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1. Management and outcomes of adolescent and young adult sarcoma patients: results from the French nationwide database NETSARC

Author

Pierre Kubicek, Axel Le Cesne, Cyril Lervat, Maud Toulmonde, Christine Chevreau, Florence Duffaud, Louis-Romée Le Nail, Magali Morelle, Nathalie Gaspar, Cécile Vérité, Marie-Pierre Castex, Nicolas Penel, Esma Saada, Sylvain Causeret, François Bertucci, Christophe Perrin, Emmanuelle Bompas, Daniel Orbach, Valérie Laurence, Sophie Piperno-Neumann, Philippe Anract, Maria Rios, Jean-Claude Gentet, Éric Mascard, Stéphanie Pannier, Pascale Blouin, Sébastien Carrère, Loïc Chaigneau, Pauline Soibinet-Oudot, Nadège Corradini, Pascaline Boudou-Rouquette, Jean-Christophe Ruzic, Valérie Lebrun-Ly, Pascale Dubray-Longeras, Sharmini Varatharajah, Céleste Lebbe, Mickaël Ropars, Jean-Emmanuel Kurtz, Cécile Guillemet, Jean-Pierre Lotz, Juliane Berchoud, Grégory Cherrier, Françoise Ducimetière, Claire Chemin, Antoine Italiano, Charles Honoré, Emmanuel Desandes, Jean-Yves Blay, François Gouin, and Perrine Marec-Bérard

Subjects
Adolescents and young adults, AYAs, Sarcoma, Management, Multidisciplinary tumor board, Reference centers, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background The initial management of patients with sarcoma is a critical issue. We used the nationwide French National Cancer Institute-funded prospective sarcoma database NETSARC to report the management and oncologic outcomes in adolescents and young adults (AYAs) patients with sarcoma at the national level. Patients and methods NETSARC database gathers regularly monitored and updated data from patients with sarcoma. NETSARC was queried for patients (15–30 years) with sarcoma diagnosed from 2010 to 2017 for whom tumor resection had been performed. We reported management, locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS) in AYA treated in French reference sarcoma centers (RSC) and outside RSC (non-RSC) and conducted multivariable survival analyses adjusted for classical prognostic factors. Results Among 3,227 patients aged 15–30 years with sarcoma diagnosed between 2010 and 2017, the study included 2,227 patients with surgery data available, among whom 1,290 AYAs had been operated in RSC, and 937 AYAs in non-RSC. Significant differences in compliance to guidelines were observed including pre-treatment biopsy (RSC: 85.9%; non-RSC 48.1%), pre-treatment imaging (RSC: 86.8%; non-RSC: 56.5%) and R0 margins (RSC 57.6%; non-RSC: 20.2%) (p

Published
2023
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2. Overall survival in patients with re-excision of positive microscopic margins of limb and trunk wall soft tissue sarcoma operated outside of a reference center: a nationwide cohort analysis

Author

Francois Gouin, Eberhard Stoeckle, Charles Honoré, Mickael Ropars, Mehrdad Jafari, Jean Camille Mattei, Alexandre Rochwerger, Sébastien Carrere, Denis Waast, Gwenaël Ferron, Jean-Christophe Machiavello, Philippe Anract, Frédéric Marchal, François Sirveaux, Oren Marco, Jérôme Guiramand, Brice Paquette, Antonio Di Marco, Sylvain Causeret, Jean-Marc Guilloit, Pauline Soibinet, Dimitri Tzanis, Pierre Gimbergues, Fabrice Fiorenza, Franck Dujardin, Louis R. Le Nail, Jean-Christophe Ruzic, Claire Chemin-Airiau, Magali Morelle, Pierre Meeus, Marie Karanian, François Le Loarer, Gualter Vaz, Jean-Yves Blay, and on behalf of the NETSARC/RREPS and French Sarcoma Group-Groupe d’Etude des Tumeurs Osseuses (GSF-GETO) networks

