Joël Coste

Classification of and Risk Factors for Estrogen Deprivation Pain Syndromes Related to Aromatase Inhibitor Treatments in Women With Breast Cancer: A Prospective Multicenter Cohort Study

UNLABELLED Aromatase inhibitors (AIs) are the first-line treatment in women with breast cancer for total estrogen depletion. Half the treated women may develop pain, and this condition may therefore be seen as a clinical model of pain related to estrogen deprivation. In this prospective multicenter study, we classified AI-related pain syndromes and identified their predictors. A 1-year, prospective, multicenter cohort study, with 6 visits, was carried out on 135 women with early-stage breast cancer and no pain at the start of AI treatment. At initial assessment, we investigated clinical (demographic and psychosocial, cancer characteristics and treatment, sleep, quality of life), biological (sex hormones, vitamin D, bone biomarkers, oxidative stress, immunologic and inflammatory markers), environmental, and genetic (polymorphism for pain mechanisms) risk factors for pain. During 1 year of follow-up, 77 women (57%) developed pain, leading to AI discontinuation in 12 cases. Five pain syndromes were identified: joint pain (36%), diffuse pain (22%), tendinitis (22%), neuropathic pain (9%), and mixed pain (11%), which are mostly persistent (57%), with diffuse and joint pains the most intense. Risk factors for the development of pain included higher levels of anxiety and impaired quality of life at the initial assessment, whereas cancer characteristics, genetic background, inflammation, and immunologic and hormonal status at baseline were not significant predictors. PERSPECTIVE This article presents a classification of AI-related pain syndromes induced by estrogen deprivation that were previously described as arthralgia, but not as neuropathic, diffuse, and mixed pain. This estrogen deprivation-related condition represents a clinical model of pain, and our study identified mostly psychological risk factors for pain development.

Statistical challenges of quality of life and cancer: new avenues for future research

Statistical modeling conference on the quality of life measurements of the French National Platform of Quality of Life and Cancer Faculty of Science in Luminy, Marseille, France, 12–13 September 2013 The French National Platform of Quality of Life and Cancer and the statistical team of the Mathematical Institute of Luminy undertook a successful first conference addressing the statistical challenges of measuring the quality of life in the field of oncology. More than 15 presentations were made over a 2-day period by the Faculty of Sciences in Luminy. The conference managed to assemble participants from different disciplines, such as mathematics and statistics, public health, epidemiology and psychology, to debate the key statistical and methodological issues of quality of life measurement and analysis. Three main topics were covered in this conference: the treatment of missing data, the development of item banking and computerised adaptive testing and the detection/understanding of response shift.

Brain natriuretic peptide usefulness in very elderly dyspnoeic patients: the BED study

To evaluate the interest of brain natriuretic peptide (BNP) for heart failure (HF) diagnosis in very old patients.

Contrasted trends in health-related quality of life across gender, age categories and work status in France, 1995–2016: repeated population-based cross-sectional surveys using the SF-36

Background Interest in monitoring health-related quality of life (HRQoL) in general populations has increased in the past 20 years, reinforced by population ageing and repeated economic crises. This study aims to identify temporal trends in HRQoL in France between 1995 and 2016 and to assess disparities according to demographic and socioeconomic characteristics. Methods Data from repeated population-based cross-sectional surveys conducted in 1995, 2003 and 2016 were used. HRQoL was measured using the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire. Results A substantial decrease in score was observed between 1995 and 2016 for both genders in almost all subscales of the SF-36, with the largest decrease being in the mental health dimension for men. However, the age group 18–54 years were the most affected with persistent negative or even worsening trends in HRQoL. The largest decreases were among men aged 45–54 years and women aged 35–44 years in most dimensions, and among the age group 18–24 years in vitality. Conversely, an overall improvement was noted among the age group 65–84 years. People in employment were more affected than the unemployed by the decline in several HRQoL dimensions. Conclusion A general decline in HRQoL was found between 1995 and 2016 in the French population, but with wide disparities in trends between age groups. Young and especially middle-aged, employed people exhibited persistent negative and worsening trends. Consistent with evidence from traditional mental health morbidity and mortality indicators, our findings raise questions about the potential influence of macro-socioeconomic factors, especially the 2008 crisis; these observations deserve special attention from health policy-makers.

