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Background Vulnerable social groups have more difficulty in accessing care and a lower quality of care. Health systems that focus on primary care appear to be more effective, efficient and equitable. However, difficulties in accessing primary care persist. We focused on primary care screening for cervical cancer by Cervico-Uterine Smear (CUS), which has been shown to be effective in reducing incidence and mortality. To analyse the population screened by CUS and the health professionals who perform these tests, and to analyse differences in access to care in socio-economic and geographical terms.Methods This was a retrospective observational study based on data from the main health insurance schemes, allowing analysis of health care consumption according to socioeconomic level, and proximity to health care services. We included women (695,694) aged 25 to 64 years in 2012 relevant to CUS. The sociodemographic and territorial indicators were age, geographical area deprivation, and the availability of gynaecological care. The analysis was performed by using multinomial logistic regression.Results 202,271 (29%) patients underwent CUS, 68% by gynaecologists and 28% by general practitioners (GPs). However, inequalities in CUS were observed, with a decrease in the number of CUS performed with age, rural location, deprivation, and sparse health care provision. GPs’ practice seemed to penalize deprived populations less.Conclusions Screening should be conducted more by GPs in primary care, thus providing better access to deprived populations. Health care should be organised more around primary care than hospital care. The specific needs of deprived populations should be considered.

Objectives: We studied both the independent and combined effects of the places of biopsy and treatment on the treatment time interval based on a population-based study.Methods: We analysed the proportion of patients having a treatment time interval higher than the EUSOMA recommendation of 6 weeks, as a function of the number and the type of care centres the patients attended, from a French population-based regional cohort of women treated in 2015 for an incident invasive non-metastatic cancer (n = 505).Results: About 33% [95% CI: 27; 38] of patients had a treatment time interval higher than 6 weeks. About 48% of the patients underwent their biopsy and their initial treatment in the different centres. Results from multivariable analyses supported the impact of the type and number of centres attended on the proportion of time intervals over 6 weeks. This proportion was higher among patients with biopsy and treatment in different centres and among patients treated in a university hospital.Conclusion: We pointed out the independent impact of the type and the number of care centres the patients attended, from biopsy to first treatment, on the treatment time interval, which is a well-known prognosis factor.

Cancer prevalence is heterogeneous because it includes individuals who are undergoing initial treatment and those who are in remission, experiencing relapse, or cured. The proposed statistical approach describes the health status of this group by estimating the probabilities of death among prevalent cases. The application concerns colorectal, lung, breast, and prostate cancers and melanoma in France in 2017.Excess mortality was used to estimate the probabilities of death from cancer and other causes.For the studied cancers, most deaths from cancer occurred during the first 5 years after diagnosis. The probability of death from cancer decreased with increasing time since diagnosis except for breast cancer, for which it remained relatively stable. The time beyond which the probability of death from cancer became lower than that from other causes depended on age and cancer site: for colorectal cancer, it was 6 years after diagnosis for women (7 years for men) aged 75-84 and 20 years for women (18 years for men) aged 45-54 years, whereas cancer was the major cause of death for women younger than 75 years whatever the time since diagnosis for breast and for all patients younger than 75 years for lung cancer. In contrast, deaths from other causes were more frequent in all the patients older than 75 years. Apart from breast cancer in women younger than 55 years and lung cancer in women older than 55 years and men older than 65 years, the probability of death from cancer among prevalent cases fell below 1%, with varying times since diagnosis.The authors' approach can be used to better describe the burden of cancer by estimating outcomes in prevalent cases.

Objective: To examine the confounding role of social determinants across the life course in the relationship of nutritional lifestyle patterns with cancer in women. Methods: In the National Child Development Study, 37 items regarding diet, alcohol and physical activity frequencies were recorded at ages 33 and 42 years. Some 6,169 women were included and 237 women reported cancer diagnosis before age 55 years. Cancer odds ratios (OR) were estimated by logistic regression for the highest versus the lowest tertile of nutritional lifestyle pattern score. Social determinants from birth to adulthood were introduced as potential confounders in logistic models using a life-course approach. Results: Four nutritional lifestyle patterns were identified: ‘Healthy active’, ‘Drinker’, ‘Sweet tooth’ and ‘Western’. The ‘Drinker’ pattern was significantly associated with increased cancer risk: covariates-adjusted OR = 1.65 (95% CI: 1.17–2.33; p = .004); ptrend = .017 for all cancers combined, and 1.65 (95% CI: 1.06–2.58; p = .03); ptrend = .07 for breast cancer. These associations were attenuated after entering social determinants of birth, childhood and adulthood in the model: covariates and social variables-adjusted OR = 1.54 (95% CI: 1.08–2.18; p = .016); ptrend = .054 for all cancers combined, and 1.50 (95% CI: 0.95–2.38; p = .08); ptrend = .19 for breast cancer. The other patterns were not associated with cancer risk. Conclusion: This study demonstrates an association between the ‘Drinker’ pattern and midlife cancer in British women. Social determinants across the life course explained a part, though modest, of this association.

