Le cancer du sein chez la femme jeune en France : conditions de vie des survivantes, fertilité et identification des profils de sexualité.

In France, the incidence of breast cancer (BC) in women aged 40 and younger is increasing, while mortality is decreasing. This improvement in survival raises the question of how to improve the living conditions of young survivors.These women are diagnosed at an age when they are in the throes of professional development and have often not yet built up their family lives. So, once treatment has been completed, they have to get on with their lives, and face issues such as sexuality, fertility and returning to work that can ultimately affect their health-related quality of life (HRQoL).Furthermore, with the increasing number of young women surviving their cancer, it is necessary to explore these women's experience of the disease and to gather the needs they consider priorities from diagnosis to post-cancer, in order to integrate them into care. In addition, the post-cancer living conditions (sexuality, fertility and HRQoL) of young women diagnosed with BC have been little studied.This mixed-methods thesis, combining a quantitative and a qualitative component, mainly aimed to:-to study the post-cancer living conditions of young women diagnosed with BC in France and more specifically to identify the factors associated with these women's sexuality, fertility and HRQoL;-to identify the aspects that these women consider to be priorities in their care, and unmet support needs in general, and in particular in terms of sexuality and fertility.Our work showed that around 8 years after diagnosis, one in two women had no sexual dysfunction and 20% of women had severely impaired sexual function. Factors associated with sexual dysfunction were depression, menopause, fatigue, ongoing endocrine therapy, dissatisfaction with perceived social support and shorter time since diagnosis.Sexual dysfunction was associated with mental and social components of HRQoL. Stage at BC diagnosis and acute treatments did not impact long-term HRQoL of young BC survivors. Other factors associated with poorer HRQoL were overweight or obesity, comorbidities, socio-economic deprivation, anxiety, depression, and lack of social support.The pregnancy plan at diagnosis was an important factor in informing women about the impact of treatments on fertility and in encouraging them to seek fertility preservation. However, few women had access to fertility preservation at diagnosis.Our work also showed that women's psychological distress persisted years after treatment had ended, and women expressed the need for more psychological support in the post-cancer period.Women's other main unmet needs were paramedical support (aesthetics, dietetics, etc.) and better reimbursement of these treatments to improve their body image, regain their femininity and regain self-confidence.Although our results must be interpreted in the light of the period of diagnosis of the women in the study, efforts still need to be made to inform women about the impact of treatments on fertility, fertility preservation, sexuality and the sequelae of treatment. The democratization of rehabilitation centers would be desirable. In addition, specific supportive care interventions (access to appropriate specialists, psychological support) for these young women would enable them to better manage their sexual dysfunction and fertility problems, thereby improving their HRQoL and their post-cancer experience.En France, l’augmentation de l’incidence du cancer du sein (CS) chez les femmes de 40 ans et moins est à contrario associée à une diminution de la mortalité. Cette amélioration de la survie pose la question de l’amélioration des conditions de vie des survivantes jeunes.Ces femmes sont diagnostiquées à un âge où elles sont en plein essor professionnel et n’ont souvent pas encore construit leur vie de famille. Ainsi, une fois les traitements terminés, elles doivent reprendre leur vie et faire face à des problèmes tels que la sexualité, la fertilité et le retour au travail qui peuvent affecter leur qualité de vie (QdV). De plus, avec l’augmentation croissante du nombre de femmes jeunes qui survivent à leur cancer, il s’avère nécessaire d’explorer le vécu de la maladie par ces femmes et recueillir les besoins qu’elles jugent prioritaires, et ce depuis le diagnostic jusqu’à l’après-cancer afin de les intégrer dans leur prise en charge. Par ailleurs, les conditions de vie (sexualité, fertilité et QdV) dans l’après-cancer des femmes jeunes diagnostiquées pour un CS en France ont été peu étudiées.Ce travail de thèse à méthodologie mixte associant un volet quantitatif et un volet qualitatif avait pour objectifs :-d'étudier les conditions de vie dans l’après-cancer des femmes jeunes diagnostiquées pour un CS en France et plus précisément d’identifier les facteurs associés à la sexualité, la fertilité et la QdV de ces femmes ;-d’identifier les aspects jugés prioritaires par ces femmes dans leur prise en charge, les besoins de soutien non satisfaits en général et en particulier en termes de sexualité et de fertilité.Les travaux réalisés ont montré qu’environ 8 ans après le diagnostic, une femme sur deux ne présentait pas de dysfonction sexuelle et 20% des femmes avaient une fonction sexuelle très altérée. Les facteurs associés à la dysfonction sexuelle étaient la dépression, la ménopause, la fatigue, le traitement par hormonothérapie, l’insatisfaction en lien avec le soutien social perçu et la proximité du diagnostic.La dysfonction sexuelle était associée aux composantes mentale et sociale de la QdV. Le stade au diagnostic du CS et les traitements n’avaient pas d’impact sur la QdV à long terme des jeunes survivantes d’un CS. Les autres facteurs associés à une moins bonne QdV étaient le surpoids ou l’obésité, les comorbidités, la précarité, l’anxiété, la dépression, l‘absence de soutien social.Le projet de grossesse au diagnostic était un facteur favorisant l’information des femmes sur le retentissement des traitements sur la fertilité et la mise en place d’une préservation de la fertilité. Cependant, peu de femmes ont eu accès à la préservation de la fertilité au diagnostic.Nos travaux ont également montré que la détresse psychologique des femmes persistait des années après la fin des traitements et les femmes ont exprimé le besoin d’un renforcement de l’accompagnement psychologique dans l’après-cancer. Les autres principaux besoins non assouvis par les femmes concernaient l’accompagnement paramédical (esthétique, diététique, etc.) et un meilleur remboursement de ces soins pour améliorer leur image corporelle, retrouver leur féminité et regagner confiance en elles.Même si nos résultats sont à interpréter au regard de la période de diagnostic des femmes de l’étude, des efforts restent à faire concernant l’information des femmes sur l’impact des traitements sur la fertilité, la préservation de la fertilité, la sexualité et les séquelles des traitements. La démocratisation des centres de réhabilitation serait souhaitable. De plus, des interventions spécifiques en soins de support (accès aux spécialistes adéquats, soutien psychologique) chez ces femmes jeunes permettraient de mieux gérer leurs dysfonctionnements sexuels et problèmes de fertilité afin d’améliorer leur QdV et leur vécu de l’après-cancer

