Publications by authors named "Sarah Dauchy"

48 Publications

QualFatigue study: which factors influence the use of specific interventions for breast cancer survivors with fatigue? A cross-sectional exploratory study.

Support Care Cancer 2021 Feb 5. Epub 2021 Feb 5.

Inserm, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.

Purpose: International guidelines recommend specific interventions to reduce cancer-related fatigue (CRF). Evidence suggests underutilization of these interventions among breast cancer survivors. The QualFatigue study aimed to explore the potential factors influencing the use of specific interventions, for relief, in patients with CRF through qualitative analyses.

Methods: Patients with stage I-III breast cancer, and CRF ≥4 on a 10-point numerical scale were recruited within 6-24 months at the end of their primary treatment. Semi-structured interviews were performed. Emergent themes were identified using a stepped content analysis (QDA Miner software).

Results: Data saturation was achieved with 15 interviews. Four main themes emerged as potential sources of influence in the participants' use of specific interventions: (1) expectations regarding the management of CRF, (2) representations of the benefits provided by the interventions, (3) individual physical and psychological conditions, and (4) social and environmental situations. Six key levers came out transversally to optimize the use of specific interventions to relieve CRF: (1) listening and recognition of the individual difficulties and needs; (2) individual and global health assessments; (3) information and advice on how to manage CRF; (4) discussion groups focused on the management of CRF; (5) group activities; and (6) professional and personalized guidance.

Conclusion: This study calls for multi-level action to address many persistent barriers and exploit levers in the management of CRF.
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http://dx.doi.org/10.1007/s00520-021-06040-zDOI Listing
February 2021

Differentiation of groups of patients with cognitive complaints at breast cancer diagnosis: Results from a sub-study of the French CANTO cohort.

Psychooncology 2020 Oct 14. Epub 2020 Oct 14.

Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, France.

Objective: Cognitive complaints are more frequent in women with breast cancer (BC) than in healthy controls and can be present before any treatment. Findings regarding contributive factors remain inconsistent. This study aimed to identify different groups of patients with cognitive complaints at BC diagnosis and to determine whether these different groups were associated with demographic, medical, or psychological characteristics.

Methods: Cognitive complaints were assessed in a subset of 264 women from the French multicenter prospective CANTO cohort, at baseline before any treatment. Clustering analyzes were performed using the six-cognitive dimension Costa's scoring of the FACT-Cog V3. Univariable analyses were used to study how cognitive function (standardized neuropsychological tests, ICCTF), anxiety, depression, fatigue, and quality of life (HADS, FA12, QLQ-C30) were associated with specific cognitive complaints groups.

Results: Results included 263 women (54±11 years), newly diagnosed with BC (69% stages I-III). Four distinct groups emerged, ranged from "no complaints" (22.8%), "low complaints" (55.1), "mixed complaints" (14.5%), to "consistent complaints" (7.6%). No significant differences were found in terms of demographic and medical factors between the four groups. However, the groups with higher proportions of patients with complaints were found to have more impairment in executive function, higher scores of anxiety, depressive symptoms, and fatigue, and lower quality of life, than the groups with lower proportions of cognitive complaints.

Conclusion: Using complete cognitive assessment prior to BC treatment, we identified four distinct cognitive complaints groups with specific characteristics. This work provides valuable clinical basis to further investigations for a better understanding of cognitive complaints and their associates.
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http://dx.doi.org/10.1002/pon.5572DOI Listing
October 2020

Cognitive rehabilitation program to improve cognition of cancer patients treated with chemotherapy: A 3-arm randomized trial.

Cancer 2020 Dec 30;126(24):5328-5336. Epub 2020 Sep 30.

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

Background: There is no treatment for cancer-related cognitive impairment, an important adverse effect that negatively impacts quality of life (QOL). We conducted a 3-arm randomized controlled trial to evaluate the impact of computer-assisted cognitive rehabilitation (CR) on cognition, QOL, anxiety, and depression among cancer patients treated with chemotherapy.

Methods: Patients who reported cognitive complaints during or after completing chemotherapy were randomly assigned to 1 of 3 12-week CR programs: computer-assisted CR with a neuropsychologist (experimental group A), home cognitive self-exercises (active control group B), or phone follow-up (active control group C). Subjective cognition was assessed by the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), objective cognition was assessed by neuropsychological tests, QOL was assessed by the FACT-General, and depression and anxiety were assessed by psychological tests. The primary endpoint was the proportion of patients with a 7-point improvement in the FACT-Cog perceived cognitive impairment (PCI) score.

Results: Among the 167 enrolled patients (median age, 51 years), group A had the highest proportion of patients with a 7-point PCI improvement (75%), followed by groups B (59%) and C (57%), but the difference was not statistically significant (P = .13). Compared with groups B and C, the mean difference in PCI score was significantly higher in group A (P = .02), with better perceived cognitive abilities (P < .01) and a significant improvement in working memory (P = .03). Group A reported higher QOL related to cognition (FACT-Cog QOL) (P = .01) and improvement in depression symptoms (P = .03).

Conclusions: These results suggest a benefit of a computer-based CR program in the management of cancer-related cognitive impairment and complaints.
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http://dx.doi.org/10.1002/cncr.33186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756299PMC
December 2020

Ethical issues related to the COVID-19 pandemic in patients with cancer: experience and organisations in a French comprehensive cancer centre.

BMJ Support Palliat Care 2020 Aug 27. Epub 2020 Aug 27.

Ethics Committee, Gustave Roussy Institute, Villejuif, France.

Background: The COVID-19 pandemic has aggressively reached the most vulnerable, not only the elderly but also patients with chronic conditions such as cancer. In this study, we present the outlines of ethical thinking and the measures implemented to try to respect our basic values of care, in the specific environment of an oncology hospital.

Methods: Our ethics committee created an ethical watch system based on 24/7 shifts to assist practitioners in their daily decisions. We discuss the challenges faced by patients with cancer during the pandemic, such as access to critical care and ethical dilemmas in the context of resource scarcity, as well as the issue of isolation of patients. We also debate the restrictions in access to oncology care in a health context strongly 'prioritised' against COVID-19.

