Luc Deschênes

Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women

The goal of this study was to assess variations with age in the management of breast carcinoma and to identify determinants of care received.

Dietary Change After Breast Cancer: Extent, Predictors, and Relation With Psychological Distress

PURPOSE Some women may try to cope with breast cancer by making lifestyle modifications, possibly in the hope of improving disease outcome. We assessed extent, predictors, and effect on psychological distress of dietary changes in the year after diagnosis among 250 women with newly diagnosed, nonmetastatic breast cancer. PATIENTS AND METHODS Data came from medical records, and from interviews 3 days and 12 months after initial treatment. RESULTS At 12 months, 41% (n = 103) reported dietary changes at some time since diagnosis, with decreases in meat (77%) and increases in fruit and vegetable intake (72%) being the most frequent. Women reporting changes were more likely to be younger, to have positive nodes, to be receiving adjuvant therapy, and to be more distressed initially. The mean 0 to 12 month decrease in psychological distress was greater in women who reported changes (9 points) than those who did not (4.7 points) (P =.03), although regression toward the mean cannot be excluded. CONCLUSION A sizable proportion of women made dietary changes on their own initiative. Most changes reported were generally consistent with current scientific hypotheses about dietary changes that might favorably affect prognosis. The profile of women reporting changes suggests a group with more concerns about recurrence, who may have initiated dietary change to help cope with and gain a sense of control over the disease, and possibly to improve prognosis. Our results suggest that newly diagnosed women could be receptive to explicit attention to diet as part of psychosocial care. However, this interest in dietary change may not, as yet, have been maximally channeled into trying to improve the care and quality of life of women facing diagnosis, treatments, and fears about recurrence.

Work absence after breast cancer diagnosis: a population-based study

Background: Absence from work after breast cancer diagnosis may be part of the burden of disease for women with cancer, but little research has addressed this. We examined work absences of 4 weeks or more among women who had had breast cancer during the 3 years after diagnosis and compared their absences with those of women who had never had cancer. Methods: Our 2 target study groups were women in Quebec 18–59 years of age who were working when they first received therapy for breast cancer between November 1996 and August 1997 and similarly aged women randomly selected from provincial health care files who had never had cancer and were working at the time of diagnosis in women who had cancer. We interviewed 646 women who had had breast cancer (73% of those eligible) and 890 women in the comparison group (51% of those eligible) by telephone 3 years after first diagnosis. Results: One year after diagnosis, 85% (459/541) of breast cancer survivors who remained free of disease during the 3-year study period were absent from work for 4 weeks or more compared with 18% (156/881) of healthy women (geometric mean total duration 5.6 v. 1.7 months, p < 0.001). By the third year, disease-free women were not absent more than women in the comparison group; however, more women who had experienced any new cancer event continued to be absent from work and to be absent from work for longer periods of time. Receiving adjuvant chemotherapy prolonged absence duration (9.5 v. 5.4 months among women not receiving chemotherapy). Compared with survivors belonging to a union, those who did not belong to a union (multivariate relative risk [RR] 7.54, 95% confidence interval [CI] 3.02–18.83) and those who were self-employed (RR 13.95, 95% CI 5.53–35.21) were more likely to report no work absence. Interpretation: Most of the women with breast cancer took time off work (almost 6 months on average) after receiving the diagnosis. Three years after diagnosis, breast cancer survivors who remained disease-free — a large proportion of women with nonmetastatic breast cancer — were not absent from work more often or for longer periods of time than other working women.

Psychological distress after initial treatment for breast cancer: A comparison of partial and total mastectomy

This study of the relation between type of mastectomy and psychological distress was based on all newly diagnosed breast cancer patients with localized or regional disease who were surgically treated in seven Quebec City hospitals in 1984. Among 235 eligible patients, 227 (96%) participated in a home interview 3 months after diagnosis and 205 of these women gave a second interview approximately 15 months later. The Psychiatric Symptom Index (PSI) was used to measure the severity of symptoms of psychological distress. At 3 months, 38.8% of partial mastectomy patients had high PSI scores compared to 25.8% of women treated by total mastectomy (OR = 1.8, p = 0.044). Fifteen months later, percentages with high scores were identical, 35.1%, in the two treatment groups. Age appeared to modify the surgery-distress relation. These results suggest that partial mastectomy does not protect against psychological distress after breast cancer. Moreover, they highlight the importance of adequate preparation and support for all breast cancer patients, regardless of type of initial surgery.

Diverticulitis of the appendix: Report of sixty-one cases

Abstract Analysis of ninety cases of diverticulum of the appendix makes it possible for us to classify this lesion into five main groups, thus recognizing this disease as a definite pathologic entity. A comparative clinical study of sixty-one cases of acute diverticulitis of the appendix and sixty-one cases of acute appendicitis has revealed some differences between both lesions, namely those concerning the age of the patient, the type of abdominal pains, and the operative findings. It then appears possible in certain cases to make a preoperative diagnosis of diverticulitis of the appendix: our observations seem to indicate that acute diverticulitis of the appendix is a clinical entity different in some respect from acute appendicitis.