Subjects
Soft tissue sarcoma, Surgery, Relapse, Reference center, Multidisciplinary tumor board resection margins, Survival, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background This French nationwide NETSARC exhaustive prospective cohort aims to explore the impact of systematic re-excision (RE) as adjuvant care on overall survival (OS), local recurrence free survival (LRFS), and local and distant control (RFS) in patients with soft tissue sarcoma (STS) with positive microscopic margins (R1) after initial resection performed outside of a reference center. Methods Eligible patients had experienced STS surgery outside a reference center from 2010 to 2017, and had R1 margins after initial surgery. Characteristics and treatment comparisons used chi-square for categorical variables and Kruskall-Wallis test for continuous data. Survival distributions were compared in patients reexcised (RE) or not (No-RE) using a log-rank test. A Cox proportional hazard model was used for subgroup analysis. Results A total of 1,284 patients had experienced initial STS surgery outside NETSARC with R1 margins, including 1,029 patients with second operation documented. Among the latter, 698 patients experienced re-excision, and 331 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, tumor size, tumor depth, and histotype in the population of patients re-excised (RE) or not (No-RE). The study identified RE as an independent favorable factor for OS (HR 0.36, 95%CI 0.23–0.56, p

Published
2022
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3. Determinants of the access to remote specialised services provided by national sarcoma reference centres

Author

Yohan Fayet, Raphaël Tétreau, Charles Honoré, Louis-Romée Le Nail, Cécile Dalban, François Gouin, Sylvain Causeret, Sophie Piperno-Neumann, Simone Mathoulin-Pelissier, Marie Karanian, Antoine Italiano, Loïc Chaigneau, Justine Gantzer, François Bertucci, Mickael Ropars, Esma Saada-Bouzid, Abel Cordoba, Jean-Christophe Ruzic, Sharmini Varatharajah, Françoise Ducimetière, Sylvie Chabaud, Pascale Dubray-Longeras, Fabrice Fiorenza, Sixtine De Percin, Céleste Lebbé, Pauline Soibinet, Paul Michelin, Maria Rios, Fadila Farsi, Nicolas Penel, Emmanuelle Bompas, Florence Duffaud, Christine Chevreau, Axel Le Cesne, Jean-Yves Blay, François Le Loarer, and Isabelle Ray-Coquard

Subjects
Cancer inequalities, Spatial inequalities, Reference networks, Sarcoma, Cancer care accessibility, Rare cancers, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background 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. Methods 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. Results 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. Conclusions 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.

Published
2021
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4. Management and Outcomes of Pediatric, Adolescent and Young Adult Sarcoma Patients: Results from the French Nationwide Database NETSARC

Author

Pierre Kubicek, Axel Le Cesne, Cyril Lervat, Maud Toulmonde, Christine Chevreau, Florence Duffaud, Louis-Romée Le Nail, Magali Morelle, Nathalie Gaspar, Cécile Vérité, Marie-Pierre Castex, Nicolas Penel, Esma Saada, Sylvain Causeret, François Bertucci, Christophe Perrin, Emmanuelle Bompas, Daniel Orbach, Valérie Laurence, Sophie Piperno-Neumann, Philippe Anract, Maria Rios, Jean-Claude Gentet, Éric Mascard, Stéphanie Pannier, Pascale Blouin, Sébastien Carrère, Loïc Chaigneau, Pauline Soibinet-Oudot, Nadège Corradini, Pascaline Boudou-Rouquette, Jean-Christophe Ruzic, Valérie Lebrun-Ly, Pascale Dubray-Longeras, Sharmini Varatharajah, Céleste Lebbe, Mickaël Ropars, Jean-Emmanuel Kurtz, Cécile Guillemet, Jean-Pierre Lotz, Juliane Berchoud, Grégory Cherrier, Françoise Ducimetière, Claire Chemin, Antoine Italiano, Charles Honoré, Emmanuel Desandes, Jean-Yves Blay, François Gouin, and Perrine Marec-Bérard