Results: In all areas of an ethical dilemma, either for sorting out access to critical care or for the dramatic consequences of prolonged isolation of patients, our common thread was our attempt to protect, whenever possible, the principles of deontological ethics by strictly resisting utilitarian pressure. Respecting democratic health decision-making processes is a cornerstone of ethically relevant decisions, including in the context of a sanitary crisis.

Conclusion: The role of an ethics committee related to real-life situations includes not only a reflexive perspective in respect of fundamental principles, but also the help to enlighten and resolve ethical dilemmas in complex clinical situations. This ethical watch team assists physicians in decision-making, promoting the supportive and palliative dimension of care with a holistic approach.
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http://dx.doi.org/10.1136/bmjspcare-2020-002504DOI Listing
August 2020

Using targeted therapies at the end of life.

BMJ Support Palliat Care 2020 Aug 27. Epub 2020 Aug 27.

Palliative Care Unit, Gustave Roussy Institute, Villejuif, France.

The prescription of chemotherapy during the last weeks of a patient's life is a recognised criterion of decreasing quality of life but also survival. Targeted therapies have a particular efficiency and tolerance profile raising the question of their use in a palliative setting. Two patients were treated for a melanoma, at terminal stage, with poor efficiency of the symptomatic treatments. We introduced targeted therapies, which was previous treatments used in both patients.The evolution and benefits of the treatment was very different in our two patients and make us discuss the interest of targeted therapies in an end-of-life context and propose criteria for their maintenance or introduction in this indication. This discussion requires close collaboration between oncologists and palliative physicians and a very clear information given to patients and their relatives.
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http://dx.doi.org/10.1136/bmjspcare-2020-002529DOI Listing
August 2020

Cognitive Impairment in Patients with Breast Cancer before Surgery: Results from a CANTO Cohort Subgroup.

Cancer Epidemiol Biomarkers Prev 2020 Sep 1;29(9):1759-1766. Epub 2020 Jul 1.

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

Background: Twenty to 30% of patients with breast cancer have cognitive impairment after surgery and before adjuvant treatment, but very few studies have focused on cognition before any treatment. This study used a subgroup of women with newly diagnosed breast cancer from the French cancer and toxicities (CANTO) cohort to describe cognition before any treatment in comparison with a group of healthy controls (HC).

Methods: Cognitive assessment was performed before any breast cancer treatment (surgery or neoadjuvant treatment) on women with newly diagnosed invasive stage I-III breast cancer and HCs. Objective cognitive performance, cognitive complaints, anxiety, depression, and fatigue were assessed. Objective cognitive impairment was defined according to International Cognition and Cancer Task Force recommendations.

Results: Of the 264 included patients with breast cancer (54 ± 11 years) and 132 age-matched HCs (53 ± 9 years), overall objective cognitive impairment was observed in 28% of patients with breast cancer and 8% of HCs ( < 0.001). Cognitive complaints were reported by 24% of patients versus 12% of HCs ( < 0.01). Patients reported significantly more anxiety and emotional and cognitive fatigue than HCs ( < 0.01). After adjustment, significantly more patients with breast cancer had overall objective cognitive impairment than HCs [OR = 3.01; 95% confidence interval (CI): 1.31-6.88] without significant difference between groups for cognitive complaints (OR = 1.38; 95% CI: 0.65-2.92). Cognitive complaints were positively associated with fatigue (OR = 1.03; 95% CI: 1.02-1.05).

Conclusions: In this prospective study, compared with HCs, patients with localized breast cancer had more objective cognitive impairment before any treatment. Cognitive complaints were mostly related to fatigue.

Impact: Baseline assessment before treatment is important to assess the impact of each cancer treatment on cognition.
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http://dx.doi.org/10.1158/1055-9965.EPI-20-0346DOI Listing
September 2020

Serum Detection of Nonadherence to Adjuvant Tamoxifen and Breast Cancer Recurrence Risk.

J Clin Oncol 2020 08 22;38(24):2762-2772. Epub 2020 Jun 22.

Institut Gustave Roussy, Villejuif, France.

Purpose: Nonadherence to long-term treatments is often under-recognized by physicians and there is no gold standard for its assessment. In breast cancer, nonadherence to tamoxifen therapy after surgery constitutes a major obstacle to optimal outcomes. We sought to evaluate the rate of biochemical nonadherence to adjuvant tamoxifen using serum assessment and to examine its effects on short-term, distant disease-free survival (DDFS).

Patients And Methods: We studied 1,177 premenopausal women enrolled in a large prospective study (CANTO/NCT01993498). Definition of biochemical nonadherence was based on a tamoxifen serum level < 60 ng/mL, assessed 1 year after prescription. Self-reported nonadherence to tamoxifen therapy was collected at the same time through semistructured interviews. Survival analyses were conducted using an inverse probability weighted Cox proportional hazards model, using a propensity score based on age, staging, surgery, chemotherapy, and center size.

Results: Serum assessment of tamoxifen identified 16.0% of patients (n = 188) below the set adherence threshold. Patient-reported rate of nonadherence was lower (12.3%). Of 188 patients who did not adhere to the tamoxifen prescription, 55% self-reported adherence to tamoxifen. After a median follow-up of 24.2 months since tamoxifen serum assessment, patients who were biochemically nonadherent had significantly shorter DDFS (for distant recurrence or death, adjusted hazard ratio, 2.31; 95% CI, 1.05 to 5.06; = .036), with 89.5% of patients alive without distant recurrence at 3 years in the nonadherent cohort versus 95.4% in the adherent cohort.

Conclusion: Therapeutic drug monitoring may be a useful method to promptly identify patients who do not take adjuvant tamoxifen as prescribed and are at risk for poorer outcomes. Targeted interventions facilitating patient adherence are needed and have the potential to improve short-term breast cancer outcomes.
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http://dx.doi.org/10.1200/JCO.19.01758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430219PMC
August 2020

Impact of Breast Cancer Treatment on Employment: Results of a Multicenter Prospective Cohort Study (CANTO).

J Clin Oncol 2020 03 13;38(7):734-743. Epub 2019 Dec 13.

Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.

