Publications by authors named "Natacha Heutte"

54 Publications

Evaluation of long-term living conditions in patients treated for localised prostate cancer.

Eur J Cancer Care (Engl) 2021 Jan 24;30(1):e13333. Epub 2020 Sep 24.

UMR 1086 « Cancers et Préventions », Inserm - University of Basse-Normandie, Caen, France.

Purpose: To evaluate the evolution of living conditions (LC) in long-term survivors of localised prostate cancer 10 years after treatment compared with those of a same-age control group from the general population.

Methods: Two hundred and eighty-seven patients diagnosed with prostate cancer in 2001 were selected in 11 French cancer registries. They were matched with controls randomly selected for age and residency. Both patients and controls completed a self-administered LC questionnaire concerning their familial, social and professional life, and general and specific quality of life (QoL) and anxiety and depression questionnaires.

Results: Compared with controls, patients reported more sexual modifications (p < .0001), but without any difference in marital status. Patients' circle of friends was more stable than that of the controls (91% vs. 63%; p < .0001) and patients reported fewer friendship modifications than controls (p < .0006). Their professional and physical activities were also preserved. They reported more anxiolytic intake (p = .002) but did not consult their general practitioner more often. Type of specialist consulted differed in the two groups.

Conclusion: Patients treated for localised prostate cancer had the same living conditions as men of the same age. Their social life was satisfying on the whole, albeit they reported more sexual difficulties than their counterparts.
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http://dx.doi.org/10.1111/ecc.13333DOI Listing
January 2021

Tumor burden of persistent disease in patients with differentiated thyroid cancer: correlation with postoperative risk-stratification and impact on outcome.

BMC Cancer 2020 Aug 14;20(1):765. Epub 2020 Aug 14.

Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer Centre, 3 Avenue Général Harris, F-14000, Caen, France.

Background: In patients with differentiated thyroid cancer (DTC), tumor burden of persistent disease (PD) is a variable that could affect therapy efficiency. Our aim was to assess its correlation with the 2015 American Thyroid Association (ATA) risk-stratification system, and its impact on response to initial therapy and outcome.

Methods: This retrospective cohort study included 618 consecutive DTC patients referred for postoperative radioiodine (RAI) treatment. Patients were risk-stratified using the 2015 ATA guidelines according to postoperative data, before RAI treatment. Tumor burden of PD was classified into three categories, i.e. very small-, small- and large-volume PD. Very small-volume PD was defined by the presence of abnormal foci on post-RAI scintigraphy with SPECT/CT or FDG PET/CT without identifiable lesions on anatomic imaging. Small- and large-volume PD were defined by lesions with a largest size < 10 or ≥ 10 mm respectively.

Results: PD was evidenced in 107 patients (17%). Mean follow-up for patients with PD was 7 ± 3 years. The percentage of large-volume PD increased with the ATA risk (18, 56 and 89% in low-, intermediate- and high-risk patients, respectively, p < 0.0001). There was a significant trend for a decrease in excellent response rate from the very small-, small- to large-volume PD groups at 9-12 months after initial therapy (71, 20 and 7%, respectively; p = 0.01) and at last follow-up visit (75, 28 and 16%, respectively; p = 0.04). On multivariate analysis, age ≥ 45 years, distant and/or thyroid bed disease, small-volume or large-volume tumor burden and FDG-positive PD were independent risk factors for indeterminate or incomplete response at last follow-up visit.

Conclusions: The tumor burden of PD correlates with the ATA risk-stratification, affects the response to initial therapy and is an independent predictor of residual disease after a mean 7-yr follow-up. This variable might be taken into account in addition to the postoperative ATA risk-stratification to refine outcome prognostication after initial treatment.
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http://dx.doi.org/10.1186/s12885-020-07269-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429727PMC
August 2020

Comparative Toxigenicity and Associated Mutagenicity of and Group Isolates Collected from the Agricultural Environment.

Toxins (Basel) 2020 07 17;12(7). Epub 2020 Jul 17.

Faculty of Health, Normandie University, UNICAEN, Centre F. Baclesse, UR ABTE EA4651, 14000 Caen, France.

The mutagenic patterns of and extracts were evaluated. These strains of toxigenic were collected from the agricultural environment. The Ames test was performed on strains TA98, TA100 and TA102, without and with S9mix (exogenous metabolic activation system). These data were compared with the mutagenicity of the corresponding pure mycotoxins tested alone or in reconstituted mixtures with equivalent concentrations, in order to investigate the potential interactions between these molecules and/or other natural metabolites. At least 3 mechanisms are involved in the mutagenic response of these aflatoxins: firstly, the formation of AFB-8,9-epoxide upon addition of S9mix, secondly the likely formation of oxidative damage as indicated by significant responses in TA102, and thirdly, a direct mutagenicity observed for higher doses of some extracts or associated mycotoxins, which does not therefore involve exogenously activated intermediates. Besides the identified mycotoxins (AFB, AFB and AFM), additional "natural" compounds contribute to the global mutagenicity of the extracts. On the other hand, AFB and AFM modulate negatively the mutagenicity of AFB when mixed in binary or tertiary mixtures. Thus, the evaluation of the mutagenicity of "natural" mixtures is an integrated parameter that better reflects the potential impact of exposure to toxigenic Aspergilli.
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http://dx.doi.org/10.3390/toxins12070458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404940PMC
July 2020

Analysis of medico-social factors for return to work among patients presenting with haematological malignancy (adamantine): results of a 'pilot study'.

BMC Res Notes 2020 Jul 2;13(1):313. Epub 2020 Jul 2.

INSERM U1086 « ANTICIPE », 14033, Caen Cedex, France.

Objective: The aim of this study was to describe return to work determinants in patients with haematological malignancy.

Results: This medico-social pilot study included patients with haematological malignancy in the département of Calvados, aged 18 to 55 years, diagnosed between 1st January and 31st December 2010 and alive at 1st January 2015. Patients were identified via consultation of the Lower Normandy haematological malignancy Registry. They completed a specially developed self-questionnaire, in addition to validated questionnaires for anxiety-depression, quality of life and fatigue. Of the patients contacted, 50% accepted to participate. The mean age at diagnosis was 49.8 years, and the majority of patients (79.2%) was professionally active at the time of diagnosis. Only 64.9% of subjects had stopped work due to illness. The psychological impact (demonstrated anxiety) was significantly greater in men (p = 0.01). The majority of subjects returned to work after treatment (80.7%) and among them, the mean duration of absence from work was 16.1 months. Only 52.6% of subjects had informed their occupational physician and 56.7% had benefited from a pre-return visit. The satisfactory response rate obtained is promising for the extension of the present project as a prospective multicentric study.
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http://dx.doi.org/10.1186/s13104-020-05149-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7331231PMC
July 2020

Genotoxicity of aldehyde mixtures: profile of exocyclic DNA-adducts as a biomarker of exposure to tobacco smoke.

