Healthcare system barriers of breast and thyroid screening for childhood and young adulthood cancer survivors in France A qualitative study of the DeNaCaPST programme at one year

Abstract

Purpose Childhood, adolescent and young adult cancer survivors (CAYACS) who were treated by radiotherapy have a significant risk of developing subsequent malignancies, particularly breast and thyroid cancers when the field of irradiation concerned these organs. Advice regarding their increased risk of developing secondary breast (SBC) and thyroid (STC) cancer are recommended to ensure risk-stratified life-long follow-up care including appropriate screening. In France, a national program called DeNaCaPST was started to promote this care. We aimed to explore the perspectives of medical practitioners (MP) on the healthcare system factors that limited inclusion in this programme. Methods Data of the DeNaCAPST programme regarding organisation were studied, including data from a qualitative survey done among MP. Results Seventeen months after the DeNaCaPST programme started, 84.6% of the French regions had participating centres/hospitals, along with one overseas territory. The main barriers to screening highlighted by MP were: 1) inconvenient and under-resourced healthcare professionals to perform these consultations, (2) difficulty determining which CAYACS need SBC and/or STC screening, (3) difficulty organising the network of professionals from paediatric to adult health services. Conclusions Despite a slow inclusion speed and a suboptimal geographical coverage, changes are underway and should allow for several improvements and interesting perspectives for this study. CAYACS lost to follow-up are difficult to invite for a consultation. The absence of real long-term follow-up care is a real barrier to promoting such screening, which must involve a transition care between the paediatric oncologists who know who are at risk and why and the adult medical professionals who have the knowledge to do the screening. The involvement and empowerment of CAYACS is necessary to promote patient-centred healthcare solutions and seems feasible.