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Between 30% and 70% of patients with breast cancer have pre-existing chronic conditions, and more than half are on long-term non-cancer medication at the time of diagnosis. Preliminary epidemiological evidence suggests that some non-cancer medications may affect breast cancer risk, recurrence, and survival. In this nationwide cohort study, we assessed the association between medication use at breast cancer diagnosis and survival. We included 235,368 French women with newly diagnosed non-metastatic breast cancer. In analyzes of 288 medications, we identified eight medications positively associated with either overall survival or disease-free survival: rabeprazole, alverine, atenolol, simvastatin, rosuvastatin, estriol (vaginal or transmucosal), nomegestrol, and hypromellose; and eight medications negatively associated with overall survival or disease-free survival: ferrous fumarate, prednisolone, carbimazole, pristinamycin, oxazepam, alprazolam, hydroxyzine, and mianserin. Full results are available online from an interactive platform ( https://adrenaline.curie.fr ). This resource provides hypotheses for drugs that may naturally influence breast cancer evolution.
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Neoplasias de la Mama , Humanos , Femenino , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Estudios de Cohortes , Comorbilidad , SimvastatinaRESUMEN
To better document cervical cancer screening (CCS) pathways, the purpose of our study was to examine CCS pathways among women who had undergone a screening test (opportunistic or organised programme), based on real-life data over a 7-year period. This study used data from the French national health care database (SNDS), which covers almost 100 % of the French population of around 66 million inhabitants. Data from 2015 to 2021 were extracted. More than one quarter (27 %) of women who were at least 25 years old in 2015 and up to 65 years old in 2021 were not screened over the 2015-2021 period. Compared to women who had undergone screening at least once, women who were not screened were older (36 % vs. 23 % in the 50-59 years age group in 2015) and lived in the most deprived urban areas (21 % vs 16 % for less and most deprived respectively). 57 % of women underwent screening within recommended intervals, 13 % of women were under-screened, and 30 % were overscreened. Overall, our study identified that, in 2021, women who participated in the French organised screening programme were less likely to be screened within the recommended interval over the 7-year period. These analyses need to be continued over time in order to assess whether the programme helps reintegrate women into the screening process.
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Increasing evidence implicates the tumor microbiota as a factor that can influence cancer progression. In patients with colorectal cancer (CRC), we found that pre-resection antibiotics targeting anaerobic bacteria substantially improved disease-free survival by 25.5%. For mouse studies, we designed an antibiotic silver-tinidazole complex encapsulated in liposomes (LipoAgTNZ) to eliminate tumor-associated bacteria in the primary tumor and liver metastases without causing gut microbiome dysbiosis. Mouse CRC models colonized by tumor-promoting bacteria (Fusobacterium nucleatum spp.) or probiotics (Escherichia coli Nissle spp.) responded to LipoAgTNZ therapy, which enabled more than 70% long-term survival in two F. nucleatum-infected CRC models. The antibiotic treatment generated microbial neoantigens that elicited anti-tumor CD8+ T cells. Heterologous and homologous bacterial epitopes contributed to the immunogenicity, priming T cells to recognize both infected and uninfected tumors. Our strategy targets tumor-associated bacteria to elicit anti-tumoral immunity, paving the way for microbiome-immunotherapy interventions.
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COVID-19 AND CANCERS: HOW TO DO BETTER IN A CRISIS? The occurrence of the Sars-CoV-2 pandemic has profoundly disorganized the care pathways. The situation of oncology quickly appeared as specific because of the high and frequent risk of loss of chance, limited by the he mobilization of screening and care actors, as well as the deployment of a dedicated crisis organization. However, the persistence of a decrease in the activity of surgical removal of esophageal and gastric cancers still raises questions and prompts to remain vigilant and active. The experience of the Covid-19 pandemic has allowed practices to evolve in the long term, for example the better consideration of the immunodepression of cancer patients. Crisis management has highlighted the need for management based on updated indicators and the need to improve information systems in this respect. These elements have been integrated into the ten-year cancer control strategy, which includes actions dedicated to crisis management.