Toxicol Lett 2020 Oct 20;331:57-64. Epub 2020 May 20.

Normandie University, UNICAEN, ABTE EA4651, Caen, France; CCC François Baclesse, UNICANCER, Caen, France. Electronic address:

Electrophilic compounds present in humans, originating from endogenous processes or pollutant exposures, pose a risk to health though their reaction with nucleophilic sites in protein and DNA. Among this chemical class, aldehydes are mainly present in indoor air and they can also be produced by endogenous lipid peroxidation arising from oxidative stress. Known to be very reactive, aldehydes have the ability to form exocyclic adducts to DNA that, for the most if not repaired correctly, are mutagenic and by consequence potential agents involved in carcinogenesis. The aim of this work was to establish profiles of exocyclic DNA adducts induced by aldehyde mixtures, which could ultimately be considered as a genotoxic marker of endogenous and environmental aldehyde exposure. Adducts were quantified by an accurate, sensitive and validated ultra high performance liquid chromatography-electrospray ionization analytical method coupled to mass spectrometry in the tandem mode (UHPLC-ESI-MS/MS). We simultaneously measured nine exocyclic DNA adducts generated during the exposure in vitro of calf thymus DNA to different concentrations of each aldehyde along, as well as, to an equimolar mixture of these aldehydes. This approach has enabled us to establish dose-response relationships that allowed displaying the specific reactivity of aldehydes towards corresponding adducts formation. Profiles of these adducts determined in DNA of current smokers and non-smokers blood samples supported these findings. These first results are encouraging to explore genotoxicity induced by aldehyde mixtures and can furthermore be used as future reference for adductomic approaches.
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http://dx.doi.org/10.1016/j.toxlet.2020.05.010DOI Listing
October 2020

Convergent Validity and Minimal Clinically Important Difference of the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) and the Chronic Obstructive Pulmonary Disease-Specific Health-Related Quality of Life questionnaire (VQ11).

Int J Chron Obstruct Pulmon Dis 2019 13;14:2895-2903. Epub 2019 Dec 13.

FormAction Santé, Pérenchies F-59840, France.

Purpose: Short and easy questionnaires have been developed to assess the health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD), such as the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) and the COPD-specific HRQoL Questionnaire (VQ11). Both are valid, reliable, and sensitive, but their minimal clinically important differences (MCID) are unknown. Consequently, this study aimed to confirm the convergent validities of the MRF-28 and VQ11 and establish their MCID. A retrospective design was used to evaluate the effect of individual home-based pulmonary rehabilitation (PR) in 400 COPD patients.

Patients And Methods: Exercise tolerance, anxiety and depression based on the Hospital Anxiety and Depression Scale (HADS), and HRQoL using three questionnaires (MRF-28, VQ11, and the Visual Simplified Respiratory Questionnaire: VSRQ) were assessed before and after an individualized home-based PR program (5 sessions of 30-45 mins/week for 8 weeks, including a weekly session supervised by a team member).

Results: PR improved all measured variables ( < 0.0001). The correlations were significant ( < 0.0001) between VSRQ and MRF-28 (r = -0.685 at baseline and r = -0.686 after the PR program), and between VSRQ and VQ11 (r = -0.691 at baseline and r = -0.753 after the PR program). Moreover, changes in score (delta between after and before PR program) of VSRQ were also significantly correlated ( < 0.0001) to changes in score of MRF-28 (r = -0.372) and VQ11 (r = -0.423). Last, we calculated MCID of -5.2 and -2.0 units for MRF-28 and VQ11, respectively.

Conclusion: The MRF-28 and VQ11 can be used in routine practice to evaluate the effects of PR on the HRQoL of COPD patients, with MCID of -5.2 and -2.0, respectively.
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http://dx.doi.org/10.2147/COPD.S222165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916677PMC
July 2020

Effectiveness of a therapeutic patient education program in improving cancer pain management: EFFADOL, a stepped-wedge randomised controlled trial.

BMC Cancer 2019 Jul 8;19(1):673. Epub 2019 Jul 8.

Clinical Research Department, Centre François Baclesse, 14000, Caen, France.

Background: Despite numerous guidelines, nearly one of two patients with cancer pain remains undertreated, thereby affecting their quality of life. Active patient involvement through Therapeutic Patient Education (TPE) is considered as a relevant strategy to overcoming hurdles in pain management. The aim of the EFFADOL study is to assess the effectiveness of a TPE program in improving cancer pain management.

Methods/design: The EFFADOL study is a stepped-wedge randomised controlled trial. A total of 260 cancer patients with unbalanced background pain will be randomised over the institutional level, i.e. stepped-wedge cluster design. Six clusters will be formed, one at the regional level of "Basse-Normandie" for patients receiving the educational approach by health providers already trained to TPE. Then, five additional centers will be gradually included at the national level, making it possible to compare the "conventional" management of pain (before medical staff training to TPE) with the educational approach (after being trained). The main study parameter is pain interference on daily life assessed with the self-administrated and validated Brief Pain Inventory questionnaire. Secondary objectives comprised the evaluation of patients' adherence to pain education program, the description of pain intensity, pain relief, analgesic adherence and pain emotional impact. Educational dimension of the program will be evaluated through the patients' acquisition of knowledge and skills about their pain and treatment as well as their self-efficacy to participate actively in pain management. The patient's feeling of pain changes will be measured. Finally, the satisfaction of participants and educators will be reported. We hypothetise active involvement of patients in TPE will lead to an improved pain management compared to standard care.

Discussion: Analyzing the impact of a TPE program in cancer pain patients will improve their pain management and quality of life. We expect that the dissemination of our project educational approach through the French territory will be accompanied by long term change in clinical practices with mutual benefit to patients and caregiver-educators.

Trial Registration: NCT03297723 , registered: 09/28/2017. Protocol version: Version n°1.1 dated from 2016/09/08.
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http://dx.doi.org/10.1186/s12885-019-5836-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615097PMC
July 2019

Use of soil fungi in the biosorption of three trace metals (Cd, Cu, Pb): promising candidates for treatment technology?

Environ Technol 2020 Oct 7;41(24):3166-3177. Epub 2019 Apr 7.

Centre F. Baclesse, Normandie Univ, UNICAEN, Caen, France.