Impact of Covid-19 on breast cancer stage at discovery, and time to treatment in Cote d’Or, France

Due to the COVID-19 pandemic, and ensuing overcrowding in the French health system, management of patients with COVID-19 was given priority over that of patients with other pathologies, including chronic diseases. The aim of this study was to study the impact of COVID-19 on the stage of discovery of cancers diagnosed in the context of an organized breast cancer screening programme, as well as the impact on time to treatment. All women diagnosed with cancer in the Côte d'Or via organized breast cancer screening (first or second reading) from January 1, 2019 to December 31, 2020 were included in this study. Using data from pathological laboratories, clinical centers, and the breast and gynecological cancer registry of the Côte d'Or, France, we collected socio-demographic, clinical and treatment data on all patients. We compared data from the year 2019 (before-Covid) with the year 2020 (Covid). We did not observe a significant difference in the stage of breast cancer at discovery, or in time to treatment. However, the number of invasive cancers and the clinical size of in situ cancers both increased in 2020. Although these results are reassuring, continued monitoring is needed to determine the downstream effects of the pandemic

Cross-sectional nationwide mixed-methods population-based study of living conditions, and identification of sexual and fertility profiles among young women after breast cancer in France: the Candy study protocol

International audienceIntroduction At the end of the treatment, many young breast cancer (BC) survivors face difficulties related to fertility and sexuality, mainly due to the side effects of treatment. Integrating patient needs into medical decisions is becoming increasingly essential for high quality care. To this end, there is a compelling need to elicit patients’ perspectives through qualitative studies, to understand their experiences and needs in the aftermath of cancer. We aim to: (1) identify clinical, social and economic determinants of sexuality and fertility, and describe other living conditions of young BC survivors in France; and (2) explore young women’s experience after BC in relation to clinical and information needs about fertility preservation and sexual health. Methods and analysis This is a mixed-methods, cross-sectional, population-based study. In the quantitative component, women diagnosed with non-metastatic BC between 2009 and 2016 and aged 40 years or younger at diagnosis will be identified through the French network of cancer registries (FRANCIM). Participants will complete self-report questionnaires including standardised measures of sexuality, health-related quality of life (HRQoL), anxiety, depression, social deprivation and social support. Fertility and professional reintegration issues will also be assessed. Sexuality profiles will be identified by ascending hierarchical classification and fertility profiles will be identified by latent class models. Determinants of sexuality, fertility and HRQoL will be identified using a mixed regression model. Subsequently, semistructured interviews will be performed with a sample of 30 women who participated in the quantitative study. Interviews will be recorded, transcribed synthetically and content analysis will be performed, with the aid of NVivo software. Ethics and dissemination This study will be performed in accordance with the declaration of Helsinki. The protocol was approved in October 2020 by the Committee for the Protection of Persons North-West III (20.07.16.44445) and by the French national data protection authority (CNIL-MR003 No1989764-v0). The results of this project will be communicated to the scientific community through publications in international scientific peer-reviewed journals and communications to national and international congresses. Popularised results will also be provided to patient associations. The results of Candy project will also be published on the website of the sponsor, www.cgfl.fr

Does baseline quality of life predict the occurrence of complications in resectable esophageal cancer?

International audienceBackground: The aim of this study was to assess the impact of baseline health related quality of life (HRQOL) on the occurrence of postoperative complications and death in patients with resectable esophageal cancer. Methods: Existing data from a prospective, multicenter, open label, randomized, controlled phase III trial comparing hybrid versus open esophagectomy in patients with resectable esophageal cancer from 2009 to 2012 in France were used. A Cox regression model was used to assess the prognostic value of the baseline HRQOL score on the occurrence of major complications (MC), and major pulmonary complications (MPC) at 30 days post-surgery, as well as on 1-year postoperative overall survival (OS). Results: Every 10-point increase in the baseline role functioning score was associated with a 14% reduction in the risk of MC, while every 10-point increase in fatigue or pain score was associated with an 18% increase in the risk of MC. Similarly, higher scores on fatigue and pain were associated with a higher risk of MPC. Compared with the hybrid procedure, patients undergoing open esophagectomy had a significantly higher risk of MC and MPC. Patients diagnosed with esophageal adenocarcinoma were at significantly lower risk of MC or MPC compared to patients with esophageal squamous cell carcinoma. Higher pain (HR = 1.23, p = 0.035) and insomnia (HR = 1.16, P = 0.031) scores were associated with increased 1-year OS. Conclusion: Fatigue, pain, insomnia, and squamous cell pathology were indicators of poor prognosis, and that the presence of these findings might possibly change the management plan towards other forms of treatment and warrant close attention. © 202

What Are Young Women Living Conditions after Breast Cancer? Health-Related Quality of Life, Sexual and Fertility Issues, Professional Reinsertion

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