Determinants of participation in colonoscopic screening by siblings of colorectal cancer patients in France

International audienceBACKGROUND: Targeted colonosocopic screening is recommended for first-degree relatives of colorectal cancer patients diagnosed before the age of 60 and offers the possibility of reducing morbidity and mortality, but participation remains too low. The objective of this study was to determine in a French population the factors that affect siblings' participation in screening, notably those relating to the individuals, their medical care, their family and their social network. METHODS: A cross sectional survey was conducted in siblings of index patients having undergone surgery for colorectal cancer between 1999 and 2002 in two French counties. Siblings were contacted during 2007 and 2008 through the index patient. The factors affecting participation in colonoscopic screening were studied by logistic regression taking into account family cluster effect. RESULTS: 172 siblings of 74 index cases were included. The declared rate of undergoing at least one colonoscopy among siblings was 66%; 95%CI 59-73%. Five variables were independently associated with colonoscopic screening: perceiving fewer barriers to screening (OR = 3.2; 95%CI 1.2-8.5), having received the recommendation to undergo screening from a physician (OR = 4.9; 1.7-13.7), perceiving centres practising colonoscopy as more accessible (OR = 3.2, 1.3-7.8), having discussed screening with all siblings (OR = 3.9; 1.6-9.6) and being a member of an association (OR = 2.6; 1.0-6.6). CONCLUSIONS: The factors independently associated with participation in CRC screening by an individual at increased risk belonged to each of four dimensions relating to his individual psychosocial characteristics, to his relationship with a physician, within the family and social environment. The relevance of these results to clinical practice may help to improve compliance to recommendations in a global preventive strategy including all stages of the information pathway from the physician to the index patient and his relatives

L' épidémie d'infections nosocomiales à Acinetobacter baumannii multirésistant de janvier 2009 au CHU [centre hospitalier universitaire] de Poitiers (investigation, gestion et estimation du coût direct)

POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF

Enquête sur la pratique du dépistage du VIH, VHB et VHC en cancérologie, France

International audienceHIV testing is recommended at time of cancer diagnosis, HBV and HCV screening because of the risk of reactivation with certain anticancer drugs.This is a cross-sectional study. The objectives were to assess the screening practices in cancer patients and the satisfaction of professionals in the event of use of the CancerHIV network. A questionnaire drafted by the CancerHIV expert and the OncoPaca-Corse Regional Cancer Network (RCN) was distributed in the region at the end of 2018 (part 1: V1) before being extended to the national level via the CancerHIV network (part 2: V2). Participation reached 160 and 130 respondents (V1 and V2, respectively). At the initial cancer assessment, 23% of respondents declared that they systematically screened for HIV at V1 (V2: 17%), 25% for HBV (V2: 20%) and 24% for HCV (V2: 19%). Before immunotherapy, the rates were 54% for HIV in V1 (V2: 52%), 57% for HBV (V2: 60%) and 55% for HCV (V2: 57%). Among the respondents, satisfaction when requesting a regional or national remedy was high (almost 100%). Screening for HIV, HBV and HCV allows supervised prescription of immunosuppressive or cytotoxic treatment to a potentially immunosuppressed patient. This study, resulting of an original collaboration between a RCN and a national expert network, underlines the lack of screening at the 2 examined stages of patient care, and the need for raising practitioners' awareness to recommendations.Le dépistage de l’infection par le VIH est recommandé lors du bilan initial de tout cancer, celui de l’hépatite B et C en raison d’un risque de réactivation avec certains anticancéreux. Il s’agit d’une étude descriptive transversale. Les objectifs étaient d’évaluer les pratiques de dépistage chez des patients atteints de cancer et la satisfaction des professionnels en cas de recours au réseau CancerVIH. Un questionnaire élaboré par l’expert CancerVIH et le Réseau Régional de Cancérologie (RRC) OncoPaca-Corse a été diffusé fin 2018 en région (volet 1 : V1) avant une extension au niveau national via le réseau CancerVIH (volet 2 : V2). La participation a atteint 160 et 130 répondants (V1 et V2, respectivement). Au bilan initial de cancer, 23 % des répondants déclaraient dépister systématiquement le VIH au V1 (V2 : 17 %), 25 % le VHB (V2 : 20 %) et 24 % le VHC (V2 :19 %). Avant immunothérapie, les chiffres étaient de 54 % pour le VIH dans le V1 (V2 : 52 %), 57 % pour le VHB (V2 : 60 %) et 55 % pour le VHC (V2 : 57 %). Parmi les répondants, la satisfaction en cas de sollicitation du recours régional ou national était élevée (près de 100 %). Le dépistage du VIH, VHB et VHC permet la prescription encadrée d’un traitement immunosuppresseur ou cytotoxique à un patient potentiellement immunodéprimé. Cette enquête, fruit d’une collaboration originale entre RRC et réseau expert national, souligne l’insuffisance du dépistage aux 2 étapes de la prise en charge étudiées et la nécessité de sensibiliser les professionnels aux recommandations existantes

Practices in management of cancer treatment-related cardiovascular toxicity: A cardio-oncology survey

International audienceBackground: Cardiovascular toxicity has become a challenging issue during cancer therapy. Nonetheless, there is a lack of consensual guidelines for their management. We aimed to determine the current practices of oncologists regarding cardiovascular toxicity related to anthracyclines, trastuzumab and angiogenic inhibitors and to gather their opinions on the development of cardio-oncology programs.Methods: A cross-sectional declarative study was submitted to French oncologists in the form of an individual, structured questionnaire.Results: A total of 303 oncologists responded to the survey. Ninety-nine percent of oncologists prescribed cardiotoxic therapies, including anthracyclines (83%), trastuzumab (51%) and other angiogenic inhibitors (64%). The method adopted for managing cardiovascular toxicity was based on guidelines from expert oncology societies for only 35% of oncologists. None was aware of recommendations from expert cardiology societies. Prescription of pre-, peri- and post-therapy cardiovascular assessment was inconsistent and significantly less frequent for all classes of angiogenic inhibitors than for anthracyclines and trastuzumab (P < 0.0001). Relative to pre-therapy assessment, post-therapy assessment was prescribed significantly less often for all cancer therapies (P < 0.0001). Attitudes regarding the onset of left ventricular dysfunction were much more inconsistent when angiogenic inhibitors were involved. Additionally, the management of hypertension and QT prolongation was also inconsistent. Finally, 88% of oncologists supported projects of cardio-oncology programs development.Conclusions:Practices of oncologists are disparate in the field of cardiovascular toxicity. This finding underlines the complexity of managing many different situations and the need for distribution of formal guidelines from oncology and cardiology expert societies. The development of personalized cardio-oncology programs seems essential