Trace metal contamination is a widespread and complex environmental problem. Because fungi are capable of growing in adverse environments, several fungal species could have an interesting potential in remediation technologies for metal contaminated environments. This study proposes to test the ability to tolerate and biosorb three trace metals (Cd, Cu and Pb) of 28 fungal isolates collected from different soils. First, a tolerance assay in agar medium was performed. Each isolate was grown in the presence of Cd, Cu, and Pb at different concentrations. Then, we exposed each soil fungus to 50 mg L of Cd, Cu, or Pb during 3 days in liquid medium. Parameters such as biomass production, pH, and biosorption were evaluated. The results showed that responses to metal exposure are very diverse even with fungi isolated from the same soil sample, or belonging to the same genera. Several isolates could be considered as good metal biosorbents and could be used in future mycoremediation studies. Among the 28 fungi tested, biosorbed more than 45% of Cd and Pb, biosorbed more than 45% of Cd, Cu, Pb, and biosorbed 100% of Pb.
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http://dx.doi.org/10.1080/09593330.2019.1602170DOI Listing
October 2020

Long-Term Cultivation of in a Novel Cell Culture Device.

Am J Trop Med Hyg 2019 04;100(4):822-827

Centre François Baclesse, Normandie Université, UNICAEN, UR ABTE EA 4651, Caen, France.

The standard cultivation procedure for requires gas exchange and a microaerophilic atmosphere. A novel system using a commercially available cell culture device (Petaka G3; Celartia Ltd., Powell, OH) was assessed for long-term cultivation of a reference laboratory clone in normal air. Parasite growth during 30 days was similar, or better, in Petaka G3 than that in the standard cultivation method with gas exchange in a CO incubator. The successful cultivation of in the Petaka G3 device suggests that low O content available in hemoglobin and dissolved gas in the blood is sufficient for long-term cultivation. This finding may open the way to novel methods to cultivate and adapt field isolates to conditions with more ease.
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http://dx.doi.org/10.4269/ajtmh.18-0527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447126PMC
April 2019

[Therapeutic education and cancer pain: Strategy and strengths of the EFFADOL program].

Presse Med 2018 Oct 24;47(10):921-924. Epub 2018 Oct 24.

Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France.

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http://dx.doi.org/10.1016/j.lpm.2018.08.002DOI Listing
October 2018

[Elaboration and evaluation of a therapeutic education program in cancer pain management].

Bull Cancer 2018 Nov 14;105(11):1074-1083. Epub 2018 Oct 14.

Centre hospitalier, 14400 Bayeux, France; Réseau régional douleur en Basse-Normandie, 14400 Bayeux, France.

Pain, one of the most feared symptoms for patients with cancer, remains insufficiently alleviated and impairs quality of life. Therapeutic patient education (TPE) is a relevant approach to this problem while allowing patients to develop skills to better manage their pain. In the "Basse-Normandie" French region, the management of pain relies on two organized networks, thus allowing proximity and accessibility for all concerned. In this context, our team has begun a broad five-step research program that is part of a regional health policy: (1) training in TPE of 10 doctor/nurse pairs; (2) identification of educational expectations of patients and their relatives in the field of cancer pain; (3) design and optimization of a TPE program dedicated to cancer pain; (4) regional pilot study aiming to assess the feasibility, quality and transferability of the program; (5) evaluation of the TPE program by interventional comparative randomization at the national level. This article aims to present the program which originality and strengths are based on collaborative work between health stakeholders. Objectives, methodology and expected results of the research phase (stages 2, 4, 5) are notably developed. The main expected outcomes are to prove the effectiveness of the program in improving the knowledge and skills of patients in the field of pain cancer in order to promote their adherence to treatment and, consequently, to enable them to better manage it. The long-term objective is to disseminate the educational approach by modifying practices that provide a mutual benefit for caregivers and patients.
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http://dx.doi.org/10.1016/j.bulcan.2018.08.012DOI Listing
November 2018

Sexual Disorders of Patients With Metastatic Renal Cell Carcinoma (mRCC) Treated With Antiangiogenic Therapies.

Clin Genitourin Cancer 2018 10 21;16(5):369-375.e1. Epub 2018 May 21.

U1086 INSERM-UCBN "Cancers & Préventions", Normandie Université, Caen, France; Departments of Clinical Research Unit, Centre François Baclesse, Caen, France; Department of Medical Oncology, Centre François Baclesse, Caen, France. Electronic address:

Background: Targeted therapies, in particular antiangiogenic therapies (AATs), have become the standard of treatment for metastatic renal cell carcinoma (mRCC). Although common adverse effects like fatigue have been well-established, sexual disorders induced by these treatments, although often reported, have been poorly evaluated. The aim of this study was to evaluate the impact of AATs on the sexual life of patients with mRCC and the relationships with quality of life (QoL), fatigue, and biologic parameters.

Patients And Methods: This longitudinal study included patients with mRCC on first- or second-line AATs. Sexuality was evaluated by the French version of Changes in Sexual Functioning Questionnaire short-Form (CSFQ); QoL and fatigue were measured by the Functional Assessment of Cancer Therapy General (FACT-G) and the Multidimensional Fatigue Inventory (MFI-20), respectively. Biologic parameters were also assessed.

Results: Among 75 patients included in the study, 39 agreed to respond to the sexual functioning questionnaire (CSFQ). At baseline, all patients had at least 1 sexual dysfunction. No relationship with QoL, fatigue, and biologic parameters was shown. After 3 months of treatment, a decrease in at least 1 sexual dimension was observed in 69% of patients. The most affected sexual dimensions were pleasure (34%) and desire/interest (38%). No significant relationship between sexual dysfunctions and biologic parameters was found. The percentage of non-participants (50%) and the absence of a control arm are the main limitations.

Discussion: Patients with mRCC exhibit sexual dysfunction that could be increased by AATs independently of the impact on fatigue and QoL. Further studies aiming to define the role of biologic parameters like inflammatory markers and thyroid parameters are warranted.

Conclusion: Sexual disorders induced or degraded by AAT are an independent side effect that should be taken into account in oncology supportive care departments.
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http://dx.doi.org/10.1016/j.clgc.2018.05.013DOI Listing
October 2018

Cognitive Changes After Adjuvant Treatment in Older Adults with Early-Stage Breast Cancer.

Oncologist 2019 01 22;24(1):62-68. Epub 2018 Jun 22.

INSERM, U1086, ANTICIPE, Caen, France

Background: Group-based trajectory modeling is particularly important to identify subgroups of patients with pathological cognitive changes after cancer treatment. To date, only one study has explored cognitive trajectories in older patients with cancer. The present article describes objective cognitive changes before to after adjuvant treatment in older adults with early-stage breast cancer (EBC) after adjuvant treatment compared with healthy controls.

