Estimation et rôle pronostique de la qualité de vie des patients âgés atteints d'un cancer colorectal. . : Etude à partir d'un registre de population

Colorectal cancer is one of the most common malignancies in France and predominantly affects older patients. Few studies evaluating baseline quality of life of those patients, its short term evolution and its prognosis value on patients' survival have been performed in the context of a population-based study. This work is based on a prospective longitudinal cohort study performed by the Burgundy Digestive Cancer Registry. All patients aged 65 and over, diagnosed with a new colorectal cancer and registered by the Registry between 2003 and 2005 were eligible. Among the 401 eligible patients, 246 fulfilled at least one questionnaire. Non-respondents were older and diagnosed with a more advanced cancer stage.Patients' quality of life improved with time. Quality of life was affected neither by the presence of adjuvant treatment, nor by the palliative or curative intent of cares. Quality of life was an independent prognosis factor of survival, only when assessed by patients themselves. The agreement between the levels of quality of life declared by patients and the level of quality of life estimated by patients' general practitioner was low. In conclusion, this study shows that quality of life is of major importance when evaluating elderly colorectal cancer patients' care. For those patients, adjuvant treatment did not seem to impact quality of life or its evolution with time, suggesting that chronological age should not determine candidacy for treatments. Lastly, it underlines the value of elderly patients' rating of their quality of life in the context of a population based study, even if getting this assessment is challenging.Par sa fréquence et sa gravité, le cancer colorectal pose un problème majeur de santé publique en France et touche majoritairement les sujets âgés. Peu d’études évaluant la qualité de vie au diagnostic de ces patients et son impact sur leur survie ont été menées en population générale. Ce travail s'appuie sur une étude de population réalisée par le Registre Bourguignon des cancers digestifs portant sur les patients âgés de 65 ans ou plus et diagnostiqués entre 2003 et 2005 en Saône et Loire. Parmi les 401 patients éligibles, 246 ont renvoyé un questionnaire à au moins un des temps d'étude. Les non-répondeurs étaient plus âgés et diagnostiqués avec un stade tumoral plus avancé. La qualité de vie des patients s'améliorait avec le temps. Elle n'était pas modifiée par la présence de traitements adjuvants. La qualité de vie au diagnostic était un facteur pronostique indépendant de la survie des patients quand elle était évaluée par les patients eux-mêmes. La concordance entre le niveau de qualité de vie déclaré par les patients et l'appréciation de leur qualité de vie par le médecin traitant était moyenne à faible En conclusion, cette étude montre que chez les patients âgés, l'administration d'un traitement adjuvant n’entraîne pas d'altération de la qualité de vie à court et moyen terme, confirmant la nécessité de ne pas prendre uniquement en compte l'âge chronologique lors de la décision thérapeutique. Enfin, elle souligne l'importance de l'évaluation de la qualité de vie par le patient lui-même, y compris dans un contexte d'étude épidémiologique en population réalisée auprès de patients âgés dont il est parfois difficile d'obtenir la participation à une étude

Occupational Factors and Socioeconomic Differences in Breast Cancer Risk and Stage at Diagnosis in Swiss Working Women.

Socioeconomic differences in breast cancer (BC) incidence are driven by differences in lifestyle, healthcare use and occupational exposure. Women of high socioeconomic status (SES) have a higher risk of BC, which is diagnosed at an earlier stage, than in low SES women. As the respective effects of occupation and SES remain unclear, we examined the relationships between occupation-related variables and BC incidence and stage when considering SES. Female residents of western Switzerland aged 18-65 years in the 1990 or 2000 census, with known occupation, were linked with records of five cancer registries to identify all primary invasive BC diagnosed between 1990 and 2014 in this region. Standardized incidence ratios (SIRs) were computed by occupation using general female population incidence rates, with correction for multiple comparisons. Associations between occupation factors and BC incidence and stage at diagnosis were analysed by negative binomial and multinomial logistic regression models, respectively. The cohort included 381,873 women-years and 8818 malignant BC, with a mean follow-up of 14.7 years. Compared with reference, three occupational groups predominantly associated with a high socioprofessional status had SIRs > 1: legal professionals (SIR = 1.68, 95%CI: 1.27-2.23), social science workers (SIR = 1.29; 95%CI: 1.12-1.49) and some office workers (SIR = 1.14; 95%CI: 1.09-1.20). Conversely, building caretakers and cleaners had a reduced incidence of BC (SIR = 0.69, 95%CI: 0.59-0.81). Gradients in BC risk with skill and socioprofessional levels persisted when accounting for SES. A higher incidence was generally associated with a higher probability of an early-stage BC. Occupation and SES may both contribute to differences in risk and stage at diagnosis of BC

Estimating 10-year risk of lung and breast cancer by occupation in Switzerland.

