Clinical care pathways of patients with biliary tract cancer: A French nationwide longitudinal cohort study.

Biliary tract cancer Cholangiocarcinoma Clinical care pathways Cluster sequence analysis Gallbladder cancer Machine learning Optimal matching PMSI

Journal

European journal of cancer (Oxford, England : 1990)
ISSN: 1879-0852
Titre abrégé: Eur J Cancer
Pays: England
ID NLM: 9005373

Informations de publication

Date de publication:
16 Mar 2024
Historique:
received: 27 11 2023
revised: 07 03 2024
accepted: 12 03 2024
medline: 20 3 2024
pubmed: 20 3 2024
entrez: 19 3 2024
Statut: aheadofprint

Résumé

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. 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. 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]. Among factors subject to healthcare policy improvement, the volume and type of centers managing BTC strongly influenced access to curative care.

Sections du résumé

BACKGROUND 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 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 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 CONCLUSIONS
Among factors subject to healthcare policy improvement, the volume and type of centers managing BTC strongly influenced access to curative care.

Identifiants

DOI: 10.1016/j.ejca.2024.114018 PMID: 38502987
pubmed: 38502987
pii: S0959-8049(24)00674-9
doi: 10.1016/j.ejca.2024.114018
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

114018

Informations de copyright

Copyright © 2024 Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Auteurs

Stylianos Tzedakis (S)

INSERM, UMR 1138, Centre de Recherche des Cordeliers, Centre Inria de Paris, Équipe HeKA, France; AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de chirurgie hépatobiliaire, digestive et endocrinienne, Paris, France. Electronic address: stylianos.tzedakis@aphp.fr.

Alexandre Challine (A)

INSERM, UMR 1138, Centre de Recherche des Cordeliers, Centre Inria de Paris, Équipe HeKA, France; AP-HP, Sorbonne Université, Hôpital Saint Antoine, Service de chirurgie digestive, Paris, France.

Sandrine Katsahian (S)

INSERM, UMR 1138, Centre de Recherche des Cordeliers, Centre Inria de Paris, Équipe HeKA, France; AP-HP, Université Paris Cité, Hôpital Européen Georges-Pompidou, Service d'Épidémiologie et de Biostatistiques, Paris, France.

David Malka (D)

Institut Mutualiste Montsouris, Département d'Oncologie Médicale, Paris, France.

Romain Jaquet (R)

INSERM, UMR 1138, Centre de Recherche des Cordeliers, Centre Inria de Paris, Équipe HeKA, France; GH-Nord Essonne, Département de chirurgie digestive, Site Longjumeau, Longjumeau, France.

Ugo Marchese (U)

AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de chirurgie hépatobiliaire, digestive et endocrinienne, Paris, France.

Martin Gaillard (M)

AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de chirurgie hépatobiliaire, digestive et endocrinienne, Paris, France.

Romain Coriat (R)

AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de gastroentérologie, d'endoscopie et d'oncologie digestive, Paris, France.

Alix Dhote (A)

AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de chirurgie hépatobiliaire, digestive et endocrinienne, Paris, France.

Vincent Mallet (V)

AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service d'Hépatologie, Paris, France.

Heithem Jeddou (H)

Hôpital Pontchaillou, Service de chirurgie hépatobiliaire et digestive, Université Rennes 1, Rennes, France.

Karim Boudjema (K)

Hôpital Pontchaillou, Service de chirurgie hépatobiliaire et digestive, Université Rennes 1, Rennes, France.

David Fuks (D)

AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de chirurgie hépatobiliaire, digestive et endocrinienne, Paris, France.

Andrea Lazzati (A)

AP-HP, Univeristé Sorbonne Paris Nord, Service de chirurgie digestive, bariatrique et endocrinienne, Hopital Avicenne, Bobigny, France.

Classifications MeSH