Purpose: Adverse effects of breast cancer treatment can negatively affect survivors' work ability. Previous reports lacked detailed clinical data or health-related patient-reported outcomes (PROs) and did not prospectively assess the combined impact of treatment and related sequelae on employment.

Methods: We used a French prospective clinical cohort of patients with stage I-III breast cancer including 1,874 women who were working and ≥ 5 years younger than legal retirement age (≤ 57 years) at breast cancer diagnosis. Our outcome was nonreturn to work (non-RTW) 2 years after diagnosis. Independent variables included treatment characteristics as well as toxicities (Common Toxicity Criteria Adverse Events [CTCAE] v4) and PROs (European Organization for Research and Treatment of Cancer [EORTC] Quality of life Questionnaires, Breast cancer module [QLQ-BR23] and Fatigue module [QLQ-FA12], Hospital Anxiety and Depression Scale) collected 1 year after diagnosis. Logistic regression models assessed correlates of non-RTW, adjusting for age, stage, comorbidities, and socioeconomic covariates.

Results: Two years after diagnosis, 21% of patients had not returned to work. Odds of non-RTW were significantly increased among patients treated with combinations of chemotherapy and trastuzumab (odds ratio [OR] chemotherapy-hormonotherapy: for chemotherapy-trastuzumab, 2.01; 95% CI, 1.18 to 3.44; for chemotherapy-trastuzumab-hormonotherapy, 1.62; 95% CI, 1.10 to 2.41). Other significant associations with non-RTW included grade ≥ 3 CTCAE toxicities (OR no, 1.59; 95% CI, 1.15 to 2.18), arm morbidity (OR no, 1.59; 95% CI, 1.19 to 2.13), anxiety (OR no, 1.47; 95% CI, 1.02 to 2.11), and depression (OR no, 2.29; 95% CI, 1.34 to 3.91).

Conclusion: Receipt of systemic therapy combinations including trastuzumab was associated with increased odds of non-RTW. Likelihood of unemployment was also higher among patients who reported severe physical and psychological symptoms. This comprehensive study identifies potentially vulnerable patients and warrants supportive interventional strategies to facilitate their RTW.
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http://dx.doi.org/10.1200/JCO.19.01726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048162PMC
March 2020

UNICANCER: French prospective cohort study of treatment-related chronic toxicity in women with localised breast cancer (CANTO).

ESMO Open 2019 8;4(5):e000562. Epub 2019 Sep 8.

Clinical Research, Centre Georges-Francois Leclerc, Dijon, Bourgogne-Franche-Comté, France.

Background: Corresponding with improved survival among patients with breast cancer, the awareness of the long-term effects of cancer treatments has increased. CANcer TOxicities (CANTO) aims to identify predictors of development and persistence of long-term toxicities in patients treated for stages I-III breast cancer and to characterise their incidence, as well their impact. In this paper, we describe the methodology used in this study and provide a first characterisation of the study population.

Methods: CANTO (NCT01993498) is a French prospective, longitudinal cohort study enrolling patients with invasive cT0-cT3cN0-3M0 breast cancer of 26 French cancer centres. Patients are assessed at diagnosis, 3-6 (M0), 12 (M12), 36 (M36) and 60 (M60) months after completion of primary surgery, chemotherapy or radiotherapy whichever comes last. CANTO collects clinical, treatment, toxicity data, an extensive list of validated patient-reported outcomes (focusing on quality of life, psychological and behavioural questionnaires) and ad hoc socioeconomic questionnaires. Blood collection is performed at diagnosis, M0, M12, M36 and M60. Biologic sub-studies are ongoing (eg, microbiotic and cognitive sub-study).

Results: Enrolment started in 2012; by October 2018, 12 012 patients had been enrolled. Data collected have a low missing completion rate (<5% for key clinical variables, <20% for patient-reported outcomes). Blood, serum and plasma samples are stored in over 96% of patients. Among the first 5801 patients enrolled in CANTO, 76.7% of patients had hormone receptor positive and human epidermal growth factor 2 negative tumours; 73.1% of patients had breast conserving surgery; 90.4% received adjuvant radiotherapy, 53.4% (neo) adjuvant chemotherapy, 11.3% adjuvant trastuzumab and 80.3% adjuvant hormonotherapy.

Conclusions: CANTO represents a unique opportunity to explore important medical, biological and psychosocial outcomes on breast cancer survivor population.
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http://dx.doi.org/10.1136/esmoopen-2019-000562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735667PMC
September 2019

[Feedback on a complementary care program combining physical activity, mindfulness-based meditation and socio-aesthetic care].

Bull Cancer 2019 Apr 15;106(4):304-315. Epub 2019 Feb 15.

Gustave-Roussy, unité de psycho-oncologie, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.

Introduction: Increasing physical activity among cancer patients is one of the priority recommendations in tertiary prevention; the level of physical activity is one of the determining factors in reducing the risk of relapse and mortality. However, many barriers to initiation and maintenance of regular physical activity have been identified. A program combining bi-weekly adapted physical activity sessions, mindfulness-based meditation and socio-aesthetic care was put together in 2015, in a Cancer Center, in order to facilitate adherence and sustainable attendance.

Methods: Data on patient participation of program components, patient satisfaction, and psycho-corporal changes, collected in ecological conditions between 2015 and 2017 from 144 participants, were retrospectively analyzed to provide a first assessment.

Results: Nearly 60% of the patients were in treatment, 17% were metastatic. The average participation time was 9 months, with an average of one physical activity session per week. Changes were observed, both quantitatively and qualitatively, in terms of emotional state, sleep and body image. The overall satisfaction rate was 96%.

Discussion: The conclusions of the study support the continuation of the program. The methodological limitations of this pilot format may be overtaken in future research, which will allow further in-depth investigations into the effects of combined approaches on sustainable physical activity.
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http://dx.doi.org/10.1016/j.bulcan.2019.01.013DOI Listing
April 2019

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

Antidepressants for the treatment of depression in people with cancer.

Cochrane Database Syst Rev 2018 04 23;4:CD011006. Epub 2018 Apr 23.

​Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Policlinico "GB Rossi", Piazzale L.A. Scuro, 10, Verona, Italy, 37134.