INTRODUCTION Lung and breast cancer are important in the working-age population both in terms of incidence and costs. The study aims were to estimate the 10-year risk of lung and breast cancer by occupation and smoking status and to create easy to use age-, and sex-specific 10-year risk charts. METHODS New lung and breast cancer cases between 2010 and 2014 from all 5 cancer registries of Western Switzerland, matched with the Swiss National Cohort were used. The 10-year risks of lung and breast cancer by occupational category were estimated. For lung cancer, estimates were additionally stratified by smoking status using data on smoking prevalence from the 2007 Swiss Health Survey. RESULTS The risks of lung and breast cancer increased with age and were the highest for current smokers. Men in elementary professions had a higher 10-year risk of developing lung cancer compared to men in intermediate and managerial professions. Women in intermediate professions had a higher 10-year risk of developing lung cancer compared to elementary and managerial professions. However, women in managerial professions had the highest risk of developing breast cancer. DISCUSSION The 10-year risk of lung and breast cancer differs substantially between occupational categories. Smoking creates greater changes in 10-year risk than occupation for both sexes. The 10-year risk is interesting for both patients and professionals to inform choices related to cancer risk, such as screening and health behaviors. The risk charts can also be used as public health indicators and to inform policies to protect workers

Age-period-cohort modelling of non-Hodgkin's lymphoma incidence in a French region: a period effect compatible with an environmental exposure

<p>Abstract</p> <p>Background</p> <p>The incidence of non-Hodgkin's lymphoma (NHL) has risen steadily during the last few decades in all geographic regions covered by cancer registration for reasons that remain unknown. The aims of this study were to assess the relative contributions of age, period and cohort effects to NHL incidence patterns and therefore to provide clues to explain the increasing incidence.</p> <p>Methods</p> <p>Population and NHL incidence data were provided for the Doubs region (France) during the 1980-2005 period. NHL counts and person-years were tabulated into one-year classes by age (from 20 to 89) and calendar time period. Age-period-cohort models with parametric smooth functions (natural splines) were fitted to the data by assuming a Poisson distribution for the observed number of NHL cases.</p> <p>Results</p> <p>The age-standardised incidence rate increased from 4.7 in 1980 to 11.9 per 100,000 person-years at risk in 1992 (corresponding to a 2.5-fold increase) and stabilised afterwards (11.1 per 100,000 in 2005). Age effects showed a steadily increasing slope up to the age of 80 and levelled off for older ages. Large period curvature effects, both adjusted for cohort effects and non-adjusted (p < 10^-4and p < 10^-5, respectively), showed departure from linear periodic trends; period effects jumped markedly in 1983 and stabilised in 1992 after a 2.4-fold increase (compared to the 1980 period). In both the age-period-cohort model and the age-cohort model, cohort curvature effects were not statistically significant (p = 0.46 and p = 0.08, respectively).</p> <p>Conclusions</p> <p>The increased NHL incidence in the Doubs region is mostly dependent on factors associated with age and calendar periods instead of cohorts. We found evidence for a levelling off in both incidence rates and period effects beginning in 1992. It is unlikely that the changes in classification (which occurred after 1995) and the improvements of diagnostic accuracy could largely account for the 1983-1992 period-effect increase, giving way to an increased exposure to widely distributed risk factors including persistent organic pollutants and pesticides. Continued NHL incidence and careful analysis of period effects are of utmost importance to elucidate the enigmatic epidemiology of NHL.</p

Estimation and prognosis value of elderly colorectal cancer patients' quality of life. : A population-based study

