Cécile Flahault

Prevalence and associated factors of sexual problems after early-stage breast cancer treatment: results of a French exploratory survey.

Objective: The objective of this study was to assess the prevalence and associated factors of sexual activity, sexual problems or sexual satisfaction in French early‐stage breast cancer survivors (BCS).

Place of death of adolescents and young adults with cancer: first study in a French population.

OBJECTIVE To improve the palliative care and more effectively meet the needs of young patients and their families at the end of life, the authors investigated the place of death of adolescents and young adults treated in their institution and identified some of the factors influencing the choice of place of death. METHODS The parents and/or partners of adolescents and young adults (15 to 25 years old) who died at Institut Curie (cancer center) between 2000 and 2003 were contacted. Twenty-one families agreed to participate in the interview between October 2005 and April 2006. Analysis of the interviews comprised a descriptive part and a thematic part. RESULTS Nineteen out of 21 (90%) families declared that they did not really choose their childs place of death due to lack of time. However, all families said that they preferred the hospital. No family attended a bereavement group after their childs death and only 3 families (14%) consulted a mental health care professional. Thematic analysis showed that representations and beliefs concerning life and death at least partly determined the familys capacity to discuss the place of death with their child. SIGNIFICANCE OF RESULTS Although progress has been made over recent years in France, there is still considerable room for improvement of palliative care to more effectively meet the needs of young patients and their families at the end of life.

The effects of mindfulness training on weight-loss and health-related behaviours in adults with overweight and obesity: A systematic review and meta-analysis.

The aim of this study was to conduct a comprehensive quantitative synthesis of the effects of mindfulness training interventions on weight-loss and health behaviours in adults with overweight and obesity using meta-analytic techniques. Studies included in the analysis (k=12) were randomised controlled trials investigating the effects of any form of mindfulness training on weight loss, impulsive eating, binge eating, or physical activity participation in adults with overweight and obesity. Random effects meta-analysis revealed that mindfulness training had no significant effect on weight loss, but an overall negative effect on impulsive eating (d=-1.13) and binge eating (d=-.90), and a positive effect on physical activity levels (d=.42). Meta-regression analysis showed that methodological features of included studies accounted for 100% of statistical heterogeneity of the effects of mindfulness training on weight loss (R2=1,00). Among methodological features, the only significant predictor of weight loss was follow-up distance from post-intervention (β=1.18; p<.05), suggesting that the longer follow-up distances were associated with greater weight loss. Results suggest that mindfulness training has short-term benefits on health-related behaviours. Future studies should explore the effectiveness of mindfulness training on long-term post-intervention weight loss in adults with overweight and obesity.

Short-term psychological impact of the BRCA1/2 test result in women with breast cancer according to their perceived probability of genetic predisposition to cancer

Background:The effect of BRCA1/2 gene test result on anxiety, depression, cancer-related thought intrusion or avoidance and perceived control over cancer risk was assessed in breast cancer (BC) patients, according to their perceived probability of genetic predisposition to cancer.Methods:Two hundred and forty-three (89% response rate) women with BC completed questionnaires after an initial genetic counselling visit (T1), of which 180 (66%) completed questionnaires again after receiving the BRCA1/2 results (T2). The discrepancy between women’s perceived probability of cancer genetic predisposition at T1 and the geneticist’s computed estimates was assessed.Results:In all, 74% of women received a negative uninformative (NU), 11% a positive BRCA1/2 and 15% an unclassified variant (UV) result. On hierarchical regression analysis, in women with a positive BRCA1/2 result (vs NU or UV), a lower perceived probability of cancer genetic predisposition than objective estimates at T1 predicted lower levels of anxiety at T2 (β=−0.28; P<0.01), whereas in women receiving a UV result (vs NU or positive BRCA1/2), a lower perceived probability of cancer genetic predisposition than objective estimates at T1 predicted higher levels of anxiety (β=0.20; P<0.01), depression (β=0.19; P<0.05) and intrusion (β=0.18; P<0.05) at T2.Conclusion:The type of BRCA1/2 test result differently affects distress according to women’s perceived probability of genetic predisposition before testing.

Communication in genetic counselling for breast/ovarian cancer.

Cancer genetic counselling represents a very special situation of interaction between the geneticist and the counselee, marked by a number of specificities that account for its complexity. Cancer genetic counselling has multiple repercussions, such as identification of a deleterious genetic mutation associated with a high probability of developing breast and/or ovarian cancer, the implementation of preventive measures ranging from close surveillance to the decision to perform mutilating prophylactic surgical procedures, or the impact of the information on the other members of the counselees family also concerned by the genetic risk. This chapter is based on a review of the literature that has been rapidly growing over recent years and on our clinical expertise as psycho-oncologists and geneticists. We will first present the reasons that make the information so critical. These reasons are both objective (complexity of the genetic information per se, difficulties of understanding the concept of risk) and subjective (information given to people with an emotionally charged family history and a perception of risks closely linked to their representation of cancer). At the same time, the counsellees are charged with the transmission of this information to members of their own family. We will then discuss the various modalities of communication in this setting. While unidirectional transfer of information from the geneticist to the counselee has been the preferred method in cancer genetics for a long time, a model based on patient-centered communication is more adequate in predictive medicine and allows shared decision making. In all cases, the different professionals involved in the process have to learn how to work in a performing cohesion. We also present the main guidelines on the subject and the various underlying objectives with regard to information delivery and the subjects personal experience. Although the psychological impact of genetic counselling consultations raises a number of questions, the results of preliminary studies are reassuring, demonstrating psychological benefits. However, a number of aspects concerning communication in predictive medicine remain to be investigated and improved.

