Equipe EMS - Département de Sciences Humaines et Sociales, Centre Léon Bérard, F-69008, Lyon, France.
Univ Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne, France.
BMC Cancer. 2021 May 29;21(1):631. doi: 10.1186/s12885-021-08393-4.
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.
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.
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.
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.
研究表明，居住在偏远或社会贫困地区的癌症患者的治疗质量或/和生存情况较低，这表明癌症管理存在空间不平等现象。NETSARC+ 是一个国家参考网络，自 2010 年以来，该网络旨在改善法国肉瘤患者的治疗效果，为远程诊断和多学科肿瘤委员会（MTB）提供服务。IGéAS 研究项目旨在评估这种创新组织的潜力，该组织通过远程管理包括罕见肿瘤在内的癌症，克服了通常阻碍癌症患者最佳治疗的地理障碍。
利用全国性的 NETSARC+数据库，分析肉瘤专科诊断和 MTB 准入的个体、临床和地理决定因素。IGéAS 队列（n=20590）包括 2011 年至 2014 年间在法国首次诊断为肉瘤的所有患者。早期治疗定义为在采样前 30 天内进行的专业评估，以及在首次手术前进行的首次肉瘤 MTB 讨论。
某些临床人群在初始管理中存在无法获得肉瘤专科服务的最大风险，例如非 GIST 内脏肉瘤患者的诊断[比值比（OR）1.96，95%置信区间（CI）1.78 至 2.15]和 MTB 讨论[OR 3.56，95%CI 3.16 至 4.01]。市政当局的社会贫困程度与 NETSARC+远程服务的早期接入无关。距离参考中心最远的五分之一患者接受专科诊断[OR 1.18，95%CI 1.06 至 1.31]和 MTB 讨论[OR 1.24，95%CI 1.10 至 1.40]的早期治疗机会较低，但与临床因素和之前关于癌症专科设施准入的研究相比，这种距离的影响是轻微的。
在以参考网络为导向的国家组织背景下，距离参考中心的远近略微改变了肉瘤专科服务的早期准入，而社会贫困对其没有影响。该参考网络的组织旨在提高对专科服务的获取能力和癌症管理质量，可被视为减少癌症管理中的社会和空间不平等的有效手段。该组织的潜力必须通过进一步的研究来确认，包括生存分析。
