Systematic Screening for Occupational Exposures in Lung Cancer Patients: A Prospective French Cohort

Occupational lung cancers are under-reported and under-compensated worldwide. We assessed systematic screening for occupational exposure to carcinogens combining a self-administered questionnaire and an occupational consultation to improve the detection of occupational lung cancers and their compensation. Social deprivation and the costs of this investigation were estimated. Patients with lung cancer received a self-administered questionnaire to collect their job history, potential exposure to carcinogens and deprivation. A physician assessed the questionnaire and recommended an occupational consultation if necessary. During the consultation, a physician assessed if the lung cancer was work-related and, if it was, delivered a medical certificate to claim for compensation. Over 18 months, 440 patients received the self-administered questionnaire: 234 returned a completed questionnaire and a consultation was required for 120 patients. Compensation was judged possible for 41 patients. Among the 35 medical certificates delivered, 19 patients received compensation. Nearly half the patients (46%) were assessed as socially deprived and these patients took significantly longer to return the questionnaire compared with those who were not deprived. The mean cost of the process was €62.65 per patient. Our results showed a systematic self-administered questionnaire can be used to identify patients potentially exposed to carcinogens and to improve compensation

Expositions professionnelles et cancer du poumon : démarche de repérage systématique des expositions professionnelles pour améliorer la reconnaissance en maladie professionnelle, association avec la survie

About 15% of lung cancers are attributable to occupational exposures. Yet, occupational cancers remain largely under-reported and under-recognized. The aim of this thesis was to implement and evaluate a systematic screening of occupational exposures as well as its reproducibility and to assess the association between occupational exposure to asbestos and survival in lung cancer patients. The PROPOUMON study validated a self-administered questionnaire for the detection of occupational exposures and confirmed the feasibility of the screening process, with an average cost of 62 euros/patient. The study confirmed the frequency of lung cancers attributable to occupational exposures (18%). The ancillary study highlighted the role that the oncologist could play in the patient's adherence to the process. The national PROPOUMON study confirmed the reproducibility of the process in other hospitals and its efficiency in detecting occupational exposures. Our data suggested an impact of occupational asbestos exposure on survival, although the results were not significant. This thesis work assessed a process for systematically screening lung cancer patients for occupational exposures that could be integrated into the care pathway. Further work is needed to increase patients’ adherence to the process. A consideration of its funding is important to maintain its sustainability. The potential role of occupational exposures on cancer prognosis strengthens the need for a systematic screening.Environ 15% des cancers du poumon seraient attribuables aux expositions professionnelles. Cependant, ces cancers d’origine professionnelle restent largement sous-déclarés et sous-reconnus. Ce travail de thèse avait pour objectif de mettre en place et d’évaluer une démarche de repérage systématique des expositions professionnelles ainsi que sa reproductibilité et d’évaluer l’association entre l’exposition professionnelle à l’amiante et la survie chez les patients atteints d’un cancer du poumon. L’étude PROPOUMON a permis de valider un auto-questionnaire de repérage des expositions professionnelles et de confirmer la faisabilité de la démarche de repérage, dont le coût moyen est de 62 euros/patient. L’étude a confirmé la fréquence des cancers du poumon liés aux expositions professionnelles (18%). L’étude ancillaire a montré le rôle que pourrait jouer l’oncologue dans l’adhésion du patient à la démarche. L’étude PROPOUMON national a confirmé la reproductibilité du dispositif dans d’autres hôpitaux et son efficacité pour repérer les expositions professionnelles. Nos données suggèrent un effet de l’exposition professionnelle à l’amiante sur la survie bien que les résultats ne soient pas significatifs. Ce travail a évalué un dispositif de repérage systématique des expositions professionnelles chez les patients avec un cancer du poumon, qui pourrait être intégré dans le parcours de soins. Des travaux devront être menés pour renforcer l’adhésion au dispositif. Une réflexion sur son financement est importante pour le pérenniser. Le rôle potentiel des expositions professionnelles sur le pronostic des cancers renforce la nécessité d’un repérage systématique

Systematic Screening for Occupational Exposures in Lung Cancer Patients: A Prospective French Cohort

Occupational lung cancers are under-reported and under-compensated worldwide. We assessed systematic screening for occupational exposure to carcinogens combining a self-administered questionnaire and an occupational consultation to improve the detection of occupational lung cancers and their compensation. Social deprivation and the costs of this investigation were estimated. Patients with lung cancer received a self-administered questionnaire to collect their job history, potential exposure to carcinogens and deprivation. A physician assessed the questionnaire and recommended an occupational consultation if necessary. During the consultation, a physician assessed if the lung cancer was work-related and, if it was, delivered a medical certificate to claim for compensation. Over 18 months, 440 patients received the self-administered questionnaire: 234 returned a completed questionnaire and a consultation was required for 120 patients. Compensation was judged possible for 41 patients. Among the 35 medical certificates delivered, 19 patients received compensation. Nearly half the patients (46%) were assessed as socially deprived and these patients took significantly longer to return the questionnaire compared with those who were not deprived. The mean cost of the process was €62.65 per patient. Our results showed a systematic self-administered questionnaire can be used to identify patients potentially exposed to carcinogens and to improve compensation

