Depression is associated with some patient-perceived cosmetic changes, but not with radiotherapy-induced late toxicity, in long-term breast cancer survivors.: Depression-associated factors in long-term breast cancer survivors

International audienceOBJECTIVE: Although depression is prevalent in long-term breast cancer survivors (LTBCS; ≥5 years since diagnosis), it is underdiagnosed and undertreated. A better understanding of factors associated with depression could improve depression screening, treatment, and prevention in this population. Our study aimed to assess the link between patient and doctor ratings of breast cosmetic outcomes, late radiotherapy toxicity, and depression in LTBCS. METHODS: In all, 214 patients recruited from the ARCOSEIN study were assessed for late radiotherapy toxicity (by using the LENT-SOMA scale) and patient and doctor ratings of breast cosmetic outcomes (mean = 6.7 years since the end of treatment). We reassessed 120 of these patients for depression (HAD) during a second wave of long-term assessment (mean = 8.1 years since the end of treatment). We used univariate analyses and polytomous logistic regression analyses to predict the HAD depression, which was defined as follows: normal, 0-7 points; and significant depression, ≥8 points (8-10 points, possible depression; ≥11 points, probable depression). RESULTS: The mean HAD depression score was 4.5 ± 3.6. 19. 2% of our population had significant depression, 6.7% with probable depression, and 12.5% with possible depression. Significant depression was not associated with late radiotherapy toxicity or initial cancer-related variables. Patients with probable depression reported worse cosmetic outcomes than nondepressed patients in terms of perceived breast largeness (p = 0.04), breast deformation (p = 0.02), and changes in skin pigmentation (p = 0.03). CONCLUSIONS: In LTBCS, depression seems to be more strongly associated with changes in some patients' perceived breast cosmetic outcome than late treatment toxicity or initial cancer-related variables. Copyright © 2012 John Wiley & Sons, Ltd

Contribution à l'analyse de l'homosexualité à l'île de La Réunion

Ce travail propose une lecture sociologique de l'homosexualité à La Réunion.Les méthodes de l'observation et de l'entretien permettent de dresser un premier état des lieux. En l'absence de constitution d'une véritable communauté, les résultats montrent comment se construisent des identités toujours menacées. Ils suggèrent aussi les différentes formes de compromis que les acteurs mettent en place pour concilier leur sexualité et une pression normative accentuée par l'insularité et la créolité.This study is a sociological approach to homosexuality in Réunion island. The observations and interview methods allow foran initial inventory of the context. Due to the lack of a real homosexual community, the results of this study demonstrate how threatened identities are building up. This results alsosuggest different forms of compromises the protagonist have recourse to in order to conciliate their sexuality and the normative pressure emphasised by insularity and creole identity.SAINT DENIS/REUNION-Droit Lettre (974112101) / SudocSudocFranceReunionFRR

Behaviour of ceria nanoparticles in standardized test media - influence on the results of ecotoxicological tests

International audienceThe main objectives of this work were to establish the behaviour of a ceria nanopowder in different ecotoxicological media commonly used in standardized aquatic ecotoxicity tests and consequently to assess the acute and chronic ecotoxicity in two microinvertebrates: Daphnia magna and Ceriodaphnia dubia and in a freshwater green algae: Pseudokirchneriella subcapitata. Different approaches to disperse the ceria nanoparticles (i.e. stirring, use of probe sonication, addition of humic acids) were tested and the influence on the biological endpoints was investigated. Despite the agglomeration phenomena observed in all the tested media, the results obtained indicated higher stability in the lower ionic strength media with addition of humic acid (2 mg.L-1, TOC). No acute toxicity were observed with D. magna, whatever the dispersal method performed and the nCeO2 concentration tested (up to 1000 mg.L-1), as no acute toxicity was recorded with C. dubia following exposure to the stirring suspensions. On contrary, acute toxicity was recorded in C. dubia with EC50 values comprise between 11.9 and 25.3 mg.L-1 using the probe sonicated suspension with or without humic acids addition. Significant chronic effect on the reproduction capability was also recorded in C. dubia. The estimated EC10 values were comprised between 2.1 and 2.9 mg.L-1. Focusing on P. subcapitata, despite the different agglomerate size recorded in the tested media at the end of the exposure periods, results obtained were similar. Adverse effect on algal growth around 5 mg.L-1 were reported (mean EC10 = 4 +- 1.8 mg.L-1). Those results suggested the needed for standardized testing protocol concerning the aqueous media used or the sample preparation for laboratory testing