Summary Introduction European Randomized Study of Screening for Prostate Cancer (ERSPC) mortality results were reported for 7 European countries (excluding France) and showed a significant reduction in Prostate cancer (PCa) mortality. As those results have not been part of the global ERSPC results, it is of interest to report PCa mortality at a median follow-up of 9 years for French section of ERSPC. Material and methods Two administrative departments were involved in the study. Only men after randomization in the screening group were invited by mail to be screened by PSA testing with two rounds at 4–6 year intervals. Biopsy was recommended if PSA > = 3.0 ng/mL. No information other that the French Association of Urology recommandations on the use of PSA was offered to the control group (own decision of physicians and patients). Follow up was based on cancer registry database. Contamination defined as the receipt of PSA testing in control arm was measured. Poisson regression models were used to estimate the Rate Ratio (RR) of PCa mortality and incidence in the screening vs. control arm. Results Starting from 2003, 80,696 men aged 55–69 years were included. The percentage of men in the screening arm with at least one PSA test (compliance) was 31%. Compared to the control arm, PCa incidence increased by 10% in the screening arm (RR = 1.10; 95% CI = [1.04–1.16], P = 0.001), but PCa mortality did not differ (0.222 and 0.215 deaths/1000 person-years; RR = 1.03[0.75–1.42], P = 0.9). Discussion Limitations include low participation rate. PSA testing in the control arm was observed in 32% of men (contamination). Conclusions Contamination in control group led to no effect of PSA-based screening on prostate cancer mortality at 9 years follow-up. Level of evidence 3.

Due to the differences in the definition, criteria of inclusion and coding of urothelial tumours (UTs), data of different cancer registries (CRs) are not comparable. The aim of this work is to study current practices of registration of UT in the European CR of the GRELL countries in order to propose new registration rules to correctly describe incidence and survival of progressive tumours like UT. A questionnaire was sent to 91 CRs to assess whether non-invasive (NI)UT, multiple UTs, UTs occurring outside or before the operating period and time between UTs are currently considered in tumour recording and reporting. All participating CRs (n = 42) record a NI bladder UT in sole occurrence. In case of progressive bladder UT, 98% of the CRs record at least one NIUT but 19% don’t record the invasive progression. 17% of the CRs don’t record an invasive pelvic tumour that occurs after a NI bladder UT. 19% of the CRs don’t record an invasive bladder UT that followed a NI tumour occurring outside the zone or period of time. The recording of two synchronous UTs is carried out with a grouping topography for 36% of the CRs. The same analysis conducted on the reporting of the incidence of UT also shows heterogeneity. We conclude that there is an urgent need to define clear rules for the registration of UT.

The aim of this study was to identify the socio-professional and behavioral factors influencing decision-making between surgical and non-surgical treatment in Upper AeroDigestive Tract (UADT) oncology among surgeons and oncologists.We conducted a nationwide online survey among surgeons and medical or radiation oncologists treating head and neck cancer patients in France. The questionnaire collected physicians' demographics, type of practice, individual behavioral characteristics (attitudes toward risk and uncertainty) and data on decision-making via clinical case scenarios.In total, 197 questionnaires were usable. Clinical case scenarios were grouped into three categories according to the prognostic and functional impact of the choice between surgical or non-surgical treatment. For clinical case scenarios where evidence-based medicine considered surgery as the best option, surgeons were significantly more likely to offer surgery in multivariable analysis. When surgery and non-surgical treatment were equivalent, multivariable analysis showed that the tendency to offer surgery increased with the physician's age, and decreased as the number of patients treated per year increased. When non-surgical treatment was the best option because of very high surgical morbidity, multivariable analysis showed a higher propensity to opt for surgery for the age group 40 - 59 versus 25 - 39, and a lower likelihood of choosing surgery among oncologists.This study sheds light on the physicians' socio-professional and behavioral factors influencing decision-making in UADT oncology. These mechanisms, poorly studied and probably underestimated, partly explain the variability of the decisions taken when confronted with clinical situations that are subject to debate.gov ID: NCT03663985.

