title: Organizing medical oncology care at a regional level and its subsequent impact on the quality of early breast cancer management: a before-after study.
abstract: BACKGROUND
  One of the main measures of the French national cancer plan is to encourage physicians to work collectively, and to minimize territorial inequities in access to care by rethinking the geographical distribution of oncologists. For this reason, cancer care services are currently being reorganized at national level. A new infrastructure for multidisciplinary cancer care delivery has been put in place in our region. Patients can receive multidisciplinary health care services nearer their homes, thanks to a mobile team of oncologists. The objective of our study was to assess, using a quality approach, the impact on medical management and on the costs of treating early breast cancer, of the new regional structure for cancer care delivery.
  
  
  METHODS
  Before-and-after study performed from 2007 to 2010, including patients treated for early breast cancer in three hospitals in the region of Franche-Comté in Eastern France. The main outcome measures were quality criteria, namely delayed treatment (>12 weeks), dose-intensity and assessment of adjuvant chemotherapy. Other outcomes were 24-month progression-free survival (PFS) and economic evaluation.
  
  
  RESULTS
  This study included 667 patients. The rate of chemotherapy tended to decrease, but not significantly (49.3% before versus 42.2% after, p=0.07), while the use of taxanes increased by 38% across all centres (59.6% before versus 98.0% after, p < 0.0001). There was a non-significant reduction in the time between surgery and adjuvant chemotherapy (6.0 ± 3.0 weeks before versus 5.6 ± 3.6 weeks after, p=0.11). Dose-dense chemotherapy improved slightly, albeit non significantly (86.3% versus 91.1% p=0.22) and time to treatment tended to decrease. The new regional infrastructure did not change 24-month PFS, which remained at about 96%. The average cost of treatment was estimated at € 7000, with no difference between the two periods.
  
  
  CONCLUSIONS
  Despite a shortage of oncologists, the new organization put in place in our region for the provision of care for early breast cancer makes it possible to maintain local community-based treatment, without negative economic consequences. This new structure for cancer care delivery offers cancer services of similar quality with no modification of 24-month PFS in early breast cancer.
authors: Department of Pharmacy, Jean Minjoz University Hospital, 2 boulevard Fleming, 25000 Besançon, France. a2voidey@chu-besancon.fr.
authors: Aline
authors: A
authors: Voidey
authors: Xavier
authors: X
authors: Pivot
authors: Anne-Sophie
authors: AS
authors: Woronoff
authors: Gilles
authors: G
authors: Nallet
authors: Laurent
authors: L
authors: Cals
authors: Francis
authors: F
authors: Schwetterle
authors: Samuel
authors: S
authors: Limat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D065187:Controlled Before-After Studies; D019468:Disease Management; D005260:Female; D005602:France / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D008495:Medical Oncology / Q000458:organization & administration*; D008875:Middle Aged; D011787:Quality of Health Care; D012042:Registries
chemical_list: D000970:Antineoplastic Agents