Patients And Methods: Participants were patients ≥65 years of age with newly diagnosed EBC and healthy controls (age-, sex-, and education-matched). The pretreatment assessment was conducted before adjuvant therapy, and the post-treatment assessment after the end of the first adjuvant treatment. Objective cognitive changes before to after treatment were evaluated based on the Reliable Change Index for cognitive decline accounting for cognitive impairment status.

Results: The sample consisted of women newly diagnosed with EBC ( = 118) and healthy controls ( = 62). Five patterns of changes before to after treatment were identified based on the presence of cognitive decline and cognitive impairment. The distribution of these five change patterns was statistically significant ( = .0001). Thirty-six percent of patients had phase shift changes, 31% without initial objective cognitive impairment developed impairment, 15% had a normal aging, 12% had a nonpathological decline, and 6% experienced accelerated cognitive decline.

Conclusion: This study described for the first time objective cognitive changes before to after treatment of older adults with EBC immediately after the end of adjuvant treatment. A longer-term remote follow-up of adjuvant treatment is needed to better understand the cognitive trajectories of older patients with EBC.

Implications For Practice: After the end of adjuvant treatment, 31% of older adults with early-stage breast cancer without initial objective cognitive impairment developed impairment, and 6% experienced accelerated cognitive decline. Initial cognitive functioning should be included in the balance of benefits and harms of systemic therapy for patients who are likely to be at highest risk for cognitive decline after cancer treatments. Regular cognitive follow-up of patients who had cognitive impairment before cancer treatment should monitor symptoms suggestive of neurodegenerative disease and avert the effect of cognitive disorders on patients' autonomy.
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http://dx.doi.org/10.1634/theoncologist.2017-0570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324624PMC
January 2019

French Therapeutic Education Programme Aimed at Improving the Quality of Life of Laryngectomised Patients and their Close Relations: the Three Stages (Observational and Interventional Randomised) of the Study "PETAL".

J Cancer Educ 2019 Aug;34(4):823-830

UMR 1086 INSERM « ANTICIPE » and University of Normandy, Caen, France.

The therapeutic education of patients and their close relations is, as yet, poorly developed in France in the field of oncology. Total laryngectomy is a mutilating surgical procedure having a major impact on the patient's life, due to its physical and functional sequelae. Its psychosocial consequences are also important and alter the quality of life of patients and their close relations. Currently, care for laryngectomised patients consists essentially in informing and educating them on some technical procedures during hospital admission. The intervention of a speech therapist, often serves as the link between the patient and the hospital care team. These healthcare modalities often insufficiently account for the social, environmental and personal factors that interact in health-related problems. This report presents the therapeutic education programme protocol "PETAL" for laryngectomised patients and their close relations to improve their quality of life. The trial will be conducted over three phases: (1) the "pilot" phase aims at developing knowledge on the consequences of laryngectomy on the quality of life of patients and their close relations and developed a pluridisciplinary therapeutic education program, (2) the prospective intervention "replication" phase aims at evaluating the programme's transferability in three centres and (3) the cluster-randomised multicentric comparative intervention phase, will assess the benefits of the developed programme. Phase I identified nine themes of workshops related to therapeutic education, training and coordination of care. The developed programme should reinforce town-hospital links to improve help, follow-up and support for patients and their close relations.
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http://dx.doi.org/10.1007/s13187-018-1380-2DOI Listing
August 2019

Chaga ( Inonotus obliquus), a Future Potential Medicinal Fungus in Oncology? A Chemical Study and a Comparison of the Cytotoxicity Against Human Lung Adenocarcinoma Cells (A549) and Human Bronchial Epithelial Cells (BEAS-2B).

Integr Cancer Ther 2018 09 27;17(3):832-843. Epub 2018 Feb 27.

1 Normandie University, UNICAEN, Centre F. Baclesse, Caen, France.

Background: Inonotus obliquus, also known as Chaga, is a parasitic fungus growing on birches and used in traditional medicine (especially by Khanty people) to treat various health problems. In this study, we aimed to quantify the 3 metabolites frequently cited in literature, that is, betulin, betulinic acid, and inotodiol in the Chaga recently discovered in forests located in Normandy (France), and to compare their concentrations with Ukrainian and Canadian Chaga. This study also explores the cytotoxicity of the French Chaga against cancer-derived cells and transformed cells.

Methods: A quantification method by HPLC-MS-MS (high-performance liquid chromatography-tandem mass spectrometry) of betulin, betulinic acid, and inotodiol was developed to study the French Chaga and compare the concentration of these metabolites with extracts provided from Chaga growing in Canada and Ukraine. This method was also used to identify and quantify those 3 compounds in other traditional preparations of Chaga (aqueous extract, infusion, and decoction). Among these preparations, the aqueous extract that contains betulin, betulinic acid, and inotodiol was chosen to evaluate and compare its cytotoxic activity toward human lung adenocarcinoma cells (A549 line) and human bronchial epithelial cells (BEAS-2B line).

Results: French Chaga contains betulin and betulinic acid at higher levels than in other Chaga, whereas the concentration of inotodiol is greater in the Canadian Chaga. Moreover, the results highlighted a cytotoxic activity of the Chaga's aqueous extract after 48 and 72 hours of exposure with a higher effect on cancer-derived cells A549 than on normal transformed cells BEAS-2B ( P = 0.025 after 48 hours of exposure and P = 0.004 after 72 hours of exposure).
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http://dx.doi.org/10.1177/1534735418757912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142110PMC
September 2018

Correction to: Impact of new generation hormone-therapy on cognitive function in elderly patients treated for a metastatic prostate cancer: Cog-Pro trial protocol.

BMC Cancer 2018 01 30;18(1):110. Epub 2018 Jan 30.

INSERM, U1086 ANTICIPE, Normandie University, UNICAEN, 14076, Caen, France.

Correction: After publication of the original article [1] the authors found that Table 2 had been formatted incorrectly, meaning that some rows in the Table did not display the correct information. An updated version of Table 2 is included with this Correction. The original article has also been updated.
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http://dx.doi.org/10.1186/s12885-017-3764-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791194PMC
January 2018

Comparison of tolerance and biosorption of three trace metals (Cd, Cu, Pb) by the soil fungus Absidia cylindrospora.

Chemosphere 2018 Apr 28;196:386-392. Epub 2017 Dec 28.

