C. Aguerre

Impact des complications tardives de la radiothérapie, de la dépression et de l’anxiété sur la qualité de vie à long terme dans le cancer du sein

INTRODUCTION 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.

Validity of the French form of the Somatosensory Amplification Scale in a Non-Clinical Sample

The SomatoSensory Amplification Scale (SSAS) is a 10-item self-report instrument designed to assess the tendency to detect somatic and visceral sensations and experience them as unusually intense, toxic and alarming. This study examines the psychometric properties of a French version of the SSAS in a non-clinical population and, more specifically, explores its construct, convergent and discriminant validities. The SSAS was completed by 375 university students, together with measures of somatization propensity (SCL-90-R somatization subscale) and trait anxiety (STAI Y form). The results of principal component and confirmatory factor analyses suggest that the French version of the SSAS evaluates essentially a single, robust factor (Somatosensory amplification) and two kinds of somatic sensitivity (Exteroceptive sensitivity and Interoceptive sensitivity). Somatosensory amplification correlated with somatization tendency and anxiety propensity. These results encourage further investigations in French of the determinants and consequences of somatosensory amplification, and its use as a therapeutic strategy.

Psychological barriers and facilitators of colorectal cancer screening: a French qualitative study

The aim of this qualitative study was to explore the psychological barriers to and facilitators of undergoing the Hemoccult-II® colorectal cancer screening test in France. Sixty-nine French people aged 50 to 74 years were divided into seven qualitative focus groups. Three issues were discussed with participants: knowledge and beliefs about colorectal cancer screening; facilitators of colorectal cancer screening by Hemoccult-II®; barriers to colorectal cancer screening by Hemoccult-II®. All the discussions were led by two psychologists and were recorded, transcribed verbatim and analyzed using qualitative data analysis software. Correspondence factor analyses identified three dimensions for each topic. The main psychological facilitators of colorectal cancer screening were: information about colorectal cancer screening, perceived simplicity of using Hemoccult-II®, and perception of risk. Uncertainty about the reliability of Hemoccult-II®, health anxiety, and embarrassment emerged as the main barriers to colorectal cancer screening. Cross-sectional analyses identified the differences between the views expressed by women and men. Women appeared more embarrassed about Hemoccult-II® and men seemed to be more worried about colorectal cancer. This preliminary study suggests that psychological factors play an important role in colorectal cancer screening by Hemoccult-II®. This finding may help health organizations to conceive better awareness campaigns to promote colorectal cancer screening in order to reduce the related mortality rate by taking into account psychological determinants.

Major depressive disorder and associated factors in elderly patients with non-Hodgkin’s lymphoma

ABSTRACT Background: Data regarding elderly patients with cancer, more particularly with non-Hodgkin’s lymphomas (NHL), are scarce, as is our knowledge concerning to comorbid depression in this population. The purpose of this work was to explore the frequency of major depressive disorder (MDD) and related factors in a group of elderly patients with these forms of cancer. Method: 42 elderly NHL patients aged 70 years and older were interviewed using the Mini International Neuropsychiatric Interview screening tool. Psychological variables such as coping strategies, cognitive status and quality of relationships, as well as clinical and socio-demographic data were collected. Results: Fourteen patients (33.3%) met criteria for current MDD of which five had melancholy features (35.7%). Elderly patients with comorbid NHL-MDD had a significantly poorer self-perceived global health and performance status than those without MDD, as well as more fatigue and history of depression. No other clinical, psychological or socio-demographic variable appeared associated with MDD in this sample. Conclusion: Further studies are needed in order to confirm these early results concerning a potential high frequency of MDD among elderly NHL patients. Depressive mood should be early recognized in order to provide appropriate treatments and avoid a detrimental effect of depression on cancer prognosis.

[Specifications of motivational interviewing within a cognitive-behavioral therapy of chronic pain].

