Trends in rates of inpatients treated for testicular cancer in France, 2000-2014.

Testicular cancer is rare, accounting for 1-3% of incidence of all malignancies in men. Forecasts predict that the incidence of testicular cancer will increase by 25% in Europe by 2025. We aimed to describe temporal and spatial trends of rates of patients surgically treated for testicular cancer (STTC) in France over the period 2000-2014. Using the International Classification of Diseases and medical procedure codes, from the national hospital discharge database, we selected patients diagnosed with testicular cancer during 2000-2014 who underwent surgery. We used the world's standard population as a reference to standardize rates. We included 29,760 STTC patients. The mean age at diagnosis was 37.4 (±13.5) years. Over the period 2000-2014, the standardized incidence rate of STTC was 6.2 [95% CI: 6.1;6.3] per 100,000 person-years. The overall rate of STTC increased by 21.3% between 2000 and 2014. The annual percentage change (APC) was +1.9% [95% CI: 1.4;2.3] over that period. The incidence rate of STTC was highest among men aged 30-44 (15.0 [95% IC: 14.7;15.2] per 100,000 person-years) and lowest among men aged 0-14 (0.2 [95% IC: 0.16;0.22]). Age-specific STTC incidence rates were similar to indicators from cancer registry data except in elderly men aged 60 years and over. Over the study period, the incidence of STTC increased over the year in all the regions of Metropolitan France. APC varied across regions from 1.0% [95% IC: -4.1;6.1] in Île-de-France to 4.2% [95% IC: -0.8;9.2] in Corse. Hospital discharge data, which are more quickly available than population-based data, are good complementary surveillance source for monitoring testicular cancer, especially in young adult patients and area without population-based registry.

Timing in initiating lung cancer treatment after bronchoscopy in France: Study from medico-administrative database.

BACKGROUND: Time-to-treatment of cancer is becoming a serious political and social issue. A greater understanding of the timeframes involved in cancer care is needed to reduce inequalities in access to care caused by delays. OBJECTIVE: To describe time delays in each phase of lung cancer treatment after bronchoscopy. METHOD: Using the international classification of diseases and medical procedures codes, from national hospital discharge database we selected patients newly diagnosed for Lung cancer in 2009-2010 who had undergone treatment. RESULTS: We included 14,596 patients. Median times from bronchoscopy to 1) neo-adjuvant chemotherapy and to surgery in patients with surgical pathway were 34d (Q25=22; Q75=47) and 44d (Q25=26; Q75=82), respectively, 2) chemotherapy and to radiotherapy in patients with non-surgical pathway, were 33d (Q25=22; Q75=49) and 88d (Q25=46; Q75=162) respectively, 3) first treatment irrespective of pathway and treatment combination was 34d (Q25=22; Q75=50). Time to first treatment was significantly higher with age and with the status of the first care center. It was longer in most northern regions and in overseas districts and shorter in southern and eastern regions of the country. CONCLUSION: To our knowledge, this is the first study based on medico-administrative database describing time to first treatment after bronchoscopy in patients suffering from lung cancer in France. It could inform decision-making on guidelines on times to access lung cancer treatment.

Time to first treatment after colonoscopy in patients suffering from colon or rectum cancer in France.

BACKGROUND: Time to treatment of cancer is becoming a serious political and social issue. A greater understanding of the timeframes involved in cancer care is needed to reduce inequalities in access to care caused by delays. OBJECTIVE: To describe indicators of time to first treatment after colonoscopy in colon cancer (CC) and rectum cancer (RC) patients in France. METHOD: Using the international classification of diseases and medical procedures codes, from national hospital discharge and long term illness databases we selected patients newly diagnosed for CC or RC in 2009-2010 who had undergone treatment. RESULTS: We included 15 694 and 6 623 patients for CC and RC, respectively. Median times to surgery in patients with a surgical treatment pathway for CC and RC were 22 (Q1=14; Q3=34) and 97 (Q1=34; Q3=141) days, respectively. Median times to chemotherapy for patients with a non-surgical treatment pathway, for CC and RC were 36 (Q1=21; Q3=59) and 40 (Q1=27; Q3=59) days, respectively. The median time to radiotherapy in RC patients was 53 (Q1=39; Q3=78) days.Time to surgery as first treatment in RC patients (46 days) was twice as long as that in CC patients (22 days). Time to treatment was longer in most northern regions and in overseas districts, and shorter in southern regions, for both CC and RC. CONCLUSION: The findings in this unprecedented study in France will inform decision-making policies on the future implementation of guidelines on timeframes for colorectal cancer treatment access.

[The contributions of local authorities to regional public health policy]. / Apports des collectivités territoriates franciliennes à la politique régionale de santé publique.

Local authorities in France are key players in shaping public health policy by their action on the determinants of health and through their actions aimed at specific population groups. Since the public health act of 9 August 2004 establishing the first regional public health plans, their level of involvement and role continues to grow as coordinators, funders and project managers within the greater Paris metropolitan region. Their active participation in regional policy to improve population health and reduce inequalities in health has led to a better organization of the public health programs implemented (in terms of visibility, dialogue, coordination, transparency, and better awareness of context and integration of local issues). Their participation is also a source of innovation resulting in the proposal and use of new approaches (such as the development of health surveillance and observation for advising the local decision-making process). Within the current context of the "Hospitals, patients, health and territories" bill, which entrusts the governance of regional health policy to a specific agency, the role given to local authorities in this new organizational structure must be clearly defined to take into account all of their existing and potential contributions to public health policy.