PLoS One

Compared to the general population, HIV-infected patients are at higher risk of developing non-AIDS-defining cancers. Chronic HCV infection has also been associated with a higher risk than that of the general population of developing cancers other than hepatocarcinoma. Evaluation of the impact of HCV-related factors on non-AIDS-defining and non HCV-liver (NANL) related cancers among HIV/HCV co-infected patients are scarce. The aim of this study was to identify the impact of HIV/HCV clinical characteristics on NANL related cancers in a large cohort of HIV/HCV-coinfected patients followed from 2005 to 2017. Cox proportional hazards models with delayed entry were used to estimate factors associated with NANL related cancer. Among 1391 patients followed for a median of 5 years, 60 patients developed NANL related cancers, yielding an incidence rate of 8.9 per 1000 person-years (95% CI, [6.6-11.1]). By final multivariable analysis, after adjustment for sex, tobacco or alcohol consumption, baseline CD4 cell count and HCV sustained viral response (SVR), age and a longer duration since HIV diagnosis were independently associated with a higher risk of NANL related cancer (aHR for each additional year 1.10, 95% CI 1.06-1.14, p<0.0001 and 1.06, 95% CI 1.01-1.11, p = 0.02, respectively). Duration of HCV infection, cirrhosis, HCV viral load, genotype and SVR were not associated with the occurrence of NANL related cancer. Among HIV/HCV-coinfected patients, age and the duration of HIV infection were the only characteristics found to be associated with the occurrence of NANL related cancer. In contrast, no association was observed with any HCV-related variables

Amélioration de la prise en charge des patients atteints de cancer de la tête et du cou

The management of cancer patients aims at ensuring the best treatment for the patient but also a better preservation of his quality of life. In this thesis work, we aimed to highlight how the implementation of patient-reported parameters such as quality of life into management could contribute to improve the management of head and neck cancer patients.Our first work, which aimed to study the impact of routine assessment of health related quality of life based on data from 200 patients who received radiotherapy as first-line treatment included in a randomized phase 3 trial, showed that assessing health related quality of life in daily clinical practice could lead to a clinically relevant improvement in quality of life and some dimensions of patient satisfaction with care. Then in our second work, based on the data of this randomized trial, we searched to demonstrate the predictive of the health related quality of life assessed before treatment on the occurrence of major toxicity. In this second work, our findings showed that the dimensions such as physical functioning, role functioning, social functioning and the symptomatic dimensions as dyspnea and loss of appetite were predictors of the occurrence of major toxicity.The findings of these different studies show the importance of health related quality of life as a parameter in the management of patients with head and neck cancer and its implementation in clinical practice could contribute to better management of these patientsLa prise charge des patients en cancérologie vise à la fois à garantir au patient le meilleur traitement mais aussi une meilleure préservation de sa qualité de vie. Dans ce travail de thèse, nous avons cherché à mettre en évidence comment l’intégration des paramètres reportés par les patients comme la qualité de vie, dans la prise en charge, pourraient contribuer à l’amélioration continue de la prise en charge des patients atteints de cancer de la tête et du cou.Notre premier travail qui avait pour objectif d’étudier l’impact de l’évaluation en routine de la qualité de vie à partir de données de 200 patients qui ont bénéficié de la radiothérapie en traitement de première intention inclus dans un essai randomisé de phase 3 a montré qu’évaluer la qualité de vie dans la pratique clinique quotidienne pourrait entrainer une amélioration cliniquement pertinente de la qualité de vie et de certaines dimensions de la satisfaction du patient à l’égard des soins.Ensuite dans notre second travail à partir des données de cet essai randomisé, nous avons recherché le rôle prédicteur de la qualité de vie évalué avant le traitement sur la survenue de toxicité majeure. Dans ce travail, nos résultats ont montré que les dimensions fonctionnement physique, fonctionnement activités de la vie courante, fonctionnement social et les dimensions symptomatiques dyspnée et perte d’appétit étaient des prédicteurs de la survenue de toxicité majeure.Les résultats de ces différents travaux montrent l’importance de la qualité de vie comme paramètre dans la prise en charge des patients atteints de cancer de la tête et du cou et son implémentation dans la pratique clinique pourrait permettre de contribuer à une meilleure prise en charge de ces patients