COVID-19 ET CANCERS : COMMENT FAIRE MIEUX EN SITUATION DE CRISE ? La survenue de la pandémie de Sars-CoV-2 a désorganisé profondément les parcours de soins. La situation de la cancérologie est rapidement apparue comme spécifique en raison du risque élevé et fréquent de pertes de chance, limité par la mobilisation des acteurs du dépistage et du soin ainsi que le déploiement d'une organisation de crise dédiée. Pourtant, la persistance d'une diminution d'activité de chirurgie d'exérèse des cancers de l'oesophage et de l'estomac interroge encore et incite à rester vigilant et actif. L'expérience de la pandémie de Covid-19 a permis de faire évoluer durablement les pratiques, par exemple par la meilleure prise en compte de l'immunodépression des patients atteints de cancer. La gestion de crise a mis en évidence l'enjeu d'un pilotage sur indicateurs actualisés et la nécessité d'améliorer en ce sens les systèmes d'information. Ces éléments ont été intégrés à la stratégie décennale de lutte contre les cancers qui prévoit des actions dédiées à la gestion de crise.
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COVID-19 , Neoplasias , Humanos , SARS-CoV-2 , Pandemias/prevención & control , Neoplasias/epidemiología , Neoplasias/terapia , Atención a la SaludRESUMEN
Importance: COVID-19 has had a major effect on health care activities, especially surgery. At first, comparisons were proposed using 2019 activities as the highest standard. However, while such an approach might have been suitable during the first months of the pandemic, this might no longer be the case for a longer period. Objective: To examine approaches that may better assess the use of cancer surgeries. Design, Setting, and Participants: In a cross-sectional design, the nationwide French hospital facility data (Medicalised Information System Program) were used to assess cancer surgery for 6 cancer site categories in adults from January 1, 2010, to December 31, 2021. Exposure: Estimated cancer surgery activity during the COVID-19 pandemic. Main Outcomes and Measures: Three models were proposed to assess the expected number of surgical procedures between 2020 and 2021 and make a comparison with those observed in earlier years. Results: In France, cancer removal surgeries account for approximately 7000 hospitalizations per year for liver cancer; 4000 for pancreatic cancer; 7700 for ovarian cancer; 1300 for esophagus cancer; 23â¯000 for ear, nose, and throat (ENT) cancer; 78â¯000 for breast cancer; and 16â¯600 for thoracic cancers. For most cancer sites, the number of surgical procedures increased from 2010 to 2019: liver, 14%; pancreas, 38%; ovary, 14%; esophagus, 18%; breast, 8%; and thoracic, 29%. Assuming stability, these values underestimate the gap in activity observed in 2020-2021. For other procedures, a decrease was observed: stomach, -10%, and ENT, -6%. Assuming stability, these values overestimate the gap in activity observed in 2020-2021. At the end of 2021, according to the model, the gap in activity observed in 2020-2021 was estimated at between -1.4% and 1.7% for breast, -6.6% and -7.3% for thoracic, -3.1% and -2.5% for ovarian, -4.2% and -1.7% for pancreas, -6.7% and 5.9% for stomach, and -13.0% and -13.9% for esophageal cancers. For ENT, liver, and urologic cancers, because the trend was different before and after 2015, it was necessary to opt for modeling using only the most recent period. The cumulative gap in activity observed in 2020-2021 was estimated at -1.0% for ENT cancers, -5.3% for liver cancers, and -2.9% for urologic cancers. Conclusions and Relevance: The findings of this study suggest that short- and medium-term trends must be considered to estimate COVID-19 cancer surgery activities. Breast cancer is the site for which the activity showed the smallest decrease during the pandemic, with almost full recovery in 2021.
