Adolescent and young adult oncology patients in France: Heterogeneity in pathways of care

• Published in: Pediatric blood & cancer Vol. 65; no. 9; pp. e27235 - n/a
• Main Authors: Desandes, Emmanuel, Brugières, Laurence, Molinié, Florence, Defossez, Gautier, Delafosse, Patricia, Jehannin‐Ligier, Karine, Velten, Michel, Trétarre, Brigitte, Amadéo, Brice, Marrer, Emilie, Woronoff, Anne‐Sophie, Ganry, Olivier, Monnereau, Alain, d'Almeida, Tania, Troussard, Xavier, Daubisse‐Marliac, Laetitia, Bara, Simona, Guizard, Anne‐Valérie, Baldi, Isabelle, Launoy, Guy, Clavel, Jacqueline, Lacour, Brigitte
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.09.2018; Wiley
• Subjects: Adolescent; Adolescents; Bone tumors; Brain tumors; Cancer; Cancer Care Facilities - statistics & numerical data; Clinical Trials as Topic; Critical Pathways; Delayed Diagnosis; Diagnosis; Disease Management; Female; France - epidemiology; Health care facilities; Hematology; Human health and pathology; Humans; Life Sciences; Male; Medical personnel; Neoplasms - epidemiology; Neoplasms - therapy; Oncology; pathway of care; Patient Care Team; Patients; Pediatrics; Referral and Consultation - statistics & numerical data; Retrospective Studies; Teenagers; Time-to-Treatment; Young Adult; Young adults; France; pathway of care; cancer; adolescents; young adults
• ISSN: 1545-5009; 1545-5017
• DOI: 10.1002/pbc.27235

Background In order to evaluate at the population level the impact of the actions developed in France since 2004 to organize the care of adolescents and young adults (AYAs) with cancer, we conducted the present study to provide an unbiased view of the pathway of care of these patients. Methods Using a population‐based registry, we conducted a review of all cases of cancer diagnosed during 2012 and 2013 in 15‐ to 24‐year‐old patients living in nineteen French administrative areas. Results The median times for diagnosis and treatment of the 993 included AYAs were 9 weeks (3–22) and 1 day (0–20), respectively. Delays in diagnosis were significantly longer in young adults than in adolescents, especially for soft‐tissue sarcomas (48.7 weeks vs. 15.4 weeks, P = 0.04) and bone tumors (21.4 weeks vs. 10.1 weeks, P = 0.04). The first physicians seen by patients were mostly general practitioners (67.4%). Most patients (77.5%) were treated in adult units. Management decisions were taken within the context of a multidisciplinary team (MDT) in 85.3% of cases. MDT meetings that involved both pediatric and adult oncologists were uncommon (15.7% of patients). Twenty‐six percent of patients were included in randomized or nonrandomized clinical studies. The proportion of inclusion was significantly higher in adolescents (39.5%) than in young adults (16.8%). Conclusion In France, pathways of care for AYAs are heterogeneous. It is necessary to organize a national network of expert centers with adequate medical skills and specific psychosocial support and facilities to provide the best possible care for these patients.