OBJECTIVES

: Inequalities in access to care for cancer patients have been identified in many countries and constitute barriers to effective care. In France, a better understanding of such inequalities in lung cancer is important because of its high incidence, of its often late diagnosis and of recently available therapeutic innovations. The aim of the study was to measure the dissimilarity of patient pathways between 4 French regions.

METHODS

: Based on hospital stay data from patients in the PMSI, a national cohort of incident patients (diagnosed in 2011) with lung cancer was followed for 2 years (2011-2013). 4 sub-cohorts were created to study regional disparities (Auvergne, Brittany, Nord-Pas-de-Calais, Rhône-Alpes). The identification of the different treatment types (chemotherapy, radiotherapy, surgery, etc.) enabled to describe the entire patients' care sequences. Disparities in care pathways between cohorts were studied thanks to the definition of 3 criteria: sequences' entropy, odds ratio on headcounts and inter-treatment delays. These criteria allow the inclusion of all the sequences and their complexity in the comparison.

RESULTS

: At the national level, 41,715 incident patients were identified, 9,327 of whom were in the 4 regions. Care pathways are very differentiated between regions. The treatment in Auvergne is very close to the national model on the 3 criteria, contrary to Rhône-Alpes (highest inter-treatment delays, lowest odds ratio). The entropy of the sequences remains high and little varies between regions.

CONCLUSIONS

: The care pathways in lung cancer in France are different among regions. In addition to monitoring indicators for access to care, we have co-constructed methodologies for analyzing and comparing patient care sequences within the territory.