Amélioration de la prise en charge des patients atteints de cancer de la tête et du cou

The management of cancer patients aims at ensuring the best treatment for the patient but also a better preservation of his quality of life. In this thesis work, we aimed to highlight how the implementation of patient-reported parameters such as quality of life into management could contribute to improve the management of head and neck cancer patients.Our first work, which aimed to study the impact of routine assessment of health related quality of life based on data from 200 patients who received radiotherapy as first-line treatment included in a randomized phase 3 trial, showed that assessing health related quality of life in daily clinical practice could lead to a clinically relevant improvement in quality of life and some dimensions of patient satisfaction with care. Then in our second work, based on the data of this randomized trial, we searched to demonstrate the predictive of the health related quality of life assessed before treatment on the occurrence of major toxicity. In this second work, our findings showed that the dimensions such as physical functioning, role functioning, social functioning and the symptomatic dimensions as dyspnea and loss of appetite were predictors of the occurrence of major toxicity.The findings of these different studies show the importance of health related quality of life as a parameter in the management of patients with head and neck cancer and its implementation in clinical practice could contribute to better management of these patientsLa prise charge des patients en cancérologie vise à la fois à garantir au patient le meilleur traitement mais aussi une meilleure préservation de sa qualité de vie. Dans ce travail de thèse, nous avons cherché à mettre en évidence comment l’intégration des paramètres reportés par les patients comme la qualité de vie, dans la prise en charge, pourraient contribuer à l’amélioration continue de la prise en charge des patients atteints de cancer de la tête et du cou.Notre premier travail qui avait pour objectif d’étudier l’impact de l’évaluation en routine de la qualité de vie à partir de données de 200 patients qui ont bénéficié de la radiothérapie en traitement de première intention inclus dans un essai randomisé de phase 3 a montré qu’évaluer la qualité de vie dans la pratique clinique quotidienne pourrait entrainer une amélioration cliniquement pertinente de la qualité de vie et de certaines dimensions de la satisfaction du patient à l’égard des soins.Ensuite dans notre second travail à partir des données de cet essai randomisé, nous avons recherché le rôle prédicteur de la qualité de vie évalué avant le traitement sur la survenue de toxicité majeure. Dans ce travail, nos résultats ont montré que les dimensions fonctionnement physique, fonctionnement activités de la vie courante, fonctionnement social et les dimensions symptomatiques dyspnée et perte d’appétit étaient des prédicteurs de la survenue de toxicité majeure.Les résultats de ces différents travaux montrent l’importance de la qualité de vie comme paramètre dans la prise en charge des patients atteints de cancer de la tête et du cou et son implémentation dans la pratique clinique pourrait permettre de contribuer à une meilleure prise en charge de ces patients

