French medico-administrative data to identify the care pathways of women with breast cancer

• Published in: Clinical breast cancer 2017-07, Vol.17 (4), p.e191-e197
• Main Authors: Lefeuvre, D., MD, Le Bihan-Benjamin, C., MD, Pauporté, I., PhD, Medioni, J., MD PhD, Bousquet, P.J., MD PhD
• Format: Article
• Language: English
• Subjects: Breast cancer; Breast Neoplasms - therapy; Care pathways; Chemotherapy, Adjuvant; Combined Modality Therapy; Critical Pathways; Databases, Factual; Diagnosis-related groups database; Female; Follow-Up Studies; France; Hematology, Oncology and Palliative Medicine; Humans; Mastectomy; Middle Aged; National Health Programs; Obstetrics and Gynecology; Population level; Practice Guidelines as Topic - standards; Practice Patterns, Physicians' - standards; Prognosis; Radiotherapy, Adjuvant; Retrospective Studies; Time between treatments
• ISSN: 1526-8209; 1938-0666
• DOI: 10.1016/j.clbc.2017.01.008

Abstract Background Study of the care pathways is an important topic for care planning, as well as to observe guidelines application. This study aimed to describe care pathways and the period of time between treatments of women with breast cancer (BC), at a population level. Methods Women with in situ, local and regional BC who were hospitalized and newly treated in 2012 were included and followed for one year. Care pathways were described, focusing on surgery (partial mastectomy – PM, total mastectomy - TM), chemotherapy and radiotherapy. The periods of time between treatments were measured and compared to the guidelines. Results The study involved 52,128 women. The most common care pathways among the 2,845 women with in situ BC were PM-radiotherapy (46.7%) and TM (28.5%). Among the 41,470 women with local BC, they were: PM-radiotherapy (44.8%) or PM-chemotherapy-radiotherapy (16.0%). The 7,813 women with regional BC had similar care pathways, although chemotherapy was given more frequently (73%). The periods of time between surgery and chemotherapy were in accordance with the guidelines for 98% of the women; those between surgery and radiotherapy were impacted by adjuvant chemotherapy. Finally, the time between chemotherapy and radiotherapy was longer than recommended for 40% of the women. Conclusion The French medico-administrative databases allow the study, at a national population level, of the care pathways and periods of time between treatments of women with BC according to the stage of the disease. They were close to the guidelines, although an improvement is highly necessary.