Cancer care and public health policy evaluations in France: Usefulness of the national cancer cohort

Abstract

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.

Access to inpatient palliative care among cancer patients in France: an analysis based on the national cancer cohort

“…For this nationwide retrospective cohort study, we used data from the French National Cancer Cohort, which includes all people living in France with health insurance coverage (i.e., nearly 100% of the French population) diagnosed with and treated for cancer. A detailed description of the methodology can be found elsewhere [ 27 ].…”

“…drugs prescribed at the hospital but dispensed in community pharmacies) were also extracted. Cancer stages for included patients were identified using ICD-10 codes, since SNDS database does not provide clinical variables such as the TNM (Tumor, Nodes and Metastasis) cancer classification [ 27 ]. Furthermore, comorbidities were identified for included patients on the basis of the SNDS and the use of algorithms to distribute beneficiaries into 56 non-exclusive disease groups of chronic diseases, health events and chronic treatments, assembled into 13 main categories [ 28 , 29 ] Finally, we used the French ecological deprivation index (Fdep99) as a proxy to consider patients’ socioeconomic status [ 30 ].…”

<p>Access to palliative care for cancer patients between diagnosis and death: a national cohort study</p>

“…For this nationwide retrospective cohort study, we used data from the French National Cancer Cohort, which includes all people living in France with health insurance coverage (ie, nearly 100% of the French population) who are diagnosed with or treated for cancer. A detailed description of the methods can be found elsewhere 34. Briefly, this cohort is extracted from the French national health system database,35 and collects the following data since 2010: 1) all individual health care utilization reimbursement data (ie, hospitalization, outpatient care, medication expenditures) collected in a unique consumption database of the various national health insurance schemes (Données de Consommation Inter-Régimes database, DCIR); 2) private and public hospital database records, collected in the medical information system program (Programme de Médicalisation des Systèmes d’Information, PMSI) by the national agency for information on hospital care.…”

“…Furthermore, cancer stages for included patients were identified using ICD-10 codes, since SNDS database does not provide clinical variables, such as the TNM (Tumour, Nodes, and Metastasis) cancer classification.34 Besides, comorbidities were identified on the basis of SNDS data. This was done using algorithms to distribute beneficiaries into 56 non-exclusive disease groups of chronic diseases, health events, and chronic treatments, assembled into 13 main categories 37,38.…”

Breast cancer screening: Impact on care pathways

“…The French compulsory National Health Insurance system has compiled a database recording expenses related to hospitalization or outpatient care for every patient, called the French National healthcare data system (SNDS). The French Cancer Cohort has been extracted from this database and includes all individuals having suffered from cancer (in situ, invasive, or tumor with unpredictable outcome) since 2010, resulting in inpatient hospital care, outpatient care, or registration under the long‐term disease (LTD) status for cancer care that enables 100% cover by National Health Insurance. At the time of inclusion, no distinction was made between incident cases (recently diagnosed) and prevalent cases (diagnosed in previous years).…”