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Neoplasias de la Mama , COVID-19 , Neoplasias Urológicas , Adulto , Femenino , Humanos , COVID-19/epidemiología , Pandemias , Estudios Transversales , Francia/epidemiologíaRESUMEN
PURPOSE: To evaluate and quantify potential sociodemographic disparities in breast cancer screening, diagnosis, and treatment due to the COVID-19 pandemic, and the use of telemedicine. METHODS: We fielded a 52-item web-based questionnaire from 14 May 2020 to 1 July 2020 in partnership with several U.S.-based breast cancer advocacy groups. Individuals aged 18 or older were eligible for this study if they: (1) received routine breast cancer screening; OR (2) were undergoing diagnostic evaluation for breast cancer; OR (3) had ever been diagnosed with breast cancer. We used descriptive statistics to understand the extent of cancer care delay and telemedicine adoption and used multivariable logistic regression models to estimate the association of sociodemographic factors with odds of COVID-19-related delays in care and telemedicine use. RESULTS: Of 554 eligible survey participants, 493 provided complete data on demographic and socioeconomic factors and were included in the analysis. Approximately half (n = 248, 50.3%) had a personal history of breast cancer. Overall, 188 (38.1%) participants had experienced any COVID-19-related delay in care including screening, diagnosis, or treatment, and 339 (68.8) reported having at least one virtual appointment during the study period. Compared to other insurance types, participants with Medicaid insurance were 2.58 times more likely to report a COVID-19-related delay in care (OR 2.58, 95% Cl: 1.05, 6.32; p = 0.039). Compared to participants with a household income of less than USD 50,000, those with a household income of USD 150,000 or more were 2.38 (OR 2.38, 95% Cl: 1.09, 5.17; p = 0.029) times more likely to adopt virtual appointments. Self-insured participants were 70% less likely to use virtual appointment compared to those in other insurance categories (OR 0.28, 95% Cl: 0.11, 0.73; p = 0.009). CONCLUSIONS: The COVID-19 pandemic has had a significant impact on breast cancer screening, diagnosis, and treatment, and accelerated the delivery of virtual care. Lower-income groups and patients with certain insurance categories such as Medicaid or self-insured could be more likely to experience care delay or less likely to use telemedicine. Careful attention must be paid to vulnerable groups to insure equity in breast cancer-related service utilization and telemedicine access during and beyond the COVID-19 pandemic.
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Neoplasias de la Mama , COVID-19 , Telemedicina , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Prueba de COVID-19 , Detección Precoz del Cáncer , Femenino , Humanos , Pandemias , Medición de Resultados Informados por el Paciente , Tiempo de Tratamiento , Estados UnidosRESUMEN
INTRODUCTION: Treatment advances for metastatic breast cancer (mBC) have improved overall survival (OS) in some mBC subtypes; however, there remains no cure for mBC. Considering the use of progression-free survival (PFS) and other surrogate endpoints in clinical trials, we must understand patient perspectives on measures used to assess treatment efficacy. OBJECTIVE: To explore global patient perceptions of the concept of PFS and its potential relation to quality of life (QoL). MATERIALS AND METHODS: Virtual roundtables in Europe and the United States and interviews in Japan with breast cancer patients, patient advocates, and thought leaders. Discussions were recorded, transcribed, and analyzed thematically. RESULTS: Lengthened OS combined with no worsening or improvement in QoL remain the most important endpoints for mBC patients. Time when the disease is not progressing is meaningful to patients when coupled with improvements in QoL and no added treatment toxicity. Clinical terminology such as "PFS" is not well understood, and participants underscored the need for patient-friendly terminology to better illustrate the concept. Facets of care that patients with mBC value and that may be related to PFS include relief from cancer-related symptoms and treatment-related toxicities as well as the ability to pursue personal goals. Improved communication between patients and providers on managing treatment-related toxicities and addressing psychosocial challenges to maintain desired QoL is needed. CONCLUSION: While OS and QoL are considered the most relevant endpoints, patients also value periods of time without disease progression. Incorporation of these considerations into the design and conduct of future clinical trials in mBC, as well as HTA and reimbursement decision-making, is needed to better capture the potential value of a therapeutic innovation.
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Neoplasias de la Mama , Calidad de Vida , Neoplasias de la Mama/tratamiento farmacológico , Progresión de la Enfermedad , Femenino , Humanos , Supervivencia sin Progresión , Resultado del TratamientoRESUMEN
PURPOSE: The French National Cancer Institute has developed, in partnership with the French National Authority for Health, breast cancer-specific Care Quality, and Safety Indicators (BC QIs). With regard to the most common form of cancer, our aim is to support local and national quality initiatives, to improve BC pathways and outcomes, reduce heterogeneity of practice and regional inequities. In this study, we measure the BC QIs available in the French National medico-administrative cancer database, the French Cancer Cohort, for 2018. MATERIALS AND METHODS: BC QIs are developed according to the RAND method. QIs are based on good clinical practice and care pathway recommendations. QI computation should be automatable without any additional workload for data collection. They will be published annually for all stakeholders, and especially hospitals. RESULTS: Finally, ten feasible and pertinent QIs were selected. In France, BC care was found to be close to compliance with most QIs: proportion of patients undergoing biopsy prior to first treatment (94.5%), proportion of patients undergoing adjuvant radiotherapy after breast-conserving surgery for BC (94.5%), proportion of women undergoing radiotherapy within 12 weeks after surgery and without chemotherapy (86.2%), proportion of DCIS patients undergoing immediate breast reconstruction (54.3%) and proportion of women with NMIBC undergoing breast reintervention (14.4%). However, some are still far from their recommended rate. In particular, some QIs vary considerably from one region, or one patient, to another. CONCLUSION: Each result needs to be analyzed locally to find care quality leverage. This will strengthen transparency actions aimed at the public.
