Référentiel de bon usage et Thésaurus national de cancérologie digestive : analyse des écarts à l’hôpital Tenon

Abstract

The financial orders of French health insurance system for anticancer treatment are guided by the National recommendations of "Good Use" of anticancer treatment (law article dated August 25, 2005 for the good use of anticancer outside the classic financial hospitals). This law of "Good Use" is based on the recommendations of référentiels de bon usage (RBU). RBU include drugs with labelling or protocoles thérapeutiques temporaires (PTT). If the prescriptions do not conform with RBU, it will be considered as not confirmed and the prescriptor has to explain clearly his point of view in the medical file supported by national and international references and publications and also that of the experts' opinions. The objective of this study, made in 2007 in Tenon Hospital, Paris, was to evaluate the percentage of the prescriptions conform with RBU and the analysis of the other different prescriptions in regards to Thésaurus national de cancérologie digestive (TNCD). We found out that 25% of the anticancer prescriptions for digestive tumours in Tenon hospital are not known by the law of "Good Use". Half of these percentages were clearly recommended via the TNCD. The other half of these non-conform prescriptions were realized in an advanced disease in which there were no clear recommendations or references and there were no other choice. The TNCD validation by the National Cancer Institute can reduce the prescriptions, which are considered as non-conform. In the other hand, for the uncertain prescriptions (non-conform), the decision must be systematically discussed in multidisciplinary stuff with detailed argumentations and clear written explications in the medical file.