Background: Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have been shown to have a negative impact in terms of quality of life, compliance with anti-cancer treatment, suicide risk and likely even the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy, tolerability and acceptability of antidepressants in this population are few and often report conflicting results.

Objectives: To assess the efficacy, tolerability and acceptability of antidepressants for treating depressive symptoms in adults (aged 18 years or older) with cancer (any site and stage).

Search Methods: We searched the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 6), MEDLINE Ovid (1946 to June week 4 2017), Embase Ovid (1980 to 2017 week 27) and PsycINFO Ovid (1987 to July week 4 2017). We additionally handsearched the trial databases of the most relevant national, international and pharmaceutical company trial registers and drug-approving agencies for published, unpublished and ongoing controlled trials.

Selection Criteria: We included RCTs comparing antidepressants versus placebo, or antidepressants versus other antidepressants, in adults (aged 18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis).

Data Collection And Analysis: Two review authors independently checked eligibility and extracted data using a form specifically designed for the aims of this review. The two authors compared the data extracted and then entered data into Review Manager 5 using a double-entry procedure. Information extracted included study and participant characteristics, intervention details, outcome measures for each time point of interest, cost analysis and sponsorship by a drug company. We used the standard methodological procedures expected by Cochrane.

Main Results: We retrieved a total of 10 studies (885 participants), seven of which contributed to the meta-analysis for the primary outcome. Four of these compared antidepressants and placebo, two compared two antidepressants, and one three-armed study compared two antidepressants and placebo. In this update we included one additional unpublished study. These new data contributed to the secondary analysis, while the results of the primary analysis remained unchanged.For acute-phase treatment response (6 to 12 weeks), we found no difference between antidepressants as a class and placebo on symptoms of depression measured both as a continuous outcome (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -1.01 to 0.11, five RCTs, 266 participants; very low certainty evidence) and as a proportion of people who had depression at the end of the study (risk ratio (RR) 0.82, 95% CI 0.62 to 1.08, five RCTs, 417 participants; very low certainty evidence). No trials reported data on follow-up response (more than 12 weeks). In head-to-head comparisons we only retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants, showing no difference between these two classes (SMD -0.08, 95% CI -0.34 to 0.18, three RCTs, 237 participants; very low certainty evidence). No clear evidence of a beneficial effect of antidepressants versus either placebo or other antidepressants emerged from our analyses of the secondary efficacy outcomes (dichotomous outcome, response at 6 to 12 weeks, very low certainty evidence). In terms of dropouts due to any cause, we found no difference between antidepressants as a class compared with placebo (RR 0.85, 95% CI 0.52 to 1.38, seven RCTs, 479 participants; very low certainty evidence), and between SSRIs and tricyclic antidepressants (RR 0.83, 95% CI 0.53 to 1.30, three RCTs, 237 participants). We downgraded the certainty (quality) of the evidence because the included studies were at an unclear or high risk of bias due to poor reporting, imprecision arising from small sample sizes and wide confidence intervals, and inconsistency due to statistical or clinical heterogeneity.

Authors' Conclusions: Despite the impact of depression on people with cancer, the available studies were very few and of low quality. This review found very low certainty evidence for the effects of these drugs compared with placebo. On the basis of these results, clear implications for practice cannot be deduced. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which agent to prescribe may be based on the data on antidepressant efficacy in the general population of individuals with major depression, also taking into account that data on medically ill patients suggest a positive safety profile for the SSRIs. To better inform clinical practice, there is an urgent need for large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer who have depressive symptoms, with or without a formal diagnosis of a depressive disorder.
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http://dx.doi.org/10.1002/14651858.CD011006.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494588PMC
April 2018

[Multidisciplinary oncopalliative meeting: Aims and pratical recommendations].

Bull Cancer 2018 May 19;105(5):458-464. Epub 2018 Mar 19.

Centre hospitalier de St-Denis, médecine palliative, 2, rue du Dr-Delafontaine, 93200 Saint-Denis, France.

Progress leads to increase life duration at the metastatic stage but metastatic disease is most often lethal. Decision-making is necessary for an increasing period of care, beyond evidence-based medicine, dealing with complexity and uncertain benefit/risk ratio. This requires to inform the patient realistically, to discuss prognostication, to develop anticipated written preferences. These changes mean to pass from a medicine based on informed consent to medicine based on respect of the patient wishes even if it can be complex to determine. A new multidisciplinarity is needed, centered on the meaning of the care, the proportionality of the care, the anticipated patient trajectory. The ASCO has published recommendations on early palliative care. The timing and the quality of the discussion between palliative care specialists and oncologists is crucial. We propose 10 steps to organize a multidisciplinary onco-palliative meeting, as it appears the key for the organization of care in non-curable disease.
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http://dx.doi.org/10.1016/j.bulcan.2018.01.017DOI Listing
May 2018

[Refusal of treatments by an adult cancer patient].

Bull Cancer 2018 Mar 23;105(3):234-244. Epub 2018 Feb 23.

Institut de cancérologie de Lorraine, département de soins de support, 54500 Vandœuvre-lès-Nancy, France.

Introduction: Refusal of treatment questions the treatment's adequacy as well as the quality of the care relationship. A rigorous analysis of these situations is necessary in order to respect the patient's fundamental right to decide for him/herself while preventing a potential loss of chance. This paper proposes practical guidelines for assessment and management of the refusal of treatment by adult cancer patients.

Methods: The French Association for Supportive Care in Cancer and the French Society for Psycho-Oncology formed a task force that applied a consensus methodology to draft guidelines.

Results: We propose five guidelines: (1) be informed of the conditions most often associated with refusal of treatment so as to reinforce adequate support measures; (2) understand the complexity of the process of refusal and accurately identify what is precisely refused; (3) apply an approach of systematic analysis to refusal, to try and increase the possibilities of finding an agreement while reinforcing the respect of the patient's position; (4) establish a legal procedure to address refusal of treatment that safeguards the stakeholders when no accord can be found; and (5) know the indications for ethical collective decision-making.

