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Journal Articles BMC Cancer Year : 2021

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

1 Centre Léon Bérard [Lyon]
2 UCBL - Université Claude Bernard Lyon 1
3 HESPER - Health Service and Performance Research
4 ICM - Institut du Cancer de Montpellier
5 IGR - Institut Gustave Roussy
6 Département de chirurgie viscérale [Gustave Roussy]
7 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
8 UT - Université de Tours
9 UNICANCER/CRLCC-CGFL - Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon]
10 Department of Medical Oncology, Institut Curie, Paris 75248, France
11 Institut Curie [Paris]
12 CIC Bordeaux
13 BPH - Bordeaux population health
14 Département de Pathologie [CHU Lyon-Sud - HCL]
15 Institut Bergonié [Bordeaux]
16 Hôpital JeanMinjoz
17 ICANS - Institut de Cancérologie de Strasbourg Europe
18 Institut Paoli-Calmettes
19 CRCM - Centre de Recherche en Cancérologie de Marseille
20 CHU Pontchaillou [Rennes]
21 UR - Université de Rennes
22 UNICANCER/CAL - Centre de Lutte contre le Cancer Antoine Lacassagne [Nice]
23 UCA - Université Côte d'Azur
24 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
25 CHU La Réunion - Centre Hospitalier Universitaire de La Réunion
26 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
27 UNICANCER/CJP - Centre Jean Perrin [Clermont-Ferrand]
28 Service de médecine interne [CHU Dupuytren]
29 Cancer Research and Personalized Medicine - CARPEM [Paris]
30 HIPI (UMR_S_976 / U976) - Immunologie humaine, physiopathologie & immunothérapie
31 CHU Reims - Centre Hospitalier Universitaire de Reims
32 Service de Radiologie [CHU Rouen]
33 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
34 Département cancer environnement (Centre Léon Bérard - Lyon)
35 Association pour l'Utilisation du Rein Artificiel Région Lyonnaise (AURAL)
36 University of Lille
37 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
38 TIMONE - Hôpital de la Timone [CHU - APHM]
39 AMU - Aix Marseille Université
40 IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole
41 Université de Lyon
Antoine Italiano
Paul Michelin
François Le Loarer


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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Dates and versions

inserm-03243378 , version 1 (31-05-2021)



Yohan Fayet, Raphaël Tétreau, Charles Honoré, Louis-Romée Le Nail, Cécile Dalban, et al.. Determinants of the access to remote specialised services provided by national sarcoma reference centres. BMC Cancer, 2021, 21 (1), pp.631. ⟨10.1186/s12885-021-08393-4⟩. ⟨inserm-03243378⟩
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