Analyse et enjeux de la métropolisation des soins de cancer en France

Following the progressive rationalization of hospital care in France, progress in cancer care over the past several decades has led to a significant improvement in patient survival but has also favored the centralization of care in specialized facilities. Based on hospital data, we offer a geographical analysis of the evolution of spatial accessibility of cancer care and surgical activity. The average time to access the nearest surgical center increased by 5 minutes between 2005 and 2018, with 2.1 % of the French population affected by an increase of more than 30 minutes. While cancer surgery activity between 2005 and 2012 increased by 9.1 % in urban areas equipped with a University Hospital or Cancer Center, it decreased very slightly (-0.3 %) in other French municipalities. This strong dynamic of spatial concentration of cancer surgery activity since the beginning of the 2000s confirms the hypothesis of a metropolization of cancer care, since the largest urban areas in metropolitan France now provide the instruction and expertise functions specific to metropolitan areas in the case of cancer care. These results also reflect the increasing use of specialized centers, of which the effects on patients and their home territories should be more widely evaluated.