Improving management of patients with head and neck cancer

La prise charge des patients en cancérologie vise à la fois à garantir au patient le meilleur traitement mais aussi une meilleure préservation de sa qualité de vie. Dans ce travail de thèse, nous avons cherché à mettre en évidence comment l’intégration des paramètres reportés par les patients comme la qualité de vie, dans la prise en charge, pourraient contribuer à l’amélioration continue de la prise en charge des patients atteints de cancer de la tête et du cou.Notre premier travail qui avait pour objectif d’étudier l’impact de l’évaluation en routine de la qualité de vie à partir de données de 200 patients qui ont bénéficié de la radiothérapie en traitement de première intention inclus dans un essai randomisé de phase 3 a montré qu’évaluer la qualité de vie dans la pratique clinique quotidienne pourrait entrainer une amélioration cliniquement pertinente de la qualité de vie et de certaines dimensions de la satisfaction du patient à l’égard des soins.Ensuite dans notre second travail à partir des données de cet essai randomisé, nous avons recherché le rôle prédicteur de la qualité de vie évalué avant le traitement sur la survenue de toxicité majeure. Dans ce travail, nos résultats ont montré que les dimensions fonctionnement physique, fonctionnement activités de la vie courante, fonctionnement social et les dimensions symptomatiques dyspnée et perte d’appétit étaient des prédicteurs de la survenue de toxicité majeure.Les résultats de ces différents travaux montrent l’importance de la qualité de vie comme paramètre dans la prise en charge des patients atteints de cancer de la tête et du cou et son implémentation dans la pratique clinique pourrait permettre de contribuer à une meilleure prise en charge de ces patients.The management of cancer patients aims at ensuring the best treatment for the patient but also a better preservation of his quality of life. In this thesis work, we aimed to highlight how the implementation of patient-reported parameters such as quality of life into management could contribute to improve the management of head and neck cancer patients.Our first work, which aimed to study the impact of routine assessment of health related quality of life based on data from 200 patients who received radiotherapy as first-line treatment included in a randomized phase 3 trial, showed that assessing health related quality of life in daily clinical practice could lead to a clinically relevant improvement in quality of life and some dimensions of patient satisfaction with care. Then in our second work, based on the data of this randomized trial, we searched to demonstrate the predictive of the health related quality of life assessed before treatment on the occurrence of major toxicity. In this second work, our findings showed that the dimensions such as physical functioning, role functioning, social functioning and the symptomatic dimensions as dyspnea and loss of appetite were predictors of the occurrence of major toxicity.The findings of these different studies show the importance of health related quality of life as a parameter in the management of patients with head and neck cancer and its implementation in clinical practice could contribute to better management of these patient

Long term gynaecological cancer survivors in Cote d'Or: health-related quality of life, social and professional reinsertion

IF 2,392 (2017)International audienc

Long‐Term Gynecological Cancer Survivors in Côte d'Or: Health‐Related Quality of Life and Living Conditions

International audienceBACKGROUND:The likelihood that health-related quality of life (HRQoL) could depend on factors other than clinical data increases with the duration of follow-up since diagnosis. The aim of this study was to identify determinants of long-term HRQoL in women with cervical, endometrial, and ovarian cancer. Secondary objectives were to describe their living conditions (sexual function, psychological distress, social and professional reinsertion).MATERIALS AND METHODS:In a cross-sectional survey, women diagnosed with cervical, endometrial, and ovarian cancers from 2006 to 2013 were selected through the French gynecological cancers registry of Côte d'Or. Validated questionnaires exploring HRQoL (short-form health survey; SF-12), anxiety and depression (Hospital Anxiety and Depression Scale), social support (Sarason's Social Support Questionnaire), sexual function (Female Sexual Function Index), and living conditions (EPICES questionnaire) were used to assess HRQoL and its determinants. Social and professional reinsertion were also investigated using study-specific questionnaires. Determinants of HRQoL were identified using a multivariable mixed-regression model for each composite score of the SF-12.RESULTS:In total, 195 gynecological cancer survivors participated in the survey. HRQoL was deteriorated for almost all the SF-12 dimensions. The main determinants of poor HRQoL were comorbidities, deprivation, lack of availability and satisfaction with social support, and psychological outcomes. Thirty-four percent of survivors of gynecological cancer reported a negative impact of cancer on their work, and 73% reported an impaired ability to work after treatment.CONCLUSIONS:Long-term HRQoL of survivors of gynecological cancer is not impacted by stage of disease. Specific interventions should focus on issues that promote social and professional reintegration and improve HRQoL.IMPLICATIONS FOR PRACTICE:This study shows that women with gynecological cancer have problems related to work and sexual dysfunction, even 5 years after diagnosis. The results of this study will help improve clinicians' awareness of the factors affecting the lives of gynecological cancer survivors, even long after diagnosis and treatment. They will also highlight for clinicians the areas that are of importance to gynecological cancer survivors, making it possible to guide management of these patients with a view to preventing deteriorated health-related quality of life after treatment. For the health authorities, the results of this study underline that more than 5 years after gynecological cancer, the initial stage of disease no longer affects quality of life, but there is a clear need for actions targeting socio-professional reintegration of survivors.© AlphaMed Press 2018

