title: Multiple myeloma: the quality of care is linked to geographical and organisational determinants. A study in a French registry.
abstract: Multiple myeloma is a haematological malignancy whose care is spread over several specialities and provided by centres that various sizes, which raises the issue of equal opportunities in care access. Incident cases of myeloma between 2008 and 2010 were exhaustively identified by the Poitou-Charentes Cancer Registry. To ascertain the quality of care, the diagnosis, staging, and treatment administered were compared to international recommendations. Three hundred and sixty-seven patients were included. The diagnostic procedure exhibited 98% compliance, the staging 58%, and treatment 89%. Concerning diagnostic and staging, non-compliance with recommendations was associated to the failure to perform collegiate case assessments in multidisciplinary team (MDT) meetings [OR 2.15 (1.15-4.04)], care provided at a secondary centre, and a distance between home and the centre of 5-25 km [2.16 (1.06-4.40)] and 25-50 km [2.86 (1.37-6.01)]. Regarding treatment, non-compliance with recommendations was associated with care provided at a secondary centre [5.28 (2.03-13.75)]. Finally, diagnosis, staging and treatment quality improved over time. This study underlines the need to improve the organisation of the healthcare offer, so that patients can receive the best possible care. MDT seems to be the main means to improve quality of care.
authors.affiliation: INSERM CIC 1402, Poitiers Cedex.|Registre des Cancers Poitou-Charentes, Faculté de Médecine et Pharmacie, Université Poitiers, Poitiers Cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Puyade
authors.affiliation: Registre des Cancers Poitou-Charentes, Faculté de Médecine et Pharmacie, Université Poitiers, Poitiers Cedex 9, France.
authors.forename: G
authors.initials: G
authors.lastname: Defossez
authors.affiliation: INSERM CIC 1402, Poitiers Cedex.
authors.forename: F
authors.initials: F
authors.lastname: Guilhot
authors.affiliation: INSERM CIC 1402, Poitiers Cedex.|Registre des Cancers Poitou-Charentes, Faculté de Médecine et Pharmacie, Université Poitiers, Poitiers Cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Ingrand
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011379:Prognosis; D015397:Program Evaluation; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014195:Travel
keywords: evaluation; heath inequalities; multiple myeloma