Clinical Epidemiology and Ageing

Isocarma, a new Cepia study

A sociological study using mixed methods of social inequalities in cancer trajectories in Reunion Island and Mayotte.

A sociological study using mixed methods of social inequalities in cancer trajectories in Reunion Island and Mayotte.

It includes Cepia team members Meoïn Hagège, PhD (principal investigator) and Florence Canouï-Poitrine, MD PhD; and IRD anthropologist Dolorès Pourette, PhD; ORS public health physician Emmanuelle Rachou, MD; CHU Réunion Cancer registry director Emmanuel Chirpaz MD; and CHU Réunion head of clinical research Catherine Marimoutou, MD.

Isocarma is funded for 4 years by the French Institute for Cancer research (INCa).

Little is known about cancers and patient trajectories in its Overseas, especially in Mayotte. However, these territories are characterized by strong social inequalities within their populations, and in comparison to Hexagonal France. “Social inequalities in cancer trajectories in Reunion and Mayotte: a sociological study using mixed methods (IsoCaRMa)” is a mixed-method sociological research proposal, which aims to describe the mechanisms that produce the social inequalities that shape the evolution of illness and care experiences, in relation to their contexts, for individuals diagnosed with cervical, breast or colorectal cancer, before, during and after treatment.

A multidisciplinary team of health social scientists and public health physicians will carry out this two-pronged study. (1) the sociology and anthropology component aims to collect data through semi-directive interviews and ethnographic observations to qualify the illness trajectories in their context up to 5 years after diagnosis, and to identify social inequalities related to age, gender, class and race (ethnocentrism). (2) The socio-epidemiology component aims to provide framing data via the characterization of care trajectories based on a retrospective cohort study using medico-administrative data on the consumption of care goods and services, i.e., hospital stays, consultations, tests and treatments (surgery, chemotherapy/targeted therapy, radiotherapy), using the French healthcare database (medicine, surgery and obstetrics section (MCO) of the Programme de Médicalisation des Systèmes d'Information, PMSI and Système national d'information inter-régimes de l'Assurance maladie, Sniiram) in Reunion and Mayotte, and the Reunion cancer registry ; and the identification of social determinants (age, sex, département, and for Reunion, social deprivation) at four key points in the care trajectories (diagnosis, treatment, follow-up and the situation five years after diagnosis).

This project will shed light on the social processes that produce differences in the illness trajectories of these two French overseas territories, which have distinct colonial histories, cultures and populations, but which come together under the same healthcare and welfare state and through migratory dynamics. It will also make it possible to produce ad hoc data on cancer trajectories, which health professionals and associations need to better care for patients and prevent treatment interruptions and lost to follow-ups.