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Neoplasias de la Mama , Neoplasias de la Mama/patología , Femenino , Humanos , Mastectomía Segmentaria , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de Salud , Radioterapia AdyuvanteRESUMEN
BACKGROUND: Breast cancer (BC) is the most frequent cancer and the leading cause of cancer-related death in women. The French National Cancer Institute has created a national cancer cohort to promote cancer research and improve our understanding of cancer using the National Health Data System (SNDS) and amalgamating all cancer sites. So far, no detailed separate data are available for early BC. OBJECTIVES: To describe the creation of the French Early Breast Cancer Cohort (FRESH). METHODS: All French women aged 18 years or over, with early-stage BC newly diagnosed between 1 January 2011 and 31 December 2017, treated by surgery, and registered in the general health insurance coverage plan were included in the cohort. Patients with suspected locoregional or distant metastases at diagnosis were excluded. BC treatments (surgery, chemotherapy, targeted therapy, radiotherapy, and endocrine therapy), and diagnostic procedures (biopsy, cytology, and imaging) were extracted from hospital discharge reports, outpatient care notes, or pharmacy drug delivery data. The BC subtype was inferred from the treatments received. RESULTS: We included 235,368 patients with early BC in the cohort (median age: 60 years). The BC subtype distribution was as follows: luminal (80.2%), triple-negative (TNBC, 9.5%); HER2+ (10.3%), or unidentifiable (n = 44,388, 18.9% of the cohort). Most patients underwent radiotherapy (n = 200,685, 85.3%) and endocrine therapy (n = 165,655, 70.4%), and 38.3% (n = 90,252) received chemotherapy. Treatments and care pathways are described. CONCLUSIONS: The FRESH Cohort is an unprecedented population-based resource facilitating future large-scale real-life studies aiming to improve care pathways and quality of care for BC patients.
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The COVID-19 pandemic has had a substantial and lasting impact on care provision, particularly in the field of cancer care. National steering has helped monitor the health situation and adapt the provision and organisation of care. Based on data from the French administrative healthcare database (SNDS) on the entire French population (67 million people), screening, diagnostic and therapeutic activity was monitored and compared 2019 on a monthly basis. A noteworthy decline in all activities (with the exception of chemotherapy) was observed during the first lockdown in France. Over the months that followed, this activity returned to normal but did not make up for the shortfall from the first lockdown. Finally, during the lockdown in late 2020, cancer care activity was conserved. In brief, in 2020, the number of mammograms decreased by 10% (- 492,500 procedures), digestive endoscopies by 19% (- 648,500), and cancer-related excision by 6% (- 23,000 surgical procedures). Hospital radiotherapy activity was down 3.8% (- 4400 patients) and that in private practice was down 1.4% (- 1600 patients). Chemotherapy activity increased by 2.2% (7200 patients), however. To summarize, COVID-19 had a very substantial impact during the first lockdown. Safeguarding cancer care activity helped limit this impact over the months that followed, but the situation remains uncertain. Further studies on the medium- and long-term impact on individuals (survival, recurrence, after-effects) will be conducted.
