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1. Cost-Effectiveness of an Organized Lung Cancer Screening Program for Asbestos-Exposed Subjects

Author

Sébastien Gendarme, Jean-Claude Pairon, Pascal Andujar, François Laurent, Patrick Brochard, Fleur Delva, Bénédicte Clin, Antoine Gislard, Christophe Paris, Isabelle Thaon, Helene Goussault, Florence Canoui-Poitrine, Christos Chouaïd, Centre Hospitalier Intercommunal de Créteil (CHIC), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Clinical Epidemiology and Ageing : Geriatrie Soins Primaires et Santé Publique (CEpiA), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Interuniversitaire de Médecine du Travail de Paris Ile-de-France (IIMTPIF), Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Bordeaux [Bordeaux], Cancer environnement (EPICENE ), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Université de Caen Normandie (UNICAEN), Normandie Université (NU), Aliments Bioprocédés Toxicologie Environnements (ABTE), Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), CHU Rouen, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), IMRB - CEPIA/'Clinical Epidemiology And Ageing : Geriatrics, Primary Care and Public Health' [Créteil] (U955 Inserm - UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), and Tapia, Claudia

Subjects
Cancer Research, screening, [SDV.CAN]Life Sciences [q-bio]/Cancer, lung neoplasms, asbestos, [SHS.ECO]Humanities and Social Sciences/Economics and Finance, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, JEL: I - Health, Education, and Welfare/I.I1 - Health/I.I1.I18 - Government Policy • Regulation • Public Health, Oncology, [SDV.CAN] Life Sciences [q-bio]/Cancer, occupational diseases, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, cost-effectiveness, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, [SHS.ECO] Humanities and Social Sciences/Economics and Finance
Abstract

Background: The National Lung Screening Trial (NLST) and NELSON study opened the debate on the relevance of lung cancer (LC) screening in subjects exposed to occupational respiratory carcinogens. This analysis reported the incremental cost-effectiveness ratios (ICER) of an organized LC screening program for an asbestos-exposed population. Methods: Using Markov modelization, individuals with asbestos exposure were either monitored without intervention or annual low-dose thoracic computed-tomography (LDTCT) scan LC screening. LC incidence came from a prospective observational cohort of subjects with occupational asbestos exposure. The intervention parameters were those of the NLST study. Utilities and LC-management costs came from published reports. A sensitivity analysis evaluated different screening strategies. Results: The respective quality-adjusted life year (QALY) gain, supplementary costs and ICER [95% confidence interval] were: 0.040 [0.010–0.065] QALY, 6900 [3700–11,800] € and 170,000 [75,000–645,000] €/QALY for all asbestos-exposed subjects; and 0.144 [0.071–0.216] QALY, 13,000 [5700–26,800] € and 90,000 [35,000–276,000] €/QALY for smokers with high exposure. When screening was based on biennial LDTCT scans, the ICER was 45,000 [95% CI: 15,000–116,000] €/QALY. Conclusions: Compared to the usual ICER thresholds, biennial LDTCT scan LC screening for smokers with high occupational exposure to asbestos is acceptable and preferable to annual scans.

Published
2022

2. Factors associated with early lung cancer mortality: a systematic review

Author

Christos Chouaid, Sebastien Gendarme, Jean Baptiste Assié, Helene Goussault, and Olivier Bylicki

Subjects
0301 basic medicine, Oncology, Male, medicine.medical_specialty, Lung Neoplasms, Early lung cancer, MEDLINE, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Epidemiology, medicine, Humans, Pharmacology (medical), Prospective Studies, Lung cancer, Lung, business.industry, Cancer, respiratory system, medicine.disease, respiratory tract diseases, 030104 developmental biology, medicine.anatomical_structure, 030220 oncology & carcinogenesis, business
Abstract

Introduction: Despite recent therapeutic advances, lung cancer remains the primary cause of cancer deaths worldwide, and early lung mortality was poorly studied.Area covered: Early lung-cancer mort...