Long term gynaecological cancer survivors in Cote d'Or: health-related quality of life, social and professional reinsertion

IF 2,392 (2017)International audienc

Randomized Trial Assessing the Impact of Routine Assessment of Health-Related Quality of Life in Patients with Head and Neck Cancer

The impact of routine assessment of health-related quality of life (HRQoL) on satisfaction with care and the HRQoL of patients with head and neck cancer (HNC) treated with radiotherapy was assessed. Patients with HNC were randomly assigned to two arms, with stratification on sex, cancer localization, and stage of the disease. In the intervention arm, the patients completed the EORTC QLQ-C30 and EORTC QLQ-H&amp;N35 questionnaires first before randomization, then before each medical appointment during radiotherapy (7 weeks), and then every 3 months until 1 year and at 2 years thereafter. In the control arm, the EORTC QLQ-C30 and EORTC QLQ-H&amp;N35 questionnaires were completed before randomization and at 1 year and 2 years thereafter. The primary endpoint was mean change in HRQoL at score at 2 years from baseline assessed by EQ VAS from the EuroQol questionnaire. The secondary endpoint was mean change in satisfaction with care at 2 years from baseline assessed by QLQ-SAT32. Two hundred patients with head and neck cancers were involved in this study (mean age, 58.83 years (range, 36.56–87.89)), of whom 100 were assigned to the intervention arm and 100 to the control arm. Patients in the intervention arm were reported to have a statistically significant increase in EQ VAS at 2 years (p &lt; 0.0001) and exceeded the minimal clinically important difference (mean change at 2 years from baseline = 10.46). In the two arms, mean differences between arms were not statistically significant, but minimal clinically important differences in favor of the intervention arm were found for EQ VAS (mean change difference (MD) = 5.84), satisfaction with care, in particular waiting times (MD = 10.85) and satisfaction with accessibility (MD = 6.52). Routine assessment of HRQoL improves HRQoL and satisfaction with care for patients with HNC treated with radiotherapy

COVID-19 epidemiological, sociological and anthropological investigation: study protocol for a multidisciplinary mixed methods research in Burkina Faso

International audienceBackground: The world has high hopes of vaccination against COVID-19 to protect the population, boost economies and return to normal life. Vaccination programmes are being rolled out in high income countries, but the pandemic continues to progress in many low-and middle-income countries (LMICs) despite implementation of strict hygiene measures. We aim to present a comprehensive research protocol that will generate epidemiological, sociological and anthropological data about the COVID-19 epidemic in Burkina Faso, a landlocked country in West Africa with scarce resources. Methods: We will perform a multidisciplinary research using mixed methods in the two main cities in Burkina Faso (Ouagadougou and Bobo-Dioulasso). Data will be collected in the general population and in COVID-19 patients, caregivers and health care professionals in reference care centers: (i) to determine cumulative incidence of SARS-CoV-2 infection in the Burkinabe population using blood samples collected from randomly selected households according to the WHO-recommended protocol; (ii) develop a score to predict severe complications of COVID-19 in persons infected with SARS-CoV-2 using retrospective and prospective data; (iii) perform semi-structured interviews and direct observation on site, to describe and analyze the healthcare pathways and experiences of patients with COVID-19 attending reference care centers, and to identify the perceptions, acceptability and application of preventive strategies among the population. Discussion: This study will generate comprehensive data that will contribute to improving COVID-19 response strategies in Burkina Faso. The lessons learned from the management of this epidemic may serve as examples to the country authorities to better design preventive strategies in the case of future epidemics or pandemics. The protocol was approved by the Ministry for Health (N° 2020-00952/MS/CAB/INSP/CM) and the Health Research Ethics Committee in Burkina Faso (N° 2020-8-140)

Recherche sur la fin de vie, la nécessité d’un consensus : premiers résultats

International audienc