Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France.

BACKGROUND: The European Society of Breast Cancer Specialists (EUSOMA), which aims to standardize the quality of patient care in Europe, has defined quality indicators (QIs) for breast cancer (BC) care to assess compliance to current care standards. These QIs are a useful tool to evaluate care organizations. Only population-based studies are able to assess health system performance in "real-life" situations. This population-based study aimed to describe compliance with several EUSOMA QIs overall and according to patient and organizational factors in France. METHODS: 1 560 adult women with primary invasive non-metastatic BC diagnosed in 2012 were randomly selected among all incident BC from 16 French geographical areas covered by cancer registries. Twelve EUSOMA QIs were selected regarding diagnosis, treatment and staging. RESULTS: The minimum standard as proposed by EUSOMA was met for nine QIs related to pre-operative definitive diagnosis, multidisciplinary discussion and treatment (single surgery, breast conserving surgery (BCS) for small BC (<3cm), radiotherapy after BCS or mastectomy for regional BC (pN≥2a), hormonotherapy, adjuvant chemotherapy and trastuzumab). Low compliance was observed for sentinel lymph node biopsy (SLNB) and staging imaging. Adherence to guidelines was usually lower in older patients and in patients with comorbidities. Multidisciplinary discussion was positively related to adherence to guidelines for diagnosis, staging practices (SNLB, imaging) and systemic treatments. Compliance also varied by area of residence and by place of first treatment. CONCLUSION: This study provides the first current, comprehensive overview of BC quality care at a population level in France. The guidelines were correctly applied in percentage satisfying the EUSOMA standards for the diagnosis and treatment of BC, although staging practices (SLNB, imaging) can be improved. These results highlight the need for continuous measurement of adherence to guidelines to improve BC care

Rôle des facteurs hormonaux et des anomalies de la thyroide dans la survenue des tumeurs primitives cérébrales

INTRODUCTION : Le rôle des hormones sexuelles dans la survenue des tumeurs cérébrales a été suggéré devant les résultats des études animales et biologiques. Néanmoins les résultats des études épidémiologiques réalisées ne sont pas concluants. Un rôle des hormones thyroidiennes a également été suggéré mais peu étudié. OBJECTIF : Mesurer les associations enttre les tumeurs cérébrales et les facteurs hormonaux et thyroidiens. METHODES : La population d'étude incluait les sujets âgés de 16 ans et plus, résidant en Gironde, Hérault et Manche, ayant participé à l'étude cas-témoin en popuLation générale CERENAT. Les cas incidents de tumeurs, diagnostiqués entre 2004 et 2006, ont été appariés sur l'âge et le département de résidence à des témoins tirés au sort à partir des listes électorales. Le recueil des données (caractéristiques reproductives, traitements hormonaux et pathologies thyroidiennes) a été réalisé à l'aide d'un questionnaire standardisé lors d'un entretien en face à face Des scores d'exposition cumulée par type d'hormone ont été calculés pour les contraceptifs oraux et les traitements hormonaux substitutifs. RESULTATS : 501 cas (209 tumeurs neuroépithéliales (TN), 199 méningiomes, 93 autres tumeurs) et 1002 témoins ont été analysés. Aucune association n'a été observée avec la présence d'une anomalie thyroidienne. Chez la femme, le nombre de naissances augmentait le risque de tumeur cérébrale (p = 0,03). Aucune association significative n'a été mise en évidence entre méningiomes et facteurs hormonaux. Pour les TN, une augmentation significative du risque était observée avec l'utilisation de traitement de la stérilité (OR = 4,8, IC 95 % = 1,3-17,6) et avec la ménopause chirurgicale (OR = 5, 2, IC 95 % = 1,2-22,9) tandis qu'une augmentation non significative du risque de gliome était observée avec un âge à la ménarche tardif (p = 0,20). CONCLUSION : Ces résultats suggèrent que les hormones sexuelles diminueraient le risque de TN.BACKGROUND : The role of sex hormones in the occurence of brain tumors has been suggested by the findings of animal and biological studies. Nevertheless, results of previous epidemiological studies are inconclusive. The role of thyroid hormones in the development of these tumors has been also suggested but little studied. OBJECTIVE : To assess the associations between brain tumors and hormonal and thyroid factors. METHODS : The study population included subjects aged 16 years and more, living in Gironde, Herault and Manche, and participating in a population-based case-control study CERENAT. Incident cases, diagnosed with brain tumors during 2004-2006, were matched for age and department of residence with controls, who were randomly selected from electoral rolls. A standardized questionnaire collected hormonal factors, including reproductive factors, thyroid disease and use of hormonal treatments. Cumulative exposure scores by type of hormone were estimated for oral contraceptives and hormone replacement therapy. RESULTS : 501 cases (209 gliomas, 199 meningiomas, 93 other tumors) and 1002 controls were analysed. No significant association was found between brain tumors and thyroid diseases. For women, number of births increased brain tumor risk (p = 0.03). No significant association was found between meningioma and hormonal factors. A significant increase in glioma risk was observed with infertility treatment (OR = 4, 8, CI 95 % = 1.3-17.6) and surgical menopause (OR = 5.2, CI 95 % = 1.2-22.9) while a non significant increase in glioma risk was shown with a later age at menarche (p = 0.20). CONCLUSION : These findings support the hypothesis that reproductive hormones may decrease the risk of glioma.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Using ecological socioeconomic position (SEP) measures to deal with sample bias introduced by incomplete individual-level measures: inequalities in breast cancer stage at diagnosis as an example

