Cancer Medicine (Apr 2023)

Factors influencing access to specialised haematology units during acute myeloblastic leukaemia patient care: A population‐based study in France

  • Kueshivi Midodji Atsou,
  • Bernard Rachet,
  • Edouard Cornet,
  • Marie‐Lorraine Chretien,
  • Cédric Rossi,
  • Laurent Remontet,
  • Laurent Roche,
  • Roch Giorgi,
  • Sophie Gauthier,
  • Stéphanie Girard,
  • Johann Böckle,
  • Stéphane Kroudia Wasse,
  • Helene Rachou,
  • Laila Bouzid,
  • Jean‐Marc Poncet,
  • Sébastien Orazio,
  • Alain Monnereau,
  • Xavier Troussard,
  • Morgane Mounier,
  • Marc Maynadie

DOI
https://doi.org/10.1002/cam4.5645
Journal volume & issue
Vol. 12, no. 7
pp. 8911 – 8923

Abstract

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Abstract Background The excess mortality observed in Acute Myeloblastic Leukaemia (AML) patients, partly attributed to unequal access to curative treatments, could be linked to care pathways. Methods We included 1039 AML incident cases diagnosed between 2012–2016 from the 3 French blood cancer registries (3,625,400 inhabitants). We describe patients according to age, the medical entry unit and access to the specialised haematology unit (SHU) during follow‐up. Multivariate logistic regression model was done to determine the association between covariables and access to SHU. A total of 713 patients (69%) had access to SHU during care. Results The most common care pathway concerned referral from the general practitioner to SHU, n = 459(44%). The univariate analysis observed a downward trend for the most deprived patients. Patients who consulted in SHU were younger (66 years vs. 83, p < 0.001), and 92% had access to cytogenetic analysis (vs. 54%, p < 0.001). They also had less poor prognosis AML‐subtypes (AML‐MRC, t‐AML/MDS and AML‐NOS) (38% vs. 69%); 77% with de novo AML (vs. 67%, p < 0.003)], more favourable cytogenetic prognostic status (23% vs. 6%, p < 0.001), less comorbidities (no comorbidity = 55% vs. 34%, p < 0.001) and treatments proposed were curative 68% (vs. 5.3%, p < 0.001). Factors limiting access to SHU were age over 80 years (OR, 0.14; 95% CI, 0.04–0.38), severe comorbidities (OR, 0.39; 95% CI, 0.21–0.69), emergency unit referral (OR, 0.28; 95% CI, 0.18–0.44) and non‐SHU referral (OR, 0.12; 95% CI, 0.07–0.18). Consultation in an academic hospital increased access to SHU by 8.87 times (95% CI, 5.64–14.2). Conclusion The high proportion of access to cytogenetic testing and curative treatment among patients admitted to SHU, and the importance of early treatment in AML underlines the importance of access to SHU for both diagnosis and treatment.

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