Sébastien Orazio

The effect of geographical accessibility to care and patients' social environment on survival has been little studied for hematological malignancies. The objective was to investigate the influence of these factors on excess mortality for these patients in France. This study included 13 French cancer registries. Hodgkin's lymphomas, myeloid haemopathies, multiple myeloma, chronic lymphatic leukemia, diffuse large B‐cell lymphoma and follicular lymphoma diagnosed between 2013 and 2015 are included ( N = 19,041). Social environment was measured using the European Deprivation Index. The access of secondary care was measured by travel time to the nearest reference care center, and access to primary care was estimated using Spatial Accessibility multiscALar (SCALe) index and Accessibilité Potentielle Localisée (APL). The effects of these indicators on excess mortality were investigated using additive excess hazard models with multidimensional penalized splines. For myeloid haemopathies, only the social environment had a significant effect on excess mortality. For diffuse large B‐cell lymphoma, the travel time to nearest reference care center had an impact on excess mortality. Finally, for follicular lymphoma, an increase of APL index was associated with a decrease of mortality. Our study showed that the social environment and the geographical accessibility to care were prognostic factors for survival in certain hematological malignancies.

Background: The excess mortality observed in Acute Myeloblastic Leukaemia (AML) patients, partly attributed to unequal access to curative treatments, could be linked to care pathways.Methods: We included 1039 AML incident cases diagnosed between 2012-2016 from the 3 French blood cancer registries (3,625,400 inhabitants). We describe patients according to age, the medical entry unit and access to the specialised haematology unit (SHU) during follow-up. Multivariate logistic regression model was done to determine the association between covariables and access to SHU. A total of 713 patients (69%) had access to SHU during care.Results: The most common care pathway concerned referral from the general practitioner to SHU, n = 459(44%). The univariate analysis observed a downward trend for the most deprived patients. Patients who consulted in SHU were younger (66 years vs. 83, p < 0.001), and 92% had access to cytogenetic analysis (vs. 54%, p < 0.001). They also had less poor prognosis AML-subtypes (AML-MRC, t-AML/MDS and AML-NOS) (38% vs. 69%); 77% with de novo AML (vs. 67%, p < 0.003)], more favourable cytogenetic prognostic status (23% vs. 6%, p < 0.001), less comorbidities (no comorbidity = 55% vs. 34%, p < 0.001) and treatments proposed were curative 68% (vs. 5.3%, p < 0.001). Factors limiting access to SHU were age over 80 years (OR, 0.14; 95% CI, 0.04-0.38), severe comorbidities (OR, 0.39; 95% CI, 0.21-0.69), emergency unit referral (OR, 0.28; 95% CI, 0.18-0.44) and non-SHU referral (OR, 0.12; 95% CI, 0.07-0.18). Consultation in an academic hospital increased access to SHU by 8.87 times (95% CI, 5.64-14.2).Conclusion: The high proportion of access to cytogenetic testing and curative treatment among patients admitted to SHU, and the importance of early treatment in AML underlines the importance of access to SHU for both diagnosis and treatment.