: Prédicteurs de qualité de vie à long terme dans le cancer du sein

International audienceINTRODUCTION: This study aimed to assess the impact of late treatment toxicity (especially radiotherapy toxicity), chemoradiotherapy treatment type (concurrent or sequential), depression and anxiety on overall, physical and emotional quality of life (QoL) in long-term breast cancer survivors. Method. We assessed 117 patients (mean follow-up since the end of treatment = 8.1 years) for late radiotherapy toxicity (LENT-SOMA scale), patient and doctor ratings of breast cosmetic outcomes, QoL (EORTC QLQ-C30), depression and anxiety (Hospital and Anxiety Depression scale). RESULTS: In univariate analyses, factors associated with significantly decreased QoL were: use of sequential treatment and decreased overall QoL (P = 0.002) and emotional QoL (P = 0.02) ; few radiotherapy late toxicity symptoms (pain and decreased physical QoL, P = 0.01 ; fibrosis and decreased emotional QoL, P = 0.04) ; probable depression or probable anxiety and decreased overall, physical and emotional QoL (P ≤ 0.005). In multivariate analyses, probable depression and probable anxiety were the most stronger predictors for decreased QoL in the overall, physical and emotional domains (P ≤ 0.02). CONCLUSION: Improving screening for and treatment of depression and anxiety might improve QoL in long-term breast cancer survivors

Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conserving surgery enhances late toxicities: long-term results of the ARCOSEIN multicenter randomized study.

International audiencePURPOSE: In 1996, a multicenter randomized study was initiated that compared sequential vs. concurrent adjuvant chemotherapy (CT) with radiation therapy (RT) after breast-conserving surgery (ARCOSEIN study). After a median follow-up of 6.7 years (range, 4.3-9 years), we decided to prospectively evaluate the late effects of these 2 strategies. METHODS AND MATERIALS: A total of 297 patients from the 5 larger participating institutions were asked to report for a follow-up examination. Seventy-two percent (214 patients) were eligible for evaluation of late toxicity. After breast-conserving surgery, patients were treated either with sequential treatment with CT first followed by RT (Arm A) or CT administered concurrently with RT (Arm B). In all patients, CT regimen consisted of mitoxantrone (12 mg/m2), 5-FU (500 mg/m2), and cyclophosphamide (500 mg/m2), 6 cycles (Day 1 to Day 21). Conventional RT was delivered to the whole breast by administration of a 2 Gy per fraction protocol to a total dose of 50 Gy (+/- boost to the primary tumor bed). The assessment of toxicity was blinded to treatment and was graded by the radiation oncologist, according to the LENT/SOMA scale. Skin pigmentation was also evaluated according to a personal 5-points scoring system (excellent, good, moderate, poor, very poor). RESULTS: Among the 214 evaluable patients, 107 were treated in each arm. The 2 populations were homogeneous for patient, tumor, and treatment characteristics. Subcutaneous fibrosis (SF), telangectasia (T), skin pigmentation (SP), and breast atrophy (BA) were significantly increased in Arm B. No statistical difference was observed between the 2 arms of the study concerning Grade 2 or higher pain, breast edema, or lymphedema. No deaths were caused by late toxicity. CONCLUSION: After breast-conserving surgery, the concurrent use of CT with RT is significantly associated with an increase incidence of Grade 2 or greater late side effects