Published
2021

3. Impact on All-Cause and Cardiovascular Mortality Rates of Coronary Artery Calcifications Detected during Organized, Low-Dose, Computed-Tomography Screening for Lung Cancer: Systematic Literature Review and Meta-Analysis

Author

Sébastien Gendarme, Christos Chouaid, Cherifa Taleb, Thierry Landre, Jean-Baptiste Assié, Helene Goussault, Centre Hospitalier Intercommunal de Créteil (CHIC), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Clinical Epidemiology and Ageing : Geriatrie Soins Primaires et Santé Publique (CEpiA), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP), Gestionnaire, Hal Sorbonne Université, and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)

Subjects
Cancer Research, medicine.medical_specialty, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, lcsh:RC254-282, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, cardiovascular mortality, Internal medicine, lung cancer screening, medicine, Prospective cohort study, Cause of death, business.industry, Mortality rate, Odds ratio, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, coronary artery calcification, 3. Good health, [SDV] Life Sciences [q-bio], meta-analysis, Oncology, Meta-analysis, Relative risk, Systematic Review, business, Lung cancer screening, Cohort study
Abstract

Simple Summary The results of several randomized studies showed the efficacy of organized, low-dose, computed-tomography (CT) scan lung-cancer screening in lowering all-cause and lung-cancer-specific mortality rates. Low-dose CT scans can also detect and quantify coronary artery calcifications (CACs). By means of meta-analysis, we were able to show that the presence of CACs in CT performed in this setting was associated with an enhanced risk of cardiovascular and all-cause mortality for men and women. These finding plead for the implementation of preventive interactions against cardiovascular risk in lung-cancer screening-program participants found to have CACs. Abstract Although organized, low-dose, computed-tomography (CT) scan lung-cancer screening has been shown to lower all-cause and lung-cancer-specific mortality, the primary cause of death for subjects eligible for such screening remains cardiovascular (CV) mortality. This meta-analysis study was undertaken to evaluate the impact of screening-scan-detected coronary artery calcifications (CACs) on CV and all-cause mortality. We conducted a systematic review and meta-analysis of studies reporting CV mortality according to the Agatson CAC score for participants in a lung-cancer screening program of randomized clinical or cohort studies. PubMed, Embase, and Cochrane databases were screened in June 2020. Two authors independently selected articles and extracted data. Six studies, including 20,175 subjects, were retained. CV and all-cause mortality rates were higher for subjects with CAC scores >0, with respective relative risks of 2.02 [95% CI 1.23–3.32] and 2.29 [95% CI 1.00–5.21]. Both mortality rates were even higher for those with high CAC scores (>400 or >1000). CACs are more common in men than in women, with an odds ratio of 1.49 [95% CI 1.40–1.59]. The presence of CAC is associated with CV mortality with an RR of 2.05 [95% CI 1.20–3.57] in men and 2.37 [CI 95% 1.29–5.09] in women, respectively. Analysis of lung-cancer-screening scans for CACs is a tool able to predict CV mortality. Prospective studies within those programs are needed to assess the benefit of primary CV prevention based on CAC detection.

Published
2021

4. Évaluation médico-économique d’un programme de dépistage des cancers broncho-pulmonaires chez des sujets exposés à l’amiante

Author

Helene Goussault, François Laurent, Christos Chouaid, Bénédicte Clin, Aude Lacourt, S. Gendarme, Pascal Andujar, C. Paris, A. Gislard, Jean-Claude Pairon, Céline Gramond, Patrick Brochard, and S. Chamming's

Subjects
Pulmonary and Respiratory Medicine, 03 medical and health sciences, 0302 clinical medicine, 030212 general & internal medicine, 030204 cardiovascular system & hematology
Abstract

