Environnement social des patientes et réinsertion professionnelle après un cancer du sein

Professional reintegration after breast cancer represents a real challenge for patients. It is often perceived as the last step towards normality (i.e. the last step to an apparent normality). Mechanisms of return to work are manifold and complex. They probably differ between men and women due to the specific evolution of women in the labour market and their position in the household. If clinical and professional factors of return to work after breast cancer are identified in the litterature, few studies have assessed other determinants such as household characteristics or change in the value of work after cancer diagnosis. Using CANTO, a large clinical prospective mulicentric cohort including patient diagnosed with stage I to III breast cancer), we studied, on the one hand, the effect of household characterististics on return to work two years after breast cancer diagnosis. On the other hand, we evaluated the change in the value of work after breast cancer by quantifying and identifying determinants of the shift toward private life between diagnosis and two years after breast cancer. In our first analyse (3,004 women), we highlighted some family situations associated with a decrease in return to work. We found that living with a partner was negatively associated with return to work after breast cancer and seemed to facilitate a decrease in working time for women returned to work. Among partnered women, lower return to work was observed among older married women (age >50) as well as among mothers of three or more economically dependent children with a low household income. Finally, the age of children could be a barrier (children under 7 years of age) sometimes but also a facilitator (children between 18 and 25 years of age). Then, the results of our second analysis (1,097 women) showed that among women who did not prioritize private life at diagnosis, almost one in two women had reordered their life priorities toward private life two years after breast cancer diagnosis. We identified several determinants of this shift toward private life: clinical (being diagnosed with stage III BC, reporting a decreased global health status), professional (perceiving one’s job as not very interesting, being an employee/clerk (vs. executive occupation), not perceiving support from the supervisor at diagnosis) and psychosocial (perceiving negative interferences of cancer in daily life, perceiving a positive impact from experiencing cancer, reporting no depressive symptoms). In addition to clinical determinants and to the important psychosocial changes induced by breast cancer, we idendified family situations and working conditions that were associated with a decrease in return to work after breast cancer. Living with a partner may allow a more gradual return to work. Personalised rehabilitation programs would avoid the double penalty with financial and social difficulties generated by non return to work after breast cancer.La réinsertion professionnelle après un cancer du sein constitue un véritable challenge pour les patientes. Elle est souvent considérée comme la dernière étape avant le retour à une certaine normalité proche de la vie antérieure au cancer. Les mécanismes du retour à l'emploi sont multiples et complexes. Ils semblent différer chez les femmes par rapport aux hommes de par l'évolution différente au sein du monde du travail et la différence de place au cœur de la cellule familiale. Si les facteurs cliniques et professionnels du retour à l'emploi après un cancer du sein sont souvent évoqués dans la littérature, peu d'études s'intéressent à d’autres déterminants comme l'environnement familial ou le changement de valeur attribuée au travail après un cancer du sein. Grâce à CANTO, une large étude de cohorte française multicentrique de patientes atteintes de cancer du sein de stade 1 à 3, nous avons étudié, tout d'abord, l'effet de l'environnement familial sur le retour au travail deux ans après un cancer du sein. D'autre part, nous avons quantifié le changement de priorité de vie vers la vie privée au détriment de la vie professionnelle des femmes deux ans après un diagnostic de cancer et identifié ses déterminants. Dans notre première analyse (3004 femmes incluses), nous avons mis en évidence des situations familiales associées à un moindre retour au travail. Être en couple est négativement associé au retour au travail et semble également faciliter le passage à temps partiel chez les femmes qui reprennent une activité professionnelle. Parmi, les femmes en couple, une diminution du retour au travail est retrouvée chez les femmes mariées de plus de 50 ans mais aussi chez les femmes cumulant au moins trois enfants à charge avec une faible position socioéconomique. Enfin, l'âge des enfants pourrait constituer tantôt une barrière (enfants en bas âge), tantôt un facilitateur (enfants entre 18 et 25 ans) au retour à l'emploi. Ensuite, les résultats de notre seconde analyse (1097 femmes incluses) montrent que parmi les femmes qui ne priorisaient pas leur vie privée au diagnostic, presque une femme sur deux a changé de priorité vers la vie privée deux ans après le diagnostic de cancer du sein. Les déterminants de ce changement de priorité de vie vers la vie privée semblaient être de plusieurs ordres : cliniques (un stade 3 de cancer du sein et un état de santé dégradé), professionnels (un travail perçu comme pas très intéressant, être employée, et ne pas percevoir de soutien de la part de son supérieur hiérarchique au diagnostic) et psychosociaux (rapporter des interférences négatives du cancer du sein sur sa vie quotidienne, rapporter un effet positif global du cancer sur sa vie et ne pas avoir de symptôme dépressif). Aux déterminants cliniques et aux bouleversements psychosociaux liés au cancer du sein viennent s'ajouter certaines situations familiales et difficultés dans l'environnement de travail qui peuvent impacter le processus de réinsertion professionnelle après un cancer du sein. Si être en couple pourraient finalement permettre un retour plus progressif des femmes au travail après un cancer du sein, une attention particulière doit être portée à certains profils de femme. Des interventions de réhabilitation personnalisée à chaque patiente permettraient d'éviter la double peine que constituent les difficultés financières et sociales engendrées par le non retour au travail après un cancer du sein

