Access to primary care and mortality in excess for patients with cancer in France: Results from 21 French Cancer Registries
2 ANTICIPE - Unité de recherche interdisciplinaire pour la prévention et le traitement des cancers
3 Registre des cancers digestifs du Calvados [CHU Caen]
4 Registre Général des Tumeurs du Calvados
5 Registre des cancers de la Manche [CHPC - Site Louis Pasteur]
6 LNC - Lipides - Nutrition - Cancer [Dijon - U1231]
7 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
8 BSB - Burgundy School of Business (BSB) - Ecole Supérieure de Commerce de Dijon Bourgogne (ESC)
9 Registre Bourguignon des Cancers Digestifs
10 Registre Général des Cancers de la Gironde
11 EPICENE - Cancer environnement
12 CHU de Bordeaux Pellegrin [Bordeaux]
13 Equipe EQUITY (CERPOP)
14 SIRIC-ILIAD - Site de Recherche Intégrée sur le Cancer - Imaging and Longitudinal Investigations to Ameliorate Decision-making
15 Registre des cancers de Loire‐Atlantique et Vendée
16 UNICANCER/CRLCC-CGFL - Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon]
17 Registre général des cancers du Tarn = Tarn Cancer Registry
18 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
19 UP - Université de Poitiers = University of Poitiers
20 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
21 Registre des Cancers du Haut-Rhin
22 Groupe hospitalier de la région de Mulhouse et Sud-Alsace
23 Centre Hospitalier de Mulhouse, site du Hasenrain (Mulhouse)
24 CHIMERE - CHirurgie, IMagerie et REgénération tissulaire de l’extrémité céphalique - Caractérisation morphologique et fonctionnelle - UR UPJV 7516
25 Registre général des cancers de la Somme
26 EA7479 SPURBO - Soins Primaires, Santé Publique, Registre des cancers de Bretagne Occidentale
27 GCS-C2RC - Registre général des cancers de Lille et de sa région
28 Registre des cancers de l’Isère [CHU de Grenoble]
29 Registre des Tumeurs de l'Hérault
30 Registre des tumeurs du Doubs et du Territoire de Belfort [CHRU Besançon]
31 Unité de Recherches et d'Evaluations en Epidémiologie [CHU Caen]
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Résumé
Background: The impact of geographical accessibility on cancer survival has been investigated in few studies, with most research focusing on access to reference care centers, using overall mortality and limited to specific cancer sites. This study aims to examine the association of access to primary care with mortality in excess of patients with the 10 most frequent cancers in France, while controlling for socioeconomic deprivation. Methods: This study included a total of 151,984 cases diagnosed with the 10 most common cancer sites in 21 French cancer registries between 2013 and 2015. Access to primary care was estimated using two indexes: the Accessibilité Potentielle Localisée index (access to general practitioners) and the Scale index (access to a range of primary care clinicians). Mortality in excess was modelized using an additive framework based on expected mortality based on lifetables and observed mortality. Findings: Patients living in areas with less access to primary care had a greater mortality in excess for some very common cancer sites like breast (women), lung (men), liver (men and women), and colorectal cancer (men), representing 46% of patients diagnosed in our sample. The maximum effect was found for breast cancer; the excess hazard ratio was estimated to be 1.69 (95% CI, 1.20-2.38) 1 year after diagnosis and 2.26 (95% CI, 1.07-4.80) 5 years after diagnosis. Interpretation: This study revealed that this differential access to primary care was associated with mortality in excess for patients with cancer and should become a priority for health policymakers to reduce these inequalities in health care accessibility.