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

Yohan Fayet 1, 2, 3 Raphaël Tétreau 4 Charles Honoré 5, 6 Louis-Romée Le Nail 7, 8 Cécile Dalban 1 François Gouin 1 Sylvain Causeret 9 Sophie Piperno-Neumann 10, 11 Simone Mathoulin-Pelissier 12, 13 Marie Karanian 14 Antoine Italiano 15 Loïc Chaigneau 16 Justine Gantzer 17 François Bertucci 18 Mickael Ropars 19, 20 Esma Saada-Bouzid 21, 22 Abel Cordoba 23 Jean-Christophe Ruzic 24 Sharmini Varatharajah 25 Françoise Ducimetière 1 Sylvie Chabaud 1 Pascale Dubray-Longeras 26 Fabrice Fiorenza 27 Sixtine de Percin 28 Céleste Lebbé 29 Pauline Soibinet 30 Paul Michelin 31 Maria Rios 32 Fadila Farsi 33, 34 Nicolas Penel 35, 23 Emmanuelle Bompas 36 Florence Duffaud 37, 38 Christine Chevreau 39 Axel Le Cesne 5 Jean-Yves Blay 1, 40, 41 François Le Loarer 15 Isabelle Ray-Coquard 25, 1
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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Submitted on : Monday, May 31, 2021 - 3:36:29 PM
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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, BioMed Central, 2021, 21 (1), pp.631. ⟨10.1186/s12885-021-08393-4⟩. ⟨inserm-03243378⟩

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