Access to primary care and mortality in excess for patients with cancer in France: Results from 21 French Cancer Registries.
cancer
excess mortality
primary care
registries
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
20 Aug 2024
20 Aug 2024
Historique:
revised:
06
05
2024
received:
19
02
2024
accepted:
24
07
2024
medline:
20
8
2024
pubmed:
20
8
2024
entrez:
20
8
2024
Statut:
aheadofprint
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
RESULTS
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
CONCLUSIONS
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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Ligue Contre le Cancer
ID : Equipe Labellisée LIGUE 2022
Informations de copyright
© 2024 American Cancer Society.
Références
FRANCIM. Survie des personnes atteintes de cancer en France métropolitaine 1989‐2018.
Tron L, Fauvernier M, Bouvier AM, et al. socioeconomic environment and survival in patients with digestive cancers: a French population‐based study. Cancers. 2021;13(20):5156. doi:10.3390/cancers13205156
Kravdal Ø. Does place matter for cancer survival in Norway? A multilevel analysis of the importance of hospital affiliation and municipality socio‐economic resources. Health Place. 2006;12(4):527‐537. doi:10.1016/j.healthplace.2005.08.005
Jones AP, Haynes R, Sauerzapf V, Crawford SM, Zhao H, Forman D. Travel times to health care and survival from cancers in Northern England. Eur J Cancer. 2007;44(2):269‐274. doi:10.1016/j.ejca.2007.07.028
Dejardin O, Jones AP, Rachet B, et al. The influence of geographical access to health care and material deprivation on colorectal cancer survival: evidence from France and England. Health Place. 2014;30C:36‐44. doi:10.1016/j.healthplace.2014.08.002
Murage P, Crawford SM, Bachmann M, Jones A. Geographical disparities in access to cancer management and treatment services in England. Health Place. 2016;42:11‐18. doi:10.1016/j.healthplace.2016.08.014
Sjöström O, Dahlin AM, Silander G, Syk I, Melin B, Hellquist BN. Travel time to care does not affect survival for patients with colorectal cancer in northern Sweden: a data linkage study from the Risk North database. In: Lee JE, ed. PLoS One. 2020;15(8):e0236799. doi:10.1371/journal.pone.0236799
Gardy J, Wilson S, Guizard AV, et al. Cancer survival and travel time to nearest reference care center for 10 cancer sites: an analysis of 21 French Cancer Registries. Cancers. 2023;15(5):1516. doi:10.3390/cancers15051516
Haynes R, Pearce J, Barnett R. Cancer survival in New Zealand: ethnic, social and geographical inequalities. Soc Sci Med. 2008;67(6):928‐937. doi:10.1016/j.socscimed.2008.05.005
Murage P, Murchie P, Bachmann M, Crawford M, Jones A. Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer: a cross‐sectional cohort study in primary care. Br J Gen Pract. 2017;67(660):e460‐e466. doi:10.3399/bjgp17X691349
Murchie P, Fielding S, Turner M, Iversen L, Dibben C. Is place or person more important in determining higher rural cancer mortality? A data‐linkage study to compare individual versus area‐based measures of deprivation: is place or person more important in determining higher rural cancer mortality? Int J Popul Data Sci. 2021;6(1). doi:10.23889/ijpds.v6i1.1403
Launoy G, Zadnik V, Coleman MP, eds. Social Environment and Cancer in Europe: Towards an Evidence‐Based Public Health Policy. Springer International Publishing; 2021. doi:10.1007/978‐3‐030‐69329‐9
Launay L, Guillot F, Gaillard D, et al. Methodology for building a geographical accessibility health index throughout metropolitan France. PLoS One. 2019;14(8):e0221417. doi:10.1371/journal.pone.0221417
Lucas‐Gabrielli V, Mangeney C. Comment améliorer les mesures d’accessibilité aux soins pour mieux cibler les zones sous‐denses. Rev DÉpidémiologie Santé Publique. 2019;67:S25‐S32. doi:10.1016/j.respe.2018.12.061
Pornet C, Delpierre C, Dejardin O, et al. Construction of an adaptable European transnational ecological deprivation index: the French version. J Epidemiol Community Health. 2012;66(11):982‐989. doi:10.1136/jech‐2011‐200311
Guillaume E, Pornet C, Dejardin O, et al. Development of a cross‐cultural deprivation index in five European countries. J Epidemiol Community Health. 2016;70(5):493‐499. doi:10.1136/jech‐2015‐205729
Perme MP, Stare J, Estève J. On estimation in relative survival. Biometrics. 2012;68(1):113‐120. doi:10.1111/j.1541‐0420.2011.01640.x
Fauvernier M, Roche L, Uhry Z, Tron L, Bossard N, Remontet L. Multi‐dimensional penalized hazard model with continuous covariates: applications for studying trends and social inequalities in cancer survival. J R Stat Soc Ser C Appl Stat. 2019;68(5):1233‐1257. doi:10.1111/rssc.12368
Remontet L, Uhry Z, Bossard N, et al. Flexible and structured survival model for a simultaneous estimation of non‐linear and non‐proportional effects and complex interactions between continuous variables: performance of this multidimensional penalized spline approach in net survival trend analysis. Stat Methods Med Res. 2019;28(8):2368‐2384. doi:10.1177/0962280218779408
Defossez G, Le Guyader‐Peyrou S, Uhry Z, Grosclaude P, Remontet L, Colonna M. Estimations Nationales de l’incidence et de La Mortalité Par Cancer En France Métropolitaine Entre 1990 et 2018. Étude à Partir Des Registres Des Cancers Du Réseau Francim. Résultats Préliminaires. Santé publique France; 2019.
