Intérêts de la mise en place d'un dispositif d'annonce dans le service de cancérologie du Centre hospitalier général de Pau

Le dispositif d'annonce a été décrit en 2005 dans les recommandations de l'INCa dans le cadre du premier Plan Cancer, et renforcé dans le deuxième Plan Cancer (2009 - 2013). Les structures de soins prenant en charge des patients atteints de cancer doivent y recourir pour une meilleure prise en charge individuelle des patients et une meilleure organisation au sein des équipes. Notre étude s'est penchée sur l'apport de ce dispositif d'annonce dans le service de cancérologie du CHG de Pau. Nous voulions savoir si la satisfaction des patients concernant leur annonce diagnostique s'en trouvait améliorée. Pour cela, nous avons remis des questionnaires aux patients de 18 ans et plus, lors d'une consultation dans les quatre mois suivant la première consultation (en général lors de la première chimiothérapie), sur une période de septembre 2008 à janvier 2009 ; et sur une deuxième période de mars à août 2010. Entre ces deux périodes, le dispositif d'annonce a été mis en place dans le service. Bien que la satisfaction globale des patients de ce service était bonne avant la mise en place du dispositif d'annonce, celui-ci semble avoir amélioré certains points ressentis moins satisfaisants d'après certains patients. Il a permis l'accès à un soutien psychologique et social ; une structure de la prise charge avec les RCP et à présent le PPS ; un conseil plus fréquent d'être accompagné lors de la consultattion d'annonce. En découle une information du patient qui semble un peu plus précise, avec moins de questions en suspens. En revanche, la participation des patients aux décisions thérapeutiques reste moyenne ; certains sujets demeurent toujours moins abordés (sexualité, séquelles à long terme, projet d'avenir) ; et la documentation concernant l'établissement insuffisamment distribuée. Ces résultats n'expriment cependant que des tendances, et doivent être confirmés ou complétés par une étude à grande échelle d'ampleur nationale.The plan of announcement was described in 2005 in the recommendations of the INCA as part of the first Plan Cancer, and strengthened in the second Plan Cancer (2009 - 2013). Care facilities that support patients affected by cancer have to use it for a better management of the patients and a better organization within the teams. Our study bent over the contribution of this plan of announcement in the cancer ward of the hospital of Pau. We wanted to know if the satisfaction of the patients regarding their diagnostic announcement was improved there. For that purpose, we gave questionnaires to the patients of 18 years old and over, during a consultation within the four months following the first consultation (generally during the first chemotherapy), over a period from September 2008 to January 2009 ; and over a second period from March to August 2010. Between these two periods, the plan of announcement was set up in the service. Although the global satisfaction of the patients of this service was good before the implementation of the plan of announcement, this one seems to have improved some points according to certain patients. It allowed the access to a psychological and social support ; a structure of the management with the RCP and at the moment the PPS ; a more frequent advice to be acompanied during the consutation of announcement. Information gave to the patient ensues from it which seems a little more precise, with fever unresolved questions. On the other hand, the participation of the patients in the therapeutic decisions remains average ; certain subjects always remain less approached (sexuality, long-term after effects, project of future) ; and the documentation concerning the establishment insufficiently distributed. However, these results express however only tendencies, and must be confirmed or completed by a large-scale survey at a national level.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Impact of the COVID-19 lockdown in France on the diagnosis and staging of breast cancers in a tertiary cancer centre

OBJECTIVES: Due to COVID-19, a lockdown took place between March 17 and May 1, 2020, in France. This study evaluates the impact of the lockdown on the diagnosis and staging of breast cancers in a tertiary cancer centre. METHODS: Our database was searched for all consecutive invasive breast cancers diagnosed in our institution during the lockdown (36 working days), during equivalent periods of 36 working days before and after lockdown and a reference period in 2019. The number and staging of breast cancers diagnosed during and after lockdown were compared to the pre-lockdown and reference periods. Tumour maximum diameters were compared using the Mann-Whitney test. Proportions of tumour size categories (T), ipsilateral axillary lymph node invasion (N) and presence of distant metastasis (M) were compared using Fisher's exact test. RESULTS: Compared to the reference period (n = 40 in average), the number of breast cancers diagnosed during lockdown (n = 32) decreased by 20% but increased by 48% after the lockdown (n = 59). After the lockdown, comparatively to the reference period, breast cancers were more often symptomatic (86% vs 57%; p = 0.001) and demonstrated bigger tumour sizes (p = 0.0008), the rates of small tumours (T1) were reduced by 38%, locally advanced cancers (T3, T4) increased by 80% and lymph node invasion increased by 64%. CONCLUSION: The COVID-19 lockdown was associated with a 20% decrease in the number of diagnosed breast cancers. Because of delayed diagnosis, breast cancers detected after the lockdown had poorer prognosis with bigger tumour sizes and higher rates of node invasion. KEY POINTS: • The number of breast cancer diagnosed in a large tertiary cancer centre in France decreased by 20% during the first COVID-19 lockdown. • Because of delayed diagnosis, breast cancers demonstrated bigger tumour size and more frequent axillary lymph node invasion after the lockdown. • In case of a new lockdown, breast screening programme and follow-up examinations should not be suspended and patients with clinical symptoms should be encouraged to seek attention promptly

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

Analysis of the StoRM cohort reveals physical activity to be associated with survival in metastatic breast cancer

International audienceBenefits of physical activity are widely demonstrated for early stage cancers but few studies have focused on metastatic disease. The purpose of this study was to determine the impact of physical activity on survival in patients with metastatic breast cancer. We conducted a secondary analysis of the national, multicentric, non-randomized, prospective cohort SNPs to Risk of Metastasis (StoRM) study. The level of physical activity was self-reported at inclusion and divided into three categories of physical activity: light level, moderate level, and vigorous level. Overall, 833 patients (56.2%) completed the physical activity questionnaire at baseline on average physical activity during the previous year: 11.6% had a light level of physical activity, 69.0% achieved moderate levels of physical activity and 19.3% reported vigorous levels of physical activity. After adjustment for confounding, physical activity was not statistically significantly associated with overall survival in the whole population. Subgroup analysis identified that both vigorous and moderate physical activity were associated with statistically significantly improved overall survival compared to light physical activity level only in the HER2 positive subgroup (HR 0.23; 95% CI 0.07-0.70, p = 0.01 and HR 0.38; 95% CI 0.15-0.96, p = 0.04). Physical activity done during the previous year was associated with survival in HER2 positive metastatic breast cancer patients. These results suggest that overall survival in metastatic breast cancer patients could be improved through physical activity which should be considered as a complementary intervention for these individuals. The study showed that moderate/vigorous levels of physical activity were associated with better overall survival, and that these associations remained statistically significant in multivariate analysis in the HER2 positive subgroup. These results have clinical relevance and justify the recommendations for physical activity interventions in metastatic breast cancer