Inequity in access to personalized medicine in France: Evidences from analysis of geo variations in the access to molecular profiling among advanced non-small-cell lung cancer patients: Results from the IFCT Biomarkers France Study.

In this article, we studied geographic variation in the use of personalized genetic testing for advanced non-small cell lung cancer (NSCLC) and we evaluated the relationship between genetic testing rates and local socioeconomic and ecological variables. We used data on all advanced NSCLC patients who had a genetic test between April 2012 and April 2013 in France in the frame of the IFCT Biomarqueurs-France study (n = 15814). We computed four established measures of geographic variation of the sex-adjusted rates of genetic testing utilization at the "départment" (the French territory is divided into 94 administrative units called 'départements') level. We also performed a spatial regression model to determine the relationship between département-level sex-adjusted rates of genetic testing utilization and economic and ecological variables. Our results are the following: (i) Overall, 46.87% lung cancer admission patients obtained genetic testing for NSCLC; département-level utilization rates varied over 3.2-fold. Measures of geographic variation indicated a relatively high degree of geographic variation. (ii) there was a statistically significant relationship between genetic testing rates and per capita supply of general practitioners, radiotherapists and surgeons (negative correlation for the latter); lower genetic testing rates were also associated with higher local poverty rates. French policymakers should pursue effort toward deprived areas to obtain equal access to personalized medicine for advanced NSCLC patients.

Two years after cancer diagnosis, what is the relationship between health-related quality of life, coping strategies and spirituality?

This study aimed to analyze the relationship between spirituality, coping strategies and health-related quality of life (HRQL) among a large representative sample of patients two years after cancer diagnosis. Using a cross-sectional design, medical and self-reported data were collected by physicians and a patient telephone interview, respectively. Among 4270 participants, 54.6% reported that spirituality was not a source of comfort at all during the disease, 23.4% stated that it was a source of moderate comfort and 22.5% a source of great comfort. After adjustment for age, gender, educational level and living in a couple, a multivariate analysis showed that a lower mental HRQL score was independently associated with finding moderate comfort in spirituality when compared with finding no comfort at all. After multiple adjustment, a lower score of physical HRQL and a higher score of fighting spirit were independently associated with having found great comfort in spirituality when compared with those who found no comfort at all. This study aimed to understand the dynamics of religious beliefs among cancer patients over the disease duration and to understand how these beliefs could be considered and utilized by patients as a source of comfort and support. The results highlight not only the role spirituality may play in disease management and the extent to which it may be a valuable source of comfort during the follow-up of cancer patients, but also its role in the evaluation of the different dimensions of HRQL.