Launoy G, Maurel J, Grosclaude P, Faivre J
Faculté de Médecine, Registre des Tumeurs Digestives du Calvados, Côte de Nacre.
Rev Epidemiol Sante Publique. 1996;44 Suppl 1:S22-32.
Improvement of health care policy requires an assessment of health care practices. In France, morbidity registries might be the best tool of such an assessment. This study shows how the treatment of colorectal cancer can be assessed by French cancer registries. Two studies were conducted. One cross-sectional on data from 7 cancer registries in 1990 and one longitudinal on data from 2 digestive cancer registries (departments of Calvados and Côte-d'Or) between 1978 and 1990. Cancer resection rate significantly increased from 1978 to 1990. In 1990, mean resection rate was 85%, higher for colon (89%) than rectum (79%). Sphincter preservation rate also significantly increased to 40.8% in 1990. No geographical variations were observed for surgical practices. The use of adjuvant radiotherapy had significantly increased between 1978 and 1990, more rapidly in university centres. In more recent years, the use of radiotherapy concerned 50% of resected rectal cancers without differences between the different types of health care centre. However, in 1990, great geographical variations were observed in the use of adjuvant radiotherapy. Similar geographical variations were observed for the use of chemotherapy which did not increased with time. Colorectal cancers were diagnosed more and more earlier from 1978 to 1990 in both departments of Calvados and Côte-d'Or. The French network of French cancer registries (FRANCIM) provides accurate and reliable knowledge on medical practices, geographical variations and trends. Information is also available on prognosis in cancer patients. Potentialities of cancer registries are not actually well known although such information is required to plan health care policy.
改善医疗保健政策需要对医疗保健实践进行评估。在法国,发病率登记可能是进行此类评估的最佳工具。本研究展示了法国癌症登记如何对结直肠癌的治疗进行评估。开展了两项研究。一项是1990年基于7个癌症登记处数据的横断面研究,另一项是1978年至1990年间基于2个消化系统癌症登记处(卡尔瓦多斯省和科多尔省)数据的纵向研究。从1978年到1990年,癌症切除率显著提高。1990年,平均切除率为85%,结肠癌(89%)高于直肠癌(79%)。1990年,保肛率也显著提高到40.8%。手术实践未观察到地理差异。1978年至1990年间,辅助放疗的使用显著增加,在大学中心增加得更快。近年来,放疗的使用涉及50%的切除直肠癌,不同类型的医疗保健中心之间没有差异。然而,1990年,辅助放疗的使用存在很大的地理差异。化疗的使用也观察到类似的地理差异,且未随时间增加。从1978年到1990年,卡尔瓦多斯省和科多尔省的结直肠癌诊断越来越早。法国癌症登记网络(FRANCIM)提供了有关医疗实践、地理差异和趋势的准确可靠知识。也有关于癌症患者预后的信息。尽管规划医疗保健政策需要此类信息,但癌症登记处的潜力实际上并不为人所知。