Alternative approaches to questionnaires in measuring health concepts: The example of measuring how patient actually performs activities in daily life

This study aims to analyse the impact of the measurement of health status on socioeconomic inequalities in health. A MIMIC model with structural equations is used to create a latent variable of health status from four health indicators: self-assessed health, report of chronic diseases, report of activity limitations and mental health. Then, we disentangle the impact of sociodemographic characteristics on latent health from their direct impact on each heath indicator and discuss their effects on the assessment of socioeconomic inequalities in health. This study emphasises differences in inequalities in health according to latent health. In addition, it suggests the existence of reporting heterogeneity biases. For a given latent health status, women and old people are more likely to report chronic diseases. Mental health problems are over-reported by women and isolated people and under-reported by the oldest people. Active and retired people as well as non manual workers in the top of the social hierarchy more often report activity limitations. Finally, highly educated and socially advantaged people more often report chronic diseases whereas less educated people under-report a poor self-assessed health. To conclude, the four health indicators suffer from reporting heterogeneity biases and the report of chronic diseases is the indicator which biases the most the measurement of socioeconomic inequalities in health.

Conceptual approaches to perceived quality of life

Chronic diseases carry important psychological and social consequences that demand significant psychological adjustment. The literature is providing increasingly nuanced conceptualizations of adjustment, demonstrating that the experience of chronic disease necessitates adaptation in multiple life domains. Heterogeneity in adjustment is apparent between individuals and across the course of the disease trajectory. Focusing on cancer, cardiovascular disease, and rheumatic diseases, we review longitudinal investigations of distal (socioeconomic variables, culture/ethnicity, and gender-related processes) and proximal (interpersonal relationships, personality attributes, cognitive appraisals, and coping processes) risk and protective factors for adjustment across time. We observe that the past decade has seen a surge in research that is longitudinal in design, involves adequately characterized samples of sufficient size, and includes statistical control for initial values on dependent variables. A progressively convincing characterization of risk and protective factors for favorable adjustment to chronic illness has emerged. We identify critical issues for future research.

Social heterogeneity in self-reported health status and the measurement of inequalities in health

Book Section: Jusot, F, Tubeuf, S orcid.org/0000-0001-9001-1157, Devaux, M et al. (1 more author) (2017) Social heterogeneity in self-reported health status and the measurement of inequalities in health. In: Guillemin, F, Leplege, A, Briancon, S, Spitz, E and Coste, J, (eds.) Perceived Health and Adaptation in Chronic Disease. Health and Social Care . Routledge , Abingdon, Oxon, UK , pp. 175-195. ISBN 9781498778985

Strategy and Methodology for Choice of Items in Psychometric Measurement: Designing a Quality of Life Instrument for Hip and Knee Osteoarthritis

The construction of composite health status or quality of life (QoL) measurement scales includes various steps, and aims to generate items with meaningful content. Standard scale construction has three stages: a qualitative stage, designed to achieve coverage of all potentially affected areas, a quantitative stage designed to test instrument scaling properties, and a stage of item selection to address feasibility and acceptability of the scale. The objectives of this paper are to investigate the relative contribution of several methods of item development and choice, to highlight the need for structuring the conceptual reflection on building an instrument, and to propose guidelines for structuring a quality of life questionnaire. As a model, we present a protocol for developing a QoL instrument for lower limbs osteoarthritis (OA). OA is a chronic disease with prevalence increasing with age. It may produce potentially severe ability limitations and social participation restrictions according to the ICIDH-2 classification. However, no real OA quality of life questionnaire has been yet developed. This study was conducted with 3 working hypotheses: (1) a generic questionnaire, the SF-36, is relevant to target consequences of lower limbs OA on patients QoL; (2) a condition specific questionnaire for lower limbs OA can be built as the combination of the SF-36 and a disease specific module; and (3) various item generation methods may each contribute relevant statements and words. These methods include cognitive interview of patients, individual or focus group interviews of patients, individual or focus group interviews of health professionals, followed by various methods of content analysis. Accordingly, the study will comprise five pathways aimed at generating items. A total of 128 OA patients and 32 health professionals will be interviewed. A trained team of sociologists will perform a semantic theme content analysis of tape-recorded and transcribed interviews. The next step consists of running content analysis completed by hierarchical cluster analysis. This will be used to identify relevant QoL dimensions. The second task will be to review the data analysis to identify verbatims pertaining to each dimension. Further analyses will identify the respective contribution of each method employed to generate items. The primary stages of composite scale construction include concepts specification and content descriptions. We expect to better document the relative contribution of each approach within each stage. We hope to contribute to future methodological guidelines to generate quality of life questionnaires.