ObjectiveThe objective of this cross-sectional study was to investigate the impact of socio-territorial characteristics on mammography and pap smear uptake according to the place of residence in the recommended age groups, and second outside the recommended age groups.Setting and participantsWe used an existing dataset of 1 027 039 women which combines data from the Health Insurance information systems, with census data from Midi-Pyrénées, France.Primary and secondary outcome measuresOur outcome was, for each woman, the uptake of the pap smear and the uptake of the mammography during the year.ResultsA social gradient of screening uptake was found in the recommended age groups. This gradient was stronger in large urban areas:(1) For mammography: decile 10 (the most deprived) vs 1 (the least deprived), adjusted OR 0.777, 95% CI (0.748 to 0.808) in large urban area; adjusted OR= 0.808 for decile 1 to 0.726 for decile 10 in other areas vs decile 1 in urban areas;(2) For pap smear: decile 10 vs 1 adjusted OR 0.66, 95%CI (0.642 to 0.679) in large urban areas; adjusted OR= 0.747 for decile 1 to 0.562 for decile 10 in other areas vs decile 1 in urban areas).Screening rates were globally higher in large urban areas.For mammography, the social and territorial disparities were higher outside the recommended age group.ConclusionsOffering a universal approach to every woman, as it is often the case in nationally organised screening programmes, is likely to be insufficient to ensure real equity in access. Developing global dataset combining health data and diverse socioeconomic data, at individual and contextual levels, could enable a better understanding of the mechanisms involved in this social gradient, and therefore, the development of targeted territorial actions to improve equity of access to healthcare.

IntroductionPatients suffering from cancer are often managed by multiple health professionals. General practitioners with specific skills in oncology could facilitate care coordination between hospital and general practice in the management of these patients. To explore this hypothesis, we run a randomised clinical trial, called ‘Concertation de REtour à DOmicile, CREDO’. The main objective is to explore the effectiveness of a ‘return home’ consultation compared with standard care. The number of unscheduled visits to care centres is used to evaluate the effectiveness of the treatment.Methods and analysisCREDO is a multicentre, randomised, open-label, prospective trial. It takes place in two specialised cancer care centres in southern France (Occitania region). Patient inclusion criteria are: be over 18 years old; be treated with a first cycle of metastatic chemotherapy in a specialised cancer care centre; have a metastatic solid cancer and be returning home after treatment. Patients are randomised in two arms: standard-arm (conventional management) or intervention-arm (CREDO management). In the intervention arm, a ‘return home’ consultation is carried out in three steps. First, the investigating GP (GP with specific skills in oncology) from the specialised care centre collects information about the patient and patient’s management choices. Then, the investigating GP conducts an interview with the patient’s referring GP to quickly communicate and discuss information about the patient. Finally, the investigating GP summarises these exchanges and transmits this information to the care centres chosen by the patient.All the patients are followed for 1 year.Statistical and medicoeconomic analysis are planned.Ethics and disseminationThis clinical trial is registered under ClinicalTrials.gov identifier and was approved by the ethics committee of South-Western French Committee for the Protection of Persons (number: 2016-A01587-44) and from the French National Drug Safety Agency (ANSM, number: 2016111500034).An international publication of the final results and conference presentations will be planned.Trial registration numberNCT02857400.

Objectives Choice between surgical or medical treatments in head and neck cancer depends of many patient-related and disease-related factors. We investigated how patients’ socioeconomic status and practitioners’ specialty could affect medical decision-making. Materials and Methods We conducted a cross-sectional online, nationwide survey, send to surgeons, oncologists and radiotherapists specialized in head and neck oncology. We collected data on medical decision-making for seven clinical scientific scenarios involving head and neck carcinoma and physicians’ demographic data. Patients’ gender and socioeconomic position were distributed across scientific scenarios using a Latin square design. The scientific scenarios were grouped into several categories according to the prognostic and functional impact of the therapeutic choice. Results We obtained 206 assessable answers. Surgeons seemed to propose surgery in 49% of cases, whereas oncologists and radiotherapists opted for it in 34% of cases only. This was particularly relevant when the oncological result of surgery and the medical approach were equivalent, and when the surgery appeared to be superior in terms of curative potential but was burdened by a large functional impact. Patient's socioeconomic position also influence therapeutic decision. Among surgeons, the “single male manager” had significantly more chance of being offered surgery than the “married male blue-collar worker”. Among oncologists and radiotherapists, the “single male blue-collar worker” had the lowest probability of being proposed surgery. Regarding gender, surgeons tended to offer surgical management more to women regardless of their clinical profile. Conclusions Patients’ sex, marital status, socioeconomic status, practitioners’ specialty affect therapeutic management decisions in head and neck oncology.