International audienceBACKGROUND:When studying the influence of socioeconomic position (SEP) on health from data where individual-level SEP measures may be missing, ecological measures of SEP may prove helpful. In this paper, we illustrate the best use of ecological-level measures of SEP to deal with incomplete individual level data. To do this we have taken the example of a study examining the relationship between SEP and breast cancer (BC) stage at diagnosis.METHODS:Using population based-registry data, all women over 18 years newly diagnosed with a primary BC in 2007 were included. We compared the association between advanced stage at diagnosis and individual SEP containing missing data with an ecological level SEP measure without missing data. We used three modelling strategies, 1/ based on patients with complete data for individual-SEP (n = 1218), or 2/ on all patients (n = 1644) using an ecological-level SEP as proxy for individual SEP and 3/ individual-SEP after imputation of missing data using an ecological-level SEP.RESULTS:The results obtained from these models demonstrate that selection bias was introduced in the sample where only patients with complete individual SEP were included. This bias is redressed by using ecological-level SEP to impute missing data for individual SEP on all patients. Such a strategy helps to avoid an ecological bias due to the use of aggregated data to infer to individual level.CONCLUSION:When individual data are incomplete, we demonstrate the usefulness of an ecological index to assess and redress potential selection bias by using it to impute missing individual SEP

Effect of Physician Notification Regarding Nonadherence to Colorectal Cancer Screening on Patient Participation in Fecal Immunochemical Test Cancer Screening: A Randomized Clinical Trial.

International audienceImportance: Increasing participation in fecal screening tests is a major challenge in countries that have implemented colorectal cancer (CRC) screening programs.Objective: To determine whether providing general practitioners (GPs) a list of patients who are nonadherent to CRC screening enhances patient participation in fecal immunochemical testing (FIT).Design, setting, and participants: A 3-group, cluster-randomized study was conducted from July 14, 2015, to July 14, 2016, on the west coast of France, with GPs in 801 practices participating and involving adult patients (50-74 years) who were at average risk of CRC and not up-to-date with CRC screening. The final follow-up date was July 14, 2016.Interventions: General practitioners were randomly assigned to 1 of 3 groups: 496 received a list of patients who had not undergone CRC screening (patient-specific reminders group, 10 476 patients), 495 received a letter describing region-specific CRC screening adherence rates (generic reminders group, 10 606 patients), and 455 did not receive any reminders (usual care group, 10 147 patients).Main outcomes and measures: The primary end point was patient participation in CRC screening 1 year after the intervention.Results: Among 1482 randomized GPs (mean age, 53.4 years; 576 women [38.9%]), 1446 participated; of the 33 044 patients of these GPs (mean age, 59.7 years; 17 949 women [54.3%]), follow-up at 1 year was available for 31 229 (94.5%). At 1 year, 24.8% (95% CI, 23.4%-26.2%) of patients in the specific reminders group, 21.7% (95% CI, 20.5%-22.8%) in the generic reminders group, and 20.6% (95% CI, 19.3%-21.8%) in the usual care group participated in the FIT screening. The between-group differences were 3.1% (95% CI, 1.3%-5.0%) for the patient-specific reminders group vs the generic reminders group, 4.2% (95% CI, 2.3%-6.2%) for the patient-specific reminders group vs the usual care group, and 1.1% (95% CI, -0.6% to 2.8%) for generic reminders group vs the usual care group.Conclusions and relevance: Providing French GPs caring for adults at average risk of CRC with a list of their patients who were not up-to-date with their CRC screening resulted in a small but significant increase in patient participation in FIT screening at 1 year compared with patients who received usual care. Providing GPs with generic reminders about regional rates of CRC screening did not increase screening rates compared with usual care.Trial registration: clinicaltrials.gov Identifier: NCT02515344