OBJECTIVES Cognitive and behavioral approach of chronic pain presents encouraging results by improving physical, functional and psychological states of chronic pain patients. This specific treatment is partially based on the acquisition of new adaptive strategies to help the patients to manage more effectively chronic pain and to improve subsequently their subjective well-being. This requires in parallel to give up noxious emotional, cognitive and behavioral attitudes towards pain. Now, we have to admit that numerous therapeutic failures are directly imputable to difficulties introducing and making the indispensable changes continue in pursuit of the fixed therapeutic objectives. Readiness to change could play a considerable role in the success or not of chronic pain treatment. The main objective of this article is to present the data of the current literature concerning the specificities of the process of change in the field of the chronic pain. METHODS We present a review of the literature describing at first, the psychological progress made by chronic pain patients longing to manage their suffering better via the trans-theoretical model of intentional change. Secondly, we develop the contributions of the technique of motivational interviewing in the improvement of chronic pain treatment. DISCUSSION The identification of the motivational profile of chronic pain patients will determine how motivational interviewing can be conducted to improve their readiness for change. There are several strategies used with chronic pain patients in pre-contemplative and contemplative stages. Therapists may facilitate the problem recognition (help chronic pain patients to become aware of and identify the nature of the difficulties they face when trying to cope with their physical suffering); increase the personal concern (empowering chronic pain patients so that they feel fully involved in what they offer and invest in the therapy); develop the intention of change (ensure that the change becomes truly intentional); cultivate optimism (to help chronic pain patients to consider the present situation as being less desperate than it seems); ask open-ended questions (the direct questioning can be used to specify a request or reveal ambivalence about change); present personal feedback (the therapist provides the patient with a maximum of information that may help to appreciate the true value of the effectiveness of their current management of pain); review consequences of change versus non-change (to review the plausible positive (pros) and negative (cons) consequences of change); and summarizing (to summarize the key points discussed during the interview). In the active stage, therapists may use other strategies like: developing a plan for change (to suggest the adoption of certain coping strategies with pain); providing information advice (provide information advice in order to help chronic pain patients to determine how they will take concrete steps to initiate change); and using a change plan worksheet (help chronic pain patients to develop a synthetic view of the change process they will undertake). CONCLUSION The various strategies discussed in this article are intended to accompany chronic pain patients to a process of change to help them consider a fundamental change in their ways of managing pain, when they are insufficient, ineffective and/or unintentionally aggravating their situation. It is important to help chronic pain patients to become aware of the nature of the adaptive problems they face, but also opportunities for change that are offered in order to encourage them to manage more efficiently and more autonomously their physical and mental suffering. In this context of openness to change, motivational interviewing can be an invaluable help to build a good therapeutic alliance in order to maximize the impact of supported global and multidimensional chronic pain by including a cognitive-behavioral approach for example.

Impact des complications tardives de la radiothérapie, de la dépression et de l’anxiété sur la qualité de vie à long terme dans le cancer du seinImpact of late treatment-related radiotherapy toxicity, depression, and anxiety on quality of life in long-term breast cancer survivors

INTRODUCTION 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.

TO66 Thérapie comportementale et cognitive de la fibromyalgie : étude pilote au centre d’évaluation et de traitement de la douleur Saint-Antoine – Paris

Rationnel Le traitement de la fibromyalgie necessite une approche multidisciplinaire proposee par la Therapie Comportementale et Cognitive (TCC). Objectifs Amelioration de la qualite de vie des patients souffrant de fibromyalgie par la TCC. Materiel et methode Etude ouverte, prospective, incluant 25 patients (80 % de femmes) d’âge moyen 49,2 ans souffrant de fibromyalgie. Le programme de TCC comprend 8 sessions hebdomadaires de 2 heures chacune, animees par un medecin et un psychologue, en groupe de 5 a 8 patients. La TCC comporte un travail d’education therapeutique, de reformulation cognitive, d’apprentissage des strategies de « coping », de reprise d’activites physiques, de gestion du stress, et de la relaxation. Resultats Les questionnaires EVA douleur, QIF (Questionnaire d’Impact de la Fibromyalgie) sont remplis par les patients (debut/fin programme). N = 25 patients (test de Student). Les resultats montrent une amelioration significative du score global du QIF (diminution de 28,41 %) et des autres items du QIF : diminution de 24,59 % de la douleur moyenne ressentie au cours des 7 derniers jours, diminution de 23,55 % de la fatigue matinale et de 21,18 % de la fatigue generale, augmentation de 29,22 % du nombre de jours de bien-etre, diminution de la tendance depressive de 28,30 %, amelioration de la raideur articulaire de 24,83 % et augmentation de la capacite fonctionnelle de 15,57 %. Diminution de l’EVA de 1,13 (p Discussion-Conclusion Cette etude pilote dont les resultats preliminaires sont encourageants, a permis de tester le programme et d’harmoniser le travail des differents intervenants. Notre objectif est de debuter fin 2007, un programme de recherche regional (PHRC), monocentrique, prospectif, randomise, controle, avec suivi pendant 12 mois.

Evaluation de la comprehension par le patient de l’information orale et/ou ecrite prealable a un examen radiologique invasif ou necessitant l’injection intraveineuse de produit de contraste iode

Objectifs Tenant compte de l’obligation morale et juridique d’information et de consentement des patients avant un examen radiologique, la SFR a elabore des fiches d’information. Le but de notre etude a ete de comparer la comprehension et la satisfaction du patient sur l’information prealable a un examen radiologique (vasculaire, tomodensitometrie avec injection intraveineuse) selon le type d’information delivree. Le deuxieme objectif etait d’evaluer la qualite du document ecrit diffuse par la SFR et son degre de comprehension et d’acceptation par le patient. Materiels et methodes Trois cents patients ont ete repartis aleatoirement en trois groupes selon la modalite d’information donnee (information habituellement donnee par le service demandeur ; remise, en sus, d’un document ecrit standardise redige par la SFR ; entretien oral la veille de l’examen). Il s’agissait d’une etude principalement qualitative (questionnaires psychologiques et entretiens semi-diriges). Resultats Vingt pour cent des patients ne desiraient aucune information (examen connu, âge, « ne veut pas savoir »). L’absence d’information a ete mal vecue. La fiche ecrite etait trop longue et complexe. Il existait des difficultes de lecture ou de langue. L’information orale avait l’avantage d’etre adaptee et permet de poser des questions. Dans tous les cas, les risques decrits etaient tres souvent oublies. Conclusion II est important de ne pas confondre information comprehensible et « couverture medico-legale ».