Resume Objectifs Selon la loi de bioethique de 2004, une consultation d’oncofertilite doit etre systematiquement proposee a toute femme en âge de procreer avant qu’elle ne soit exposee a un traitement potentiellement gonadotoxique. L’objectif principal de cette etude etait d’evaluer la proportion des femmes âgees de moins de 40 ans, traitees par chimiotherapie pour un cancer du sein en Midi-Pyrenees, ayant beneficie d’une consultation d’oncofertilite. L’un des objectifs secondaires etait d’evaluer les connaissances des praticiens sur le sujet. Methodes Il a ete realise un croisement des bases de donnees du reseau d’oncologie en Midi-Pyrenees et des deux centres agrees pour la preservation de la fertilite dans la region. Un questionnaire praticien informatise a ete envoye a tous les chirurgiens et oncologues susceptibles de prendre en charge ces patientes. Resultats De 2012 et 2017, 667 femmes d’âge ≤ 40 ans ont recu un traitement par chimiotherapie (neo)adjuvante : seules 156 (23,4 %) ont eu acces a une consultation d’oncofertilite et 58 (8,7 %) ont beneficie d’une preservation. Ce taux (23,4 %) retrouve variait en fonction de l’âge des patientes allant de 56,9 % pour les 25–29 ans a 13,4 % pour les 35–39 ans et de l’etablissement de prise en charge. Sur les 85 praticiens interroges, 45 (55 %) ont repondu au questionnaire, et parmi eux 20 (44 %) savaient qu’il est possible de recourir a un traitement de stimulation ovarienne meme dans les situations de cancer du sein hormono-dependant et 13 (29 %) estimaient que le delai necessaire a une preservation de la fertilite etait superieur a 1 mois. Conclusion Notre etude a mis en evidence une importante disparite dans l’acces a la consultation d’oncofertilite. Il est indispensable de continuer a mettre en place des actions d’information et de sensibilisation sur le sujet.

Purpose of the review: More than 50% of all gynaecological cancers can be classified as rare tumours (defined as an annual incidence of

A population-based cancer registry (PBCR) is an ongoing surveillance system to collect, store, manage, analyse and disseminate information on the occurrence of cancer in a defined population. Modern cancer registration started in Europe in the 1930s and 1940s. PBCRs gradually developed over the following decades and have now become the best tools for measuring the burden of cancer in the community. In addition, PBCRs, nowadays, are considered critically important for planning and evaluation of National Cancer Control Plans, in the field of primary and secondary prevention, diagnostics, treatment and rehabilitation, and also when it comes to planning for facilities and funding needed for cancer control as well as for clinical and epidemiological research, including regional and international multi-centric studies. Currently, there are 24 out of 40 European countries with complete population coverage; partial registration has been introduced in 10 countries, and only 6 countries have no registries. Sixty per cent of the European population is covered by population-based cancer registration. In 1990, the European Network of Cancer Registries (ENCR; www.encr.eu) was established to promote collaboration between cancer registries, define data collection standards, provide training for cancer registry personnel and regularly disseminate information on incidence and mortality from cancer in Europe. ENCR is supported by the European Commission’s Joint Research Centre.

Background In many countries, epidemiological surveillance of chronic diseases is monitored by local registries (LR) which do not necessarily cover the whole national territory. This gap has fostered interest in using non-registry databases (e.g., health care or mortality databases) available for the whole territory as proxies for incidence at the local level. However, direct counts from these databases do not provide reliable incidence measures. Accordingly, specific methods are needed to correct proxies and assess their epidemiological usefulness. Methods This study’s objective was to implement a three-stage turnkey methodology using national non-registry data to predict incidence in geographical areas without an LR as follows: constructing a calibration model to make predictions including accurate prediction intervals; accuracy assessment of predictions and rationale for the criteria to assess which predictions were epidemiologically useful; mapping after spatial smoothing of the latter predictions. The methodology was applied to a real-world setting, whereby we aimed to predict cancer incidence, by gender, at the district level in France over the 2007–15 period for 24 different cancer sites, using several health care indicators and mortality. In the present paper, the spatial smoothing performed on predicted incidence of epidemiological interest is illustrated for two examples. Results Predicted incidence of epidemiological interest was possible for 27/34 solid site-gender combinations and for only 2/8 haematological malignancies-gender combinations. Mapping of smoothed predicted incidence provided a clear picture of the main contrasts in incidence between districts. Conclusions The methodology implemented provides a comprehensive framework to produce valuable predictions of incidence at a district level, using proxy measures and existing LR.

