Abstract

Official recognition of cancer as “occupational disease” (OD) by the Social Security compensation system depends on medical and legal criteria, plus the information and willingness of patients to assert their rights. In France, only 1 in 10 work-related lung cancer are recognised as OD, even less so for urinary bladder (<1%). Our aim was to identify key factors that could favour or hamper access to OD recognition and its timing.

An intervention research was set within an ongoing prospective cancer patients study (Giscop93) from March-2002 to December-2013. Once occupational exposures were reconstructed, patients eligible for OD notification were followed-up as to their access to OD recognition. The second phase of intervention (October-2009/December-2013) was very pro-active, with personalised counselling and close partnership with social services and lawyers. We assessed factors that could favour/hamper OD notification and compensation through multiple logistic regression. Delays between OD notification and death or recognition were assessed through Kaplan-Meier estimator followed by Cox proportional hazards modelling (SAS 9.3).

Among the 1058 lung cancer patients, 558 were eligible for OD notification; 72% notified their cancer as an OD, of whom 76% were officially recognised. The median delay between notification and recognition by Social Security was 5.70 months (95% CI [5.57; 5.77]). About 39% of patients died within 6 months after they notified. In multivariate Cox-models (outcome: OD recognition), the hazard ratio was 1.74 for asbestos exposure (ref: exposed less than 10 years; p = 0.0003) and 1.29 for the intervention period (ref: first phase March-2003/September-2009, p = 0.036).

These results suggest that personalised interventions may improve notification by patients and its outcome in terms of OD recognition and shorter delays. Yet, asbestos remains the main recognised exposure and the legal response delay (6 months) seems incompatible with access to compensation during lifetime for many patients since lung cancer has a bad prognosis.