Access to primary care and mortality in excess for patients with cancer in France: Results from 21 French Cancer Registries.

Autor: Gardy J; FRANCIM Network, Toulouse, France.; ANTICIPE U1086 INSERM-UCN, Caen, France.; Calvados Digestive Cancer Registry, University Hospital of Caen, Caen, France.; Calvados General Tumor Registry, Centre François Baclesse, Caen, France., Wilson S; ANTICIPE U1086 INSERM-UCN, Caen, France., Guizard AV; FRANCIM Network, Toulouse, France.; Calvados General Tumor Registry, Centre François Baclesse, Caen, France., Bouvier V; FRANCIM Network, Toulouse, France.; ANTICIPE U1086 INSERM-UCN, Caen, France.; Calvados Digestive Cancer Registry, University Hospital of Caen, Caen, France., Launay L; ANTICIPE U1086 INSERM-UCN, Caen, France., Alves A; FRANCIM Network, Toulouse, France.; ANTICIPE U1086 INSERM-UCN, Caen, France.; Calvados Digestive Cancer Registry, University Hospital of Caen, Caen, France., Bara S; FRANCIM Network, Toulouse, France.; Manche Cancer Registry, Cherbourg-en-Cotentin, France., Bouvier AM; FRANCIM Network, Toulouse, France.; Digestive Cancer Registry of Burgundy, Dijon, France.; Dijon University Hospital, Dijon, France.; NSERM UMR 1231, I, Dijon, France.; University of Burgundy, Dijon, France., Coureau G; FRANCIM Network, Toulouse, France.; University of Bordeaux, Gironde General Cancer Registry, Bordeaux, France.; Inserm, Bordeaux Population Health, Research Center U1219, Team EPICENE, Bordeaux, France.; CHU Bordeaux, Bordeaux, France., Cowppli-Bony A; FRANCIM Network, Toulouse, France.; Loire-Atlantique/Vendée Cancer Registry, Nantes, France.; SIRIC ILIAD INCa-DGOS-Inserm_12558, CHU Nantes, Nantes, France.; CERPOP, UMR 1295, Université de Toulouse III, Toulouse, France., Dabakuyo Yonli S; FRANCIM Network, Toulouse, France.; National Quality of Life and Cancer Clinical Research Platform, Georges François Leclerc Cancer Center -UNICANCER, Dijon, France., Daubisse-Marliac L; FRANCIM Network, Toulouse, France.; Tarn Cancer Registry, Claudius Regaud Oncopole, IUCT-O, Toulouse, France.; CERPOP INSERM U1295, Toulouse III University, Toulouse, France.; Toulouse University Hospital, Toulouse, France., Defossez G; FRANCIM Network, Toulouse, France.; Poitou-Charentes General Cancer Registry, CHU de Poitiers, Poitiers, France.; CIC-1402 INSERM, Université de Poitiers, Poitiers, France., Hammas K; FRANCIM Network, Toulouse, France.; Haut-Rhin Cancer Registry, Groupe hospitalier de la région de Mulhouse et Sud-Alsace (GHRMSA), Mulhouse, France., Hure F; FRANCIM Network, Toulouse, France.; Haute-Vienne General Cancer Registry, CHU Limoges, Limoges, France., Jooste V; FRANCIM Network, Toulouse, France.; Digestive Cancer Registry of Burgundy, Dijon, France.; Dijon University Hospital, Dijon, France.; NSERM UMR 1231, I, Dijon, France.; University of Burgundy, Dijon, France., Lapotre-Ledoux B; FRANCIM Network, Toulouse, France.; Somme Cancer Registry, CHU Amiens-Picardie, Amiens, France.; CHIMERE (Chirurgie, imagerie et régénération tissulaire de l'extrémité céphalique - Caractérisation morphologique et fonctionnelle) UR UPJV, Amiens, France., Nousbaum JB; FRANCIM Network, Toulouse, France.; Digestive Tumor Registry of Finistère, Brest University Hospital, Brest, France.; EA 7479 SPURBO, Brest University Hospital, Brest, France.; Hepato-Gastroenterology Department, University Hospital, Brest, France., Plouvier S; FRANCIM Network, Toulouse, France.; Lille Area General Cancer Registry, GCS-C2RC Alliance Cancer, Lille, France., Seigneurin A; FRANCIM Network, Toulouse, France.; Isère Cancer Registry, CHU Grenoble Alpes, Pavillon E - BP 217, Grenoble CEDEX 9, France., Tretarre B; FRANCIM Network, Toulouse, France.; CERPOP INSERM U1295, Toulouse III University, Toulouse, France.; Hérault Cancer Registry, Montpellier, France., Vigneron N; FRANCIM Network, Toulouse, France.; Calvados General Tumor Registry, Centre François Baclesse, Caen, France., Woronoff AS; FRANCIM Network, Toulouse, France.; Doubs Cancer Registry, University hospital Besançon, Besançon, France., Launoy G; ANTICIPE U1086 INSERM-UCN, Caen, France., Molinie F; FRANCIM Network, Toulouse, France.; Loire-Atlantique/Vendée Cancer Registry, Nantes, France.; SIRIC ILIAD INCa-DGOS-Inserm_12558, CHU Nantes, Nantes, France.; CERPOP, UMR 1295, Université de Toulouse III, Toulouse, France., Bryere J; ANTICIPE U1086 INSERM-UCN, Caen, France., Dejardin O; ANTICIPE U1086 INSERM-UCN, Caen, France.; Epidemiology Research and Evaluation Unit, Department of Research, University Hospital of Caen, Caen, France.
Jazyk: angličtina
Zdroj: Cancer [Cancer] 2024 Dec 01; Vol. 130 (23), pp. 4096-4108. Date of Electronic Publication: 2024 Aug 20.
DOI: 10.1002/cncr.35519
Abstrakt: Background: The impact of geographical accessibility on cancer survival has been investigated in few studies, with most research focusing on access to reference care centers, using overall mortality and limited to specific cancer sites. This study aims to examine the association of access to primary care with mortality in excess of patients with the 10 most frequent cancers in France, while controlling for socioeconomic deprivation.
Methods: This study included a total of 151,984 cases diagnosed with the 10 most common cancer sites in 21 French cancer registries between 2013 and 2015. Access to primary care was estimated using two indexes: the Accessibilité Potentielle Localisée index (access to general practitioners) and the Scale index (access to a range of primary care clinicians). Mortality in excess was modelized using an additive framework based on expected mortality based on lifetables and observed mortality.
Findings: Patients living in areas with less access to primary care had a greater mortality in excess for some very common cancer sites like breast (women), lung (men), liver (men and women), and colorectal cancer (men), representing 46% of patients diagnosed in our sample. The maximum effect was found for breast cancer; the excess hazard ratio was estimated to be 1.69 (95% CI, 1.20-2.38) 1 year after diagnosis and 2.26 (95% CI, 1.07-4.80) 5 years after diagnosis.
Interpretation: This study revealed that this differential access to primary care was associated with mortality in excess for patients with cancer and should become a priority for health policymakers to reduce these inequalities in health care accessibility.
(© 2024 American Cancer Society.)
Databáze: MEDLINE
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