The articulation of the fight against cancer at the regional level

2023-08-28 06:30:24

The ten-year strategy for the fight once morest cancer, which covers the period 2021/2030, should enable the French health ecosystem to improve the prevention and treatment of cancers.

The health section of the France 2030 investment plan, called Health Innovation 2030provides for the launch of a cluster dedicated to the fight once morest cancer, the Paris Saclay cancer cluster. This cluster, piloted by the AIS – Health Innovation Agencylaunched in 2022 – aims to catalyze the development of a true large-scale innovation ecosystem by bringing together the key players in oncology innovation within a single site located in Villejuif.

In parallel, the ten-year cancer strategylaunched in 2021, is implemented at regional level by the ARS – Regional Health Agencies – around four key areas: innovation, prevention, quality of life and cancers with poor prognosis.

The implementation by the ARS of this strategy in the field should make it possible to put in place contextualized actions to improve the various parameters of the fight once morest cancer: screening, treatment, follow-up… in order, ultimately, to have a system more effective in the fight once morest cancer.

Juliette Daniel is a public health physician, medical advisor, and also works in the Transformation and Support Support Department (DATA) within thePays de Loire regional health agency. She explained to Engineering Techniques the specifics of ten-year cancer strategy in the Pays de Loire region, as well as the coordination of this strategy between the various local health players. With the aim, of course, of improving the various aspects of the fight once morest cancer.

Engineering Techniques: What are the strong points of the ten-year strategy to fight once morest cancer?

Juliet Daniel: First and foremost, what characterizes it is its duration, ten years. This allows you to plan and carry out actions over a longer period of time. Beyond that, this strategy was thought out by a whole group of experts, public health doctors, researchers, oncologists (…). It was presented in 2021, a few months following the start of the Covid crisis.

This strategy is established around four strong axes, the main one of which, in terms of field of action, is prevention, in a global way. This translates into actions both at the level of primary and secondary prevention, the analysis of risk factors – mainly alcohol, tobacco and the environment -, organized screening for cancers of the colon, breast, and soon lung.

The second axis of this strategy emanates from a strong will of the users of the leagues, patient associations, to improve the quality of life vis-a-vis the cancer. This covers, for example, the field of management of the sequelae of sick patients.

The last two areas are the best treatment for cancers with a very poor prognosis, and innovation in the broad sense in the face of cancer.

How is this policy structured at the level of the Pays de Loire region?

At the regional level, each ARS develops, within the framework set by theInstitut National du Cancer, the INCA, a strategy around the four axes that we have just mentioned, depending on the specific parameters of the region: the risk factors, for example, vary greatly from one region to another and are subject to of particular attention. These risk factors are highlighted through the data provided by theRegional Health Observatory et Public health France. In the Pays de Loire region, for example, there is a major alcohol-related risk factor. Just as we observe more melanomas in Vendée than in other departments. We therefore adapt our actions to the regional context, and we also adapt the weight we want to give to each axis. These observations lead us, for example, to set up teams to offer addictology services in the region. For skin cancers resulting from melanomas, we hope to be able to quickly detect them better in order to treat them as soon as possible, which considerably improves the chances of complete recovery.

How are actions coordinated at regional level?

Within the region, there is a steering committee, which includes the major cancer services and the cancer registry, the cancer network, the screening structures, the regional health observatory… All the world to collectively drive the actions of our roadmap. Beyond the region, a national coordination is in place and meets three to four times a year, under the leadership of Thierry Breton, the director of the INCA.

What also characterizes this ten-year plan for the fight once morest cancer is that the players concerned are used to cooperating, they know each other well. It is the fourth plan of this type and the actors are stable, it allows to carry out actions in depth. It is also a characteristic of the teams working in the field of oncology to be more cohesive and more sustainable over time. This is an observation that often emerges, and which allows the actors to be more efficient in the conduct of this type of project, which calls on many entities on the territory of the region. Also, oncology is a highly regulated area of ​​activity, so the number of players is limited, which also allows for a clearer and clearer operation to be put in place between the different entities.

Is the population receptive to these strategies, for example with regard to screening?

One characteristic that stands out, particularly in Brittany and in the Pays de la Loire, and which was observed during the health crisis, is that the populations living in these territories adhere more easily to public health policies than in other territories. For example, the vaccination campaign once morest Covid in the Pays de Loire region went very well. This translates, in terms of the fight once morest cancer, into a higher screening rate than the national average in the Pays de Loire region. This is an important element in improving cancer control outcomes, knowing that early detection is vital to improving cure prognoses.

What other major actions have been undertaken in the Pays de Loire region?

We have focused on what is called the post-cancer journey. All the regions are implementing actions around the quality of life following cancer, but it is an aspect of the cancer-related health journey that seems fundamental to us: psychological and aesthetic support, support also through appropriate physical activity… we have set up calls for projects in this direction to encourage patients to take care of themselves in this phase of the health journey.

On another level, another illustration of regional specificities in the fight once morest cancer is linked to the specific history of the regions. In Pays de Loire, certain episodes, such as that of cancers in Sainte-Pazanne or at the CARENE of Saint-Nazaire have emphasized certain risk factors and situations where certain populations are exposed to certain types of cancer. In the case of the CARENE of Saint-Nazaire, there is an overexposure to cancers of the upper aerodigestive tract (throat, oesophagus, etc.): it is therefore a question of implementing actions to detect these cancers as soon as possible, which are more common in some areas.

We can now see the importance of collecting data at the local level to establish appropriate strategies. How is this fundraising going with regard to the fight once morest cancer?

In our area we have a cancer registry. It concerns Loire Atlantique and Vendée and brings together around ten people, who collect all the data on all people with cancer. There are thirteen centers of this type in France, and the data they process allows us to obtain information relating to the development of a certain type of cancer in the region, or throughout the territory. This information is crucial in the case of excess mortality in a territory, as for the Saint-Nazaire example that we mentioned. In this case, we were able to establish that half of the patients had been unemployed quite early, and that they had therefore not been monitored by occupational medicine over the long term. They therefore had less chance of being detected early.

Finally, can you tell us regarding the last axis of the cancer control strategy, which is centered on innovation?

The innovation axis wants to stimulate concrete actions, in particular for everything concerning childhood cancers, which are generally cancers with a poor prognosis for the most part. We need to carry out early screening and treatment, clinical trials. We also want to be able to follow children who had cancer when they were young into adulthood, to establish their risk of developing new cancers, or other associated pathologies.

Also, on the innovation aspect, the development of remote scanner reading, for example, should make it possible to rebalance the existing inequalities in our territory in terms of access to radiology centres.

Interview by Pierre Thouverez

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