Monitoring Breast Cancer Care Quality at National and Local Level Using the French National Cancer Cohort

Houzard, Sophie; Courtois, Émilie; Benjamin, Christine; Erbault, M.; Arnould́, Laurent; Barranger, Emmanuel; Couturaud, Benoît; Cutuli, B.; Crémoux, Patricia de; Reilhac, P. De; Seze, Chantal de; Foucaut, Aude-Marie; Gompel, Anne; Honoré, Stéphane; Lesur, A.; Mathelin, Carole; Verzaux, Laurent; Bousquet, Philippe‐Jean

doi:10.1016/j.clbc.2022.05.006

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…Overall, none of the consensual target thresholds were met for the indicators of the quality of breast cancer care pathways in the SMI population. However, this was also the case for women without a preexisting SMI, which corroborates results from studies using recent data on the overall population treated for breast cancer in France [ 53 ]. The odds for meeting care-quality targets were lower for women with SMI for all indicators, but statistically significant differences between cases and controls were only found for indicators of diagnosis process, process between diagnosis and treatment, and follow-up post-treatment.…”

Section: Discussionsupporting

confidence: 90%

“…Finally, we relied on a complementary set of outcome variables covering diagnosis, treatment, follow-up, and mortality. They included highly consensual indicators of the quality of cancer care pathways, taking into account the particularities of a specific cancer site and specifically developed for the SNDS data [ 53 ]. We used information on causes of deaths, for which data linkage was much higher than in previous research [ 32 ], and that was analyzed by considering competing causes of deaths.…”

Section: Discussionmentioning

confidence: 99%

“…The indicators cover diagnosis, treatment, and follow-up of breast cancer. For each indicator, a target threshold (representing the ideal share of women for which the indicator should be met) and an alert threshold (representing the share of women under or above which there should be concerns regarding the quality of the care provided) have been previously defined based on expert consensus [ 52 , 53 ]. The indicators were first programmed on the French cancer cohort by INCa before being adapted and applied to our study population.…”

Section: Methodsmentioning

confidence: 99%

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Breast Cancer Care Pathways for Women with Preexisting Severe Mental Disorders: Evidence of Disparities in France?

Seppänen

Daniel

Houzard

et al. 2023

JCM

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The excess cancer mortality in persons with severe mental illness (SMI) has been well documented, and research suggests that it may be influenced by care-related factors. Our objective was to assess breast cancer care pathways in women with SMI in France, using an exhaustive population-based data-linkage study with a matched case-control design. The cases were 1346 women with incident breast cancer in 2013/2014 and preexisting SMI who were matched with three controls without SMI presenting similar demographics, initial breast cancer type, and year of incidence. We compared cancer care pathways and their quality for cases and controls, using a consensual set of indicators covering diagnosis, treatment, follow-up, and mortality (until 2017). After adjusting for covariates, cases had lower odds to undergo the main diagnostic tests, lumpectomy, adjuvant chemotherapy, and radiotherapy, as well as hormone therapy, but higher odds for mastectomy. Suboptimal quality in cancer pathways was observed for both groups, but to a higher extent for cases, especially for not receiving timely care after diagnosis and post-treatment follow-up. Breast cancer mortality, considering competing risks of deaths, was significantly elevated in women with SMI. These findings highlight disparities in cancer care pathways for individuals with SMI, as well as specific aspects of the care continuum which could benefit from targeted actions to reach equity of outcomes.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Breast Cancer Care Pathways for Women with Preexisting Severe Mental Disorders: Evidence of Disparities in France?

Seppänen

Daniel

Houzard

et al. 2023

JCM

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“…The amounts reimbursed by the national health insurance for all these healthcare consumptions are also recorded in this information system. This cohort, whose data have already been used to trace the care pathway of patients treated for breast cancer ( 18 ) or assess access to palliative care in France ( 19 , 20 ), offers unique resources for an exhaustive evaluation, at a national level, of the health care expenditure of patients with thyroid cancer.…”

Section: Introductionmentioning

confidence: 99%

Hypoparathyroidism-related health care utilization and expenditure during the first postoperative year after total thyroidectomy for cancer: a comprehensive national cohort study

et al. 2023

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ObjectivesHypoparathyroidism is the most common complication of total thyroidectomy for cancer, and requires calcium and/or vitamin D supplementation for an unpredictable period of time. The additional cost associated with this complication has not hitherto been assessed. The aim of this study was to assess the economic burden of postoperative hypoparathyroidism after total thyroidectomy for cancer in France.MethodsBased on the French national cancer cohort, which extracts data from the French National Health Data System (SNDS), all adult patients who underwent a total thyroidectomy for cancer in France between 2011 and 2015 were identified, and their healthcare resource use during the first postoperative year was compared according to whether they were treated postoperatively with calcium and/or vitamin D or not. Univariate and multivariate cost analyses were performed with the non-parametric Wilcoxon test and generalized linear model (gamma distribution and log link), respectively.ResultsAmong the 31,175 patients analyzed (75% female, median age: 52y), 13,247 (42%) started calcium and/or vitamin D supplementation within the first postoperative month, and 2,855 patients (9.1%) were still treated at 1 year. Over the first postoperative year, mean overall and specific health expenditures were significantly higher for treated patients than for untreated patients: €7,233 vs €6,934 per patient (p<0.0001) and €478.6 vs €332.7 per patient (p<0.0001), respectively. After adjusting for age, gender, Charlson Comorbidity index, ecological deprivation index, types of thyroid resection, lymph node dissection and complications, year and region, the incremental cost of overall health care utilization was €142 (p<0.004).ConclusionOur study found a significant additional cost in respect of health expenditures for patients who had hypoparathyroidism after thyroidectomy for cancer, over the first postoperative year. Five-year follow-up is planned to assess the impact of more severe long-term complications on costs.

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Actualisation des indications chirurgicales et des indicateurs de qualité et sécurité des soins dans la prise en charge des carcinomes mammaires invasifs

Mathelin,

Brousse,

Schmitt

et al. 2024

Gynécologie Obstétrique Fertilité & Sénologie

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Monitoring Breast Cancer Care Quality at National and Local Level Using the French National Cancer Cohort

Cited by 4 publications

References 23 publications

Breast Cancer Care Pathways for Women with Preexisting Severe Mental Disorders: Evidence of Disparities in France?

Breast Cancer Care Pathways for Women with Preexisting Severe Mental Disorders: Evidence of Disparities in France?

Hypoparathyroidism-related health care utilization and expenditure during the first postoperative year after total thyroidectomy for cancer: a comprehensive national cohort study

Actualisation des indications chirurgicales et des indicateurs de qualité et sécurité des soins dans la prise en charge des carcinomes mammaires invasifs

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