Social environment of patients and professional reintegration after breast cancer

La réinsertion professionnelle après un cancer du sein constitue un véritable challenge pour les patientes. Elle est souvent considérée comme la dernière étape avant le retour à une certaine normalité proche de la vie antérieure au cancer. Les mécanismes du retour à l'emploi sont multiples et complexes. Ils semblent différer chez les femmes par rapport aux hommes de par l'évolution différente au sein du monde du travail et la différence de place au cœur de la cellule familiale. Si les facteurs cliniques et professionnels du retour à l'emploi après un cancer du sein sont souvent évoqués dans la littérature, peu d'études s'intéressent à d’autres déterminants comme l'environnement familial ou le changement de valeur attribuée au travail après un cancer du sein. Grâce à CANTO, une large étude de cohorte française multicentrique de patientes atteintes de cancer du sein de stade 1 à 3, nous avons étudié, tout d'abord, l'effet de l'environnement familial sur le retour au travail deux ans après un cancer du sein. D'autre part, nous avons quantifié le changement de priorité de vie vers la vie privée au détriment de la vie professionnelle des femmes deux ans après un diagnostic de cancer et identifié ses déterminants. Dans notre première analyse (3004 femmes incluses), nous avons mis en évidence des situations familiales associées à un moindre retour au travail. Être en couple est négativement associé au retour au travail et semble également faciliter le passage à temps partiel chez les femmes qui reprennent une activité professionnelle. Parmi, les femmes en couple, une diminution du retour au travail est retrouvée chez les femmes mariées de plus de 50 ans mais aussi chez les femmes cumulant au moins trois enfants à charge avec une faible position socioéconomique. Enfin, l'âge des enfants pourrait constituer tantôt une barrière (enfants en bas âge), tantôt un facilitateur (enfants entre 18 et 25 ans) au retour à l'emploi. Ensuite, les résultats de notre seconde analyse (1097 femmes incluses) montrent que parmi les femmes qui ne priorisaient pas leur vie privée au diagnostic, presque une femme sur deux a changé de priorité vers la vie privée deux ans après le diagnostic de cancer du sein. Les déterminants de ce changement de priorité de vie vers la vie privée semblaient être de plusieurs ordres : cliniques (un stade 3 de cancer du sein et un état de santé dégradé), professionnels (un travail perçu comme pas très intéressant, être employée, et ne pas percevoir de soutien de la part de son supérieur hiérarchique au diagnostic) et psychosociaux (rapporter des interférences négatives du cancer du sein sur sa vie quotidienne, rapporter un effet positif global du cancer sur sa vie et ne pas avoir de symptôme dépressif). Aux déterminants cliniques et aux bouleversements psychosociaux liés au cancer du sein viennent s'ajouter certaines situations familiales et difficultés dans l'environnement de travail qui peuvent impacter le processus de réinsertion professionnelle après un cancer du sein. Si être en couple pourraient finalement permettre un retour plus progressif des femmes au travail après un cancer du sein, une attention particulière doit être portée à certains profils de femme. Des interventions de réhabilitation personnalisée à chaque patiente permettraient d'éviter la double peine que constituent les difficultés financières et sociales engendrées par le non retour au travail après un cancer du sein.Professional reintegration after breast cancer represents a real challenge for patients. It is often perceived as the last step towards normality (i.e. the last step to an apparent normality). Mechanisms of return to work are manifold and complex. They probably differ between men and women due to the specific evolution of women in the labour market and their position in the household. If clinical and professional factors of return to work after breast cancer are identified in the litterature, few studies have assessed other determinants