Clinical care pathways of patients with biliary tract cancer: A French nationwide longitudinal cohort study.
Eur J Cancer
; 202: 114018, 2024 May.
Article
em En
| MEDLINE
| ID: mdl-38502987
ABSTRACT
BACKGROUND:
Although the incidence of BTC is raising, national healthcare strategies to improve care lack. We aimed to explore patient clinical care pathways and strategies to improve biliary tract cancer (BTC) care.METHODS:
We analysed the French National Healthcare database of all BTC inpatients between January 1, 2017 and December 31, 2021. Multinomial logistic regression adjusted odds ratios (aOR) were used to identify healthcare organisation factors that influenced access to curative care both overall and in a longitudinal sensibility analysis using optimal matching and hierarchical ascending classification to detect a subgroup of curative-care patients with a high survival over a two-year period.RESULTS:
A total of 19,825 new BTC patients and three clinical care pathways (CCP) were identified 'Palliative care' (PC-CCP), 'Non-curative Care' (NCC-CCP) and 'Curative Care' (CC-CCP) involving 7669 (38.7%), 7721 (38.9%) and 4435 (22.4%) patients respectively. Out of 1200 centers involved in BTC treatment, 84%, 11% and 5% were of low- (<15 patients/year), medium- (15-30 patients/year) and high-volume (>30 patients/year) respectively. Among patient, tumor and hospital factors, BTC management in academic (aOR 2.32; 95%CI 1.98-2.71), private (2.51; 2.22-2.83), semi-private (2.25; 1.91-2.65) and in high- (2.09; 1.81-2.42) or medium-volume (1.49; 1.33-1.68) centers increased probability to CC-CCP. These results were maintained in a longitudinal cluster of 2363 (53%) CC-CCP patients presenting a higher two-year survival compared with the rest [96.4% (95.1; 97.6) vs. 38.8% (36.3; 41.4), log-rank p < 0.001].CONCLUSIONS:
Among factors subject to healthcare policy improvement, the volume and type of centers managing BTC strongly influenced access to curative care.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Neoplasias dos Ductos Biliares
/
Neoplasias do Sistema Biliar
/
Colangiocarcinoma
Limite:
Humans
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article