Partage social de l'expérience de la maladie, soutien social perçu et ajustement psychologique des femmes atteintes d'un cancer du sein

Objectifs et méthodes: le premier volet quantitatif et transversal de cette étude, menée auprès de 113 femmes atteintes d'un cancer du sein, explore, à partir d'auto-questionnaires, les liens entre partage social du vécu de la maladie, soutien perçu, et ajustement psychologique après la chirurgie mammaire (T1). Parmi ces femmes, 102 ont répondu au second volet quantitatif et longitudinal de cette étude qui visait à comprendre en quoi le partage social et le soutien perçu à T1 expliquent l'ajustement psychologique à la fin des traitements (T2). Nous avons exploré le rôle médiateur des représentations liées au cancer et le rôle modérateur de l'alexithymie sur ces liens. Résultats: les résultats transversaux montrent que les effets du partage social sur l'ajustement à la maladie dépendent d'interactions complexes dans lesquelles entrent en jeu: les caractéristiques de ce partage, les réactions du proche face à l'expression du vécu de la patiente et les ressources de régulation émotionnelle de celle-ci. Les résultats longitudinaux montrent que seul le soutien instrumental à T1 explique une diminution des symptômes dépressifs à T2. Cependant, la perception d'attitudes négatives dans l'entourage et l'évitement du partage social à T1 majorent les pensées intrusives à T2. Ces liens sont expliqués par une troisième variable: la perception d'une maladie récurrente. Conclusion: cette recherche souligne l'impact délétère tant de la présence d'attitudes négatives dans l'entourage que de l'évitement du partage social sur le traitement cognitif de l'expérience du cancer. En revanche, l'existence d'un soutien instrumental favorise la diminution des affects dépressifs à long terme.Objectives and methods: the first part of the quantitative and cross-selectional study, conducted with 113 women with breast cancer, explored, with self-reported questionnaires, associations between social sharing of the disease, social support and psychological adjustment after breast surgery (T1). Among these patients, 102 responded to the quantitative and longitudinal study which aimed at understanding how the social sharing of the disease and the perceived social support at T1 explains the psychological adjustment at the end of treatment (T2). We explored in these studies the mediator effect of representations associated with cancer and the moderator effect of alexithymia on these links. Results: the cross-sectional results shows that the effects of social sharing on patient's adjustment to the disease depends on complex interactions between: the characteristics of this sharing, the reactions of the confident and the emotional regulation resources. The longitudinal results show that only instrumental support at T1 accounts for a decrease in depressive symptoms at T2. However, the perception of aversive attitudes in the surroundings and the avoidance of social sharing at T1 explains an increase of the cancer-related intrusive thoughts. These links are explained by a third variable: the perception of a cyclical illness. Conclusion: this research highlights the negative impact of the presence of aversive attitudes in the environment and the avoidance of social sharing on the cognitive processing of cancer. However, the existence of instrumental support reduce depressive affects in long term.BOULOGNE-BU Psych. Henri Pieron (920125201) / SudocSudocFranceF

Quality of life of young women with early breast cancer and their partners: specific needs result in the necessity of development of specific questionnaires for the patient and the partner

PMID: 22640925International audiencePurpose. To determine the feelings of young women with early breast cancer concomitantly with their partners at different treatment periods in order to create a specific quality of life (QOL) scale for this population. Materiel and methods. It was a prospective, multicentre, qualitative study, in patients younger than 45 years old at diagnosis and living with a partner for at least six months. Patients and partners were interviewed by a psychologist, from the diagnosis disclosure until follow up, using non-directing individual talks. Results. Sixty-nine couples were interviewed. Analyses of the interviews have highlighted the impact of disease on eight dimensions: psychological, physical, family, social, couple, sexuality, domestic, professional and economic dimensions. These impacts are mostly negative and are present in all periods and even after treatment for follow up. Discussion. A multidimensional profile of this specific population was established. A QOL scale dedicated to this population is being validated

Quelle est la place des professionnels de santé dans l’adhésion aux programmes thérapeutiques en ligne de l’insomnie ? Éléments de réflexion issus de l’étude Sleep-4-All-1 et protocole de l’étude Sleep-4-All-2.0

La thérapie cognitivocomportementale de l’insomnie (TCC-I) demeure difficile d’accès pour les patients atteints de cancer. Sa digitalisation semble une solution prometteuse pour bénéficier au plus grand nombre. La faisabilité d’un programme TCC-I québécois a été démontrée en France, tout en révélant les limites d’un dispositif suivi en autonomie et à distance. L’enjeu reste de mieux comprendre le rôle des professionnels de santé dans l’accompagnement des patients dans ce type de programme. C’est l’objectif de l’étude Sleep-4-All-2.0 dont nous présenterons ici le protocole.Cognitive behavioral therapy for insomnia (CBTI) remains difficult to access for patients with cancer. Its digitalization seem like a promising solution to benefit as many people as possible. The feasibility of a Quebec CBTI program was thus demonstrated in France, while revealing the limits of a self-help remote program for patients with cancer. The challenge remains to better understand with the Sleep-4-All-2.0 protocol study the role of healthcare professionals in supporting patients in this type of program

The Quality of Life of Young Women with Nonmetastatic Breast Cancer and their Partners': Specific Needs Require Development of Specific Questionnaires for Each of them