International audience; BackgroundThe choice between surgical or medical treatments in head and neck cancer is a function of many patient-related and disease-related factors. We investigated how physicians' behavioural characteristics and patients’ socioeconomic status could affect medical decision-making between surgical or non-surgical treatment.MethodsA nationwide cross-sectional online survey of surgeons, medical and radiation oncologists specialized in head and neck oncology collected data on medical decision-making for 7 clinical vignettes involving head and neck squamous cell carcinoma patients that were representative of routine practice. Questionnaires elicited physicians' demographic and occupational characteristics along with their individual behavioural characteristics according to the decision theory framework. Patients’ gender and socioeconomic position were distributed across vignettes using a Latin square design.ResultsWe obtained 206 assessable answers. A multivariate analysis showed that surgeons suggested surgery more often than other professionals, which is mostly related to vignettes corresponding to clinical cases for which there is no consensus Oncologists are 68% less likely than surgeons to choose surgery. For clinical vignettes, with an absence of consensus, physicians with lower risk aversion more often recommended surgery compared to those with higher risk aversion (OR=1.88, P=0.052). When the vignette corresponded to a clinical case for which there is a surgical consensus decision, the unmarried male male manual worker has a 75% lower chance of being offered surgery compared to the married male small business owner (OR=0.25, P=0.024). We did not observe any differences based on the gender of the patient.ConclusionsPatients’ socioeconomic status did affect clinical management decisions in head and neck oncology. The significant association between medical decision and individual behavioural characteristics of the physician documented still understudied mechanisms that involved nonbiological factors to variations in clinical practice.

This work examines the impact of the SARS-CoV2 epidemic and the organizational recommendations that have been issued since March 16 on tumor boards (TB) activity. The tumor board activity was measured from tumor board sheets extracted from the oncologic electronic file between January 7, 2019 and April 24, 2020. The pre-containment activity was compared to the activity of the containment periods but also to the equivalent periods in 2019. The number of meetings held, the average number of files reviewed per meeting including first presentations and the average number of physicians' attendance were the evaluation criteria. The study covered 191 TB that held 3943 multidisciplinary team meetings (MTM) and reviewed 72,070 files (including 30,127 first submissions). There was a moderate decrease of 8 % in the number of meetings after March 16, 2020. The number of files examined decreased by 23 % in the following month and even more by 33 % in the third period. The physicians' number who attended MTM also decreased by 25 %. The negative impact was higher in the Mediterranean part of the region. This first study of tumor board activity, covering a large region but little affected by the pandemic, shows that its impact on the participation to the MTM has been moderate. In addition, tumor boards have followed the recommendations for optimizing quorum. However, the decrease in average MTM activity, particularly for first submissions, suggests a potential delay in patient management. Complementary qualitative and quantitative works are warranted to estimate the real impact on carcinologic outcomes.

Introduction During the active phase of treatment, major difficulties appear in the transmission and quality of the information communicated to the General Practitioner (GP). Our objective was to carry out an inventory of the coordination tools used to improve exchanges between the hospital and the GP in the management of the patient suffering from cancer during this phase. Material and method A scoping review was conducted using MEDLINE databases via PubMed, The Cochrane Library, Web of Science. Articles published between 1998 and 2018, in English and French, were analysed. Results Over 4,863 articles were extracted, and 11 studies were included. They highlight an increase in the quality of patient care after the introduction of information sheets or training by video vignettes with GPs. They demonstrate the importance of using standardised letters between health professionals. The role of a "leader physician" is discussed, and its first evaluations are positive. An increase in information transmitted to GPs leads to a better satisfaction of patients and GPs. Conclusion Communication tools are essential for the transmission of information, but direct and oral communication between all health professionals seems to be a point to be further developed.

Résumé Ce travail étudie l’impact de l’épidémie de SARS-CoV2 et des recommandations qui ont été diffusées depuis le 16 mars sur l’activité des réunions de concertations pluridisciplinaires (RCP). L’activité des RCP d’Occitanie a été mesurée à partir des fiches RCP extraites du dossier communicant de cancérologie qui regroupe toutes les RCP. L’activité précédant le confinement a été comparée à celles des périodes de confinement (jusqu’au 24 avril) et des périodes équivalentes en 2019. Les critères de jugement étaient le nombre de réunions tenues, le nombre moyen de dossiers examinés par réunion, dont les premières présentations, et le nombre moyen de médecins présents. Les 191 RCP ont organisé 3943 réunions et étudié 72 070 dossiers (dont 30 127 premières soumissions). Nous avons observé une baisse de 8 % du nombre de réunions après le confinement. Le nombre de dossiers examinés a diminué de 23 % dans le mois suivant et jusqu’à 33 % dans la troisième quinzaine. Le nombre de médecins participant aux réunions a diminué initialement de 25 %. L’impact a été plus important dans la partie méditerranéenne de la région. Cette première étude à l’échelle d’une région montre que si l’impact de l’épidémie sur le nombre de RCP qui se sont réunies a été modeste, et que les RCP ont suivi les recommandations d’optimisation du quorum, la diminution du nombre de premières présentations laisse présager un retard au diagnostic et à la prise en charge des patients. Elle devra être complétée par des travaux qualitatifs et quantitatifs afin d’estimer l’impact réel de l’épidémie sur la prise en charge globale oncologique.