Development of a software based on automatic multi-temporal aerial images classification to assess retrospective environmental exposures to pesticides in epidemiological studies

National audienceEnvironmental exposure to agricultural pesticides (EEAP) resulting from the drift of agricultural pesticides applied on fields and is suspected to be a risk factor for several diseases. Geographic Information Systems (GIS) are increasingly used in environmental epidemiological studies to assess EEAP. Crop acreage proximate to subjects residences has been suggested as a surrogate for EEAP. Retrospective characterization of EEAP is essential due to long latency. Earlier data are lacking and limitting the capacity to capture the life-course effects of exposure. We aimed to develop an innovative software to analyze the historical monochromatic aerial images to reconstruct land use to characterize EEAP retrospectively

Design and methods of a national, multicenter, randomized and controlled trial to assess the efficacy of a physical activity program to improve health-related quality of life and reduce fatigue in women with metastatic breast cancer: ABLE02 trial

International audienceAbstract Background Patients with a metastatic breast cancer suffer from a deteriorated health-related quality of life and numerous symptoms such as pain, severe fatigue and a decrease of their physical fitness. As the feasibility of a physical activity program has been demonstrated in this population, ABLE02 aims to assess the efficacy of a 6 month-physical activity program using connected devices to improve health-related quality of life and to reduce fatigue in women with metastatic breast cancer. Methods ABLE02 is a prospective, national, multicenter, randomized, controlled and open-label study. A total of 244 patients with a metastatic breast cancer, with at least one positive hormone receptor and a first-line chemotherapy planned, will be randomly assigned (1:1 ratio) to: (i) the intervention arm to receive physical activity recommendations, an activity tracker to wear 24 h a day during the whole intervention (6 months) with at least three weekly walking sessions and quizzes each week on physical activity and nutrition (ii) the control arm to receive physical activity recommendations only. Health-related quality of life will be assessed every 6 weeks and main assessments will be conducted at baseline, M3, M6, M12 and M18 to evaluate the clinical, physical, biological and psychological parameters and survival of participants. All questionnaires will be completed on a dedicated application. Discussion An activity program based on a smartphone application linked to an activity tracker may help to improve quality of life and reduce fatigue of patients with a metastatic breast cancer. The growth of e-health offers the opportunity to get real-time data as well as improving patient empowerment in order to change long-term behaviors. Trial registration NCT number: NCT04354233

Effect of acute aerobic exercise before immunotherapy and chemotherapy infusion in patients with metastatic non-small-cell lung cancer: protocol for the ERICA feasibility trial

International audienceIntroduction Patients with metastatic non-small cell lung cancer (mNSCLC) suffer from numerous symptoms linked to disease and treatment which may further impair the patient’s overall condition. In addition to its benefits on quality of life and fatigue, physical exercise may improve treatment response, notably due to its known effects on the immune system. The ERICA study is designed to assess the feasibility of a supervised acute physical exercise therapy realised immediately prior immune-chemotherapy infusion in patients with mNSCLC. Secondary objectives will examine the effects of acute exercise combined with an unsupervised home-walking programme on clinical, physical, psychosocial and biological parameters. Methods and analysis ERICA is a prospective, monocentric, randomised controlled, open-label feasibility study conducted at the Centre Léon Bérard Comprehensive Cancer Center (France). Thirty patients newly diagnosed with mNSCLC will be randomised (2:1 ratio) to the ‘exercise’ or the ‘control’ group. At baseline and during the last treatment cycle, participants in both groups will receive Physical Activity recommendations, and two nutritional assessments. In the exercise group, participants will receive a 3-month programme consisting of a supervised acute physical exercise session prior to immune-chemotherapy infusion, and an unsupervised home-based walking programme with an activity tracker. The acute exercise consists of 35 min interval training at submaximal intensity scheduled to terminate 15 min prior to infusion. Clinical, physical, biological and psychosocial parameters will be assessed at baseline, 3 and 6 months after inclusion. Biological measures will include immune, inflammatory, metabolic, oxidative stress biomarkers and molecular profiling. Ethics and dissemination The study protocol was approved by the French ethics committee (Comité de protection des personnes Ile de France II, N°ID-RCB 20.09.04.65226, 8 December 2020). The study is registered on ClinicalTrials.gov (NCT number: NCT04676009 ) and is at the pre-results stage. All participants will sign an informed consent form. The findings will be disseminated in peer-reviewed journals and academic conferences

Évaluation d’un auto-questionnaire de repérage des expositions professionnelles chez les patients atteints de cancer bronchopulmonaire