Conclusion: A systematic assessment procedure of treatment refusal is necessary in order to ensure that all the physical, psychological and contextual aspects of it are taken into account, and to provide patients with the best treatment possible. The setting of good care relationship, the improvement of communication skills training and of comprehensive multidisciplinary care are all crucial elements in the prevention of these situations.
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http://dx.doi.org/10.1016/j.bulcan.2017.11.016DOI Listing
March 2018

Everolimus induced mood changes in breast cancer patients: a case-control study.

Invest New Drugs 2018 06 18;36(3):503-508. Epub 2017 Dec 18.

Paris Descartes University, Sorbonne Paris Cité, Paris, France.

Introduction The PI3K/Akt/mTOR pathway plays a critical role in cancer cell growth, proliferation and angiogenesis, but also in brain homeostasis and the pathophysiology of mood disorders. The impact of the mTOR inhibitor everolimus on the mood of breast cancer patients is unknown. Materials and methods Consecutive, post-menopausal metastatic breast cancer patients receiving hormone therapy +/- everolimus were prospectively followed-up using the Beck Depression Inventory (BDI) and the MADRS (Montgomery and Asberg Depression Rating Scale) questionnaires. Results Post hoc tests comparing everolimus + hormonotherapy to hormonotherapy alone demonstrated a significant effect of everolimus after 6 weeks of treatment on BDI scores (t(1,38) = -2.0716, p < 0.05), and after 3 weeks (t(1,38) = -3.9165, p < 0.001) and 6 weeks of treatment (t(1,38) = -2.0373, p < 0.05) on MADRS scores. Analysis within each treatment group showed that the effect of time since treatment initiation on BDI and MADRS scores was specifically observed in the everolimus + hormonotherapy group (F(2,34) = 11.875, p < 0.001 and F(2,34) = 7.820, p < 0.01 respectively), but not in the hormonotherapy alone group (F(2,34) = 1.671, p > 0.2 and F(2,34) = 0.830, p > 0.2 respectively). Conclusions The mTOR inhibitor everolimus induces significant mood alterations in breast cancer patients. The evaluation of psychiatric symptoms is not only mandatory in the context of phase 1, dose-finding studies of PI3K/Akt/mTOR inhibitors, but is also clinically relevant in daily practice.
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http://dx.doi.org/10.1007/s10637-017-0554-9DOI Listing
June 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

Patient satisfaction with a rapid diagnosis of suspicious breast lesions: Association with distress and anxiety.

Breast J 2018 03 13;24(2):154-160. Epub 2017 Jul 13.

Department of Medical Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France.

Few studies have explored with standard measures patient satisfaction with care at the time of the diagnosis through rapid diagnostic pathways. This study aimed to assess satisfaction levels at the time of the diagnosis in a One-Stop Breast Unit and to examine associations with psychological states. An anonymous cross-sectional survey was conducted at a single center's One-Stop Breast Unit, to assess patient satisfaction regarding several aspects of the Unit. Two days after the diagnosis, 113 participants completed self-reported questionnaires evaluating satisfaction (Out-Patsat35), anxiety (State Anxiety Inventory), and psychological distress (Distress Thermometer). Overall, patients were very satisfied (80.7±20.7) with the One-Stop Breast Unit. The highest mean satisfaction scores concerned nurses' technical skills, interpersonal skills and availability. The lowest mean scores concerned physicians' availability, waiting time, and the provision of information. The results revealed a significant association between high state anxiety levels, lower levels of satisfaction with doctors' interpersonal skills (r=-.41, P<.001) and lower levels for information provided by nurses (r=-.38, P<.001). Moreover, greater psychological distress was associated with less satisfaction with the different aspects of care (doctors' interpersonal skills, doctors' availability and waiting-time). The results of regression models showed that doctor-related satisfaction scales explained 20% of the variance in anxiety (P<.01). Facing cancer diagnosis remains a stressful situation. However, our study suggested that a substantial part of this anxiety is sensitive to the quality of the patient-doctor relationship. Consequently, further efforts should be expended on adapting patient-doctor communication to improve patient reassurance.
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http://dx.doi.org/10.1111/tbj.12856DOI Listing
March 2018

[Nursing ethics in the face of the refusal of nursing care].

Rev Infirm 2016 10;224:19-21

Service interdisciplinaire de Soins de Support, Centre Alexis Vautrin, 6, avenue de Bourgogne, CS30519, 54519, Vandoeuvre-lès-Nancy, France.

Caregivers can find themselves faced with a refusal of nursing care. A number of questions are then raised. While it is firstly important to understand the reasons for this refusal and what is at stake for the patient, there are a number of nursing strategies in place, not least of all dialogue and analysis. The role of the multi-disciplinary team is essential in such situations.
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http://dx.doi.org/10.1016/j.revinf.2016.08.002DOI Listing
October 2016

Screening for psychological distress in very long-term adult survivors of childhood cancer.

Pediatr Hematol Oncol 2016 Aug 22;33(5):295-313. Epub 2016 Sep 22.

a Department of Pediatrics , Institut Gustave-Roussy , Villejuif , France.

This study evaluated the prevalence of psychological distress (PD) in a cohort of 348 adult childhood cancer survivors with a very long-term follow-up and assessed the characteristics associated with this distress (cancer type, treatment, sex, age at diagnosis, self-reported late effects, social support, type of remembrance, time since the diagnosis, age at evaluation), assuming that with time since the diagnosis, the PD of survivors will approximate that of the general population. Before attending a long-term follow-up consultation, survivors were sent 3 questionnaires: the Brief Symptom Inventory-18, the Impact of Event Scale, and the Illness Worry Scale (IWS). During the visit, they were administered the Mini-International Neuropsychiatric Interview (MINI) by a psychologist. The mean age of the survivors was 38.5 years (18.1-65.8) at consultation, 7 years (0.0-18.0) at cancer diagnosis, and mean time since diagnosis was 31.5 years (8.8-56.1). Multiple regression analyses of the data collected from self-administered questionnaires confirmed that being female, living alone, and self-reported late effects were associated with the high scores for all scales. Negative remembrances and being accompanied to the clinic were associated with higher IWS scores. Unlike the initial hypothesis, the MINI showed that, compared with controls, survivors experienced a higher prevalence of anxiety and mood disorders even after a very long time since the diagnosis. These findings show that a substantial subset of survivors experiment a high prevalence of PD, higher than the general population, and should be screened for PD whatever the time since the diagnosis.
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http://dx.doi.org/10.1080/08880018.2016.1204400DOI Listing
August 2016

Impact of dermatologic adverse events induced by targeted therapies on quality of life.