BackgroundCancer-incidence and mortality-trend analyses require appropriate statistical modelling. In countries without a nationwide cancer registry, an additional issue is estimating national incidence from local-registry data. The objectives of this study were to (i) promote the use of multidimensional penalized splines (MPS) for trend analyses; (ii) estimate the national cancer-incidence trends, using MPS, from only local-registry data; and (iii) propose a validation process of these estimates.MethodsWe used an MPS model of age and year for trend analyses in France over 1990–2015 with a projection up to 2018. Validation was performed for 22 cancer sites and relied essentially on comparison with reference estimates that used the incidence/health-care ratio over the period 2011–2015. Alternative estimates that used the incidence/mortality ratio were also used to validate the trends.ResultsIn the validation assessment, the relative differences of the incidence estimates (2011–2015) with the reference estimates were ConclusionsThe validation process confirmed the validity of the national French estimates; it may be applied in other countries to help in choosing the most appropriate national estimation method according to country-specific contexts. MPS form a powerful statistical tool for trend analyses; they allow trends to vary smoothly with age and are suitable for modelling simple as well as complex trends thanks to penalization. Detailed trend analyses of lung and prostate cancers illustrated the suitability of MPS and the epidemiological interest of such analyses.

Background Patients suffering from cancers are increasingly numerous in general practice consultations. The General Practitioner (GP) should be at the heart of the management of patients. Several studies have examined the perceptions of GPs confronted with the patient suffering from cancer and the relationships of GPs with oncologists, but few studies have focused on the patients’ perspective. We studied the three-way relationship between the oncologist, the GP, and the patient, from the patient’s point of view. Methods A questionnaire validated by a group consisting of GPs, oncologists, nurses, an epidemiologist and quality analyst, was administered over a three-week period to patients suffering from cancer receiving chemotherapy in a day hospital. Results The analysis was based on 403 questionnaires. Patients had confidence in the GP’s knowledge of oncology in 88% of cases; 49% consulted their GP for pain, 15% for cancer-related advice, and 44% in emergencies. Perceived good GP/oncologist communication led patients to turn increasingly to their GP for cancer-related consultations (RR = 1.14; p = 0.01) and gave patients confidence in the GP’s ability to manage cancer-related problems (RR = 1.30; p p p Conclusion Patients suffering from cancer considered that the GP was competent, but did not often consult their GP for cancer-related problems. There is a discrepancy between patients’ beliefs and their behaviour. When the oncologist spoke to patients of the GP’s role, patients had recourse to their GP more often. Systematically integrating a GP consultation to conclude cancer diagnosis disclosure, could improve management and care coordination.

Despite the frequency and lethality of oral cancers in France, there are no detailed general population data regarding the characteristics of these patients to fuel the public health authorities' reflections about early detection policies. Thus, the objective of this study was to determine, in the general population, the characteristics of both patients and tumours at the time of the diagnosis. A high-resolution, population-based study using 13 French registries was conducted on 1089 tumours diagnosed in 2010. Men accounted for 75% of cases. The most frequent sites were tonsil (28.4%) and oral tongue (21.1%). The median age varied from 56.7 years for floor of mouth to 66.4 years for gum. The lesions were mainly diagnosed on pain and those diagnosed after routine clinical examination were scarce (2.6%). There were 65.5% stage III and IV at diagnosis. Oral tongue, floor of mouth and palate presented tumours less than 2cm only in 34 to 40% of cases. Advanced stage was associated with the presence of comorbidities, and tonsil or base of tongue topography. Stage was not associated with Département, deprivation index or gender. This study provided a picture of the characteristics of oral cancer patients and their tumours and showed that diagnoses are often made late, even for those tumours most easily accessible to direct visual and tactile examination. Nevertheless, it remains to define the target population of an early detection and to evaluate the benefit of such detection on the mortality rate.

