NETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation ...to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry.
Patients’ characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N=35784) and in the subgroup of incident patient population (N=29497).
Among the 35784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li–Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29497 incident patients, 25851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS P<0.001 for all, with a hazard ratio of 0.681 (95% CI 0.618–0.749) for OS.
This nationwide registry of sarcoma patients shows that surgical treatment in a reference center reduces the risk of relapse and death.
Abstract Objective An overview of the economic consequences – overall costs as well as cost breakdown (direct and indirect) – of hip and knee osteoarthritis (OA) worldwide. Methods A systematic ...literature search of EMBASE, MEDLINE, Scopus and Cochrane databases for articles was performed independently by two rheumatologists who used the same predefined eligible criteria. Papers without abstracts and in languages other than English or French were excluded. Extracted costs were converted to an annual cost and to 2013 euros (€) by using the Consumer Price Index of the relevant countries and the 2013 Purchasing Power Parities between these countries and the European Union average. Results A total of 45 abstracts were selected, and 32 articles were considered for the review. The studied populations were heterogeneous: administrative, hospital and national health survey data. Annual total costs per patient ranged from 0.7 to 12 k€, direct costs per patient from 0.5 to 10.9 k€ and indirect costs per patient from 0.2 to 12.3 k€. The weighted average annual costs per patient living with knee and hip OA were 11.1, 9.5 and 4.4 k€ for total, direct and indirect costs, respectively. Conclusions This review highlights the heterogeneity of studies and lack of methodologic consensus to obtain reliable cost-of-illness estimates for lower-limb OA. However, costs induced by the disease seem substantial and deserve to be more extensively explored.
Intervention research in population health focuses on actions carried out by researchers in partnership with those involved in the intervention: health professionals, patients, carers, public policy ...makers and population communities. The diversity of actors shapes PHIR projects, testifies to the richness of this research and gives it a privileged place to analyse and intervene as accurately as possible in different contexts and populations. It also implies the need for a better understanding of how to intervene by considering the determinants of health in these interventions. PHIR in health promotion in the domain of cancer thus proposes a paradigm shift from describing the problem and its causes to intervention. RISP bases its theoretical anchors on the one hand on the contributions and models of public health, health promotion and human and social sciences and on the other hand, on its own contributions to theorise and build its own theoretical and methodological corpus. This presentation will aim to clarify this paradigm shift and five methodological challenges of PHIR: the imperialism of epidemiology as a research model; the evaluation models of PHIR and their polymorphism; the complexity of the objects of study; the partnership dynamics between researchers and field actors without which research cannot be carried out. Finally, the challenges of publication and valorisation of this type of research. Through concrete examples, participants will be invited to understand the challenges of the RISP methodology, and to analyse different concrete perspectives to address them. The first part will focus on identifying the participants' representations of the methodological difficulties of PHIR. The second part will be an interactive presentation of 12 minutes, the last 2-3 minutes will be devoted to final questions.
Data on the economic consequences of hip and knee osteoarthritis (OA) are scarce. We aimed to estimate the annual direct and indirect costs for patients followed for hip and/or knee OA in the Knee ...and Hip Osteoarthritis Long term Assessment (KHOALA) cohort.
The KHOALA cohort, set up from 2007 to 2009, is a French multicenter study of 878 individuals with symptomatic knee/hip OA who were 40–75 years old. Resources used were collected annually for 5 years. Costs were assigned by using official sources and expressed in 2018 euros per patient.
The mean annual total costs per patient over the 5-year study period were 2,180 ± 5,305€. The mean annual direct medical costs per patient were 2,120 ± 5,275€ and mean annual indirect costs per patient 180 ± 1,735€ for people of working age. Costs increased slightly over the study period. Drugs were the largest cost share, representing over 50% of all direct costs. However, the proportion attributable to OA drugs accounted for only 10.5% of drug costs. The second cost share was hospitalizations; hip and knee prosthetic surgery accounted for 27% of surgery hospitalization costs. Health professional visits were the third cost share, accounting for 3% of direct medical costs. The median costs induced could be as high as 2 billion €/year (IQR 0.7–4.3) in France.
Hip and knee OA costs were substantial and increased over the study period in France. However, the costs attributable to OA represented only a small fraction of overall costs.