Normandie Univ, UNICAEN, ABTE EA 4651, Centre F. Baclesse, 14000, Caen, France. Electronic address:

Trace metals cause deterioration of the soil and constitute a major concern for the environment and human health. Bioremediation could be an effective solution for the rectification of contaminated soils. Fungi could play an important role in biodegradation because of the morphology of their mycelium (highly reactive and extensive biological surface) and its physiology (high tolerance to many stresses, production of enzymes and secondary metabolites). Fungi can effectively biosequestrate, or biotransform many organic and inorganic contaminants into a non-bioavailable form. This experiment was designed to evaluate the tolerance and the biosorption abilities of the fungus Absidia cylindrospora against three trace metals: Cadmium (Cd), Copper (Cu), and Lead (Pb). Firstly, the tolerance of the strain was evaluated on metal-enriched malt extract agar (MEA). Secondly, the strain was exposed to trace metals, in a liquid malt extract medium. After 3 or 7 days of exposure, the quantities of absorbed and adsorbed metals were measured with Inductively Coupled Plasma-Optical Emission Spectrometry (ICP-OES). Biomass production and pH evolution were also evaluated during the test. Our experiment revealed differences between the three metals. In agar medium, Cd and Pb were better tolerated than Cu. In liquid medium, Cd and Pb were mostly absorbed whereas Cu was mostly adsorbed. A. cylindrospora biosorbed 14% of Cu, 59% of Pb and 68% of Cd when exposed for 3 days at 50 mg L.
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http://dx.doi.org/10.1016/j.chemosphere.2017.12.156DOI Listing
April 2018

Shear Wave Elastography in Thyroid Nodules with Indeterminate Cytology: Results of a Prospective Bicentric Study.

Thyroid 2017 11;27(11):1441-1449

10 Department of Thyroid and Endocrine Tumors Unit, Institute of Endocrinology; Pitié Salpêtrière Hospital, IUC, University Paris VI , Paris, France .

Background: The clinical management of thyroid nodules with indeterminate cytology (IC) remains challenging. The role of shear wave elastography (SWE) in this setting is controversial. The aim of the study was to assess the performances of SWE in terms of prediction of malignancy, reproducibility, and combined analysis with ultrasound (US) examination in thyroid nodules with IC.

Methods: This prospective study was conducted in two referral centers. Eligible patients had a thyroid nodule ≥15 mm with IC (Bethesda class III-V) for which surgery had been recommended. Patients underwent a standardized US evaluation combined with a SWE exam followed by surgery. SWE parameters included mean (meanEI; kPa) and max (maxEI) elasticity values, and ratio (meanEI nodule/parenchyma).

Results: One hundred and thirty-one nodules (median size 30 mm) in 131 patients were studied. IC was class III in 28%, class IV in 64%, and class V in 8% of cases. After surgery, 21 (16%) nodules were malignant, including nine papillary thyroid cancers (PTC), six follicular thyroid cancers, five poorly differentiated carcinomas, and one large B-cell lymphoma. SWE parameters were similar in benign and malignant nodules, including meanEI (20.2 vs. 19.6 kPa), maxEI (34.3 vs. 32.5 kPa), and ratio (1.57 vs. 1.38). In malignant nodules, meanEI, maxEI, and ratio were higher in the classic PTC variants (n = 4) than in the other PTC variants (n = 5; p < 0.02) and in non-PTC tumors (n = 12; p < 0.005). Intra- and inter-observer coefficients of variations for meanEI in nodules were 23% and 26%, respectively. The French Thyroid Imaging Reporting and Data System score, the American Thyroid Association US classification, and the EU-Thyroid Imaging Reporting and Data System were not associated with malignancy.

Conclusions: Despite high elasticity values in classic PTC variants, conventional SWE indexes failed to discriminate between benign and malignant tumors in thyroid nodules with IC.
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http://dx.doi.org/10.1089/thy.2017.0293DOI Listing
November 2017

Impact of new generation hormone-therapy on cognitive function in elderly patients treated for a metastatic prostate cancer: Cog-Pro trial protocol.

BMC Cancer 2017 Aug 16;17(1):549. Epub 2017 Aug 16.

INSERM, U1086 ANTICIPE, Normandie University, UNICAEN, 14076, Caen, France.

Background: New generation hormone-therapies (NGHT) targeting the androgen signalling pathway are nowadays proposed to elderly patients with metastatic castration-resistant prostate cancer (CRPCa). The impact of these treatments on cognitive function has never been evaluated whereas cognitive impairment may have an impact on the autonomy and the treatment adherence. The aim of this study is to prospectively assess the incidence of cognitive impairment in elderly men after treatment by NGHT for a metastatic CRPCa.

Methods/design: The Cog-Pro study is a multicentre longitudinal study including CRPCa patients ≥70 years old treated with NGHT (n = 134), control metastatic prostate cancer patients without castration resistance treated with first generation androgen deprivation therapy (n = 55), and healthy participants (n = 33), matched on age and education. Cognitive, geriatric and quality of life assessment and biological tests will be performed at baseline, 3, 6 and 12 months after start of the treatment (inclusion time). The primary endpoint is the proportion of elderly patients receiving a NGHT who will experience a decline in cognitive performances within 3 months after study enrollment. Secondary endpoints concern: autonomy, quality of life, anxiety, depression, cognitive reserve, adherence to hormone-therapy, comparison of the cognitive impact of 2 different NGHT (abiraterone acetate and enzalutamide), impact of co-morbidities and biological assessments.

Discussion: Evaluating, understanding and analyzing the incidence, severity of cognitive impairments and their impact on quality of life, autonomy and adherence in this group of patients with advanced disease is a challenge. This study should help to improve cancer care of elderly patients and secure the use of oral treatments as the risk of non-observance does exist. Our results will provide up-to date information for patients and caregivers on impact of these treatments on cognitive function in order to help the physicians in the choice of the treatment.

Trial Registration: NCT02907372 , registered: July 26, 2016.
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http://dx.doi.org/10.1186/s12885-017-3534-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559794PMC
August 2017

Therapeutic Patient Education in Cancer Pain Management: from Practice to Research: Proposals and Strategy of the French EFFADOL Program.

J Cancer Educ 2018 12;33(6):1355-1361

Bayeux Hospital, Bayeux, France.

In the field of cancer pain, therapeutic patient education (TPE) allows patients to develop skills to better manage their pain. In the Lower Normandy region of France, the management of pain is based on networking, thus allowing proximity and accessibility for all concerned. We have thus designed and initiated a broad five-stage research program that includes the following: (1) training for caregivers in TPE; (2) identifying the educational expectations of patients and their relatives with regard to cancer pain; (3) the design of a TPE program; (4) the evaluation of its quality; and (5) the evaluation of its effectiveness by comparative randomization. This article presents this approach and more particularly the research phases (stages 2, 4, 5) for which the objectives, the methodology, and the expected results are justified. Among the key points, particular attention is paid to the evaluation of the educational dimension that provides patients with self-efficacy to participate actively in the management of their pain, their perception of changes in relation to it and its impact. The choice of a specific assessment criterion (subscale 9 of the Brief Pain Inventory) and of the step-wedge design are thus argued. This approach, which is based on a partnership between health care professionals and researchers, aims to demonstrate the benefits provided by TPE to patients in order to enable them to better manage their pain on a daily basis.
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http://dx.doi.org/10.1007/s13187-017-1258-8DOI Listing
December 2018

Prospective Evaluation of the Impact of Antiangiogenic Treatment on Cognitive Functions in Metastatic Renal Cancer.