Abstract

Background. The initial management of patients with sarcoma is critical. We used the French National Cancer Institute-funded nationwide sarcoma database NETSARC to report the management and oncologic outcomes in children, adolescents and young adults (AYAs) patients with sarcoma at the national level. Patients and methods. Data from patients with sarcoma are collected, regularly monitored and updated using NETSARC. NETSARC was searched for pediatric (Results. We collected data from 3,972 pediatric and AYA patients with sarcoma diagnosed between 2010 and 2017, including 714 children, 1,290 AYAs treated in RSC, and 937 AYAs in non-RSC. Significant differences in compliance to guidelines were observed regarding pre-treatment biopsy (Children: 83.5%; AYA in RSC: 85.9%; AYA in non-RSC 48.1%), pre-treatment imaging (Children: 81.2%; AYA in RSC: 86.8%; AYA in non-RSC: 56.5%) and R0 margins (Children: 52%; AYA in RSC 57.6%; AYA in non-RSC: 20.2%) (pConclusions. This study highlights the importance for AYA patients with sarcoma to be managed in national sarcoma reference centers involving multidisciplinary medical teams with paediatric and adult oncologists.

Published
2022

5. No Geographical Inequalities in Survival for Sarcoma Patients in France: A Reference Networks’ Outcome?

Author

Yohan Fayet, Christine Chevreau, Gauthier Decanter, Cécile Dalban, Pierre Meeus, Sébastien Carrère, Leila Haddag-Miliani, François Le Loarer, Sylvain Causeret, Daniel Orbach, Michelle Kind, Louis-Romée Le Nail, Gwenaël Ferron, Hélène Labrosse, Loïc Chaigneau, François Bertucci, Jean-Christophe Ruzic, Valérie Le Brun Ly, Fadila Farsi, Emmanuelle Bompas, Sabine Noal, Aurore Vozy, Agnes Ducoulombier, Clément Bonnet, Sylvie Chabaud, Françoise Ducimetière, Camille Tlemsani, Mickaël Ropars, Olivier Collard, Paul Michelin, Justine Gantzer, Pascale Dubray-Longeras, Maria Rios, Pauline Soibinet, Axel Le Cesne, Florence Duffaud, Marie Karanian, François Gouin, Raphaël Tétreau, Charles Honoré, Jean-Michel Coindre, Isabelle Ray-Coquard, Sylvie Bonvalot, Jean-Yves Blay, Centre Léon Bérard [Lyon], Research on Healthcare Performance (RESHAPE - Inserm U1290 - UCBL1), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut Gustave Roussy (IGR), Département de médecine oncologique [Gustave Roussy], Institut Bergonié [Bordeaux], UNICANCER, Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), Institut Curie [Paris], CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université de Tours (UT), Centre de Recherches en Cancérologie de Toulouse (CRCT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut Claudius Regaud, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), CHU Sud Saint Pierre [Ile de la Réunion], Hôpital Dupuytren [CHU Limoges], Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Universitaire de Cancérologie [Sorbonne Université] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Galilée (Galilée), Institut national des sciences de l'Univers (INSU - CNRS)-Observatoire de la Côte d'Azur, COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Centre National de la Recherche Scientifique (CNRS), Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Cochin [AP-HP], Cancer Research and Personalized Medicine - CARPEM [Paris], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Necker - Enfants Malades [AP-HP], Institut Cochin (IC UM3 (UMR 8104 / U1016)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), CHU Pontchaillou [Rennes], Université de Rennes (UR), Hôpital privé de la Loire, Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Institut de Cancérologie de Strasbourg Europe (ICANS), Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), Centre Hospitalier Universitaire de Reims (CHU Reims), Aix Marseille Université (AMU), Hôpital de la Timone [CHU - APHM] (TIMONE), CHU Lyon, Institut du Cancer de Montpellier (ICM), Pôle chirurgical et interventionnel [Gustave Roussy], Université Paris sciences et lettres (PSL), ARC Foundation [PGA1*20160203865], INCA (French National Cancer Institute) [SHSESP16-063], SIRIC LYriCAN [INCa-DGOS-Inserm_12563], INCa, DGOS, and EURACAN European Reference Network [EC 739521]

