BackgroundIn the context of the national Cancer Plans of France that have changed the healthcare landscape, it has become necessary to better document and assess the related actions, and to promote research and understanding. The national cancer cohort, an exhaustive population-based cohort, was set up on the basis of the National Health Data System (SNDS) by the French National Cancer Institute.ObjectivesThe aim is to describe the French national cancer cohort.MethodsAll people living in France (67 million population) with universal insurance coverage and diagnosed, treated or followed up for a cancer, such as survivors, are included and will be followed up for 25 years. It contains all healthcare consumptions and reimbursements (i.e. hospitalization, outpatient care, medication…) since 2010. Every year, around 650 000 new cases are included.ResultsFrom 2010 to 2015, 6.2 million subjects have been included. Most subjects were entered in 2010, in 2015 it concerned 0.6 million. In 2015, the median age was 65 [54–76]; 51% were women. The primary cancer organ could be attributed with certitude to 87% of the people. The most frequent locations were skin (16%), breast (15%), prostate (12%), colon-rectum (11%) and lung (9%). In 2015, 40% of included subjects underwent surgery for cancer, 16% chemotherapy at hospital and 11% at least one session of radiotherapy.ConclusionBased on SNDS, the cancer cohort has been designed to study cancer care use in the short-, medium- and long-term, and evaluate healthcare and public health policies.

The COVID-19 pandemic has had a substantial and lasting impact on care provision, particularly in the field of cancer care. National steering has helped monitor the health situation and adapt the provision and organisation of care. Based on data from the French administrative healthcare database (SNDS) on the entire French population (67 million people), screening, diagnostic and therapeutic activity was monitored and compared 2019 on a monthly basis. A noteworthy decline in all activities (with the exception of chemotherapy) was observed during the first lockdown in France. Over the months that followed, this activity returned to normal but did not make up for the shortfall from the first lockdown. Finally, during the lockdown in late 2020, cancer care activity was conserved. In brief, in 2020, the number of mammograms decreased by 10% (− 492,500 procedures), digestive endoscopies by 19% (− 648,500), and cancer-related excision by 6% (− 23,000 surgical procedures). Hospital radiotherapy activity was down 3.8% (− 4400 patients) and that in private practice was down 1.4% (− 1600 patients). Chemotherapy activity increased by 2.2% (7200 patients), however. To summarize, COVID-19 had a very substantial impact during the first lockdown. Safeguarding cancer care activity helped limit this impact over the months that followed, but the situation remains uncertain. Further studies on the medium- and long-term impact on individuals (survival, recurrence, after-effects) will be conducted.

ImportanceCOVID-19 has had a major effect on health care activities, especially surgery. At first, comparisons were proposed using 2019 activities as the highest standard. However, while such an approach might have been suitable during the first months of the pandemic, this might no longer be the case for a longer period.ObjectiveTo examine approaches that may better assess the use of cancer surgeries.Design, Setting, and ParticipantsIn a cross-sectional design, the nationwide French hospital facility data (Medicalised Information System Program) were used to assess cancer surgery for 6 cancer site categories in adults from January 1, 2010, to December 31, 2021.ExposureEstimated cancer surgery activity during the COVID-19 pandemic.Main Outcomes and MeasuresThree models were proposed to assess the expected number of surgical procedures between 2020 and 2021 and make a comparison with those observed in earlier years.ResultsIn France, cancer removal surgeries account for approximately 7000 hospitalizations per year for liver cancer; 4000 for pancreatic cancer; 7700 for ovarian cancer; 1300 for esophagus cancer; 23 000 for ear, nose, and throat (ENT) cancer; 78 000 for breast cancer; and 16 600 for thoracic cancers. For most cancer sites, the number of surgical procedures increased from 2010 to 2019: liver, 14%; pancreas, 38%; ovary, 14%; esophagus, 18%; breast, 8%; and thoracic, 29%. Assuming stability, these values underestimate the gap in activity observed in 2020-2021. For other procedures, a decrease was observed: stomach, −10%, and ENT, −6%. Assuming stability, these values overestimate the gap in activity observed in 2020-2021. At the end of 2021, according to the model, the gap in activity observed in 2020-2021 was estimated at between −1.4% and 1.7% for breast, −6.6% and −7.3% for thoracic, −3.1% and −2.5% for ovarian, −4.2% and −1.7% for pancreas, −6.7% and 5.9% for stomach, and −13.0% and −13.9% for esophageal cancers. For ENT, liver, and urologic cancers, because the trend was different before and after 2015, it was necessary to opt for modeling using only the most recent period. The cumulative gap in activity observed in 2020-2021 was estimated at −1.0% for ENT cancers, −5.3% for liver cancers, and −2.9% for urologic cancers.Conclusions and RelevanceThe findings of this study suggest that short- and medium-term trends must be considered to estimate COVID-19 cancer surgery activities. Breast cancer is the site for which the activity showed the smallest decrease during the pandemic, with almost full recovery in 2021.

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EML) of 2017 was analyzed. List of medicines registered in Armenia (2018) was analyzed to identify authorized tracer medicines. Data on availability and prices were collected from pricelists of 5 main wholesalers, 3 pharmacy chains and 10 independent pharmacies. Affordability was calculated using methodology developed by WHO and Health Action International; it was expressed as the number of days needed by a person who earns the minimum wage that was set by legislation, to purchase a course of treatment. RESULTS: Only 72.5% of 51 antineoplastics and immunosuppressives and 65.0% of 103 formulations of these medicines listed in WHO EML are included in the new Armenian EML (72.3% and 54.3%, correspondingly, in Armenian EML of 2013); 68.6% of tracer medicines and 44.7% of their formulations are authorized. 49.0% of medicines and 25.2% of formulations were found in wholesalers' pricelists. Only 19.4% of formulations were available in different pharmacy outlets; the most of chain and all independent pharmacies did not have any tracer medicine. Only 16 of 86 formulations of cytotoxic and adjuvant medicines listed in WHO EML were available on the market; and cost of treatment only for 3 of them was less than 1 day wage. CONCLUSIONS: Only less than half of essential antineoplastics and immunosuppressives and less than one quarter of their formulations recommended by WHO are available on the pharmaceutical market of Armenia. Cost of treatment for the great majority of these essential medicines is unaffordable for those patients who are not covered by the reimbursement system.

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