Eur Urol Focus 2016 Dec 17;2(6):642-649. Epub 2016 May 17.

Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France.

Background: Little is known about the cognitive effects of antiangiogenic therapies (AATs) in metastatic renal cell carcinoma (mRCC) and their relation with fatigue.

Objective: To evaluate the impact of AATs on cognition and its connection with fatigue and quality of life (QoL) in patients with mRCC.

Design, Setting, And Participants: This prospective study enrolled 75 patients starting AAT as first or second line for mRCC and assessed them at 3 mo (n=58) and 6 mo (n=50).

Outcome Measurements And Statistical Analysis: We assessed objective cognitive decline with a neuropsychological battery of tests and cognitive complaint, fatigue, and QoL with validated self-reported questionnaires using the Fisher exact test, Wilcoxon test, and Spearman correlation coefficient.

Results And Limitations: A decline of cognitive functions was observed in 18 patients (31%) including 13 without cognitive impairment at baseline. The score of fatigue was increased in all patients except one. A relationship between cognitive complaints and fatigue was observed (p<0.05) but not with objective cognitive decline. Cognitive complaints and fatigue had a significant impact on most of the domains of QoL (p<0.01). A positive correlation was found between fatigue and inflammatory markers but not with cognition. The main limitation of this study is the absence of a control group.

Conclusions: AAT induced cognitive decline in patients with mRCC independently of fatigue. These side effects affecting QoL should be better assessed in clinical trials and taken into account in routine practice.

Patient Summary: Fatigue is a well-known effect of antiangiogenic therapies (AATs) of cancer. The study performed in patients with treated metastatic renal cancer shows a decline of cognitive functions induced by AATs, such as information-processing speed or working memory, in a third of patients, independently of fatigue. Patients on AATs should be informed of these possible adverse effects.
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http://dx.doi.org/10.1016/j.euf.2016.04.009DOI Listing
December 2016

Assessment of multi-contaminant exposure in a cancer treatment center: a 2-year monitoring of molds, mycotoxins, endotoxins, and glucans in bioaerosols.

Environ Monit Assess 2017 Jan 23;189(1):31. Epub 2016 Dec 23.

ABTE EA 4651, Normandie Université, UNICAEN, UNIROUEN, 14000, Caen, France.

Indoor air quality in health care facilities is a major public health concern, particularly for immunocompromised patients who may be exposed to microbiological contaminants such as molds, mycotoxins, endotoxins, and (1,3)-ß-D-glucans. Over 2 years, bioaerosols were collected on a monthly basis in a cancer treatment center (Centre F. Baclesse, Normandy, France), characterized from areas where there was no any particular air treatment. Results showed the complexity of mycoflora in bioaerosols with more than 100 fungal species identified. A list of major strains in hospital environments could be put forward due to the frequency, the concentration level, and/or the capacity to produce mycotoxins in vitro: Aspergillus fumigatus, Aspergillus melleus, Aspergillus niger, Aspergillus versicolor, Cladosporium herbarum, Purpureocillium lilacinum, and Penicillium brevicompactum. The mean levels of viable airborne fungal particles were less than 30.530 CFU per m of air and were correlated to the total number of 0.30 to 20 μm particles. Seasonal variations were observed with fungal particle peaks during the summer and autumn. Statistical analysis showed that airborne fungal particle levels depended on the relative humidity level which could be a useful indicator of fungal contamination. Finally, the exposure to airborne mycotoxins was very low (only 3 positive samples), and no mutagenic activity was found in bioaerosols. Nevertheless, some fungal strains such as Aspergillus versicolor or Penicillium brevicompactum showed toxigenic potential in vitro.
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http://dx.doi.org/10.1007/s10661-016-5751-zDOI Listing
January 2017

Decline in Cognitive Function in Older Adults With Early-Stage Breast Cancer After Adjuvant Treatment.

Oncologist 2016 Nov 29;21(11):1337-1348. Epub 2016 Jul 29.

Normandie University, UNICAEN, INSERM, U1086, Caen, France

Background: The impact of chemotherapy on cognition among elderly patients has received little attention, although such patients are more prone to presenting with age-related cognitive deficits and/or cognitive decline during chemotherapy. The present study assessed the cognitive function in older adults treated for early-stage breast cancer (EBC).

Patients And Methods: The participants were newly diagnosed EBC patients aged ≥65 years without previous systemic treatment or neurological or psychiatric disease and matched healthy controls. They underwent two assessments: before starting adjuvant therapy and after the end of chemotherapy (including doxorubicin ± docetaxel [CT+ group], = 58) or radiotherapy for patients who did not receive chemotherapy (CT- group, = 61), and at the same interval for the healthy controls ( = 62). Neuropsychological and geriatric assessments were performed. Neuropsychological data were analyzed using the Reliable Change Index.

Results: Forty-nine percent of the patients (mean age, 70 ± 4 years) had objective cognitive decline after adjuvant treatment that mainly concerned working memory. Among these patients, 64% developed a cognitive impairment after adjuvant treatment. Comorbidity was not associated with cognitive decline. No significant difference in objective cognitive decline was found between the two groups of patients; however, the CT+ group had more subjective cognitive complaints after treatment ( = .008). The oldest patients (aged 70-81 years) tended to have more objective decline with docetaxel ( = .05).

Conclusion: This is the largest published study assessing cognitive function in older adults with EBC that included a group of patients treated with modern chemotherapy regimens. Approximately half the patients had objective cognitive decline after adjuvant treatment. The oldest patients were more likely to have cognitive decline with chemotherapy, particularly with docetaxel.

Implications For Practice: This is the largest published study assessing cognitive function in older adults with early-stage breast cancer that included a group of patients treated with modern chemotherapy regimens. Approximately half the patients had objective cognitive decline after adjuvant treatment. The oldest patients were more likely to have cognitive decline with chemotherapy, particularly with docetaxel. Cognitive deficits could affect patients' quality of life and their compliance to treatment. Assessing cognitive dysfunctions in the elderly cancer population is a challenge in clinical practice, but it could influence the choice of the most appropriate therapy, including the use of oral drugs.
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http://dx.doi.org/10.1634/theoncologist.2016-0014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5189619PMC
November 2016

Long-term quality of life among localised prostate cancer survivors: QALIPRO population-based study.

