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 often do not know the level of activity of the establishment that receives them. Will they be taken care of in a service that performs enough cancer operations? No patient has access to this crucial information. The more the surgical teams practice, the higher the chances of recovery. After a year of investigation, “Cash Investigation” reveals the number of operations performed by health establishments near you.
A report published by the Health Insurance in 2018 (report “expenses and income”) shows that the operations carried out by medical teams practicing little lead to a high excess mortality. For breast cancer, for example, the death rate one year after the operation increases by 84% for patients operated on in an establishment that performs less than 30 procedures each year compared to an establishment that performs more than 150 operations per year. year.
For Professor Fabien Reyal, specialist in gynecological cancers and head of department at the Institut Curie in Paris, it is the “repetition of gestures” who makes the right surgeon: “It is not specific to surgery. It is true of manual trades, it is true when you are a cabinetmaker, it is true when you are a violinist. Very simply, when you practice this profession of oncologist surgeon a lot. , you see rather rare situations repeating themselves. “
In France, to perform this type of operation, establishments must have an authorization, based on the number of operations performed. This is called “the minimum activity threshold”. For digestive, urological, thoracic and breast cancers, an establishment must therefore perform at least 30 operations per year to retain its authorization. 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 data of the establishments.
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 Health Field (Cesrees) for the right to access the database which lists all the activities of health establishments in France. This is the first time that journalists have 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 transactions per year is not disclosed. These data fall under “statistical confidentiality”.
Methodology :
Our work was authorized by the scientific committee of Cesrees then by the Cnil (authorization n ° 919425). We were able to work on the Medical Information Systems Program (PMSI) in the Medicine, Surgery and Obstetrics (MCO) field made available on the servers of the Technical Agency for Hospitalization Information (Atih). From this database listing the medical activity of health 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 surgical patients (MHM) (C) and mentioning a main diagnosis (PD) of cancer according to the established list. by the general direction of the offer of care (DGOS) starting from the nomenclature CIM10. As in the methodology, transurethral surgery (urology) and dilations, curettages and conizations for malignant tumors (gynecology) are excluded from the scope of analysis.
Once the SARs corresponding to cancers were identified, we crossed the result with the Finess database to obtain results by health establishment.