The Generic Adherence for Chronic Diseases Profile is a French generic scale (GACID-P) developed to measure adherence in several disease areas such as cardiology, rheumatology, diabetes, cancer and ...infectiology.
We aimed to study the measurement invariance of the Generic Adherence for Chronic Diseases Profile by an item response model, optimize the new instrument version from item response model and qualitative content analyses results, and validate the instrument. The metric properties of the optimized version were studied according to classical test theory and item response model analysis.
A sample of 397 patients consulting at two French hospitals (in diabetes, cardiology, rheumatology, cancerology and infectiology) and in four private practices was recruited; 314 (79%) patients also completed the questionnaire 15 days later. Factor analyses revealed four dimensions: "Forgetting to take medication", "Intention to comply with treatment", "Limitation of risk-related consumer habits" and "Healthy lifestyle". The item response model and content analyses optimized these four dimensions, regrouping 32 items in four dimensions of 25 items, including one item conditioned on tobacco use. The psychometric properties and scale calibration were satisfactory. One score per dimension was calculated as the sum of the items for the dimensions "Forgetting to take medication" and "Intention to comply with treatment" and as a weighted score according to the item response model analysis for the two other dimensions because of differential item functioning found for two items.
Four adherence profile scores were obtained. The instrument validity was documented by a theoretical approach and content analysis. The Generic Adherence for Chronic Diseases Profile is now available for research targeting adherence in a broad perspective.
Summary Objective To adapt the Knee injury and Osteoarthritis Outcome Score (KOOS) into French and to evaluate the psychometric properties of this new version. Methods The French version of the KOOS ...was developed according to cross-cultural guidelines by using the “translation-back translation” method to ensure content validity. KOOS data were then obtained in patients with symptomatic knee osteoarthritis (OA). The translated questionnaire was evaluated in two knee OA population groups, one with no indication for joint replacement (medicine), and the other waiting for joint replacement (surgery). The psychometric properties evaluated were feasibility: percentage of responses, floor and ceiling effects; construct validity: internal consistency using Cronbach's alpha, correlations with osteoarthritis knee and hip quality of life domains using Spearman's rank test, and known group comparison between medicine and surgery groups; reliability: intra-class correlation coefficient (ICC), Bland and Altman representation; responsiveness using data obtained prior to and 3 months after surgery: standardized response mean (SRM), and effect size. Results Thirty-seven patients were included in the medicine group (68% women, mean age = 70 ± 10 years) and 30 in the surgery group (73% women, mean age = 71 ± 10 years). The percentage of responses was excellent. Neither a floor nor a ceiling effect was observed, except for the sport and recreation subscale (20.6% of patients with the worst possible score in the medicine group, 40 and 0% in the surgery group prior to and after surgery, respectively). Results for internal consistency (Cronbach's alpha ranging from 0.76 to 0.93), and convergent and divergent construct validity were satisfactory. The patients waiting for knee surgery presented with significantly lower scores in all KOOS domains. The reproducibility of measurements of all KOOS subscales was good to excellent, with ICC ranging from 0.755 to 0.914. The responsiveness was high, with SRM ranging from 0.89 to 1.93, and effect size from 1.31 to 2.8. Conclusion The French version of KOOS is a valid, reliable, and responsive instrument to capture specific aspects of functional disability affecting quality of life of knee OA patients.
Background and purpose: We sought to identify predictive clinical factors of disability during initial course in multiple sclerosis (MS) patients.
Methods: A total of 2871 MS patients from the ...LORSEP (Lorraine Multiple Sclerosis) population‐based cohort were analyzed. The relationships between baseline demographic, clinical predictors and time to assignment of Expanded Disability Status Scale (EDSS) scores of 3, 4 and 6 were assessed using a Cox regression model.
Results: Multivariate analysis showed that, for relapsing–remitting patients, a shorter time to assignment of an EDSS score of 4 was associated with an older age of onset of MS and incomplete recovery from the first relapse. Median times were not influenced by gender or the time between the first two relapses. The results also demonstrated that MS progression is independent of the initial clinical data once an EDSS score of 4 is reached rather than a score of 3 because the time from EDSS 3 to assignment of EDSS 4 were correlated with predicting variables. The data were very different for the time between assignment of scores of 4 and 6 because the median times were not influenced by any of the predicting variables.
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