Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 1;130(23):4096-4108.
doi: 10.1002/cncr.35519. Epub 2024 Aug 20.

Access to primary care and mortality in excess for patients with cancer in France: Results from 21 French Cancer Registries

Joséphine Gardy  1   2   3   4 , Sarah Wilson  2 , Anne-Valérie Guizard  1   4 , Véronique Bouvier  1   2   3 , Ludivine Launay  2 , Arnaud Alves  1   2   3 , Simona Bara  1   5 , Anne-Marie Bouvier  1   6   7   8   9 , Gaëlle Coureau  1   10   11   12 , Anne Cowppli-Bony  1   13   14   15 , Sandrine Dabakuyo Yonli  1   16 , Laëtitia Daubisse-Marliac  1   17   18   19 , Gautier Defossez  1   20   21 , Karima Hammas  1   22 , Florent Hure  1   23 , Valérie Jooste  1   6   7   8   9 , Bénédicte Lapotre-Ledoux  1   24   25 , Jean-Baptiste Nousbaum  1   26   27   28 , Sandrine Plouvier  1   29 , Arnaud Seigneurin  1   30 , Brigitte Tretarre  1   18   31 , Nicolas Vigneron  1   4 , Anne-Sophie Woronoff  1   32 , Guy Launoy  2 , Florence Molinie  1   13   14   15 , Joséphine Bryere  2 , Olivier Dejardin  2   33
Affiliations

Access to primary care and mortality in excess for patients with cancer in France: Results from 21 French Cancer Registries

Joséphine Gardy et al. Cancer. .

Abstract

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.

Keywords: cancer; excess mortality; primary care; registries.

PubMed Disclaimer

References

REFERENCES

    1. FRANCIM. Survie des personnes atteintes de cancer en France métropolitaine 1989‐2018.
    1. Tron L, Fauvernier M, Bouvier AM, et al. socioeconomic environment and survival in patients with digestive cancers: a French population‐based study. Cancers. 2021;13(20):5156. doi:10.3390/cancers13205156
    1. Kravdal Ø. Does place matter for cancer survival in Norway? A multilevel analysis of the importance of hospital affiliation and municipality socio‐economic resources. Health Place. 2006;12(4):527‐537. doi:10.1016/j.healthplace.2005.08.005
    1. Jones AP, Haynes R, Sauerzapf V, Crawford SM, Zhao H, Forman D. Travel times to health care and survival from cancers in Northern England. Eur J Cancer. 2007;44(2):269‐274. doi:10.1016/j.ejca.2007.07.028
    1. Dejardin O, Jones AP, Rachet B, et al. The influence of geographical access to health care and material deprivation on colorectal cancer survival: evidence from France and England. Health Place. 2014;30C:36‐44. doi:10.1016/j.healthplace.2014.08.002

LinkOut - more resources