Subjects
spatial inequalities, Cancer Research, reference networks, Oncology, rare cancers, remoteness, social deprivation, France, [SDV.CAN]Life Sciences [q-bio]/Cancer
Abstract

International audience; Simple Summary As patients with rare cancers face specific problems, reference networks have been developed in several European countries and then at the European level to improve their management. In some cases, the specialized centers belonging to reference networks provide remote services (specialized diagnosis review, discussion in the Multidisciplinary Tumour Board, etc.) to increase access to these services. Using data from the national sarcoma reference network implemented in France (NETSARC+), the IGeAS research program assesses the potential of its organization to address the geographical inequalities in cancer management. We analyze the individual, clinical, and geographical determinants of the overall survival of sarcoma patients in France. We found no association between the overall survival of sarcoma patients and variables measuring their social deprivation, remoteness from reference centers, and geographical context. Following previous results from the research program, this study suggests that reference network organization should be considered to reduce cancer inequalities. The national reference network NETSARC+ provides remote access to specialized diagnosis and the Multidisciplinary Tumour Board (MTB) to improve the management and survival of sarcoma patients in France. The IGeAS research program aims to assess the potential of this innovative organization to address geographical inequalities in cancer management. Using the IGeAS cohort built from the nationwide NETSARC+ database, the individual, clinical, and geographical determinants of the 3-year overall survival of sarcoma patients in France were analyzed. The survival analysis was focused on patients diagnosed in 2013 (n = 2281) to ensure sufficient hindsight to collect patient follow-up. Our study included patients with bone (16.8%), soft-tissue (69%), and visceral (14.2%) sarcomas, with a median age of 61.8 years. The overall survival was not associated with geographical variables after adjustment for individual and clinical factors. The lower survival in precarious population districts [HR 1.23, 95% CI 1.02 to 1.48] in comparison to wealthy metropolitan areas (HR = 1) found in univariable analysis was due to the worst clinical presentation at diagnosis of patients. The place of residence had no impact on sarcoma patients' survival, in the context of the national organization driven by the reference network. Following previous findings, this suggests the ability of this organization to go through geographical barriers usually impeding the optimal management of cancer patients.

Published
2022
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6. Determinants of the access to remote specialised services provided by national sarcoma reference centres

Author

Céleste Lebbé, Justine Gantzer, Antoine Italiano, Jean-Yves Blay, C. Dalban, Sylvain Causeret, François Le Loarer, Pauline Soibinet, Isabelle Ray-Coquard, Sophie Piperno-Neumann, Fabrice Fiorenza, Louis-Romée Le Nail, Jean-Christophe Ruzic, Esma Saada-Bouzid, Sixtine De Percin, Sharmini Varatharajah, François Gouin, Axel Le Cesne, Maria Rios, Charles Honoré, Yohan Fayet, Christine Chevreau, P. Dubray-Longeras, Paul Michelin, François Bertucci, Marie Karanian, Simone Mathoulin-Pélissier, Françoise Ducimetière, Loic Chaigneau, Florence Duffaud, Raphaël Tetreau, Abel Cordoba, Emmanuelle Bompas, Sylvie Chabaud, Nicolas Penel, Mickaël Ropars, Fadila Farsi, Centre Léon Bérard [Lyon], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Health Service and Performance Research (HESPER), Université de Lyon-Université de Lyon, Institut du Cancer de Montpellier (ICM), Institut Gustave Roussy (IGR), Département de chirurgie viscérale [Gustave Roussy], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université de Tours (UT), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Department of Medical Oncology, Institut Curie, Paris 75248, France, Institut Curie [Paris], CIC Bordeaux, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), Département de Pathologie [CHU Lyon-Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Institut Bergonié [Bordeaux], Hôpital JeanMinjoz, Institut de Cancérologie de Strasbourg Europe (ICANS), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Pontchaillou [Rennes], Université de Rennes (UR), Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Université Côte d'Azur (UCA), Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), Service de médecine interne [CHU Dupuytren], CHU Dupuytren, Cancer Research and Personalized Medicine - CARPEM [Paris], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Immunologie humaine, physiopathologie & immunothérapie (HIPI (UMR_S_976 / U976)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre Hospitalier Universitaire de Reims (CHU Reims), Service de Radiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), Département cancer environnement (Centre Léon Bérard - Lyon), Association pour l'Utilisation du Rein Artificiel Région Lyonnaise (AURAL), University of Lille, Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), Hôpital de la Timone [CHU - APHM] (TIMONE), Aix Marseille Université (AMU), Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES), Université Lille Nord de France (COMUE)-UNICANCER, UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-CHU Necker - Enfants Malades [AP-HP], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Université de Tours, Université Côte d'Azur (UCA)-UNICANCER, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Malbec, Odile