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COVID-19 , Atención a la Salud/estadística & datos numéricos , Neoplasias/diagnóstico , Neoplasias/terapia , Servicio de Oncología en Hospital/estadística & datos numéricos , Cuarentena/estadística & datos numéricos , COVID-19/prevención & control , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/estadística & datos numéricos , Atención a la Salud/métodos , Francia/epidemiología , HumanosRESUMEN
BACKGROUND: Since 2004, an organised screening programme (OS) for breast cancer has been in place for 50-74 years women who are not at an increased risk. Despite this, 17% of cancers diagnosed within 24 months following an OS mammogram are interval cancers (IC), diagnosed even though the OS had not reported cancer. After identifying IC from the French administrative healthcare database (SNDS), our objective was to describe the care pathways of women with IC in 2016. MATERIALS AND METHODS: The IC identification algorithm is based on breast imaging tests conducted in the 24 months prior to diagnosis and on the compatibility of their timeline with ACR3 lesion follow-up (BIRADS guidelines). The care pathways of 3 groups were compared: women with IC, diagnosed through the OS, and diagnosed outside the OS programme (personalised screening or based on clinical signs, PSCS group). RESULTS: Respectively, 12,965 (46%), 3433 (12%), and 11,761 women (42%) were classified in the OS, IC and PSCS groups, i.e. 20.9% IC cases among the women taking part in the OS programme. The women from the IC group presented with more forms with lymph node or metastatic involvement than those of the OS group. Their pathways were more complex than in the OS group: at an equivalent stage, more total mastectomies and more adjuvant or neoadjuvant chemotherapy regimens. CONCLUSION: The care pathways of women with IC are intermediate with respect to those of the OS or PSCS group.Cases of IC probably include several cancer prognosis profiles.
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Neoplasias de la Mama , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/terapia , Vías Clínicas , Femenino , Humanos , Mamografía , Tamizaje Masivo/métodos , PronósticoRESUMEN
BACKGROUND: Adjuvant endocrine therapy (AET) improves long-term survival of breast cancer patients, yet many women are nonadherent or discontinue this treatment. In this study we aimed to describe AET adherence trajectories over 5 years after treatment initiation and to identify factors associated with these trajectories, in a nationwide French cohort of breast cancer survivors. PATIENTS AND METHODS: Every woman diagnosed with a first nonmetastatic breast cancer in 2011 in France who initiated AET in the 12 months after surgery was included from the French cancer cohort. We identified all reimbursements for AET from national health administrative data sets and modeled AET adherence trajectories over 5 years, using group-based trajectory modeling on the basis of the monthly proportion of days covered by AET. Associated factors were identified using multinomial logistic regressions. RESULTS: We included 33,260 women. A 6-trajectory model was selected: 1, immediate discontinuation (6.6%); 2, continuous suboptimal adherence (4.3%); 3, progressive nonadherence then discontinuation (6.3%); 4, early nonadherence then discontinuation (5.7%); 5, continuous optimal adherence (68.8%); and 6, late nonadherence then discontinuation (8.3%). The main factors associated with nonadherence trajectories were extreme age (younger than 50 and older than 70 years) and switching AET. CONCLUSION: Approximately 70% of women had optimal adherence over all 5 years. The original nationwide approach enabled us to identify the "continuous suboptimal adherence trajectory" never previously described.
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Antineoplásicos Hormonales/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/psicología , Supervivientes de Cáncer/psicología , Antagonistas de Estrógenos/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Supervivientes de Cáncer/estadística & datos numéricos , Quimioterapia Adyuvante , Estudios de Cohortes , Femenino , Francia , Humanos , Mastectomía , Persona de Mediana Edad , Tamoxifeno/uso terapéuticoRESUMEN
BACKGROUND: Closely linked to the concept of supportive care, the integrated model of palliative care (PC) implies identifying, assessing and treating physical and psychological suffering as early as needed, irrespective of patient characteristics. In France, as in the most southern European countries, little is known about the proportion of cancer patients who have access to PC. Accordingly, we aimed in this study to estimate the proportion of cancer patients in France who have access to inpatient PC, and to explore associated factors. We carried out a nationwide retrospective cohort study using data from the French national health system database (SNDS) for all individuals diagnosed with cancer in 2013 and followed between 2013 and 2016. We compared patients who had inpatient PC with those who did not. RESULTS: Of the 313,059 cancer patients included in the national French cancer cohort in 2013, 53,437 (17%) accessed inpatient PC at least once between 2013 and 2016, ranging from 2% in survivors to 56% in the deceased population. Multivariate logistic regression revealed that women and younger patients (18-49 years old) were less likely to access inpatient PC while patients with a greater number of comorbidities, metastatic cancer, or cancer of the nervous system, were more likely to have done so. CONCLUSIONS: A negligible proportion of cancer survivors accessed inpatient PC. More research and training are needed to convince healthcare providers, patients, and families about the substantial benefits of PC, and to promote better integration of PC and oncology.