Long-term quality of life among localised prostate cancer survivors: QALIPRO population-based study

International audienceBackgroundTo evaluate quality of life (QoL) 10 years after treatments for localised prostate cancer (LPCa) patients in comparison with aged-matched healthy controls.MethodsLPCa patients diagnosed in 2001 were obtained from 11 French cancer registries. Controls were recruited among the general population and were matched to patients on age and geographic area. EORTC Quality of Life Questionnaire – Core 30 items, Expanded Prostate Cancer Index Composite, Hospital Anxiety and Depression Scale and Multidimensional Fatigue Inventory self-reported questionnaires were used to measure QoL, anxiety and fatigue. Patients were classified in three groups according to previous treatments: radical prostatectomy (RP), radiotherapy (RT) and radical prostatectomy and radiotherapy (RP+RT). The differences in QoL between patients and controls and according to treatment groups were evaluated.ResultsThere were 287 patients and 287 controls. There was no socio-demographic difference between patients and controls. Treatments were: RP (143), RT (78), PR+RT (33), baseline hormone therapy (49) and hormone therapy at the time of the study (34). Patients had similar levels of global QoL, anxiety, depression and fatigue as controls. They reported more urinary troubles (urinary function and incontinence) (p < 0.0001) and more sexual dysfunctions (p < 0.0001) than controls, whatever the treatment group. Worse bowel dysfunction was reported in patients treated by RT and RP+RT (p < 0.002). According to the treatments, RP groups had the worst urinary function and incontinence (p < 0.01), and reported more bowel bother when the treatment was combined with RT.ConclusionsEven though patients reported similar global QoL as control 10 years after treatment, patients reported numerous urinary and sexual dysfunctions. Patients treated with RP+RT reported cumulative sequelae of both treatments

Cancer Among Adolescents and Young Adults Between 2000 and 2016 in France: Incidence and Improved Survival

International audiencePurpose: This study was undertaken to determine cancer survival and describe the spectrum of cancers diagnosed among French adolescent and young adult (AYA) population.Methods: All cases of cancer diagnosed in 15-24 years, recorded by all French population-based registries (18% of the French population), over the 2000-2016 period, were included. Age-standardized incidences rates (ASR), conventional annual percentage change (cAPC) of incidence over time, and 5-year overall survival (5yOS) were calculated.Results: We analyzed 2,734 cancer diagnoses in adolescents and 4,199 in young adults. Overall incidence rates were 231.9/106 in 15-19 year olds and 354.0/106 in 20-24 year olds. The most frequently diagnosed cancers in male AYA were malignant gonadal germ-cell tumors (GCT), Hodgkin lymphoma (HL), and malignant melanoma, and were HL, thyroid carcinoma, and malignant melanoma in females. Cancer incidence was stable over time with a cAPC of 0.8% (p=0.72). For all cancers combined, 5yOS was 86.6% (95%CI: 85.8-87.4), greater than 85% for HL, non-Hodgkin lymphomas (NHL), GCT, thyroid carcinomas, and malignant melanomas, and around 60% and lower for osteosarcomas, Ewing tumors, hepatic carcinomas, and rhabdomyosarcomas. The 5yOS has significantly improved from 2000-2007 to 2008-2015 for all cancers pooled, with a substantial gain of 4% for 15-19 year-olds, and 3% for 20-24 year-olds.Conclusion: Notwithstanding the encouraging results for some cancers, and overall, persistent poorer survivals in AYA were shown compared to children for acute lymphoblastic leukemia, osteosarcoma, Ewing tumor, rhabdomyosarcoma and malignant hepatic tumors. These disparities require further investigation to identify and address the causes of these inferior outcomes

[Descriptive epidemiology of cancer in metropolitan France Incidence, survival and prevalence]

International audienceIncidence, mortality, survival and prevalence are key indicators to assess public health policies and estimate the needs of the population for cancer management. The aim of this article is to provide the more current estimates of these indicators, in line with the fifteenth operational objective of the 2014-2019 Cancer Plan "Collect data/Support Public Health"

Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000–14 (CONCORD-3): analysis of individual data from 258 cancer registries in 61 countries

Background: Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0–14 years) and adults (aged 15–99 years) diagnosed with a haematological malignancy during 2000–14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0–24 years). Methods: We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0–14 years), adolescents (15–19 years), and young adults (20–24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. Findings: 164 563 young people were included in this analysis: 121 328 (73·7%) children, 22 963 (14·0%) adolescents, and 20 272 (12·3%) young adults. In 2010–14, the most common subtypes were lymphoid leukaemia (28 205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010–14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000–14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. Interpretation: This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group