No Geographical Inequalities in Survival for Sarcoma Patients in France: A Reference Networks’ Outcome?
Yohan Fayet, Christine Chevreau, Gauthier Decanter, Cécile Dalban, Pierre Méeus, Sébastien Carrère, Leila Haddag‐Miliani, François Le Loarer, Sylvain Causeret, Daniel Orbach, Michelle Kind, Louis‐Romée Le Nail, Gwénaël Ferron, H Labrosse, L. Chaigneau, François Bertucci, J Ruźić, Valérie Le Brun Ly, Fadila Farsi, Emmanuelle Bompas, Sabine Noal, Aurore Vozy, Agnès Ducoulombier, Clément Bonnet, Sylvie Chabaud, Françoise Ducimetière, Camille Tlemsani, M. Ropars, Olivier Collard, Paul Michelin, Justine Gantzer, Pascale Dubray‐Longeras, María Rios, Pauline Soibinet, Axel Le Cesne, Florence Duffaud, Marie Karanian, F. Gouin, R. Tétreau, Charles Honoré, Jean‐Michel Coindre, Isabelle Ray‐Coquard, Sylvie Bonvalot, Jean‐Yves Blay
Abstract
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 IGéAS research program aims to assess the potential of this innovative organization to address geographical inequalities in cancer management. Using the IGéAS 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.