Introduction Les Resultats de l’etude NLST aux Etats-Unis et de l’etude NELSON en Europe ont ouvert le debat sur l’opportunite d’un depistage du cancer broncho-pulmonaire (CBP) chez des patients exposes a des carcinogenes respiratoires [1] , [2] . L’objectif de cette analyse est d’evaluer l’impact medico-economique, en France, de la mise en place d’un programme de depistage du CBP dans une cohorte de sujets exposes a l’amiante. Methodes L’analyse est basee sur une modelisation MCMC (Monte Carlo Markok Chain) permettant d’etablir le rapport cout utilite de la mise en place d’un depistage annuel du CBP par tomodensitometrie thoracique chez des sujets fumeurs et exposes fortement a l’amiante. Les donnees utilisees dans la modelisation sont l’incidence de CBP dans la cohorte francaise ARDCO (cohorte multiregionale de sujets exposes a l’amiante avec suivi longitudinal depuis 2002), et leurs consommations de soins, les parametres d’intervention sont issus de l’etude NLST. Les donnees d’utilites et de couts de prise en charge des CBP diagnostiques sont issues de la litterature. Une analyse de sensibilite a permis d’evaluer differentes strategies de depistage selon l’intervalle entre les scanners et la population cible. Resultats La mise en place d’un depistage annuel par TDM thoracique chez les sujets fumeurs et exposes fortement a l’amiante permet un gain de QALY de 0.041 par personne [IC 95 % 0.028–0.052] pour un cout de 6208 € par personne [IC 95 % 4536€–7904€], soit un ratio cout-utilite differentiel de 93 020 €/QALY [IC 95 % 51 898€–170 492€]. Lorsque le depistage repose sur un scanner tous les 2 ans, le rapport cout-utilite est plus favorable: 40 938 €/QALY [IC 95 % 22 440€–65 364€]. Conclusion Au regard des seuils habituels pour une intervention de sante, un depistage du CBP par TDM thoracique tous les 2 ans est acceptable et preferable a un depistage annuel dans cette population.

Published
2021

5. Facteurs de risque de mortalité précoce dans le cancer pulmonaire en France : une analyse nationale à partir des données du PMSI

Author

S. Epaud, M. Rousseau, Helene Goussault, S. Gendarme, A. Lazzati, Christos Chouaid, N. Salaun-Penquer, Camille Jung, Jean-Baptiste Assié, and C. Algans

Subjects
Pulmonary and Respiratory Medicine
Abstract

Introduction Le cancer pulmonaire est la premiere cause de deces par cancer dans le monde. Malgre les avancees therapeutiques, le pronostic reste sombre. L’objectif principal est d’identifier des facteurs de risque de mortalite a 90 jours de la premiere hospitalisation pour cancer pulmonaire (mortalite precoce). Methodes Il s’agit d’une analyse des donnees du Systeme National des Donnees de Sante incluant les patients avec une premiere hospitalisation pour cancer pulmonaire entre le 1er janvier 2016 et le 31 decembre 2018 (code C34* de la CIM-10). L’analyse inclue des caracteristiques cliniques, les modes d’entree et de sortie, et des indicateurs socio-economiques (a partir du lieu de domicile). Un modele predictif de mortalite precoce est developpe a partir des variables disponibles lors du premier sejour. Resultats L’etude inclut 144 087 patients, majoritairement des hommes (67 %), avec un âge median de 68 ans [60–76]. Parmi eux 47 % sont diagnostiques a un stade metastatique, 34 % et 23 % beneficient respectivement d’une chimiotherapie et d’une chirurgie; 27 % souffrent de BPCO. La duree de la premiere hospitalisation est de 6 jours [95 %IC: 1–13]; les patients sont pris en charge a 40 % dans des CH et a 26 % dans des CHU; 26 % sont hospitalises apres un passage aux urgences; la majorite (58 %) habite en zones urbaines. La mortalite precoce est de 19 %. Elle augmente avec l’âge (OR 1.33 [1.22–1.45] pour les plus de 70 ans), le sexe masculin (OR 1.50 [1.44–1.55), le stade metastatique (OR 3.30 [3.18–3.43]), une entree via les urgences (OR 1.65 [1.59–1.71]), et la duree du premier sejour (OR 1.58 [1.49–1.68] pour plus de 30 jours). Les facteurs socio-economiques (densite de population, territoires ruraux, indicateur d’accessibilite potentielle localisee et indice de privation sociale) n’influencent pas la mortalite precoce. Le modele predictif le plus performant est celui obtenu par regression logistique (score F1 0.44, specificite 0.88 et AUC ROC 0.65). Les variables avec le plus gros poids dans ce modele sont le statut metastatique, l’hospitalisation via les urgences et une duree de sejour initial de plus de 7 jours. Conclusion En France, 19 % des patients decedent dans les 90 jours suivants la premiere hospitalisation pour cancer pulmonaire. Ce sont majoritairement des hommes, âges, diagnostiques a un stade metastatique apres un passage aux urgences. Un diagnostic plus precoce pourrait reduire la mortalite precoce. Le developpement d’un modele predictif pourrait aider la prise en charge des patients.