PMID: 22284212International audienceno abstrac

Decision of adjuvant chemotherapy in intermediate risk luminal breast cancer patients: A prospective multicenter trial assessing the clinical and psychological impact of EndoPredict® (EpClin) use (UCBG 2–14)

International audienceGenomic tests can identify ER-positive HER2-negative localized breast cancer patients who may not benefit from adjuvant chemotherapy. Such tests seem especially interesting in "intermediate" clinico-pathological risk categories. The psychological impact of the decision uncertainty in these women remains largely unexplored. We assessed the clinical and psychological impact of EndoPredict® (EpClin), a clinico-genomic test, in these patients

Opérer ou non une lésion atypique du sein ? Prise en compte de l’anxiété dans l’aide à la décision partagée à partir d’une cohorte prospective de 300 patientes

INTRODUCTION: Organized and individual breast screening have been accompanied by an increase in the detection of "atypical breast lesions "(ABL). Recently, the NOMAT multicenter study proposed a predictive model of the risk of developing breast cancer after detection of an ABL in order to avoid surgical removal of "low-risk" lesions. It also aimed to provide information on psychological experience, in particularly anxiety, to assist in the shared medical decision process. METHODS: Three hundred women undergoing surgery for ABL were included between 2015 and 2018 at 18 French centers. Women completed questionnaires before and after surgery assessing their level of anxiety (STAI-State, STAI-Trait), their level of tolerance to uncertainty, their perceived risk of developing a breast cancer, and their satisfaction with the management care. RESULTS: One hundred nighty nine patients completed the STAI-Status before and after surgery. Overall, a decrease in anxiety level (35.4 vs 42.7, p<0.001) was observed. Anxious temperament and greater intolerance to uncertainty were significantly associated swith decreased anxiety (33%), whereas younger age was associated with increased anxiety (8%). CONCLUSION: Surgery for ABL seems to be associated with only a few cases with an increase in anxiety and seems to increase the perception of the risk of developing breast cancer. Taking into account the psychological dimension remains in all cases essential in the process of shared therapeutic decision.INTRODUCTION: Les dépistages mammaires organisés et individuels se sont accompagnés d’une augmentation de la détection de lésions « frontières » (LF). Récemment, l’étude multicentrique NOMAT a proposé un modèle prédictif du risque de développer un cancer après détection d’une LF afin d’éviter l’exérèse chirurgicale de lésions à « bas risque ». Elle avait également pour objectif de renseigner le vécu psychologique, notamment l’anxiété, afin d’orienter le processus de décision médicale partagée. MATÉRIELS ET MÉTHODES : Trois cents femmes opérées pour une LF du sein ont été incluses entre 2015 et 2018 dans 18 centres français. Les femmes remplissaient avant et après chirurgie des questionnaires évaluant leurs niveaux d’anxiété situationnelle et habituelle (STAI-Etat et Trait) et d’intolérance à l’incertitude, leur perception du risque de développer un cancer et leur satisfaction vis-à-vis de la prise en charge. RÉSULTATS : Cent quatre-vingt-dix-neuf femmes ont complété le STAI-Etat avant et après chirurgie. Globalement, une diminution du niveau d’anxiété (35,4 vs. 42,7, p < 0,001) a été observée. Un tempérament anxieux et une plus grande intolérance à l’incertitude étaient significativement associés à une diminution de l’anxiété (33 % des femmes), tandis qu’un plus jeune âge était associé à une augmentation de l’anxiété (8 % des femmes). CONCLUSION : La chirurgie des LF ne semble s’associer que dans très peu de cas à une augmentation de l’anxiété et ne fait évoluer qu’à la marge la perception du risque de développer un cancer. La prise en compte de la dimension psychologique reste dans tous les cas essentielle dans la décision médicale partagée

Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer

International audiencePURPOSE Optimal comprehensive survivorship care is insufficiently delivered. To increase patient empowerment and maximize the uptake of multidisciplinary supportive care strategies to serve all survivorship needs, we implemented a proactive survivorship care pathway for patients with early breast cancer at the end of primary treatment phase. METHODS Pathway components included (1) a personalized survivorship care plan (SCP), (2) face-to-face survivorship education seminars and personalized consultation for supportive care referrals (Transition Day), (3) a mobile app delivering personalized education and self-management advice, and (4) decision aids for physicians focused on supportive care needs. A mixed-methods process evaluation was performed according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework including administrative data review, pathway experience survey (patient, physician, and organization), and focus group. The primary objective was patient-perceived satisfaction with the pathway (predefined progression criteria for pathway continuation ≥70%). RESULTS Over 6 months, 321 patients were eligible for the pathway and received a SCP and 98 (30%) attended the Transition Day. Among 126 patients surveyed, 77 (66.1%) responded. 70.1% received the SCP, 51.9% attended the Transition Day, and 59.7% accessed the mobile app. 96.1% of patients were very or completely satisfied with the overall pathway, whereas perceived usefulness was 64.8% for the SCP, 90% for the Transition Day, and 65.2% for the mobile app. Pathway implementation seemed to be positively experienced by physicians and the organization. CONCLUSION Patients were satisfied with a proactive survivorship care pathway, and the majority reported that its components were useful in supporting their needs. This study can inform the implementation of survivorship care pathways in other centers