La construction du couple chez les adolescents et jeunes adultes atteints de cancer

International audienceDeveloping one’s psycho-affective autonomy is one of the major challenges of the process that unfolds from adolescence, over a period that embraces young adulthood. Building a couple and trying out an emotional and sexual life are the cornerstones of this process. For young people with cancer, the difficulties in starting or maintaining a couple are increased by the physiological and psychosocial treatments damage. The notion of narcissistic contract is relevant to understanding what cancer imposes on the couple and on each of its members.Développer une autonomie psycho-affective est un des enjeux majeurs du processus qui se déploie à partir de l’adolescence, sur une période qui embrasse l’âge jeune adulte. Construire un couple, s’essayer à la vie affective et sexuelle, en est la pierre angulaire. Pour les jeunes atteints de cancer, les difficultés à débuter ou maintenir une vie de couple sont majorées par les atteintes physiologiques et psychosociales qu’induisent les traitements. La notion de contrat narcissique s’avère pertinente pour appréhender ce qu’impose le cancer au couple et à chacun de ses protagonistes

Être soignant à l’hôpital auprès d’adolescents atteints d’une maladie potentiellement mortelle : une clinique de l’extrême ?

À partir de propos tenus lors d’entretiens de recherche par des soignants travaillant dans une unité dédiée aux adolescents et jeunes adultes traités pour des leucémies aiguës, les auteurs montreront les processus psychiques que les soignants mettent en œuvre pour supporter, accompagner ces situations de soins et juguler ainsi l’extrême que cette clinique représenteThis research is based on interviews with carers working in a hospital ward for teenagers and young adults suffering from acute forms of leukaemia and it illustrates the mental processes at play in carers as they accompany patients through treatment, thereby containing the extreme nature of their clinical role

Consultations de suivi à long terme d’adultes guéris d’un cancer survenu dans l’enfance : vécus traumatiques et travail de narration. Récits dans l’après-coup de la maladie

International audienceAs part of the medical follow-up program for adult survivors of childhood cancer at the Institut Gustave Roussy (Villejuif, France), a psychological consultation is offered. This article is based on 198 interviews with patients between the ages of 18 and 67 who were diagnosed between the ages of 0 and 24. These meetings give voice to the subjectivity of cancer and recovery, revealing the traces of this experience aprèscoup . The issues at stake in the narrative activity initiated in the context of this consultation, and which may continue beyond, are approached from a metapsychological perspective.Dans le cadre du dispositif de suivi médical destiné aux adultes guéris d'un cancer pédiatrique à l'Institut Gustave-Roussy (Villejuif, France), un entretien psychologique est proposé. Cet article s'appuie sur 198 entretiens auprès de patients ayant entre 18 et 67 ans, diagnostiqués entre 0 et 24 ans. Ces rencontres donnent à entendre la subjectivité du vécu du cancer et de la guérison, révélant les traces de cette expérience dans l'après-coup. Les enjeux de l'activité narrative amorcée dans le cadre de cette consultation, et pouvant se poursuivre au-delà, sont abordés dans une perspective métapsychologique

Ethical and social implications of approaching death prediction in humans - when the biology of ageing meets existential issues

International audienceAbstract Background The discovery of biomarkers of ageing has led to the development of predictors of impending natural death and has paved the way for personalised estimation of the risk of death in the general population. This study intends to identify the ethical resources available to approach the idea of a long-lasting dying process and consider the perspective of death prediction. The reflection on human mortality is necessary but not sufficient to face this issue. Knowledge about death anticipation in clinical contexts allows for a better understanding of it. Still, the very notion of prediction and its implications must be clarified. This study outlines in a prospective way issues that call for further investigation in the various fields concerned: ethical, psychological, medical and social. Methods The study is based on an interdisciplinary approach, a combination of philosophy, clinical psychology, medicine, demography, biology and actuarial science. Results The present study proposes an understanding of death prediction based on its distinction with the relationship to human mortality and death anticipation, and on the analogy with the implications of genetic testing performed in pre-symptomatic stages of a disease. It leads to the identification of a multi-layered issue, including the individual and personal relationship to death prediction, the potential medical uses of biomarkers of ageing, the social and economic implications of the latter, especially in regard to the way longevity risk is perceived. Conclusions The present study work strives to propose a first sketch of what the implications of death prediction as such could be - from an individual, medical and social point of view. Both with anti-ageing medicine and the transhumanist quest for immortality, research on biomarkers of ageing brings back to the forefront crucial ethical matters: should we, as human beings, keep ignoring certain things, primarily the moment of our death, be it an estimation of it? If such knowledge was available, who should be informed about it and how such information should be given? Is it a knowledge that could be socially shared

Semen Cryopreservation in Adolescents and Young Adults with Hematologic Diseases: from Bed to Benchside

International audiencePurpose: Infertility in adolescents and young adult (AYA) survivors of malignant disease remains a major long-term adverse effect, but semen collection for fertility preservation in fertility centers is not always feasible and makes AYAs uncomfortable. We evaluated the feasibility of collecting sperm samples on the ward versus in fertility centers. Methods: Consecutive hospitalized AYA-aged male patients in the Hematology AYA unit (Saint-Louis Hospital, France) between August 2010 and June 2016 with hematological disease and indication of semen collection (n = 95) were included in this retrospective study. Semen quality was analyzed according to World Health Organization guidelines and was compared according to semen collection place: on the ward (n = 46) or in fertility center (n = 49). Results: The median age was median age 19.1 years (range: 13.7-33.3; interquartile range: 17.1-22.8) and 85 patients successfully collected semen. Sperm collection failure was ∼11% and was comparable between the two modalities as were main sperm quality characteristics (semen volume, sperm concentration, total sperm count, progressive motility and vitality, sperm morphology, and multiple anomalies index). Oligospermia was significantly higher in the samples obtained in fertility center (47.7%) than on the ward (26.8%), p = 0.047. Average frozen straws were comparable, 12.2 ± 6.4 on the ward versus 11.9 ± 6.3 in fertility center. Conclusion: Semen collection on the ward is feasible and would be particularly interesting for AYA male patients without altering semen quality characteristics