Disparities in Cancer Care: The Example of Sarcoma-In Search of Solutions for a Global Issue. Am Soc Clin Oncol Educ Book 2021; 41:1-7. [PMID: 33770458 DOI: 10.1200/edbk_320463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Disparities in health care have an adverse effect on the outcome of disadvantaged patients with cancer. Patients may be at a disadvantage because of geographic isolation; insurance status; or racial, ethnic, or other factors. In this article, we examine how disparities affect the care of patients with sarcoma in the United States, Canada, and the Asia-Pacific region. Because of the rarity of sarcomas and their challenging diagnosis and complex treatment patterns, some professional or national guidelines stipulate that patients with sarcoma should be treated at centers of expertise by multidisciplinary teams. This recommendation, based on published evidence, is not always applicable because of various sociopolitical or patient-related factors. We are proposing solutions to overcome these obstacles in a practical and patient-centered way while acknowledging that disparities exist among countries as well as within any country.
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Affiliation(s)
| | | | | | - David M Thomas
- Garvan Institute of Medical Research, Darlinghurst, Australia
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14
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Honoré C, Mir O, Geraud A, Drovetti G, Garcia GCTE, Gustin P, Colomba E, Pilorge S, Matias M, Majer M, Balleyguier C, Azoulay M, Besse B, Herve R, Vial G, Ducreux M. Intercontinental Multidisciplinary Oncology Videoconferencing for Rare and Complex Cancer: An Alternative to Systematic Transfer. JCO Oncol Pract 2021; 17:e1311-e1317. [PMID: 33621118 DOI: 10.1200/op.20.00525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To report our experience of intercontinental multidisciplinary oncology videoconferencing between the French mainland and South Pacific to discuss rare and/or complex cancer cases. METHODS On the first and third Friday of each month, all participants connected between 6:30 am and 8:00 am GMT to discuss using a web conference service. RESULTS Between November 2019 and April 2020, 99 cases concerning 78 patients were discussed. Oncology subspecialties required were sarcoma (n = 36), digestive (n = 29), dermatology (n = 5), gynecology (n = 5), breast (n = 5), urology (n = 5), hematology (n = 5), ENT (n = 3), thoracic (n = 3), thyroid (n = 2), and pediatric (n = 1). Median patient age was 58 years, 41 were female (53%), 37 were male (47%), and 43 had a metastatic disease (55%). Following discussion, 16 patients (21%) were transferred to the French mainland. Reasons for transfer were requirement for complex surgery (n = 11) and need for specialized diagnostic biopsy (n = 5). Fifty-six patients were treated locally, with systemic chemotherapy (n = 36), surveillance (n = 8), surgery (n = 8), radiotherapy (n = 3), or endoscopy (n = 1). Direct benefits for patients treated in their local facility included strategy changes (surveillance or surgery contraindication, n = 9), targeted therapy decision (n = 14), immunotherapy decision (n = 9), and diagnostic or metastatic status corrections (n = 4). Six patients are still awaiting decision. CONCLUSION Using real-time intercontinental multidisciplinary oncology videoconferencing to discuss complex or rare cancer cases is reliable and effective for decision making. This concept helped to limit to 21% the need for transfers to the mainland.
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Affiliation(s)
- Charles Honoré
- Department of Surgical Oncology, Gustave Roussy, Villejuif, France
| | - Olivier Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - Arthur Geraud
- Department of Medical Oncology, Gustave Roussy, Villejuif, France.,Department of Early Drug Development (DITEP), Gustave Roussy, Villejuif, France
| | - Gianmaria Drovetti
- Department of Medical Oncology, Clinique Kuindo-Magnin, Nouméa, New Caledonia, France
| | | | - Pierre Gustin
- Department of Radiotherapy, Centre Hospitalier de Polynésie Francaise, Papeete, France
| | - Emeline Colomba
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Margarida Matias
- Department of Medical Oncology, Gustave Roussy, Villejuif, France.,Department of Medical Oncology, Clinique Kuindo-Magnin, Nouméa, New Caledonia, France
| | - Michael Majer
- Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France
| | | | | | - Benjamin Besse
- Department of Medical Oncology, Gustave Roussy, Villejuif, France.,Paris-Saclay University, Saint-Aubin, France
| | - Robert Herve
- Department of Medical Oncology, Centre Hospitalier de Polynésie Francaise, Papeete, France
| | - Gregory Vial
- Strategy Department, Gustave Roussy, Villejuif, France
| | - Michel Ducreux
- Department of Medical Oncology, Gustave Roussy, Villejuif, France.,Paris-Saclay University, Saint-Aubin, France
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15
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Drabbe C, Grünhagen DJ, Van Houdt WJ, Braam PM, Soomers VLMN, Van der Hage JA, De Haan JJ, Keymeulen KBMI, Husson O, Van der Graaf WTA. Diagnosed with a Rare Cancer: Experiences of Adult Sarcoma Survivors with the Healthcare System-Results from the SURVSARC Study. Cancers (Basel) 2021; 13:cancers13040679. [PMID: 33567553 PMCID: PMC7914609 DOI: 10.3390/cancers13040679] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Patients with rare cancers face obstacles including delays in diagnosis, inadequate treatments and limited scientific evidence to guide decision making. These obstacles may have a unique impact on their experience with the healthcare system and might be different at various ages. Some aspects of care that shape the experience with the healthcare system include information needs, satisfaction with care and supportive care. Very little is known about these aspects of care, specifically for rare cancer patients. Sarcomas are prime examples of rare cancers and are diagnosed at all ages. In this study, we explored the experience of sarcoma patients (N = 1099) with the healthcare system and looked into detail at whether differences in experience existed between age groups. The results of this nationwide study showed that healthcare experiences differ per age group and we identified needs related to the rarity of these tumors, such as improvements concerning (non-)medical guidance and diagnostic intervals. Abstract The