Stressful life events and survival after breast cancer.

Objective This study assessed the relation of stressful life events with survival after breast cancer. Methods This study was based on women with histologically confirmed, newly diagnosed, localized or regional stage breast cancer first treated in 1 of 11 Quebec City (Canada) hospitals from 1982 through 1984. Among 765 eligible patients, 673 (88%) were interviewed 3 to 6 months after diagnosis about the number and perceived impact of stressful events in the 5 years before diagnosis. Three scores were calculated: number of events; number weighted by reported impact; and for almost 80% of events, number weighted by community-derived values reflecting adjustment required by the event. Scores were divided into quartiles to assess possible dose-response relationships. Survival was assessed in 1993. Hazard ratios and 95% confidence intervals (CIs) comparing all-cause and breast cancer–specific mortality were calculated with adjustment for age, presence of invaded axillary nodes, adjuvant radiotherapy, and systemic therapy (ie, chemotherapy and hormone therapy). Results When quartiles 2, 3, and 4 were compared with the appropriate lowest quartile, adjusted hazard ratios for all-cause mortality were 0.99 (CI = 0.70–1.38), 0.97 (CI = 0.73–1.31), and 1.04 (CI = 0.78–1.40) for number, number weighted by impact, and number weighted by community-derived values, respectively. Results were essentially similar for the relation between stressful life events limited to those occurring within the 12 months before diagnosis and overall mortality and between stressful life events in the 5 years before diagnosis and breast cancer–specific mortality. Conclusions Stress was conceptualized as life events presumed to be negative, undesirable, or to require adjustment by the person confronting them. We found no evidence indicating that this kind of stress during the 5 years before diagnosis negatively affected survival among women with nonmetastatic breast cancer. Evidence from this study and others on the lack of effect of this type of stress on survival may be reassuring for women living with breast cancer.

Time trends in systemic adjuvant treatment for node-negative breast cancer.

PURPOSE We conducted a population-based study in Quebec, Canada, to assess longitudinal changes in systemic adjuvant therapy for node-negative breast cancer. MATERIALS AND METHODS A stratified random sample was selected among women with newly diagnosed node-negative breast cancer in 1988, 1991, and 1993. Information on the patient, her tumor, source of care, and treatment was abstracted from medical charts. Patients were classified as being at minimal, moderate, or high risk of recurrence on the basis of criteria proposed at the 4th International Conference on Adjuvant Therapy of Primary Breast Cancer (St. Gallen, Switzerland, 1992), and systemic adjuvant treatment received was dichotomized as being consistent or not consistent with consensus recommendations. RESULTS Overall, 1,578 cases of invasive breast carcinoma were reviewed. The proportion of patients who were given hormonal or cytotoxic treatment increased from 51.7% to 73.1% from 1988 to 1993. Virtually all women at minimal risk were treated in 1991 and 1993 according to the consensus statement. The proportions of women so treated were 75.0% and 65.4% in the moderate- and high-risk categories, respectively, in 1991. In 1993, these proportions were 71.4% and 67.0%, respectively. Omission of chemotherapy, especially in high-risk women with estrogen receptor-negative tumors who were 50 to 69 years of age, was the most frequent inconsistency with guidelines. CONCLUSION Systemic adjuvant therapy for node-negative breast cancer has gained acceptance. Better understanding of the decision-making process, of the perception of the risks and benefits involved, and of the impact of alternative strategies for the dissemination of consensus recommendations are needed to promote the use of chemotherapy in specific categories of women who are at high risk of recurrence.

Hyperactive production of antibody of a boy with thymic dysplasia undergoing graft versus host reaction.

Abstract A 22-month-old boy with thymic dysplasia produced an unusually large amount of isohemagglutinin and anti Gm(a) antibodies during the course of a fatal graft-versus-host reaction. This enhanced B cell activity is attributed to the helper effect of soluble factors released by the activated T cells which caused the reaction.

Intra‐arterial infusion—an adjuvant to the treatment of oral carcinoma

Intra‐arterial infusion, since introduced to clinical use, has been used extensively as a palliative method in treating patients with oral cancer. However, from the studies reported, this approach to treatment offers limited palliation. The object of our study was to determine the value of primary infusion as an adjuvant to operation or irradiation. Results were reasonably good in a group of 39 patients treated by the method described. Tumor regressions of 75% or more were common in one group treated by infusion followed by conservative surgery; in one patient, complete tumor regression has persisted more than 7 years. After infusion, it was possible, in some older patients, to obtain excellent results without extensive radical surgical procedures. Although no firm conclusions can be drawn from this group of patients, the authors feel that, with proper case selection, some form of combined therapy might improve the treatment of carcinoma of the mouth. From these results, it is suggested that intra‐arterial infusion can be considered as part of the treatment of oral carcinoma, not only as a palliative measure, but also as an adjuvant to conventional methods.