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No Geographical Inequalities in Survival for Sarcoma Patients in France: A Reference Networks' Outcome?

Yohan Fayet 1, 2, * Christine Chevreau 3 Gauthier Decanter 4 Cécile Dalban 1 Pierre Méeus 1 Sebastien Carrere 5 Leïla Haddag-Miliani 6, 7 François Le Loarer 8 Sylvain Causeret 9 Daniel Orbach 10 Michelle Kind 8 Louis-Romée Le Nail 11, 12 Gwénaël Ferron 13, 14, 3 Hélène Labrosse 1 Loïc Chaigneau 15 François Bertucci 16 Jean-Christophe Ruzic 17 Valérie Le Brun-Ly 18 Fadila Farsi 1 Emmanuelle Bompas 19 Sabine Noal 20 Aurore Vozy 21, 22, 23 Agnès Ducoulombier 24 Clement Bonnet 25 Sylvie Chabaud 1 Françoise Ducimetière 1 Camille Tlemsani 26, 27, 28 Mickael Ropars 29, 30 Olivier Collard 31 Paul Michelin 32 Justine Gantzer 33 Pascale Dubray-Longeras 34 Maria Rios 35 Pauline Soibinet-Oudot 36 Axel Le Cesne 6, 7 Florence Duffaud 37, 38 Marie Karanian 39 Francois Gouin 1 Raphaël Tetreau 40 Charles Honoré 6, 41 Jean-Michel Coindre 8 Isabelle Ray-Coquard 1 Sylvie Bonvalot 10, 42 Jean-Yves Blay 1 
* Corresponding author
Abstract : 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.
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https://hal.archives-ouvertes.fr/hal-03718397
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Submitted on : Friday, July 8, 2022 - 4:57:08 PM
Last modification on : Tuesday, December 6, 2022 - 12:42:13 PM
Long-term archiving on: : Sunday, October 9, 2022 - 8:11:24 PM

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Yohan Fayet, Christine Chevreau, Gauthier Decanter, Cécile Dalban, Pierre Méeus, et al.. No Geographical Inequalities in Survival for Sarcoma Patients in France: A Reference Networks' Outcome?. Cancers, 2022, 14 (11), pp.2620. ⟨10.3390/cancers14112620⟩. ⟨hal-03718397⟩

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