aim of this study was to explore the experience of rare cancer patients with the healthcare system and examine differences between age groups (adolescents and young adults (AYA, 18–39 years), older adults (OA, 40–69 years) and elderly (≥70 years)). Dutch sarcoma patients, 2–10 years after diagnosis, completed a questionnaire on their experience with the healthcare system, satisfaction with care, information needs, patient and diagnostic intervals (first symptom to first doctor’s visit and first doctor’s visit to diagnosis, respectively) and received supportive care. In total, 1099 patients completed the questionnaire (response rate 58%): 186 AYAs, 748 OAs and 165 elderly. Many survivors experienced insufficient medical and non-medical guidance (32% and 38%), although satisfaction with care was rated good to excellent by 94%. Both patient and diagnostic intervals were >1 month for over half of the participants and information needs were largely met (97%). AYAs had the longest patient and diagnostic intervals, experienced the greatest lack of (non-)medical guidance, had more desire for patient support groups and used supportive care most often. This nationwide study among sarcoma survivors showed that healthcare experiences differ per age group and identified needs related to the rarity of these tumors, such as improvements concerning (non-)medical guidance and diagnostic intervals.
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Affiliation(s)
- Cas Drabbe
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.D.); (W.T.A.V.d.G.)
- Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Dirk J. Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;
| | - Winan J. Van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
| | - Pètra M. Braam
- Department of Radiation Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
| | - Vicky L. M. N. Soomers
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
| | - Jos A. Van der Hage
- Department of Surgical Oncology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands;
| | - Jacco J. De Haan
- Department of Medical Oncology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Kristien B. M. I. Keymeulen
- Department of Surgical Oncology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
| | - Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.D.); (W.T.A.V.d.G.)
- Division of Clinical Studies, Institute of Cancer Research, 15 Cotswold Road, Sutton, London SM2 5NG, UK
- Correspondence:
| | - Winette T. A. Van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.D.); (W.T.A.V.d.G.)
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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16
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Berardi R, Morgese F, Rinaldi S, Torniai M, Mentrasti G, Scortichini L, Giampieri R. Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management. Cancer Manag Res 2020; 12:9363-9374. [PMID: 33061625 PMCID: PMC7533227 DOI: 10.2147/cmar.s220976] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022] Open
Abstract
Over the years, a growing body of literature has confirmed as beneficial the implementation of a multidisciplinary approach in the so-often-intricate scenario of cancer patients' management. Together with the consolidation of tumor-board experience in clinical practice, certain aspects have emerged as controversial and a source of current debate. In this systematic literature review, we focused our attention on the impact of multidisciplinary tumor boards, assessing benefits and limitations as a result of the dissemination of such approaches. On the bright side, adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes have been recognized as advantages. On the other side, our analysis highlights a few limitations that should be taken into account to optimize cancer patients' management. Of note, some issues, such as costs, legal responsibility, geographic barriers, and treatment delays, have yet to be resolved. In order partly to address this matter, software platforms and novel methods of computational analysis may provide the needed support. Therefore, the aim of our analysis was to describe the multidisciplinary approach in cancer care in terms of adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes through a systematic review of the literature.
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Affiliation(s)
- Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesca Morgese
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Silvia Rinaldi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mariangela Torniai
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giulia Mentrasti
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Laura Scortichini
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Riccardo Giampieri
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
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Disparities in Geographical Access to Hospitals in Portugal. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2020. [DOI: 10.3390/ijgi9100567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Geographical accessibility to health care services is widely accepted as relevant to improve population health. However, measuring it is very complex, mainly when applied at administrative levels that go beyond the small-area level. This is the case in Portugal, where the municipality is the administrative level that is most appropriate for implementing policies to improve the access to those services. The aim of this paper is to assess whether inequalities in terms of access to a hospital in Portugal have improved over the last 20 years. A population-weighted driving time was applied using the census tract population, the roads network, the reference hospitals’ catchment area and the municipality boundaries. The results show that municipalities are 25 min away from the hospital—3 min less than in 1991—and that there is an association with premature mortality, elderly population and population density. However, disparities between municipalities are still huge. Municipalities with higher rates of older populations, isolated communities or those located closer to the border with Spain face harder challenges and require greater attention from local administration. Since municipalities now have responsibilities for health, it is important they implement interventions at the local level to tackle disparities impacting access to healthcare.
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