No effect of comorbidities on the association between social deprivation and geographical access to the reference care center in the management of colon cancer

Rollet, Quentin; Bouvier, Anne–Marie; Launay, Ludivine; Mil, Rémy De; Launoy, Guy; Dejardin, Olivier; Alvès, Arnaud

doi:10.1016/j.dld.2017.10.015

Cited by 12 publications

(11 citation statements)

References 21 publications

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“…Longer travel time to the reference care centres was associated with more unknown presentation in MDTMs. Other studies on registry data showed poorer care management and survival for patients furthest from reference care centres [ 27 , 28 ]. Even if, in this study, travel time was not associated with poorer survival, vigilance is needed to ensure health care equity.…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary team meetings: are all patients presented and does it impact quality of care and survival – a registry-based study

Rollet

Bouvier

Moutel

et al. 2021

BMC Health Serv Res

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Background Multidisciplinary team meetings (MDTMs) are part of the standard cancer care process in many European countries. In France, they are a mandatory condition in the authorization system for cancer care administration, with the goal to ensure that all new patients diagnosed with cancer are presented in MDTMs. Aim Identify the factors associated with non-presentation or unknown presentation in MDTMs, and study the impact of presentation in MDTMs on quality of care and survival in patients diagnosed with colorectal cancer (CRC). Methods 3999 CRC patients diagnosed between 2005 and 2014 in the area covered by the “Calvados Registry of Digestive Tumours” were included. Multivariate multinomial logistic regression was used to assess the factors associated with presentation in MDTMs. Univariate analyses were performed to study the impact of MDTMs on quality of care. Multivariate Cox model and the Log-Rank test were used to assess the impact of MDTMs on survival. Results Non-presentation or unknown presentation in MDTMs were associated with higher age at diagnosis, dying within 3 months after diagnosis, unknown metastatic status, non-metastatic cancer and colon cancer. Non-presentation was associated with a diagnosis after 2010. Unknown presentation was associated with a diagnosis before 2007 and a longer travel time to the reference care centres. Presentation in MDTMs was associated with more chemotherapy administration for patients with metastatic cancer and more adjuvant chemotherapy for patients with stage III colon cancer. After excluding poor prognosis patients, lower survival was significantly associated with higher age at diagnosis, unknown metastatic status or metastatic cancer, presence of comorbidities, rectal cancer and non-presentation in MDTMs (HR = 1.5 [1.1–2.0], p < 0.001). Conclusions Elderly and poor prognosis patients were less presented in MDTMs. Geriatric assessments before presentation in MDTMs were shown to improve care plan establishment. The 100% objective is not coherent if MDTMs are only to discuss diagnosis and curative cares. They could also be a place to discuss therapeutic limitations. MDTMs were associated with better treatment and longer survival. We must ensure that there is no inequity in presentation in MDTMs that could lead to a loss of chance for patients.

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Section: Discussionmentioning

confidence: 99%

Multidisciplinary team meetings: are all patients presented and does it impact quality of care and survival – a registry-based study

Rollet

Bouvier

Moutel

et al. 2021

BMC Health Serv Res

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“…Chow et al [33] observed that, in the US, rural patients with colon cancer were more likely to have a late diagnosis and lower access to proper treatment. Furthermore, Rollet et al [34] assessed if social deprivation and geographical access were mediating the influence of comorbidities and treatment on the rise of colon cancer mortality. They discarded the influence of comorbidities and confirmed geographical disparities in each step of the treatment.…”

Section: Discussionmentioning

confidence: 99%

Describing mortality trends for major cancer sites in 133 intermediate regions of Brazil and an ecological study of its causes

et al. 2019

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Background In Brazil, 211 thousand (16.14%) of all death certificates in 2016 identified cancer as the underlying cause of death, and it is expected that around 320 thousand will receive a cancer diagnosis in 2019. We aimed to describe trends of cancer mortality from 1996 to 2016, in 133 intermediate regions of Brazil, and to discuss macro-regional differences of trends by human development and healthcare provision. Methods This ecological study assessed georeferenced official data on population and mortality, health spending, and healthcare provision from Brazilian governmental agencies. The regional office of the United Nations Development Program provided data on the Human Development Index in Brazil. Deaths by misclassified or unspecified causes (garbage codes) were redistributed proportionally to known causes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed calculating trends for each region, sex and cancer type. Results Trends were predominantly on the increase in the North and Northeast, whereas they were mainly decreasing or stationary in the South, Southeast, and Center-West. Also, the variation of trends within intermediate regions was more pronounced in the North and Northeast. Intermediate regions with higher human development, government health spending, and hospital beds had more favorable trends for all cancers and many specific cancer types. Conclusions Patterns of cancer trends in the country reflect differences in human development and the provision of health resources across the regions. Increasing trends of cancer mortality in low-income Brazilian regions can overburden their already fragile health infrastructure. Improving the healthcare provision and reducing socioeconomic disparities can prevent increasing trends of mortality by all cancers and specific cancer types in Brazilian more impoverished regions.

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“…The first three quintiles were grouped together and compared with the last two as proposed in previous studies. 22 The road distance between a patient's home and the university hospital was transformed into quartile of distribution: <8 km, [8–33], [33–54], ≥54 km. Attending physicians were divided into two groups according to the number of years of practice (<10 or ≥10).…”

Section: Methodsmentioning

confidence: 99%

“…EDI score was separated into national quintiles ( Q 1 represents the most affluent patients and Q 5 the most deprived). The first three quintiles were grouped together and compared with the last two as proposed in previous studies 22 . The road distance between a patient's home and the university hospital was transformed into quartile of distribution: <8 km, [8–33], [33–54], ≥54 km.…”

Section: Methodsmentioning

confidence: 99%

Deprived social status is associated with decreased use of oral chemotherapy in patients with metastatic colorectal cancer: A retrospective cohort study on administrative databases in a French University Hospital

Gautier

Lucas

Vermeulin

et al. 2021

Pharmacology Res & Perspec

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Factors associated with the choice of oral versus intravenous CT are not clearly established. Our purpose was to evaluate the influence of social status and home distance to hospital on the use of oral CT in patients with metastatic colorectal cancer (mCRC). This retrospective single‐center study included mCRC patients between 2011 and 2017. Patient social status was assessed by European Deprivation Index (EDI) and home distance to the hospital was calculated. Univariable and multivariable logistic regression analyses were performed. One hundred and seventy‐five mCRC patients were included, with 71 receiving oral CT. Most deprived patients received less oral CT (OR 0.5 [0.26, 0.96], p = .039). No association was found for road distance. Previous use of adjuvant oral CT was associated with oral CT in mCRC (OR 2.65 [1.06, 6.66], p = .038). Our results suggest that deprived social status is a factor associated with decreased use of oral CT in patients with mCRC. Clinical trial registration: no registration.

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No effect of comorbidities on the association between social deprivation and geographical access to the reference care center in the management of colon cancer

Cited by 12 publications

References 21 publications

Multidisciplinary team meetings: are all patients presented and does it impact quality of care and survival – a registry-based study

Multidisciplinary team meetings: are all patients presented and does it impact quality of care and survival – a registry-based study

Describing mortality trends for major cancer sites in 133 intermediate regions of Brazil and an ecological study of its causes

Deprived social status is associated with decreased use of oral chemotherapy in patients with metastatic colorectal cancer: A retrospective cohort study on administrative databases in a French University Hospital

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