Published
2021

6. Risk factors for early mortality of lung cancer patients in France: A nationwide analysis

Author

Hélène Goussault, Sébastien Gendarme, Jean‐Baptiste Assié, Camille Jung, Salomé Epaud, Christelle Algans, Noémie Salaun‐Penquer, Mathilde Rousseau, Andrea Lazatti, and Christos Chouaïd

Subjects
early mortality, epidemiology, lung cancer, mortality, prognosis, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background Despite therapeutic advances, lung cancer remains the first cause of death from cancer. The main objective of this study was to identify risk factors associated with death within 3‐months of the first hospitalization for lung cancer in France. Methods This analysis included patients with a first hospitalization for lung cancer (between January 1, 2016 and December 31, 2018) according to diagnosis‐related groups entered into the French national medical‐administrative database. Clinical and socioeconomic parameters and characteristics of that first hospitalization were analyzed. A model predictive of early mortality was developed based on those variables. Results The 144,087 included patients were 67% men; median age of 68 [interquartile range 60–76] years; 47% had metastatic disease at diagnosis; and 34% and 23%, respectively, had received systemic treatment or undergone curative surgery. The 3‐month mortality was 19%, and significantly higher for those ≥70 versus 30 days (OR, 1.58 1.49–1.68). In contrast, no socioeconomic characteristic was associated with early mortality. Conclusion Almost 1 in 5 patients diagnosed with lung cancer in France died within 3 months post‐diagnosis. Improving survival requires diagnosis at an earlier stage and better organization of diagnosis and specific care pathways.

Published
2022
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7. Primary immunodeficiency-related bronchiectasis in adults: comparison with bronchiectasis of other etiologies in a French reference center

Author

Hélène Goussault, Hélène Salvator, Emilie Catherinot, Marie-Laure Chabi, Colas Tcherakian, Alexandre Chabrol, Morgane Didier, Elisabeth Rivaud, Alain Fischer, Felipe Suarez, Olivier Hermine, Fanny Lanternier, Olivier Lortholary, Nizar Mahlaoui, Philippe Devillier, and Louis-Jean Couderc

Subjects
Bronchiectasis, Primary immunodeficiency, Common variable immune deficiency, Immunoglobulins, Diseases of the respiratory system, RC705-779
Abstract

Abstract Background Bronchiectasis is a heterogeneous disease depending on etiology. It represents the most frequent non-infectious pulmonary complication of primary immunodeficiencies (PID). We investigated whether bronchiectasis associated with PID had a distinct course in comparison to bronchiectasis of other causes. Methods Retrospective single-center study of adult patients diagnosed with non-cystic fibrosis bronchiectasis with more than 5 years of follow-up and at least 4 pulmonary functional tests available at one year apart. They were divided into three groups: PID- related bronchiectasis, idiopathic/post infectious-related bronchiectasis and other causes of bronchiectasis. Respiratory functional data and clinical outcomes were compared. Results Of 329 patients with bronchiectasis diagnosed in Foch Hospital (Suresnes, France), 98 patients fulfilled the selected criteria (20 PID-related cases, 39 idiopathic or post-infectious cases, and 39 cases with other causes). Median time of follow-up was 9.5 years. Groups were similar concerning initial characteristics (female 70.4%, never smokers 59.2%, mild severity bronchiectasis according to the FACED score and median FEV1 at diagnosis 73.5% predicted values [Q1–Q3: 53.75–90.5]), except PID patients who were younger (median age of 51.5 vs 62 years, p = 0.02). Eighty-five percent of PID patients received immunoglobulin substitution (median trough level was measured at 10.5 g/dl [10;10.92]). Global median FEV1 annual decline was 25.03 ml/year [8.16;43.9] and 19.82 ml/year [16.08;48.02] in the PID patients group. Forty-five percent of patients had bacterial colonization, pneumoniae occurred in 56% of patients and median exacerbation annual rate was 0.8 [0.3–1.4]. Hemoptysis occurred in 31.6% of patients. Global mortality rate was 11.2%. We did not record any significant difference for all clinical and functional outcomes between patients with PID and other etiologies. The median decline in FEV1 was similar in the three groups. Conclusions The course of PID-related bronchiectasis was similar to bronchiectasis of other causes. Provided that patients receive immunoglobulin replacement, the course of PID-related bronchiectasis seems to be independent of the underlying immune disorder.

Published
2019
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