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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] [What about the content of this article? (0)] [Affiliation(s)] [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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