Crit Rev Oncol Hematol 2016 May 5;101:158-68. Epub 2016 Mar 5.

Psycho-Oncology Unit, Gustave Roussy, Villejuif, France.

Background: Investigations about the impact of dermatologic adverse events on quality of life in the context of targeted therapies are quite recent and results vary in some dimensions. This article aims to summarize the existing data and to clarify needs in terms of clinical management and future research.

Methods: A literature review was done with Pubmed, Medline, Scopus and PsycInfo databases and it combined the empirical studies published in English and in French over the past ten years.

Results And Conclusions: Dermatologic adverse events globally have a low to moderate impact on quality of life, mainly in the physical and emotional domains. Reasons for inter-individual variations in adjustment and long-term impact are still not well known. Making quality of life assessments systematic, making early referrals of patients to dermatology consultations and giving more attention to individual experience were identified as measures that could help prevent deterioration in quality of life.
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http://dx.doi.org/10.1016/j.critrevonc.2016.03.003DOI Listing
May 2016

Impact of Skin Toxicities Associated with Targeted Cancer Therapies on Body Image: A Prospective Study.

Clin Drug Investig 2016 Mar;36(3):235-42

Dermatology Service, Gustave Roussy Cancer Campus Grand-Paris-Sud Villejuif, Villejuif, France.

Background And Objective: Body-image issues associated with dermatological side effects induced by anticancer-targeted therapies have not been specifically explored until now despite growing literature about their impact on quality of life. Prospective and longitudinal investigations were needed. The aim of our study was to describe body-image changes occurring with cutaneous toxicities and their psychosocial impact on patients.

Patients And Methods: Thirty-three patients were evaluated four times during the first 3 months of targeted therapy in terms of body satisfaction, physical attitudes and depression with validated and ad hoc questionnaires. The NCI-CTCAE V4.0 was used to grade adverse dermatological events. Descriptive and inferential analyses were conducted with SPSS 14.0 software.

Results: Ninety-four per cent of the patients developed skin toxicities. Body satisfaction remained stable and slightly better than average over this period. About one-third of the patients reported body-image issues at baseline. Body satisfaction and depression levels at baseline appeared to be significantly associated with body-image issues after 3 months of therapy.

Conclusion: In the framework of regular dermatological monitoring, skin toxicities did not appear to be associated with body-image issues. Body satisfaction and depressive symptoms at the beginning of targeted therapy emerged as critical factors that practitioners should consider in order to prevent deterioration of body image that could impact on quality of life and compromise compliance.
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http://dx.doi.org/10.1007/s40261-015-0373-8DOI Listing
March 2016

Laparoendoscopic Single-site Surgery (LESS) for Prophylactic Salpingo-oophorectomy Improves Cosmetic Satisfaction Compared to Standard Laparoscopy.

Anticancer Res 2015 Nov;35(11):6105-10

Department of Surgery, Institut Gustave Roussy, Villejuif, France

Aim: Less invasive prophylactic bilateral salpingo-oophorectomy (PBSO) may diminish the general consequences of surgery for BRCA mutation carriers. The objective of the present study was to compare the psychological impact and satisfaction following minimal-invasive laparoendoscopic single-site surgery (LESS) versus that observed with the standard procedure.

Patients And Methods: This prospective longitudinal study was proposed to all consecutive patients who underwent ambulatory PBSO between January 2012 and January 2014 at our Center. The psychological impact and esthetic satisfaction were prospectively studied. Patients rated their satisfaction using the 4-grade Likert scale. Their emotional state and postoperative pain were explored respectively with validated questionnaires (IES-R, PANAS) and the Verbal Numerical Rating Scale (VNRS). Operative outcomes were also analyzed.

Results: Twenty patients underwent LESS PBSO and 10 patients had the standard laparoscopic (SL) PBSO. The mean satisfaction scores were significantly higher in the LESS group one month and six months after surgery. Both groups reported a reduction of intrusive thoughts and negative affects after surgery. Postoperative pain and operative outcomes were similar.

Conclusion: A significant improvement of cosmetic satisfaction after LESS compared to SL could help patients accept PBSO. The emotional impact of PBSO is not modified by ambulatory LESS.
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November 2015

Validation of the French translation-adaptation of the impact of cancer questionnaire version 2 (IOCv2) in a breast cancer survivor population.

Health Qual Life Outcomes 2015 Jul 29;13:110. Epub 2015 Jul 29.

EA4275, Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences, University of Nantes, Nantes, France.

Background: The Impact of Cancer version 2 (IOCv2) was designed to assess the physical and psychosocial health experience of cancer survivors through its positive and negative impacts. Although the IOCv2 is available in English and Dutch, it has not yet been validated for use in French-speaking populations. The current study was undertaken to provide a comprehensive assessment of the reliability and validity of the French language version of the IOCv2 in a sample of breast cancer survivors.

Methods: An adapted French version of the IOCv2 as well as demographic and medical information were completed by 243 women to validate the factor structure divergent/divergent validities and reliability. Concurrent validity was assessed by correlating the IOCv2 scales with measures from the SF-12, PostTraumatic Growth Inventory and Fear of Cancer Recurrence Inventory.

Results: The French version of the IOCv2 supports the structure of the original version, with four positive impact dimensions and four negative impact dimensions. This result was suggested by the good fit of the confirmatory factor analysis and the adequate reliability revealed by Cronbach's alpha coefficients and other psychometric indices. The concurrent validity analysis revealed patterns of association between IOCv2 scale scores and other measures. Unlike the original version, a structure with a Positive Impact domain consisting in the IOCv2 positive dimensions and a Negative Impact domain consisting in the negative ones has not been clearly evidenced in this study. The limited practical use of the conditional dimensions Employment Concerns and Relationship Concerns, whether the patient is partnered or not, did not make possible to provide evidence of validity and reliability of these dimensions as the subsets of sample to work with were not large enough. The scores of these conditional dimensions have to be used with full knowledge of the facts of this limitation of the study.

