Opportunities for Improvement
Recommendation
Participation in lung cancer screening trials and studies may enable France to determine whether screening is appropriate for its
population.
Rationale
Indicator 6: While a pilot trial of low-dose computed tomography screening was launched in France in 2002, there is no
information on any recent evidence-based approaches to lung cancer screening. Workshop participants suggested that an
experimental screening programme may start in some target areas in 2020. Decisions on this and whether it will be regional
or national will be based upon the publication of the NELSON study. In 2016 HAS stated that they do not consider that there is
sufficient scientific evidence to demonstrate that lung cancer screening can impact disease management.Recommendation
Referral for diagnostic assessment for patients suspected of having lung cancer should be prioritised within a specified time
period as there is currently no mention of a rapid referral for diagnostic testing.
Rationale
Indicators 8 & 9: Providing a timeframe within which patients suspected of having lung cancer should receive testing is an
important milestone for delivery of care as well as having a timeframe for confirmed lung cancer patients to receive secondary or
tertiary care. France does not provide such timeframes, nor does it have dedicated fast track referral processes in its lung cancer
guidelines. Workshop participants noted, however, that some Parisian centres use a fast track system.Recommendation
Decreasing the time between EMA approval and reimbursement may improve access for patients to innovations in care.
Rationale
Indicator 13: Workshop participants cited the challenging gap between EMA approval and reimbursement in France. Access
in clinical trials and through compassionate use can help to alleviate some of the pressures in the short term. Longer term it is
important to try and ensure that medications are available—in a financially sustainable manner—as soon as possible after they
have been approved. Because hospitals pay for treatment, at the moment there is a two-tiered system between patients treated
in hospitals whose budgets allow for the financing of treatments (otherwise not yet reimbursed) and those whose budgets do not
allow it.Recommendation
The use of molecular testing for lung cancer should be accessible for patients with advanced or recurring lung cancer.
Rationale
Indicator 12: Workshop participants emphasised the importance of reimbursement for biomarker testing. While the French lung
cancer clinical guidelines recommend the use of histology and molecular testing in patients with locally advanced or metastatic
non- small squamous cell carcinoma, the system of reimbursement is complex and not comprehensive. Participants noted that
current funding is not sufficient due to the number of tests needed. Currently, the prescriber pays for the test from an annual
budget, then once that budget is depleted the hospital pays—if it can afford to do so—from its own funds. France should take
steps to safeguard equitable access to testing.Opportunity 1
Opportunity 2
Opportunity 3
Opportunity 4