Par sa fréquence et sa gravité, le cancer colorectal pose un problème majeur de santé publique en France et touche majoritairement les sujets âgés. Peu d’études évaluant la qualité de vie au diagnostic de ces patients et son impact sur leur survie ont été menées en population générale. Ce travail s'appuie sur une étude de population réalisée par le Registre Bourguignon des cancers digestifs portant sur les patients âgés de 65 ans ou plus et diagnostiqués entre 2003 et 2005 en Saône et Loire. Parmi les 401 patients éligibles, 246 ont renvoyé un questionnaire à au moins un des temps d'étude. Les non-répondeurs étaient plus âgés et diagnostiqués avec un stade tumoral plus avancé. La qualité de vie des patients s'améliorait avec le temps. Elle n'était pas modifiée par la présence de traitements adjuvants. La qualité de vie au diagnostic était un facteur pronostique indépendant de la survie des patients quand elle était évaluée par les patients eux-mêmes. La concordance entre le niveau de qualité de vie déclaré par les patients et l'appréciation de leur qualité de vie par le médecin traitant était moyenne à faible En conclusion, cette étude montre que chez les patients âgés, l'administration d'un traitement adjuvant n’entraîne pas d'altération de la qualité de vie à court et moyen terme, confirmant la nécessité de ne pas prendre uniquement en compte l'âge chronologique lors de la décision thérapeutique. Enfin, elle souligne l'importance de l'évaluation de la qualité de vie par le patient lui-même, y compris dans un contexte d'étude épidémiologique en population réalisée auprès de patients âgés dont il est parfois difficile d'obtenir la participation à une étude.Colorectal cancer is one of the most common malignancies in France and predominantly affects older patients. Few studies evaluating baseline quality of life of those patients, its short term evolution and its prognosis value on patients' survival have been performed in the context of a population-based study. This work is based on a prospective longitudinal cohort study performed by the Burgundy Digestive Cancer Registry. All patients aged 65 and over, diagnosed with a new colorectal cancer and registered by the Registry between 2003 and 2005 were eligible. Among the 401 eligible patients, 246 fulfilled at least one questionnaire. Non-respondents were older and diagnosed with a more advanced cancer stage.Patients' quality of life improved with time. Quality of life was affected neither by the presence of adjuvant treatment, nor by the palliative or curative intent of cares. Quality of life was an independent prognosis factor of survival, only when assessed by patients themselves. The agreement between the levels of quality of life declared by patients and the level of quality of life estimated by patients' general practitioner was low. In conclusion, this study shows that quality of life is of major importance when evaluating elderly colorectal cancer patients' care. For those patients, adjuvant treatment did not seem to impact quality of life or its evolution with time, suggesting that chronological age should not determine candidacy for treatments. Lastly, it underlines the value of elderly patients' rating of their quality of life in the context of a population based study, even if getting this assessment is challenging

Heurs et malheurs des œuvres du 1% artistique de l'enseignement universitaire à Clermont-Ferrand

National audienceLe 1% artistique est un dispositif mis en place dès 1951 pour favoriser la création d’œuvres de plasticiens, associées à la construction de bâtiments de l’Éducation nationale. A partir de 2002, le dispositif s'est élargi à d'autres formes d'expression artistiques (créations visuelles, sonores, paysagères …). A Clermont-Ferrand, comme dans nombre de villes universitaires, de nombreux bâtiments ont vu le jour dans les années 1960 et 1970. Mais c'est surtout la création, en 1965, d'un campus de type anglo-saxon sur le plateau des Cézeaux qui occasionna la commande de nombreuses œuvres d'art dans le cadre de la loi sur le 1% du fait du transfert de la Faculté des Sciences, puis de la construction continue de nouveaux bâtiments sur ce site. Au fil des ans, tout un ensemble de sculptures et d'installations, commandées à des artistes parfois prestigieux, virent le jour à l'intérieur (mosaïques, tapisseries, sculptures...) comme à l'extérieur (sculptures monumentales, design de places, dispositifs lumineux …) des divers bâtiments (laboratoires, salles de cours, bibliothèques, cafétéria, etc...), voire parfois sur leurs façades (panneaux polychromes du Pôle Chimie) ou dans le prolongement du bâti (haie paysagère du Cemagref, mur de béton de Polytech). Le Service Université Culture (SUC), mobilisé par la conservation et la valorisation de ce patrimoine depuis le milieu des années 2000, a recensé au total une trentaine d’œuvres, encore insuffisamment (re)connues et valorisées, quand elles ne sont pas hors d'usage - ce arrive tout particulièrement aux dispositifs lumineux fragiles (canon de Lantero ; vidéos de la Maison internationale et de la Maison de la vie Étudiante ...) - ou gravement endommagées (destruction de la place Vasarely). Cet article présente les créations et leur devenir sur la longue durée et rend compte d'un travail de recherche en géographie culturelle engagé dans un cadre pédagogique, en concertation avec le SUC, dans le but d'apporter des éléments de réflexion quant à la réception de ces œuvres par les publics qui fréquentent les sites