In France, each year, more than 400,000 people are operated on for cancer, according to the National Cancer Institute (Inca). But when choosing the hospital or clinic where they will be treated, patients are often unaware of the level of activity of the establishment that receives them. Will they be cared for in a service that performs enough cancer operations? No patient has access to this crucial information. The more surgical teams practice, the higher the chances of recovery. After a year of investigation, “Cash Investigation” reveals the number of operations carried out by health establishments near you.
A report published by Health Insurance in 2018 (report “expenses and products”) demonstrates that operations carried out by medical teams with little practice result in high excess mortality. For breast cancer, for example, the mortality rate one year after the operation increases by 84% for patients operated on in an establishment which performs fewer than 30 acts each year in comparison with an establishment which carries out more than 150 operations per year. year.
For Professor Fabien Reyal, specialist in gynecological cancers and head of department at the Curie Institute in Paris, it is the “repetition of gestures” who makes the good surgeon: “It’s not specific to surgery. It’s true of manual trades, it’s true when you’re a cabinetmaker, it’s true when you’re a violinist. In a very simple way when you do a lot of work as a cancer surgeon , you see rather rare situations repeating themselves.”
In France, to carry out this type of operation, establishments must have an authorization, established on the basis of the number of operations performed. This is called “the minimum activity threshold”. For digestive, urological, thoracic and breast cancers, an establishment must thus perform at least 30 operations per year to maintain its authorisation. For cancers of the gynecological and ENT spheres, it is 20 operations per year. Some scientists believe that these thresholds are not high enough and recommend, for example, 150 breast cancer operations per year.
“Cash Investigation” and franceinfo give you access to the level of activity of hospitals and clinics in France. Find in our search engine the average activity of each establishment between 2016 and 2018 for six types of cancer (digestive, breast, gynecological, ENT, urological and thoracic).
You can also find this information on our maps. Search or click on a department to display the establishment data.
To obtain this information, the “Cash Investigation” team wrote a scientific protocol in October 2019 and asked the Ethics and Scientific Committee for research, studies and evaluations in the field of health (Cesrees) the right to access the database which lists all the activities of healthcare establishments in France. This is the first time that journalists have had direct access to this database. The request was then approved by the CNIL. In accordance with a request from the CNIL and in order to preserve any risk of direct or indirect identification, the level of activity of establishments carrying out less than 10 operations per year is not disclosed. These data are subject to “statistical secrecy”.
Methodology :
Our work has been authorized by the scientific committee of Cesrees and then by the CNIL (authorization n°919425). We were able to work on the Program for the medicalization of information systems (PMSI) in the field of Medicine, Surgery and Obstetrics (MCO) made available on the servers of the Technical Agency for Information on Hospitalization (Atih). From this database listing the medical activity of healthcare establishments in France, we followed the methodology described in circular DHOS/O/INCa/2008/101 of March 26, 2008 updated in December 2017 defining the thresholds activity in oncology.
It counts the number of anonymized discharge summaries (RSA) for adults (age ≥ 18 years), classified in a homogeneous group of patients (GHM) surgical (C) and mentioning a main diagnosis (DP) of cancer according to the established list by the Directorate General for Healthcare (DGOS) based on the CIM10 nomenclature. As in the methodology, transurethral surgery (urology) and dilation, curettage and conization for malignant tumors (gynecology) are excluded from the scope of analysis.
Once the RSAs corresponded to identified cancers, we crossed the result with the Finess database to obtain results by health establishment.