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Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Neoplasias/terapia , Cuidados Paliativos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Controversy persists concerning screening programs (SPs), related to a potential risk of overdiagnosis or the impact on survival. One of the main questions to be addressed concerns the aggressiveness of the related treatments. METHODS: Using the "Cancer Cohort," a national-based cohort (medico-administrative database), all women between the ages of 50 and 74 years and treated in 2014 for incident breast cancer were compared, according to whether their diagnosis was made following a mammogram performed within the framework of the SP (SP group) or outside it (NSP group). RESULTS: A total of 23 788 women were identified: 13 530 (57%) in the SP group and 10 258 (43%) in the NSP group. The women in the SP group had a higher rate of in situ or localized invasive breast cancer. They had a higher rate of breast-conserving surgery (82% vs 70%), and a lower rate of chemotherapy (34% vs 53%). These findings were observed irrespective of the stage. They had a higher rate of pathways involving breast-conserving surgery followed by radiotherapy. Among women with metastatic cancer, those in the SP group had a lower proportion of liver, lung, brain, and bone metastases, and a higher proportion of lymph node metastases (other than axillary), irrespective of the time to onset of the metastases. CONCLUSION: The women in whom cancer was diagnosed following a mammogram performed in the context of the SP had less advanced cancer and less aggressive treatments. This observational study helps illustrate the benefit of the SP in France using a different approach.
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Neoplasias de la Mama/epidemiología , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Vías Clínicas , Bases de Datos Factuales , Manejo de la Enfermedad , Detección Precoz del Cáncer , Femenino , Francia/epidemiología , Humanos , Mamografía , Tamizaje Masivo , Mastectomía Segmentaria , Uso Excesivo de los Servicios de Salud , Persona de Mediana Edad , Vigilancia en Salud PúblicaRESUMEN
INTRODUCTION: This study describes the characteristics, management and outcome of patients one year after a diagnosis of renal cancer, according to the presence of a history of another tumour and metastases at diagnosis or during the first year. METHODS: Based on information from the national health data system (SNDS), 10,989 general scheme beneficiaries (>15 years) with a first hospital stay in 2015 for renal cancer were divided into groups according to the presence of a history of another tumour or metastases. RESULTS: In this cohort of 10,989 people (75 years and older: 30%, men: 65%), 12% had a history of another tumour diagnosed during the two years before and 22% presented one or more metastases at the time of the index hospitalisation or during the following year. Overall, nephrectomy was performed in 56% of cases (partial nephrectomy in 29% of cases), in 63% and 36% of cases without metastases and in 68% and 40% of cases without metastases and with no history of another tumour. Overall, 2% of patients received at least one monoclonal antibody and 15% received a protein kinase inhibitor. These drugs were used in 6% and 53% of cases, respectively, in the presence of metastases and in 7% and 31% of cases, respectively, in the presence of metastases and a history of another tumour. CONCLUSION: This study highlights the high rate of a history of another tumour and adaptation of treatment according to a history of cancer and the presence of metastases.
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Neoplasias Renales/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Manejo de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Inmunoterapia , Neoplasias Renales/patología , Neoplasias Renales/terapia , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Neoplasias Primarias Secundarias/epidemiología , Nefrectomía , Adulto JovenRESUMEN
BACKGROUND: In 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. OBJECTIVES: The aim is to describe the French national cancer cohort. METHODS: All 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. RESULTS: From 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. CONCLUSION: Based 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.