International audienceTen to 29% of lung cancers might be linked to occupational factors but 60% of them are not compensated. The PROPOUMON project aimed to improve the identification, recognition and compensation of occupational lung cancer as occupational disease using a self-administered questionnaire (AQREP). One objective was to assess the AQREP, comparing it with the questionnaire drawn up by the French Language Pneumology Society (Q-SPLF). From March 2014 to September 2015, 90 lung cancer patients treated at the Centre Léon-Bérard responded to the AQREP and Q-SPLF. The two physicians in charge of the consultation assessed independently whether or not a consultation was indicated. A certificate for the compensation process was proposed when a suspicion of high or average imputability was identified. Analysis of the questionnaires was concordant for 73% of the patients. The AQREP has a sensitivity of 72% and a specificity of 73%. Its positive and negative predictive values were 62 and 82%. The information provided by 24 patients were discordant between questionnaires. In two patients with discordant evaluation (AQREP+/Q-SPLF-; AQREP-/Q-SPLF+), one Initial Medical Certificate (IMC) was written. This study made it possible to conclude that AQREP is relevant for the identification of potentially occupational lung cancers. Collegial discussion of complex cases might be considered. The project is currently been extended to other centers and to lymphoma.Dix à 29 % des cancers bronchopulmonaires seraient d’origine professionnelle dont 60 % ne seraient pas indemnisés. Le projet Propoumon vise à améliorer le repérage, la reconnaissance et l’indemnisation des cancers bronchopulmonaires d’origine professionnelle en maladie professionnelle à partir d’un auto-questionnaire (AQREP). Un des objectifs était d’évaluer sa capacité à détecter les patients pouvant bénéficier d’une consultation « cancers professionnels », en le comparant avec le questionnaire de la Société de pneumologie de langue française (Q-SPLF). De mars 2014 à septembre 2015, 90 patients suivis au centre Léon-Bérard pour un cancer bronchopulmonaire ont répondu aux deux questionnaires. Les deux médecins responsables de la consultation évaluaient de façon indépendante, sur la base de l’AQREP ou du Q-SPLF, l’indication d’une consultation. Si à l’issue de la consultation des arguments en faveur d’une origine professionnelle étaient réunis, une démarche de déclaration était proposée. L’analyse des questionnaires par les médecins était concordante à 73 %. L’AQREP a une sensibilité de 72 % et une spécificité de 73 %. Ses valeurs prédictives positive et négative sont de 62 et 82 %. Les informations renseignées par 24 patients étaient discordantes entre les questionnaires. Pour deux patients ayant une évaluation discordante (AQREP+/Q-SPLF- ; AQREP-/Q-SPLF+), un « Certificat médical initial » a été rédigé. Le premier a été refusé par l’Assurance maladie, le second est en cours d’instruction. Cette étude a permis de conclure en la capacité de l’AQREP à repérer les cancers bronchopulmonaires potentiellement d’origine professionnelle. Une réunion de concertation pour discuter des cas complexes pourrait être envisagée. Le projet s’élargit actuellement à d’autres centres et aux lymphomes

Diverging incidence trends of oral tongue cancer compared to other head and neck cancers in young adults in France

International audienceAbstract While head and neck cancer incidence decreased worldwide due to reduced tobacco and alcohol consumption, oral tongue cancer (OTC) incidence has been reported to be increasing in several countries. Our study examines the incidence trends of OTC in France from 1990 to 2018, globally and by age; and compares the incidence trends with the evolution of the incidence of other human papilloma virus‐unrelated head and neck squamous cell carcinoma, that is, cancers of the remaining subsites of the oral cavity (RSOCC) and laryngeal cancers for the period 1990 to 2018. World age‐standardized incidence rates of oral tongue cancers ( C02 ), cancers of the remaining subsites of the oral cavity (RSOCC, C03‐06 ) and laryngeal cancers ( C32 ) were estimated using the French National Network of Cancer Registries for the period 1990 to 2018. Trends in national incidence rates were estimated from a mixed‐effect Poisson model including age and year effects using penalized splines and a district‐random effect. In women aged 30 and 40, a significant increase in OTC incidence was observed, while ROSCC showed a nonsignificant incidence decrease. In young men aged 25, a marginally significant increase of OTC incidence years was observed, while incidence rates of RSOCC significantly declined. The results suggest a tendency towards diverging incidence trends for OTC compared to RSOCC and laryngeal cancer in young adults. The observed trends may reflect changes in underlying exposures or emerging exposures not yet identified, and stress the need to further investigate the etiology of oral tongue cancers

A Personalized Physical Activity Program With Activity Trackers and a Mobile Phone App for Patients With Metastatic Breast Cancer: Protocol for a Single-Arm Feasibility Trial

International audienc

Feasibility and health benefits of an individualized physical activity intervention in women with metastatic breast cancer: results of the ABLE single-arm Trial study

International audienc