Resume But Evaluer la qualite de la prise en charge diagnostique et therapeutique des cancers prostatiques en Midi-Pyrenees en 2011. Materiel La population etudiee a ete tiree au sort parmi les nouveaux cas de cancer de la prostate presentes en Reunion de concertation pluridisciplinaire (RCP) en 2011. Les indicateurs definis avec les professionnels ont permis d’evaluer la qualite de la prise en charge en phase diagnostique, lors de l’initiation du traitement et au moment de la realisation de la RCP. Resultats Six cent trente-trois nouveaux patients ont ete inclus (âge median au diagnostic = 69 ans, min : 48 ; max : 93). En periode diagnostique, 92 % des patients ont eu une biopsie prostatique. La realisation d’une IRM pelvienne, d’un scanner abdomino-pelvien et d’une scintigraphie osseuse a concerne respectivement 53 %, 55 % et 61 % des patients de risque intermediaire ou eleve. Le score de Gleason, l’etat des marges et le stade pathologique figuraient dans plus de 98 % des dossiers de patients traites par prostatectomie totale. Un dosage de PSA dans les 3 mois suivant la prostatectomie etait retrouve chez 59 % des patients operes. La RCP a ete realisee avant traitement pour 83 % des patients. Environ trois-quarts des patients operes de stade pT ≥ 3 ou pN1 ou ayant des marges non saines ont ete discutes en RCP apres la chirurgie. Conclusion La plupart des indicateurs etudies atteignent un niveau eleve. Toutefois, le moindre niveau de realisation des examens complementaires peut questionner sur leur place reelle, leur accessibilite et leur tracabilite. Niveau de preuve 4.

Today, the reduction of social inequalities in health is on the political agenda in public health. The complex reality of the determinants of these health inequalities remains difficult to understand and translate into practical actions. One of the reasons is that the circulation of expertise amongst researchers, actors in the field, and public decision is not systematic and still too rare. In 2013, the Federative Institute of Interdisciplinary Research and Studies Health Society (IFERISS) of Toulouse has an interdisciplinary platform (health, the humanities, and the social sciences) that directly offers expertise to public health actors, institutions, and local communities in order to respond to public health issues. At the request of the actors, AAPRISS can intervene at all stages of a study or an intervention, from conceptual and methodological construction to implementation support, and data analysis and use. In particular, the team has expertise in public policy evaluation, support for transferability according to the key functions/implementation/context (FIC) model, and awareness-raising at the intersection of urban planning and health. The platform is in a multi-year partnership with local authorities, the regional health agency of Occitanie, the primary health insurance funds of Occitanie, and various partners in civil society. Six years after the establishment of the AAPRISS platform, there is a strong demand for support and research from the actors and institutions. However, funding for activities remains uncertain despite the support of the National Cancer League and an increasingly strong network of partners. Mixed structures housing spaces for both research and action, which create a dynamic of Population Health Intervention Research, are showing themselves to be effective and seem to meet a need, but their financial stability is insufficient to sustain their activities and promote sustainable reduction of social inequalities in health. Key messages Mixed structures housing spaces for both research and action, which create a dynamic of Population Health Intervention Research, are showing themselves to be effective and seem to meet a need. But the financial stability of this mixed structures is insufficient to sustain their activities and promote sustainable reduction of social inequalities in health.

Summary Objective Due to their advanced age in average, colon cancer patients are likely to be exposed to comorbidity. However, the influence of comorbidity on patients’ care trajectory and survival is largely under-explored. Hence, we investigate the effect of comorbidity on patients care trajectory and survival based on an observational study in “real-life” setting. Methods This prospective observational study in two French regions includes patients aged over 18 and firstly treated for a colon cancer, stage II and III, diagnosed between 1st January and 31st December 2010. We assessed the influence of comorbidity (severe vs moderate or none), using the Charlson Comorbidity Index, on overall survival and patients’ management steps. Results We analyzed 762 patients. We found comorbidity to be associated with adjuvant treatment delivery with a longer delay between surgery and chemotherapy initiation among patients with severe comorbidity. Severe comorbidity had an independent detrimental effect on overall survival that is slightly downsized after adjustment for adjuvant treatment delivery. Conclusion Using observational “real-life” data, we showed that comorbidity impacts the colon cancer patients’ care trajectory directly but also through indirect pathways involving adjuvant chemotherapy delivery. However, further studies are needed to better understand this mechanism.