such as household characteristics or change in the value of work after cancer diagnosis. Using CANTO, a large clinical prospective mulicentric cohort including patient diagnosed with stage I to III breast cancer), we studied, on the one hand, the effect of household characterististics on return to work two years after breast cancer diagnosis. On the other hand, we evaluated the change in the value of work after breast cancer by quantifying and identifying determinants of the shift toward private life between diagnosis and two years after breast cancer. In our first analyse (3,004 women), we highlighted some family situations associated with a decrease in return to work. We found that living with a partner was negatively associated with return to work after breast cancer and seemed to facilitate a decrease in working time for women returned to work. Among partnered women, lower return to work was observed among older married women (age >50) as well as among mothers of three or more economically dependent children with a low household income. Finally, the age of children could be a barrier (children under 7 years of age) sometimes but also a facilitator (children between 18 and 25 years of age). Then, the results of our second analysis (1,097 women) showed that among women who did not prioritize private life at diagnosis, almost one in two women had reordered their life priorities toward private life two years after breast cancer diagnosis. We identified several determinants of this shift toward private life: clinical (being diagnosed with stage III BC, reporting a decreased global health status), professional (perceiving one’s job as not very interesting, being an employee/clerk (vs. executive occupation), not perceiving support from the supervisor at diagnosis) and psychosocial (perceiving negative interferences of cancer in daily life, perceiving a positive impact from experiencing cancer, reporting no depressive symptoms). In addition to clinical determinants and to the important psychosocial changes induced by breast cancer, we idendified family situations and working conditions that were associated with a decrease in return to work after breast cancer. Living with a partner may allow a more gradual return to work. Personalised rehabilitation programs would avoid the double penalty with financial and social difficulties generated by non return to work after breast cancer

A Time-Based Analysis of Inflammation in Infants at Risk of Bronchopulmonary Dysplasia

Objective: To precisely delineate the timing and contribution of inflammation to bronchopulmonary dysplasia (BPD) in preterm infants during the neonatal period. Study Design: Longitudinal study of blood inflammatory biomarkers (IL-6, IL-8 and GCSF) measured between birth and 42 days of age, at high temporal (daily) resolution, in infants born at or below 30 weeks of gestation. Cytokine predictors of BPD at 36 weeks post-menstrual age were adjusted for infant-specific and time-dependent factors, using hierarchical mixed effects regressions models. Results: A total of 1518 data points were obtained in 62 infants (mean GA 27 weeks). Infants who developed BPD later on presented increased inflammation after birth compared to infants without BPD. Inflammation was sustained, with gradual attenuation over three weeks (IL-8: OR: 6.5 [95%CI: 1.8 – 24]; GCSF: 3.3 [1.5 – 7.6]) and was higher in boys and in infants of lower birth weight. This inflammation preceded the clinical increased requirement in supplemental oxygen characteristic of BPD, and preceded the peak occurrence of neonatal sepsis or necrotizing enterocolitis. Conclusion: Systemic inflammation occurs early in the neonatal period and precedes clinical symptoms in infants with BPD. These data provide a discrete vulnerability window period, supporting a role for targeted intensive care interventions during the early phase of BPD.Applied Science, Faculty ofMedicine, Faculty ofScience, Faculty ofNon UBCNursing, School ofPediatrics, Department ofStatistics, Department ofReviewedFacultyResearche