Conclusions: Integrating IOCv2 into studies will contribute to evaluate the psychosocial health experience of the growing population of cancer survivors, enabling better understanding of the multi-dimensional impact of cancer.
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http://dx.doi.org/10.1186/s12955-015-0301-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517314PMC
July 2015

Antidepressants for the treatment of depression in people with cancer.

Cochrane Database Syst Rev 2015 Jun 1(6):CD011006. Epub 2015 Jun 1.

Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico "GB Rossi", Piazzale L.A. Scuro, 10, Verona, Italy, 37134.

Background: Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have been shown to have a negative impact in terms of quality of life, compliance with anti-cancer treatment, suicide risk and likely even the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy and tolerability of antidepressants in this population group are few and often report conflicting results.

Objectives: To assess the effects and acceptability of antidepressants for treating depressive symptoms in adults (18 years or older) with cancer (any site and stage).

Search Methods: We searched the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 3), MEDLINE Ovid (1946 to April week 3, 2014), EMBASE Ovid (1980 to 2014 week 17) and PsycINFO Ovid (1987 to April week 4, 2014). We additionally handsearched the trial databases of the most relevant national, international and pharmaceutical company trial registers and drug-approving agencies for published, unpublished and ongoing controlled trials.

Selection Criteria: We included RCTs allocating adults (18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis) comparing antidepressants versus placebo, or antidepressants versus other antidepressants.

Data Collection And Analysis: Two review authors independently checked eligibility and extracted data using a form specifically designed for the aims of this review. The two authors compared the data extracted and then entered data into RevMan 5 with a double-entry procedure. Information extracted included study and participant characteristics, intervention details, outcome measures for each time point of interest, cost analysis and sponsorship by a drug company. We used the standard methodological procedures expected by The Cochrane Collaboration.

Main Results: We retrieved a total of nine studies (861 participants), with seven studies contributing to the meta-analysis for the primary outcome. Four of these compared antidepressants and placebo, two compared two antidepressants and one-three armed study compared two antidepressants and a placebo arm. For the acute phase treatment response (6 to 12 weeks), we found very low quality evidence for the effect of antidepressants as a class on symptoms of depression compared with placebo when measured as a continuous outcome (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -1.01 to 0.11, five RCTs, 266 participants) or as a proportion of people who had depression (risk ratio (RR) 0.82, 95% CI 0.62 to 1.08, five RCTs, 417 participants). No trials reported data on the follow-up response (more than 12 weeks). In head-to-head comparisons we only retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants, providing very low quality evidence for the difference between these two classes (SMD -0.08, 95% CI -0.34 to 0.18, three RCTs, 237 participants). No clear evidence of an effect of antidepressants versus either placebo or other antidepressants emerged from the analyses of the secondary efficacy outcomes (dichotomous outcome, response at 6 to 12 weeks, very low quality evidence). We found very low quality evidence for the effect of antidepressants as a class in terms of dropouts due to any cause compared with placebo (RR 0.87, 95% CI 0.49 to 1.53, six RCTs, 455 participants), as well as between SSRIs and tricyclic antidepressants (RR 0.83, 95% CI 0.53 to 1.30, three RCTs, 237 participants). We downgraded the quality of the evidence because the included studies were at an unclear or high risk of bias due to poor reporting, imprecision arising from small sample sizes and wide confidence intervals, and inconsistency due to statistical or clinical heterogeneity.

Authors' Conclusions: Despite the impact of depression on people with cancer, available studies were very few and of low quality. This review found very low quality evidence for the effects of these drugs compared with placebo. On the basis of these results clear implications for practice cannot be made. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which agent should be prescribed may be based on the data on antidepressant efficacy in the general population of individuals with major depression, also taking into account that data on medically ill patients suggest a positive safety profile for the SSRIs. Large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer with depressive symptoms, with or without a formal diagnosis of a depressive disorder, are urgently needed to better inform clinical practice.
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http://dx.doi.org/10.1002/14651858.CD011006.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457578PMC
June 2015

Relations between arthralgia and fear of recurrence: results of a cross-sectional study of breast cancer patients treated with adjuvant aromatase inhibitors therapy.

Support Care Cancer 2015 Dec 17;23(12):3581-8. Epub 2015 Apr 17.

Psycho-Oncology Unit, Institut Gustave Roussy, Villejuif, France.

Purpose: The aim of this study was to explore associations between arthralgia and fear of recurrence in breast cancer patients treated by aromatase inhibitors (AI).

Method: We sent a set of questionnaires to 100 patients examining their pain characteristics, anxiety (STAI), depression (BDI-SF), quality of life (SF-36), fear of recurrence (FCRI), and representations of AI treatment (ad hoc questionnaire). Nonparametric tests were used to investigate between-group comparisons (arthralgia vs. nonarthralgia) in these domains as well as the associations between arthralgia and fear of recurrence.

Results: Of the 77 patients who returned the questionnaires (response rate = 77%), 60 (78%) reported arthralgia. The mean score of fear of recurrence exceeded the pathological threshold in the arthralgia group and was significantly higher than that in the nonarthralgia group (14.8 vs. 10.7, p < 0.01). Significant associations were observed between fear of recurrence and pain intensity (r = 0.274, p < 0.05) and pain relief (r = -0.409, p < 0.05). More than 80% of the total sample declared that they were well informed about the aim of AI, their side effects, and the risk of developing arthralgia. Fear of recurrence did not appear to be associated with representations of AI.

Conclusion: The study revealed a close relationship between pain intensity and fear of recurrence. In particular, it showed that effective pain management was accompanied by a reduced fear of recurrence. Information, although essential, appeared insufficient to overcome patients' concerns about pain. Therefore, the implement of a systematic screening for arthralgia and the improvement of analgesic treatment are essential issues. New strategies for pharmacological and nonpharmacological treatment must be developed.
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http://dx.doi.org/10.1007/s00520-015-2722-9DOI Listing
December 2015

Telling the Truth…With Kindness: Retrospective Evaluation of 12 Years of Activity of a Support Group for Children and Their Parents With Cancer.