Describing and understanding depression in spouses of cancer patients in palliative phase

The cancer patients relatives and family constitute one of the patients main sources of support throughout the disease. In recent years, several studies have emphasized the psychological vulnerability of spouses‐caregivers with a high proportion suffering from anxiety and depression symptoms. The literature underlines several factors of detrimental outcomes but critical aspects of the spousal relationship as attachment were neglected.

How do researchers conceive of spousal grief after cancer? A systematic review of models used by researchers to study spousal grief in the cancer context.

Although spouses bereaved after cancer are considered vulnerable people, there have been few empirical studies to explore grief specifically in this context.

Qualité de vie et état psychologique de patients atteints d’un mélanome de la choroïde : étude longitudinale

UNLABELLED Treatments for choroidal melanoma (CM) generate largely unknown consequences on the level of the quality of life (QoL) and psychological state. Prospective published work is relatively rare and their results are not consistent. The objective of this study is to describe the QoL and psychological states evolution in patients treated by conservative treatment for CM. POPULATION Sixty-nine patients treated for CM by conservative treatment (proton beam irradiation or iodine plaques). QoL (EORTC-QLQ-C30 + QLQ-OPT-30), anxiety and depression (HADS, STAI-B-trait). DATA COLLECTION Prospective study comprising four evaluations T0: before the beginning of the treatment, T1: one month, T2: six month, T3: one year after the treatment. The preliminary results of the first two evaluations showed that the level of the QoL remained relatively good and stable with an exception for the social functioning, which decreased after the treatment. More than half of the patients had a moderated rate of anxiety before the beginning of the treatment, which decreased significantly a month later. The depressive symptoms were lower and remained stable one month after the treatment. These results confirmed the importance of exploration and screening the fear of cancer recurrence among choroidal melanoma patients.

A Cognitive and Virtual Reality Treatment Program for the Fear of Flying.

BACKGROUND Passenger air transport has considerably increased in the past 50 yr. It is estimated that between 7 and 40% of the population of industrialized countries is currently afraid of flying. Programs treating the fear of flying have been developed to meet this problem. This study measures the effectiveness of one of these programs by focusing on flight-related anxiety before the program and after the first flight following the intervention. METHODS There were 157 individuals recruited to participate in a 1-d intervention aiming at treating the fear of flying, and using both cognitive behavioral techniques and virtual reality. Anxiety was measured with the Flight Anxiety Situations (FAS) and the Flight Anxiety Modality (FAM) questionnaires. RESULTS Statistical analyses were conducted on 145 subjects (69.7% female; ages from 14 to 64) after the exclusion of individuals with missing data. The results showed a decrease in flight-related anxiety for each subscale of the two questionnaires: the somatic (d=2.44) and cognitive anxiety (d=1.47) subscales of the FAM, and the general flight anxiety (d=3.20), the anticipatory flight anxiety (d=1.74), and the in-flight anxiety (d=1.04) subscales of the FAS. CONCLUSIONS The effectiveness of the treatment program using both cognitive behavioral techniques and virtual reality strategies for fear of flying reduced flight-related anxiety in the subjects in our study. Our results show that subjects demonstrated lower anxiety levels after the first flight following the program than before the intervention.

Randomized controlled trial of a 12-month computerized mindfulness-based intervention for obese patients with binge eating disorder: The MindOb study protocol

BACKGROUND Mindfulness-based interventions for healthy behaviors such as exercise and dietary modifications have aroused growing interest. This study aims to test the effectiveness of a mindfulness-based intervention for the reduction of impulsive eating and the improvement of motivation to exercise among obese individuals. METHODS One-hundred and twenty obese outpatients, aged 18 to 65years, diagnosed with a binge eating disorder, will be randomly assigned to one of the three following groups: mindfulness practice, sham meditation, or treatment as usual control. The tested intervention consists of a 1-year computerized mindfulness-based program. Mindfulness sessions are audio recordings that the patients are asked to listen to, 10min every day. Self-reported questionnaires measuring impulsive eating, motivation to exercise, physical activity level, mood, and mindfulness skills are filled in at baseline, 1, 6, and 12months. Physical activity, calories consumption, and biomarkers are measured with more objective measurement tools at baseline, 6months and 12months. CONCLUSION Mindfulness, as both a de-automation element and as a moderator of motivation to exercise, can lead to the reduction of impulsive eating and also to an increase in levels of physical activity. These effects could cause weight loss in obese patients suffering from binge eating disorder. TRIAL REGISTRATION clinicaltrials.gov: NCT02571387.