Place of multidisciplinary consulting meetings and clinical trials in the management of colorectal cancer in France in 2000.
OBJECTIVE
The 1998 consensus conference dealing with colon cancer, and the 2003 Cancer Plan underlined the need for multidisciplinary meetings and for including patients in therapeutic trials. The aim of this study, which pooled data from the French Cancer Registries operating within the Francim network, was to report on diagnostic and therapeutic practices in the general French population before implementation of the Cancer Plan.


METHODS
The study population was composed of 2935 patients with colorectal cancer diagnosed in 2000 in twelve French administrative districts accounting for 15% of the geographical area of France. Data were collected using a standardized procedure. Three categories of place of diagnosis were defined: public university hospitals, public non-university hospitals, and private clinics.


RESULTS
Overall, multidisciplinary meeting was conducted for 32.2% of patients with colorectal cancer. This proportion varied from 6.4% to 76.9%, depending on the geographical area (P<0.001). The place of diagnosis affected this practice: 52% in public university hospitals, 31% in public non-university hospitals and 29% in private clinics (P<0.001). In multivariate analysis, age (OR(>75 years): 0.71, P<0.001), site (OR(rectum): 1.80, P<0.001) and health care facilities (OR(public non-university vs public university): 0.36, P<0.001, OR(private vs public university): 0.40, P<0.001) affected the use of multidisciplinary meeting. Overall, 4.3% of patients were included in a therapeutic trial. This concerned 6.2% of patients aged under 75 and 1.0% of those aged over 75 (P<0.001). The proportion of inclusions, taking into account the trials proposed in 2000 and 2001, varied from 0.7% to 16.4% according to geographical area (P<0.001). This proportion was 10.3% if there had been multidisciplinary meeting and 5.1% if not (P<0.001). Neither cancer site, gender, nor healthcare facility responsible for diagnosis influenced trial inclusion.


CONCLUSIONS
This population-based study underlines geographical variations in the management of colorectal cancer in France. In 2000, multidisciplinary meeting was conducted for an insufficient proportion of patients, and an insufficient number of patients were included in therapeutic trials. Repeating the same survey in 2005 will provide information on the effects of the Cancer Plan and the diffusion of these recommendations.
Bouvier
Anne-Marie
AM
Registre des Cancers Digestifs, Faculté de Médecine, Dijon, INSERM EPI 0106. anne-marie.bouvier@u-bourgogne.fr
Bauvin
Eric
E
Danzon
Arlette
A
Grosclaude
Pascale
P
Delafosse
Patricia
P
Buémi
Antoine
A
Trétarre
Brigitte
B
Raverdy
Nicole
N
Maarouf
Nabil
N
Velten
Michel
M
Launoy
Guy
G
Faivre
Jean
J
D000367:Age Factors; D000368:Aged; D002986:Clinical Trials as Topic; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005602:France; D006291:Health Policy; D016304:Hospitals, Private / Q000458:organization & administration; D006779:Hospitals, Public / Q000458:organization & administration; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010348:Patient Care Team / Q000458:organization & administration*; D010358:Patient Participation; D018579:Patient Selection; D011159:Population Surveillance; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D012017:Referral and Consultation / Q000458:organization & administration*; D012042:Registries; D012737:Sex Factors