title: The patient-breast cancer care pathway: how could it be optimized?
abstract: BACKGROUND
  A care pathway is defined as patient-focused global care that addresses temporal (effective and coordinated management throughout the illness) and spatial issues (treatment is provided near the health territory in or around the patient's home). Heterogeneity of the care pathways in breast cancer (BC) is presumed but not well evaluated. The OPTISOINS01 study aims to assess every aspect of the care pathway for early BC patients using a temporal and spatial scope.
  
  
  METHODS
  An observational, prospective, multicenter study in a regional health territory (Ile-de-France, France) in different types of structures: university or local hospitals and comprehensive cancer centers. We will include and follow during 1 year 1,000 patients. The study consists of 3 work-packages: - Cost of pathway The aim of this WP is to calculate the overall costs of the early BC pathway at 1 year from different perspectives (society, health insurance and patient) using a cost-of-illness analysis. Using a bottom-up method, we will assess direct costs, including medical direct costs and nonmedical direct costs (transportation, home modifications, home care services, and social services), and indirect costs (loss of production). - Patient satisfaction and work reintegration Three questionnaires will assess the patients' satisfaction and possible return to work: the occupational questionnaire for employed women; the questionnaire on the need for supportive care, SCNS-SF34 ('breast cancer' module, SCNS-BR8); and the OUTPASSAT-35 questionnaire. - Quality, coordination and access to innovation Quality will be evaluated based on visits and treatment within a set period, whether the setting offers a multidisciplinary consultative framework, the management by nurse coordinators, the use of a personalized care plan, the provision of information via documents about treatments and the provision of supportive care. The coordination between structures and caregivers will be evaluated at several levels. Day surgery, home hospitalization and one-stop breast clinic visits will be recorded to assess the patient's access to innovation.
  
  
  CONCLUSIONS
  The assessment of care pathways encourages the implementation of new payment models. Our approach could help health care professionals and policymakers to establish other cost-of-illness studies and plan the allocation of resources on a patient basis rather than a visit basis.
authors.affiliation: Department of Health Economy, Institut Curie, 26 rue d'Ulm, 75005, Paris, France. sandrine.baffert@curie.fr.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Baffert
authors.affiliation: Department of Health Economy, Institut Curie, 26 rue d'Ulm, 75005, Paris, France. huongly.hoang@curie.fr.
authors.forename: Huong Ly
authors.initials: HL
authors.lastname: Hoang
authors.affiliation: Department of Supportive Care, Institut Curie, 26 rue d'Ulm, 75005, Paris, France. anne.bredart@curie.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Brédart
authors.affiliation: Department of Biostatistics, Institut Curie, 26 rue d'Ulm, 75005, Paris, France. b.asselain@gmail.com.
authors.forename: Bernard
authors.initials: B
authors.lastname: Asselain
authors.affiliation: Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005, Paris, France. severine.alran@curie.fr.
authors.forename: Séverine
authors.initials: S
authors.lastname: Alran
authors.affiliation: Department of Gynecology, René Dubos Hospital, 6, avenue de L'Ile de France, 95303, Pontoise, France. helene.berseneff@ch-pontoise.fr.
authors.forename: Hélène
authors.initials: H
authors.lastname: Berseneff
authors.affiliation: Department of Gynecology, Poissy-St Germain hospital, 10 Rue du Champ Gaillard, 78300, Poissy, France. cyrillehuchon@yahoo.fr.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Huchon
authors.affiliation: Department of Gynecology, Antoine Béclère Hospital, 157 rue de la Porte de Trivaux, 92140, Clamart, France. caroline.trichot@abc.aphp.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Trichot
authors.affiliation: Department of Gynecology, André Mignot Hospital, 50 rue Berthier, 78000, Versailles, France. acombes@ch-versailles.fr.
authors.forename: Aline
authors.initials: A
authors.lastname: Combes
authors.affiliation: Department of Gynecology, Argenteuil Hospital, 69 Rue Lt Colonel Prudhon, 95100, Argenteuil, France. alveskarine22@yahoo.fr.
authors.forename: Karine
authors.initials: K
authors.lastname: Alves
authors.affiliation: Department of Gynecology, Bichat Hospital, 46 rue Henri Huchard, 75018, Paris, France. martin.koskas@wanadoo.fr.
authors.forename: Martin
authors.initials: M
authors.lastname: Koskas
authors.affiliation: Department of Gynecology, Louis Mourier Hospital, 178 rue des Renouillers, 92700, Colombes, France. thuy.nguyen@lmr.aphp.fr.
authors.forename: Thuy
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Department of Surgical Oncology, Institut Curie-René Huguenin, 35 rue Dailly, 92210, St Cloud, France. aurelie.roulot@curie.fr.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Roulot
authors.affiliation: Department of Surgical Oncology, Institut Curie-René Huguenin, 35 rue Dailly, 92210, St Cloud, France. roman.rouzier@curie.fr.|Equipe d'Accueil 7285, Risk and safety in clinical medicine for women and perinatal health, University Versailles-Saint-Quentin, Montigny-le-Bretonneux, France. roman.rouzier@curie.fr.
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.affiliation: Department of Surgical Oncology, Institut Curie-René Huguenin, 35 rue Dailly, 92210, St Cloud, France. delphine.hequet@curie.fr.|Equipe d'Accueil 7285, Risk and safety in clinical medicine for women and perinatal health, University Versailles-Saint-Quentin, Montigny-le-Bretonneux, France. delphine.hequet@curie.fr.
authors.forename: Delphine
authors.initials: D
authors.lastname: Héquet
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy*; D002173:Cancer Care Facilities / Q000592:standards*; D019468:Disease Management; D005260:Female; D006801:Humans; D015337:Multicenter Studies as Topic; D064887:Observational Studies as Topic; D005791:Patient Care; D017060:Patient Satisfaction; D011446:Prospective Studies; D058996:Quality Improvement; D011788:Quality of Life; D011795:Surveys and Questionnaires