Summary Background The care management of colorectal cancers has evolved, particularly since the implementation of multidisciplinary team meetings (MDTm). The aim of this study was to identify factors associated with the non-presentation of colon cancer patients in MDTm (no-MDTm) and to assess the association between no-MDTm and the diagnostic and therapeutic care management, in two areas in France, in 2010. Methods Patients over 18 years diagnosed for invasive colon cancer in Gironde and Tarn during 2010 were included from the cancer registries of these two departments. We used five indicators to evaluate the care management of colon cancer patients (about diagnosis, treatment and selection of patients for chemotherapy). Results No-MDTm patients were more likely to die early after diagnosis (OR = 2.94, 95% CI = [1.52–5.66]). Elderly patients and those living in more disadvantaged areas were less often presented in MDTm (OR≥85years = 2.10, 95% CI = [1.06–4.18]; OREDI Q4-Q5 = 1.96, 95% CI = [1.23–3.14]). After adjusting for patient-related variables (age, comorbidities, deprivation) and tumor (stage at diagnosis), we found that thoracic CT scan was less often performed among no-MDTm patients (OR = 0.40, 95% CI = [0.24–0.65]). There was no association between the absence of MDTm and the therapeutic care management indicators. Conclusion In conclusion, therapeutic care management was not associated with the absence of MDTm but with patient and tumor characteristics, including age, comorbidities and level of deprivation, that influence the non-presentation in MDTm.

Summary Background Studies have shown clinical practices variation between centers in colorectal cancer (CRC) management. After the implementation of national cancer plans, we tested for differences in center and patients’ socioeconomic position (SEP)-related variation in CRC guidelines. Methods All patients aged 18 years and over, cared for a first CRC in 2010 in Southwest of France. We used mixed effect model to test for center-related heterogeneity (CRH) in recommendation, from the oldest to the more recent: (1) at least 12 lymph nodes analysed for stage II, (2) the prescription of adjuvant chemotherapy stage III and (3) the assessment of CRC molecular phenotype regarding KRAS status for stage IV. Patients’ SEP was approached by an ecological social deprivation index. Results We found: higher adherence for the oldest than for the most recent recommendations; no CRH in recommendation No. 2 but lower adherence in academic centers; a CRH for recommendations No. 1 and 3; no SEP-related differences in clinical practices. Conclusion Results showed that older recommendations have higher adherence but did not support increasing influence of centers characteristics and CRH as recommendations are more recent.

Purpose To evaluate the evolution of living conditions (LC) in long‐term survivors of localised prostate cancer 10 years after treatment compared with those of a same‐age control group from the general population. Methods Two hundred and eighty‐seven patients diagnosed with prostate cancer in 2001 were selected in 11 French cancer registries. They were matched with controls randomly selected for age and residency. Both patients and controls completed a self‐administered LC questionnaire concerning their familial, social and professional life, and general and specific quality of life (QoL) and anxiety and depression questionnaires. Results Compared with controls, patients reported more sexual modifications (p < .0001), but without any difference in marital status. Patients' circle of friends was more stable than that of the controls (91% vs. 63%; p < .0001) and patients reported fewer friendship modifications than controls (p < .0006). Their professional and physical activities were also preserved. They reported more anxiolytic intake (p = .002) but did not consult their general practitioner more often. Type of specialist consulted differed in the two groups. Conclusion Patients treated for localised prostate cancer had the same living conditions as men of the same age. Their social life was satisfying on the whole, albeit they reported more sexual difficulties than their counterparts.

Rare cancers epidemiology is better known compared to the other rare diseases. Thanks to the long history of the European population-based cancer registries and to the EUROCARE huge database, the burden of rare cancers has been estimated the European (EU28) population. A considerable fraction of all cancers is represented by rare cancers (24%). They are a heterogeneous group of diseases, but they share similar problems: uncertainty of diagnosis, lack of therapies, poor research opportunities, difficulties in clinical trials, lack of expertise and of centres of reference. This paper analyses the major epidemiological indicators of frequency (incidence and prevalence) and outcome (5-year survival) of all rare cancers combined and of selected rare cancers that will be in depth treated in this monographic issue. Source of the results is the RARECAREnet search tool, a database publicly available. Disparities both in incidence and survival, and consequently in prevalence of rare cancers were reported across European countries. Major differences were shown in outcome: 5-year relative survival for all rare cancers together, adjusted by age and case-mix, varied from 55% or more (Italy, Germany, Belgium and Iceland) and less than 40% (Bulgaria, Lithuania and Slovakia). Similarly, for all the analyzed rare cancers, a large survival gap was observed between the Eastern and the Nordic and Central European regions. Dramatic geographical variations were assessed for curable cancers like testicular and non epithelial ovarian cancers. Geographical difference in the annual age-adjusted incidence rates for all rare cancers together varied between >140 per 100,000 (Italy, Scotland, France, Germany, and Switzerland) and