Eur J Cancer 2016 08 15;63:143-53. Epub 2016 Jun 15.

UMR 1086 « Cancers et Préventions », Inserm - University of Basse-Normandie, Caen, France; Department of Medical Oncology, François Baclesse Cancer Center, Caen, France; CHU Côte de Nacre, University of Basse-Normandie, Caen, France.

Background: To evaluate quality of life (QoL) 10 years after treatments for localised prostate cancer (LPCa) patients in comparison with aged-matched healthy controls.

Methods: LPCa patients diagnosed in 2001 were obtained from 11 French cancer registries. Controls were recruited among the general population and were matched to patients on age and geographic area. EORTC Quality of Life Questionnaire - Core 30 items, Expanded Prostate Cancer Index Composite, Hospital Anxiety and Depression Scale and Multidimensional Fatigue Inventory self-reported questionnaires were used to measure QoL, anxiety and fatigue. Patients were classified in three groups according to previous treatments: radical prostatectomy (RP), radiotherapy (RT) and radical prostatectomy and radiotherapy (RP+RT). The differences in QoL between patients and controls and according to treatment groups were evaluated.

Results: There were 287 patients and 287 controls. There was no socio-demographic difference between patients and controls. Treatments were: RP (143), RT (78), PR+RT (33), baseline hormone therapy (49) and hormone therapy at the time of the study (34). Patients had similar levels of global QoL, anxiety, depression and fatigue as controls. They reported more urinary troubles (urinary function and incontinence) (p < 0.0001) and more sexual dysfunctions (p < 0.0001) than controls, whatever the treatment group. Worse bowel dysfunction was reported in patients treated by RT and RP+RT (p < 0.002). According to the treatments, RP groups had the worst urinary function and incontinence (p < 0.01), and reported more bowel bother when the treatment was combined with RT.

Conclusions: Even though patients reported similar global QoL as control 10 years after treatment, patients reported numerous urinary and sexual dysfunctions. Patients treated with RP+RT reported cumulative sequelae of both treatments.
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http://dx.doi.org/10.1016/j.ejca.2016.05.020DOI Listing
August 2016

Cognitive complaints in cancer: The French version of the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), normative data from a healthy population.

Neuropsychol Rehabil 2016 7;26(3):392-409. Epub 2015 May 7.

b INSERM, U1077, EPHE, Normandie Université, CHU de Caen , Caen , France.

Cancer patients often report cognitive changes after chemotherapy. The Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) is a self-report questionnaire that assesses these changes. The aims of the present study were (1) to establish normative data, and (2) to compare the scores of patients and healthy controls to assess whether or not the questionnaire is able to discriminate between these populations. The normative sample included 213 healthy participants. The patient group included 63 cancer patients treated with chemotherapy, who were compared to a subsample of 63 matched healthy controls. The questionnaire had good internal consistency reliability (Cronbach's alphas = .74-.91). The oldest patients had significantly more cognitive complaints (p < .001). Cognitive complaints were significantly related with Trail Making Test scores (p < .001). Furthermore, the FACT-Cog subscales correlated significantly with anxiety and depression. Patients had more complaints than matched controls on the subscales Perceived Cognitive Impairments (p = .01), Impact on Quality of Life (p = .001) and Perceived Cognitive Abilities (p = .027). The reference values from the healthy population reported here could be used for comparison with the values measured in French-speaking cancer patients. The values provide a benchmark against which clinicians can evaluate the impact of the disease and/or the treatments on cognitive complaints and help to improve quality of life by providing appropriate care.
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http://dx.doi.org/10.1080/09602011.2015.1036890DOI Listing
December 2016

Prognostic value of microscopic lymph node involvement in patients with papillary thyroid cancer.

J Clin Endocrinol Metab 2015 Jan;100(1):132-40

Department of Nuclear Medicine and Thyroid Unit (S.B., R.C., E.Q.), and Departments of Head and Neck Surgery (J.-P.R., D.B., D.d.R.), and Pathology (J.-J.M.), Biology (D.V.), Centre François Baclesse, 14076 Caen, France; Department of Head and Neck Surgery (E.B.), University Hospital, Caen 14000, France; Unité 1086 (N.H.), INSERM-University of Caen-Basse Normandie, "Cancers and Préventions" Program, University of Caen-Basse Normandie, 14032 Caen, France.

Context: The impact of microscopic nodal involvement on the risk of persistent/recurrent disease (PRD) remains controversial in patients with papillary thyroid carcinoma (PTC).

Objective: The goal of the study was to assess the risk of PRD and the 4-year outcome in PTC patients according to their initial nodal status [pNx, pN0, pN1 microscopic (cN0/pN1) or pN1 macroscopic (cN1/pN1)].

Design: We conducted a retrospective cohort study.

Patients: The study included 305 consecutive PTC patients referred for radioiodine ablation from 2006 to 2011.

Main Outcome Measure: We evaluated the risk of structural PRD and the disease status at the last follow-up. At ablation, persistent disease was consistently assessed by using post-radioiodine ablation scintigraphy combining total body scan and neck and thorax single-photon computed tomography-computed tomography (SPECT-CT) acquisition.

Results: Of 305 patients, 128 (42%) were pNx, 84 (28%) pN0, 44 (14%) pN1 microscopic, and 49 (16%) pN1 macroscopic. The 4-year cumulative risk of PRD was higher in pN1 macroscopic than in pN1 microscopic patients (49% vs 24%, P = .03), and higher in pN1 microscopic than in pN0 (12%, P = .01) or pNx patients (6%, P < .001). On multivariate analysis, tumor size of 20 mm or greater [relative risk (RR) 3.4; P = .0001], extrathyroid extension (RR 2.6; P < .003), pN1 macroscopic (RR 4.5; P < .0001), and pN1 microscopic (RR 2.5; P < .02) were independent risk factors for PRD. At the last visit, the proportion of patients with no evidence of disease decreased from pNx (98%), pN0 (93%), and pN1 microscopic (89%) to pN1 macroscopic patients (70%) (P < .0001, Cochran-Armitage trend test). Extrathyroid extension (odds ratio 9.7; P < .0001) and N1 macroscopic (OR 4.9; P < .001) independently predicted persistent disease at the last visit, but N1 microscopic did not.

Conclusions: PATIENTS with microscopic lymph node involvement present an intermediate outcome between that observed in pN0-pNx patients and pN1 macroscopic patients. These data may justify modifications to the risk recurrence staging systems.
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http://dx.doi.org/10.1210/jc.2014-1199DOI Listing
January 2015

Baseline cognitive functions among elderly patients with localised breast cancer.

