Determinants of the access to remote specialised services provided by national sarcoma reference centres

Abstract

Background Spatial inequalities in cancer management have been evidenced by studies reporting lower quality of care or/and lower survival for patients living in remote or socially deprived areas. NETSARC+ is a national reference network implemented to improve the outcome of sarcoma patients in France since 2010, providing remote access to specialized diagnosis and Multidisciplinary Tumour Board (MTB). The IGéAS research program aims to assess the potential of this innovative organization, with remote management of cancers including rare tumours, to go through geographical barriers usually impeding the optimal management of cancer patients. Methods Using the nationwide NETSARC+ databases, the individual, clinical and geographical determinants of the access to sarcoma-specialized diagnosis and MTB were analysed. The IGéAS cohort (n = 20,590) includes all patients living in France with first sarcoma diagnosis between 2011 and 2014. Early access was defined as specialised review performed before 30 days of sampling and as first sarcoma MTB discussion performed before the first surgery. Results Some clinical populations are at highest risk of initial management without access to sarcoma specialized services, such as patients with non-GIST visceral sarcoma for diagnosis [OR 1.96, 95% CI 1.78 to 2.15] and MTB discussion [OR 3.56, 95% CI 3.16 to 4.01]. Social deprivation of the municipality is not associated with early access on NETSARC+ remote services. The quintile of patients furthest away from reference centres have lower chances of early access to specialized diagnosis [OR 1.18, 95% CI 1.06 to 1.31] and MTB discussion [OR 1.24, 95% CI 1.10 to 1.40] but this influence of the distance is slight in comparison with clinical factors and previous studies on the access to cancer-specialized facilities. Conclusions In the context of national organization driven by reference network, distance to reference centres slightly alters the early access to sarcoma specialized services and social deprivation has no impact on it. The reference networks’ organization, designed to improve the access to specialized services and the quality of cancer management, can be considered as an interesting device to reduce social and spatial inequalities in cancer management. The potential of this organization must be confirmed by further studies, including survival analysis.

No Geographical Inequalities in Survival for Sarcoma Patients in France: A Reference Networks’ Outcome?

“…In the same manner, if the tobacco control policies have succeeded in reducing tobacco use, “the negative correlation between smoking prevalence and socioeconomic status has increased” [ 50 ]. The IGéAS research program has not observed any such “side effects” on inequalities for sarcoma patients since the implementation of the NETSARC+ reference network in France, either for inequalities in access to remote services [ 34 ], or for inequalities in survival thanks to this study.…”

“…Indeed, a previous nationwide analysis of the determinants of early access to specialized services within the French sarcoma reference network NETSARC+ reports that, contrary to the overriding impact of some clinical factors, the distance to reference centers slightly alters the early access to sarcoma specialized services and social deprivation has no impact on it [ 34 ]. This ability is also illustrated by published maps showing the large geographical coverage of the French sarcoma reference centers that are often requested to review specimens or to discuss the therapeutic strategy of patients living several hundred kilometers away [ 22 ].…”

“…As patients’ follow-up and post-treatment data collection could not be conducted on the entire IGéAS cohort due to the large size of the cohort (N = 20589), our survival analysis focused on patients diagnosed in 2013. While the number of patients benefiting from the NETSARC+ network’s expertise has increased each year since its launch in 2010 [ 34 ], 2013 was the best compromise to ensure sufficient hindsight to collect patient follow-up. Due to their lower prognostic risk, intermediate malignancies, GISTs, and low-grade sarcomas were excluded from the survival study ( Figure 2 ).…”

“…Previous analysis by the IGéAS research program showed the overriding impact of clinical factors (such as the type or size of tumor) on the access to NETSARC+ remote services in comparison to geographical variables. Indeed, the distance to reference centers had a slight influence on the access to these services, while social deprivation was not associated with access [ 34 ]. Here, we analyze the determinants of the survival of sarcoma patients within the French sarcoma reference network NETSARC+.…”

Mortality patterns of soft-tissue sarcomas worldwide up to 2018, with predictions for 2025

“…Running a multimodality group, as well as developing multi-institutional clinical trials, is expensive and resource demanding (Lewin et al, 2013). Reaching centralized care is limited by many potential barriers including insurance coverage, and lack of socioeconomic support, infrastructures, and facilities Fayet et al, 2021). Within Europe, a geographical variation in STS prognosis was previously reported with somewhat lower survival rates observed in Eastern European countries (Stiller et al, 2013).…”