title: The care center influences the management of lymphoma patients in a universal health care system: an observational cohort study.
abstract: Healthcare providers-related disparities in adherence to the treatment plan among lymphoma patients are found even in a universal healthcare system, but the mechanism remains unclear. We investigated the association between the type of care center and the relative dose intensity and determined whether it persists after adjustment for patients' recruitment differences.
  
  
  
  Prospective observational cohort study of 294 patients treated with standard protocols for diffuse large B-cell lymphoma (DLBCL) in teaching or community public hospitals or in private centers in the French Midi-Pyrénées region from 2006-2013. To test our assumptions, we used multinomial and mixed-effect logistic models progressively adjusted for patients' biomedical characteristics, socio-spatial characteristics and treatment-related toxicity events.
  
  
  
  Patients treated using standard protocols in the teaching hospital had more advanced stage and poorer initial prognosis without limitation regarding the distance from the residence to the care center. Patients' recruitment profile across the different types of care center failed to explain the difference in relative dose intensity. Low relative dose intensity was less often observed in teaching hospital than elsewhere.
  
  
  
  We showed that even in a universal healthcare system, disparities in the management of DLBCL patients' do exist according to the types of care center. A main issue may be to find and diffuse the reasons of this benefit in cancer management in the teaching hospital to the other centers.
authors.affiliation: University of Toulouse III Paul Sabatier, Toulouse, France. sebastien.lamy@inserm.fr.|Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France. sebastien.lamy@inserm.fr.|INSERM UMR1027 (The French National Institute of Health and Medical Research), Toulouse, France. sebastien.lamy@inserm.fr.
authors.forename: S
authors.initials: S
authors.lastname: Lamy
authors.affiliation: Department of Hematology, Toulouse University Hospital, Toulouse University Cancer Institute (IUCT-O), Toulouse, France.
authors.forename: C
authors.initials: C
authors.lastname: Bettiol
authors.affiliation: INSERM UMR1027 (The French National Institute of Health and Medical Research), Toulouse, France.|Tarn Cancers Registry, Albi, France.
authors.forename: P
authors.initials: P
authors.lastname: Grosclaude
authors.affiliation: Department of Hematology, Toulouse University Hospital, Toulouse University Cancer Institute (IUCT-O), Toulouse, France.
authors.forename: G
authors.initials: G
authors.lastname: Compaci
authors.affiliation: INSERM UMR1027 (The French National Institute of Health and Medical Research), Toulouse, France.
authors.forename: G
authors.initials: G
authors.lastname: Albertus
authors.affiliation: University of Toulouse III Paul Sabatier, Toulouse, France.|Department of Hematology, Toulouse University Hospital, Toulouse University Cancer Institute (IUCT-O), Toulouse, France.|INSERM UMR1037 (The French National Institute of Health and Medical Research), Cancer Research Center of Toulouse, Toulouse, France.
authors.forename: C
authors.initials: C
authors.lastname: Récher
authors.affiliation: Department of Hematology, Toulouse University Hospital, Toulouse University Cancer Institute (IUCT-O), Toulouse, France.
authors.forename: J C
authors.initials: JC
authors.lastname: Nogaro
authors.affiliation: University of Toulouse III Paul Sabatier, Toulouse, France.|Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France.|INSERM UMR1027 (The French National Institute of Health and Medical Research), Toulouse, France.
authors.forename: F
authors.initials: F
authors.lastname: Despas
authors.affiliation: University of Toulouse III Paul Sabatier, Toulouse, France.|Department of Hematology, Toulouse University Hospital, Toulouse University Cancer Institute (IUCT-O), Toulouse, France.|INSERM UMR1037 (The French National Institute of Health and Medical Research), Cancer Research Center of Toulouse, Toulouse, France.
authors.forename: G
authors.initials: G
authors.lastname: Laurent
authors.affiliation: INSERM UMR1027 (The French National Institute of Health and Medical Research), Toulouse, France.
authors.forename: C
authors.initials: C
authors.lastname: Delpierre
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011787:Quality of Health Care; D019472:Universal Health Insurance
keywords: Center-related management disparity; French current practice; Lymphoma; Observational cohort; Relative dose intensity