Eur J Cancer 2014 Sep 20;50(13):2181-9. Epub 2014 Jun 20.

Normandie Université, UMR-S1077, Caen, France; INSERM, U1086, Caen, France; Unité de Recherche Clinique, Centre François Baclesse, Caen, France; CHU de Caen, Service d'Oncologie, Caen, France. Electronic address:

Purpose: Cognitive deficits (CD) are reported among cancer patients receiving chemotherapy, but may also be observed before treatment. Though elderly patients are expected to be more prone to present age-related CD, poor information is available regarding the impact of cancer and chemotherapy on this population. This study assessed baseline cognitive functions (before adjuvant treatment) in elderly early stage breast cancer (EBC) patients.

Methods: Women >65years-old with newly diagnosed EBC were included in this prospective study. Episodic memory, working memory, executive functions and information processing speed were assessed by neuropsychological tests. Questionnaires were used to assess subjective CD, anxiety, depression, fatigue, quality of life and geriatric profile. Objective CD were defined using International Cognition and Cancer Task Force criteria. A group of elderly women without cancer coupled with published data related to healthy women were used for comparison (respectively to subjective and objective CD).

Results: Among the 123 elderly EBC patients (70±4years) included, 41% presented objective CD, which is greater than expected in healthy population norms (binomial test P<.0001). Verbal episodic memory was mainly impaired (21% of patients). No correlation was observed between objective CD and cancer stage or geriatric assessment. Subjective CD only correlated with verbal episodic memory (P=.01).

Conclusions: This is the first large series assessing baseline cognitive functions in elderly EBC patients. More than 40% presented objective CD before any adjuvant therapy, which is higher than what is reported among younger patients. Our results reinforce the hypothesis that age is a risk factor for CD in EBC patients.
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http://dx.doi.org/10.1016/j.ejca.2014.05.026DOI Listing
September 2014

[Quality of life and supportive care in head and neck cancers].

Bull Cancer 2014 May;101(5):505-10

CHU de Caen, Service ORL et chirurgie cervico-faciale, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France.

The quality of life of patients treated for head and neck cancers and their carers is part of the current concerns of health care teams. Assessment tools were created and helped to highlight the severe physical effects (pain, mucositis…) and chronic (mutilation, post-radiation complications…) related to the disease or to different treatments but also to consider the psychosocial impact of this disease. Improving the quality of life through a thoughtful and comprehensive support that must be associated with somatic care, mental health care, rehabilitation and inclusion of social difficulties and suffering relatives. Supportive care shall ensure a good quality of life for patients treated and their families but also reduce the physical effects associated with the disease and treatment. They rely on coordination of care including the cancer networks established in the cancer plan to ensure comprehensive and continuous care for these patients.
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http://dx.doi.org/10.1684/bdc.2014.1960DOI Listing
May 2014

Stimulated thyroglobulin level at ablation in differentiated thyroid cancer: the impact of treatment preparation modalities and tumor burden.

Eur J Endocrinol 2014 Aug 27;171(2):247-52. Epub 2014 May 27.

Departments of Nuclear Medicine and Thyroid UnitCentre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, FranceDepartment of EndocrinologyCentre Hospitalo-Universitaire, Caen, FranceU1086 INSERM-UCBN Cancers et PréventionsCaen, FranceDepartments of BiologyHead and Neck SurgeryCentre François Baclesse, Caen, France.

Objective: In patients with differentiated thyroid cancer (DTC), the stimulated serum thyroglobulin (Tg) level at radioiodine ablation is a known predictive factor of persistent disease. This prognostic value is based on data obtained after thyroid hormone withdrawal (THW), but little is known about this prognostic value after recombinant human TSH (rhTSH) stimulation and about the relationship between the stimulated Tg level and the burden of persistent tumor. We aimed to assess the impact of both radioiodine preparation modalities and persistent tumor burden on stimulated Tg levels.

Design And Methods: The stimulated Tg level was measured at radioablation in 308 consecutive DTC patients without serum Tg antibodies. Of these, 123 (40%) were prepared with rhTSH and 185 with THW. Post-ablation scintigraphy included total-body scan and neck and thorax single photon emission computed tomography with computed tomography (SPECT-CT). During a mean follow-up of 43 months, persistent/recurrent disease (PRD) was found in 56 patients (18%). PRD was considered structural in the presence of lesions >1 cm and nonstructural otherwise.

Results: Nonstructural PRD was more frequent in the rhTSH group than in the THW group (64 vs 26%, P=0.01). Stimulated Tg levels were lower after rhTSH than after THW in patients with (13.5 vs 99.5 ng/ml, P<0.01) and without (1.2 vs 3.2 ng/ml, P<0.001) PRD. Also, Tg levels were lower in nonstructural disease than in structural disease in both rhTSH (3.8 vs 127.0 ng/ml, P<0.01) and THW (13.0 vs 143.5 ng/ml, P<0.0001) patients. The best Tg cutoff to predict PRD was 2.8 in rhTSH and 28 ng/ml in THW patients.

Conclusion: Both radioiodine preparation modalities and the burden of persistent tumor affect the stimulated Tg level at ablation.
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http://dx.doi.org/10.1530/EJE-14-0192DOI Listing
August 2014

[Impact of cancer treatments on cognitive functions: the patients' view, their expectation and their interest in participating to cognitive rehabilitation workshops].

Bull Cancer 2013 Mar;100(3):223-9

EA4700, université de Rouen, laboratoire PSY-NCA, rue Lavoisier, 76821 Mont-Saint-Aignan cedex, France.

Introduction: Cancer and chemotherapy can have adverse effects on cognitive functions and quality of life of patients. We wanted to know the patients' view on these disorders, but also their expectations in terms of assessment and support.

Methods And Results: A survey was conducted in day care hospital among 551 patients from three cancer centers. Most of the patients were between 40 and 74 years and suffered from breast cancer. Eighty-four percent were treated with chemotherapy. Forty-one percent of patients report memory problems, 26% were affected by specific concentration disorders, and 19% of the attention. On the whole, 52% of patients report at least one of the previous cognitive impairment. Among these patients, 80% evoked that the support of these problems was essential and 70% were willing to participate in "workshops" to deal with these disorders.

Conclusion: The cognitive impairment occurrence is a real problem for patients receiving chemotherapy and becomes a priority in the global management of their disease. Studies assessing a specific support of theses symptoms should be encouraged to help patients.
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http://dx.doi.org/10.1684/bdc.2013.1710DOI Listing
March 2013