Bryere J, Dejardin O, Bouvier V, et al. Socioeconomic environment and cancer incidence: a French population‐based study in Normandy. BMC Cancer. 2014;14(1):87. doi:10.1186/1471‐2407‐14‐87
Tron L, Belot A, Fauvernier M, et al. Socioeconomic environment and disparities in cancer survival for 19 solid tumor sites: an analysis of the French Network of Cancer Registries (FRANCIM) data. Int J Cancer. 2019;144(6):1262‐1274. doi:10.1002/ijc.31951
Abrahamowicz M, Beauchamp ME, Sylvestre MP. Comparison of alternative models for linking drug exposure with adverse effects. Stat Med. 2012;31(11‐12):1014‐1030. doi:10.1002/sim.4343
Fauvernier M, Remontet L, Uhry Z, Bossard N, Roche L. survPen: an R package for hazard and excess hazard modelling with multidimensional penalized splines. J Open Source Softw. 2019;4(40):1434. doi:10.21105/joss.01434
Butler DC, Petterson S, Phillips RL, Bazemore AW. Measures of social deprivation that predict health care access and need within a rational area of primary care service delivery. Health Serv Res. 2013;48(2pt1):539‐559. doi:10.1111/j.1475‐6773.2012.01449.x
Murchie P, Falborg AZ, Turner M, Vedsted P, Virgilsen LF. Geographic variation in diagnostic and treatment interval, cancer stage and mortality among colorectal patients – an international comparison between Denmark and Scotland using data‐linked cohorts. Cancer Epidemiol. 2021;74:102004. doi:10.1016/j.canep.2021.102004
Green T, Atkin K, Macleod U. Cancer detection in primary care: insights from general practitioners. Br J Cancer. 2015;112(S1):S41‐S49. doi:10.1038/bjc.2015.41
Maclean R, Jeffreys M, Ives A, Jones T, Verne J, Ben‐Shlomo Y. Primary care characteristics and stage of cancer at diagnosis using data from the national cancer registration service, quality outcomes framework and general practice information. BMC Cancer. 2015;15(1):500. doi:10.1186/s12885‐015‐1497‐1
Campbell NC. Primary care oncology: essential if high quality cancer care is to be achieved for all. Fam Pract. 2002;19(6):577‐578. doi:10.1093/fampra/19.6.577
Emery JD, Shaw K, Williams B, et al. The role of primary care in early detection and follow‐up of cancer. Nat Rev Clin Oncol. 2014;11(1):38‐48. doi:10.1038/nrclinonc.2013.212
Perfors IAA, May AM, Boeijen JA, De Wit NJ, Van Der Wall E, Helsper CW. Involving the general practitioner during curative cancer treatment: a systematic review of health care interventions. BMJ Open. 2019;9(4):e026383. doi:10.1136/bmjopen‐2018‐026383
Kyte L, Wells C. Variations in life expectancy between rural and urban areas of England, 2001‐07. Health Stat Q. 2010;46(46):25‐50. doi:10.1057/hsq.2010.10
Chevillard G, Lucas‐Gabrielli V, Mousques J. Déserts médicaux » en France : état des lieux et perspectives de recherches. L’Espace Géographique. 2018;47(4):362‐380. Tome. doi:10.3917/eg.474.0362