Initial management of patients with colon cancer according to the presentation in multidisciplinary team meeting and socioeconomic conditions in the Gironde and the Tarn departments in 2010, France

Abstract

Background In France, in 2015, colorectal cancer is the third most common cancer and the second leading cause of cancer deaths. The management of these cancers has evolved, particularly since the setting up of multidisciplinary team meetings (MDTm) to present the medical records of cancer patients to a multidisciplinary team. The presentation in MDTm has progressively increased and in 2010, in the Gironde, 80% of patients with colorectal cancer were presented in MDTm. Given this finding, we conducted a study aimed, in a first objective, at highlighting the factors associated with non-presentation in MDTm, as well as, in a second objective, to estimate the link between non-presentation in MDTm and the diagnostic and therapeutic management of these patients, in two departments: Gironde and Tarn, in 2010. Patients and methods All cases of invasive colon cancer diagnosed in the Gironde and Tarn during 2010 in patients over 18 years of age and not presented in MDTm were included from the cancer registries of these two departments. A comparison group was selected on the same criteria corresponding to a random draw of 50% of patients presented in MDTm. After a description step, we compared these two groups according to a case-control design (without MDTm/MDTm) to assess the factors associated with the absence of MDTm presentation in patients with colon cancer. A second analysis compared these groups, without the early deaths following the diagnosis of colon cancer, according to an exposed/unexposed type design (without MDTm/MDTm) to study the link between non-presentation in CPR and management. Five indicators were defined and validated: performing a thoracic CT scan during the extension assessment, performing chemotherapy (stages II and III), delay surgery-chemotherapy, death during chemotherapy. In order to take into account the socio-demographic level of the patients, we used the aggregate index of deprivation “European Deprivation Index” (EDI). This EDI was divided into quintiles: Q5 corresponding to patients living in most disadvantaged geographic areas. The analyzes were performed using logistic regression models. Results The first factor explaining patients’ non-presentation in MDTm was death in the month following diagnosis (OR = 2.94, 95% CI = [1.52–5.66]), these patients were therefore excluded from the analyzes of the second objective. Moreover, regardless of the early death, advanced age and living in more deprived areas were associated with non-presentation in MDTm (OR85–103 years = 2.10, 95% CI = [1.06–4.18] and ORQ4–Q5 = 1.96, 95% CI = [1.23–3.14]). For the second objective of this study, after adjusting for patient-related variables (age, comorbidities, EDI) and tumor (stage to diagnosis), thoracic CT scan was less often performed in non-MDTm patients (OR = 0.40, 95% CI = [0.24–0.65]). There was no association between the absence of MDTm and the others management indicators, these remain influenced by patient and tumor characteristics such as age at diagnosis, comorbidities and stage of tumor. However, regardless of stage of diagnosis and MDTm status, patients living in a more disadvantaged area died more often during postoperative chemotherapy (ORQ4 Q5 = 2.08, 95% CI = [1.02–4.25]). Discussion In 2010, in Gironde and in the Tarn departments, the factors associated with the non-presentation of a patient file in MDTm were having died in the month following the diagnosis, as well as two independent factors of death: the advanced age of patients (over 85 years) and residing in more disadvantaged areas. In the end, therapeutic management was not associated with the presentation in MDTm but with patient and tumor characteristics, including age, comorbidities but also level of deprivation. For the continuation, survival analyzes of patients with colon cancer based on their MDTm status are underway.