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Política de Salud , Neoplasias , Atención al Paciente/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Neoplasias/economía , Sistema de Registros/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVE: A significant proportion of cancer survivors experience chronic health sequelae, one of them being fertility impairment. However, even if many reports, guidelines and positions papers focus on fertility preservation and its needs, access to fertility preservation is not currently offered to all the patients concerned, and the targeted population is not well counted. STUDY DESIGN: A cross sectional study was conducted using the French cancer cohort, a cohort covering the whole French population and including around 7 million of cancer patients. Women under the age of 40 and men under the age of 60 included in the cancer cohort in 2013 who had, in the first year, cancer surgery, chemotherapy or radiotherapy were considered. Patients treated by surgery alone for cancers in locations distant from the reproductive organs, or being treated for a cancer the past 3 years were excluded. The number of patients concerned by fertility preservation was estimated at a national and regional level, and by cancer types. RESULTS: 40,000 patients - 30,000 men under the age of 60 years and 10,000 women under the age of 40 years - were identified. A second estimation concerning women under the age of 35 and men under 50 reduced the number of patients to 17,200-10,400 men and 6800 women. The most frequent locations were malignant neoplasm of lymphoid and hematopoietic tissue, lung cancer, cervix uteri, prostate and colorectal cancer. In 2014, around 5 400 persons had a preservation. CONCLUSION: Around 17,200 cancer patients of reproductive age should be informed about the fertility preservation options available. Medical professionals have to better integrate in their daily practice fertility preservation.
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Supervivientes de Cáncer , Preservación de la Fertilidad , Neoplasias , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Salud Pública , Adulto JovenRESUMEN
BACKGROUND: Study of the care pathways is an important topic for care planning, as well as to observe guidelines application. This study aimed to describe care pathways and the period of time between treatments of women with breast cancer (BC), at a population level. MATERIALS AND METHODS: Women with in situ, local and regional BC who were hospitalized and newly treated in 2012 were included and followed for 1 year. Care pathways were described, focusing on surgery (partial mastectomy [PM], total mastectomy [TM]), chemotherapy, and radiotherapy. The periods of time between treatments were measured and compared with the guidelines. RESULTS: The study involved 52,128 women. The most common care pathways among the 2845 women with in situ BC were PM-radiotherapy (46.7%) and TM (28.5%). Among the 41,470 women with local BC, they were: PM-radiotherapy (44.8%) or PM-chemotherapy-radiotherapy (16.0%). The 7813 women with regional BC had similar care pathways, although chemotherapy was given more frequently (73%). The periods of time between surgery and chemotherapy were in accordance with the guidelines for 98% of the women; those between surgery and radiotherapy were affected by adjuvant chemotherapy. Finally, the time between chemotherapy and radiotherapy was longer than recommended for 40% of the women. CONCLUSION: The French medicoadministrative databases allow the study, at a national population level, of the care pathways and periods of time between treatments of women with BC according to the stage of the disease. They were close to the guidelines, although an improvement is highly necessary.
Asunto(s)
Neoplasias de la Mama/terapia , Vías Clínicas , Programas Nacionales de Salud , Guías de Práctica Clínica como Asunto/normas , Pautas de la Práctica en Medicina/normas , Quimioterapia Adyuvante , Terapia Combinada , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Francia , Humanos , Mastectomía , Persona de Mediana Edad , Pronóstico , Radioterapia Adyuvante , Estudios RetrospectivosRESUMEN
BACKGROUND: An accurate risk score able to predict in-hospital mortality in patients undergoing surgery may improve both risk communication and clinical decision making. The aim of the study was to develop and validate a surgical risk score based solely on preoperative information, for predicting in-hospital mortality. METHODS: From January 1, 2010, to December 31, 2010, data related to all surgeries requiring anesthesia were collected from all centers (single hospital or hospitals group) in France performing more than 500 operations in the year on patients aged 18 yr or older (n = 5,507,834). International Statistical Classification of Diseases, 10th revision codes were used to summarize the medical history of patients. From these data, the authors developed a risk score by examining 29 preoperative factors (age, comorbidities, and surgery type) in 2,717,902 patients, and then validated the risk score in a separate cohort of 2,789,932 patients. RESULTS: In the derivation cohort, there were 12,786 in-hospital deaths (0.47%; 95% CI, 0.46 to 0.48%), whereas in the validation cohort there were 14,933 in-hospital deaths (0.54%; 95% CI, 0.53 to 0.55%). Seventeen predictors were identified and included in the PreOperative Score to predict PostOperative Mortality (POSPOM). POSPOM showed good calibration and excellent discrimination for in-hospital mortality, with a c-statistic of 0.944 (95% CI, 0.943 to 0.945) in the development cohort and 0.929 (95% CI, 0.928 to 0.931) in the validation cohort. CONCLUSION: The authors have developed and validated POSPOM, a simple risk score for the prediction of in-hospital mortality in surgical patients.