Subjects
Adult, Male, Cancer Research, medicine.medical_specialty, Adolescent, Databases, Factual, Spatial inequalities, [SDV]Life Sciences [q-bio], Context (language use), Medical Oncology, Cancer inequalities, Health Services Accessibility, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Multidisciplinary approach, Reference networks, Genetics, medicine, Humans, Rare cancers, 030212 general & internal medicine, Healthcare Disparities, Cancer care accessibility, RC254-282, Survival analysis, Aged, Quality of Health Care, Patient Care Team, business.industry, Research, Remote Consultation, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Cancer, Sarcoma, Middle Aged, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Social deprivation, Oncology, 030220 oncology & carcinogenesis, Family medicine, Cohort, Female, France, business
Abstract

BackgroundSpatial 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.MethodsUsing 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.ResultsSome 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.ConclusionsIn 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.

Published
2021

7. Management and Outcomes of Adolescent and Young Adult Sarcoma Patients in the French Multicenter NETSARC Database

Author

Marie-Pierre Castex, Christine Chevreau, S. Carrere, Jean-Yves Blay, Christophe Perrin, Nicolas Penel, Cyril Lervat, Pascale Dubray-Longeras, Mickaël Ropars, Pierre Kubicek, Sharmini Varatharajah, Pauline Soibinet-Oudot, Maria Rios, Eric Mascard, Antoine Italiano, Jean-Pierre Lotz, Stéphanie Pannier, Cécile Guillemet, Grégory Cherrier, Sophie Piperno-Neumann, Charles Honoré, Claire Chemin, Valerie Lebrun-Ly, Emmanuelle Bompas, Nadège Corradini, Jean-Emmanuel Kurtz, Pascaline Boudou-Rouquette, Cécile Vérité, François Gouin, Françoise Ducimetière, Daniel Orbach, Esma Saada-Bouzid, Loic Chaigneau, Pascale Blouin, Maud Toulmonde, Louis-Romée Le Nail, Perrine Marec-Berard, Sylvian Causeret, Axel Le Cesne, Jean-Claude Gentet, François Bertucci, Juliane Berchoud, Philippe Anract, Jean-Christophe Ruzic, Magali Morelle, Céleste Lebbé, Nathalie Gaspar, and Florence Duffaud

Subjects
Database, GiST, business.industry, Significant difference, Hazard ratio, Cancer, medicine.disease, computer.software_genre, Statistical significance, Clinical endpoint, Medicine, Sarcoma, Young adult, business, computer
Abstract

Introduction: This study evaluates the management of patients aged 0 to 30 years treated for sarcoma with data registered in the NETSARC French national database and compared the survival of adolescents and young adults (AYA) patients managed in reference sarcoma national centers (AYA in NC) and in non-NC (AYA outside NC). Patients and Methods: NETSARC (netsarc.org) is a network of 26 reference sarcoma centers funded by the French National Cancer Institute. Patients’ characteristics and follow-up are prospectively collected in a database regularly monitored and updated. Patients’ survival was compared between groups. The primary endpoint was overall survival (OS). Secondary endpoints were local progression-free survival (LPFS), progression-free survival (PFS), and the quality of initial surgery. Results: Among 3,972 patients aged 0 to 30 years diagnosed between 2010 and 2017, 714 children, 1,290 AYAs in NC and 937 AYAs outside NC were included. Compliance to guidelines between AYAs treated in versus outside reference centers was significantly different (p

Published
2020

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