Cancer Nurs 2016 Mar-Apr;39(2):E10-8

Author Affiliations: Unité de Psycho-Oncologie, Département de Soins de Support, Gustave Roussy, Villejuif (Ms Landry-Dattée and Drs Boinon and Dauchy); Service de Pneumologie, Hôpital Beaujon, Clichy (Ms Roig); Ligue Nationale Contre le Cancer, Paris (Mr Bouregba); and Département des Blocs, Gustave Roussy, Villejuif (Dr Delaigue-Cosset), France.

Background: Cancer in a parent can have harmful effects on a child's ability to cope with the situation, in particular if communication about the disease is limited.

Objective: The aim was to evaluate whether the parent-child group run by a psychoanalyst and a doctor at the hospital helps facilitate communication about the disease with a child and helps to sooth the child and his/her symptoms.

Methods: This qualitative retrospective study conducted among 61 families (71 adults, 19 children) using semidirected interviews made it possible to identify the expectations and benefits perceived by the parents and children.

Results: The main expectations of the parents were to meet professionals who would help them to speak about the disease and to help the children understand it better in order to reduce their symptoms. The parents' expectations were largely satisfied. As far as the children are concerned, they expressed more benefits (better understanding of the disease, reduction of symptoms, meeting similar others) than expectations.

Conclusions: The group is a resource that helps both parents and children. Meeting similar others made it possible to justify each participant's own experiences and promote better communication during the continued course of the disease.

Implications For Practice: The benefits brought about by this group testify to the need to offer such support to a greater number of parents with cancer. Improvements to the way in which the group is organized are discussed.
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http://dx.doi.org/10.1097/NCC.0000000000000262DOI Listing
March 2017

[Communication in the context of phase I clinical trials in oncology: implementation and evaluation of training programs].

Bull Cancer 2015 Feb 15;102(2):174-81. Epub 2015 Jan 15.

Institut Gustave-Roussy, département interdisciplinaire de soins de support aux patients en oncohématologie, 114, rue Édouard-Vaillant, 94805 Villejuif, France.

Communication training programs in oncology have demonstrated some efficacy to improve doctors' communication skills. The goal of our study was to evaluate the impact of such training in the particular context of phase I clinical trials. Self-satisfaction and self-efficacy scales evaluating doctor-patient communication was completed by 6 medical oncologists (3 juniors and 3 seniors) before and after their communication training for a total of sixty visits. Two types of visit have been distinguished: the visits between the oncologist and the patient alone (a dual situation) and those with a third party (a trilateral situation). For all the doctors in dual and trialateral situations, self-efficacy scores improved significantly after training. This improvement was more pronounced for juniors oncologists in trilateral situations. Before training, satisfactory scores were worst in duel versus trilateral situations (P=0.01). This was particularly pronounced for junior compared to senior doctors (P=0.035). After training, in trilateral situations, the satisfaction scores of junior doctors matched that of the senior doctors. The communication training programs appear to benefit junior oncologists to a greater extent in trilateral situations.
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http://dx.doi.org/10.1016/j.bulcan.2014.12.013DOI Listing
February 2015

[Psychological adjustment in couples facing woman's breast cancer: perceptions of spousal support].

Bull Cancer 2014 Jul-Aug;101(7-8):690-7

Université Paris-Descartes, Institut de psychologie, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France.

This cross-sectional study for couples explores the relationship between the perceptions within the couple of the spouse's supportive behaviors and the psychological adjustment of both partners during treatment for breast cancer. Forty-eight women operated on for a non-metastatic breast cancer and their spouses completed questionnaires assessing psychological adjustment (STAI, BDI-SF), and the spouse's support behaviors during discussions about the disease (PSE). Support behaviors are positively valued by both partners, especially non-verbal comfort and concrete actions. Support by minimization is associated with fewer depressive symptoms in patients and spouses. For spouses, the positive perception of support by concrete action is associated with a lower depression score. Moreover, high adjustment difficulties for spouses are linked to greater perception differences between partners on emotional support and minimization. These results highlight the importance of non-verbal comfort and minimization for the perception of social support within the couple, and the usefulness of support by concrete actions proposed by spouses. Advices for professionals are available.
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http://dx.doi.org/10.1684/bdc.2014.1951DOI Listing
September 2014

[Physical activity and sports for oncology patients].

Rev Infirm 2014 Feb(198):23-4

Physical activity and sport are integrated into support care and their indication is officially recognised. The aim is to improve patients' physical capacities, restore social contact and help improve their psychological condition, by reinforcing in particular their self-esteem. However, patients are not sufficiently well-informed.
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http://dx.doi.org/10.1016/j.revinf.2013.11.008DOI Listing
February 2014

Exploring frontiers: use of complementary and alternative medicine among patients with early-stage breast cancer.

Breast 2014 Jun 13;23(3):279-85. Epub 2014 Feb 13.

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

Introduction: Complementary and alternative medicine (CAM) is increasingly popular among cancer patients but can interfere with conventional therapies; timely data are needed to adapt current patients' care.

Materials And Methods: This transversal, prospective study evaluated the use of CAM among patients receiving adjuvant chemotherapy or endocrine therapy for early stage breast cancer. We assessed the prevalence of use, the motivations and predictive factors for use, as well as patients' information needs over a three months period.

Results: 69/184 responders (37.5%) reported using at least one CAM. CAM use was associated with younger age (p = 0.03) and higher education level (p < 0.001). Pharmacological substances (e.g., homeopathy, phytotherapy) were the most commonly used (79.7%) before physical means (42%) and dietary methods (31.9%). A total of 65.8% of users felt that these treatments have demonstrated evidence of efficacy and 74.8% that they were not associated with side effects. The main goal for use was improvement of treatment-related symptoms (28.3%); secondary goal was increasing the general health status (20.5%). Patients reported high needs for information on CAMs. CAM use was associated with mild differences in secondary adverse events reported by patients.

Conclusion: Breast cancer patients are common users of CAM concomitantly to their conventional cancer treatments and should be investigated regarding their current consumption of CAM. Furthermore, they need advice evidence-based data on these treatments and potential interactions with on-going treatments.
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http://dx.doi.org/10.1016/j.breast.2014.01.009DOI Listing
June 2014