The Challenge of Return to Work after Breast Cancer: The Role of Family Situation, CANTO Cohort

International audienceReturn to work (RTW) after breast cancer is associated with improved quality of life. The link between household characteristics and RTW remains largely unknown. The aim of this study was to examine the effect of the family situation on women’s RTW two years after breast cancer. We used data of a French prospective cohort of women diagnosed with stage I-III, primary breast cancer (CANTO, NCT01993498). Among women employed at diagnosis and under 57 years old, we assessed the association between household characteristics (living with a partner, marital status, number and age of economically dependent children, support by the partner) and RTW. Logistic regression models were adjusted for age, household income, stage, comorbidities, treatments and their side effects. Analyzes stratified by age and household income were performed to assess the association between household characteristics and RTW in specific subgroups. Among the 3004 patients included, women living with a partner returned less to work (OR = 0.63 [0.47–0.86]) and decreased their working time after RTW. Among the 2305 women living with a partner, being married was associated with decreased RTW among women aged over 50 (OR = 0.57 [0.34–0.95]). Having three or more children (vs. none) was associated with lower RTW among women with low household income (OR = 0.28 [0.10–0.80]). Household characteristics should be considered in addition to clinical information to identify vulnerable women, reduce the social consequence of cancer and improve their quality of life

Perceived Discrimination at Work: examining social, health and work-related factors as determinants among breast cancer survivors. Evidence from the prospective CANTO cohort

International audienceBackground We assessed the prevalence of self-reported perceived discrimination in the workplace after the end of treatment among breast cancer (BC) survivors and studied its association with social, health-related and work-related factors. Methods We used data from a French prospective cohort (CANcer TOxicities) including women diagnosed with stage I–III BC. Our analysis included 2130 women who were employed, <57 years old at BC diagnosis and were working 2 years afterwards. We assessed the association between social, health-related and work-related factors and perceived discrimination in the workplace using logistic regression models. Results Overall, 26% of women reported perceived discrimination in the workplace after the end of treatment. Women working for a small company, in the public sector or with better overall health status were less likely to report perceived discrimination. Women who benefited from easing dispositions at their workplace, who did not feel supported by their colleagues and those who returned to work because of fear of job loss were more likely to report perceived discrimination. Conclusions One in four BC survivors perceives discrimination in the workplace. Health and work-related factors are associated with increased likelihood of reporting perceived discrimination. Trial registration number NCT01993498

Sustainable return to work among breast cancer survivors

Abstract Purpose This study assessed sustainable return to work (SRTW) of breast cancer survivors (BCS). Methods We used data from the prospective French cohort, CANTO. We included 1811 stage I–III BCS who were  50 (OR = 0.59; 95%CI = 0.43–0.82), stage III (2.56; 1.70–3.85), tumour subtype HR+/HER2+ (0.61; 0.39–0.95), severe fatigue (1.45; 1.06–1.98), workplace accommodations (1.63; 1.14–2.33) and life priorities (0.71; 0.53–0.95). Unemployment was associated with age > 50 (0.45; 0.29–0.72), working in the public sector (0.31; 0.19–0.51), for a small company (3.00; 1.74–5.20) and having a fixed‐term contract (7.50; 4.74–11.86). Conclusions A high number of BCS have periods of sick leave or unemployment after RTW. The determinants differ between sick leave and unemployment. Implications for cancer survivors BCS need to be supported even after RTW, which should be regarded as a process