Marc-Karim Bendiane

Adjuvant endocrine therapy with tamoxifen in young women with breast cancer: determinants of interruptions vary over time

BACKGROUND In premenopausal women with hormone receptor-positive breast cancer (BC), 5 years of tamoxifen is recommended. Little is known about reasons for interruption in this population. The aim was to estimate the incidence of tamoxifen interruption and its correlates among younger women. PATIENTS AND METHODS Using a prospective cohort Elippse 40 of women with BC aged ≤ 40 diagnosed between 2005 and 2008, we studied 196 women. Tamoxifen interruption was defined as two or more consecutive months without dispensed prescription of tamoxifen, based on pharmacy refill database. Two periods were studied: between tamoxifen initiation and 16 months after BC diagnosis, and between 16 and 28 months. RESULTS Among women treated with tamoxifen, 42% interrupted within the first 2 years of treatment. During the first period, treatment interruptions were associated with a lack of understandable information about endocrine treatment and insufficient social support. During the second period, another set of factors were associated with interruption: treatment side-effects, no longer fearing cancer relapse, lack of social support, no opportunity to ask questions at the time of diagnosis, and fewer treatment modalities. CONCLUSIONS Improving information and patient-provider relationship might prevent interruption. Particular attention should be paid to women with little social support.

The labour market, psychosocial outcomes and health conditions in cancer survivors: protocol for a nationwide longitudinal survey 2 and 5 years after cancer diagnosis (the VICAN survey)

Introduction Today, a growing need exists for greater research into cancer survivorship, focusing on different spheres of the day-to-day life of diagnosed patients. This article describes the design and implementation of VICAN (VIe après le CANcer), a national survey on French cancer survivors. Method and analysis The target population included patients aged 18–82, diagnosed with cancer between January and June 2010, and registered in one of the three main French Health Insurance Schemes. It was restricted to 12 tumour sites. Sampling was stratified using a non-proportional allocation, based on age at diagnosis (18–52 and 53–82) and tumour site. Data were collected from telephone interviews with patients 2 and 5 years after diagnosis, a medical survey completed by the physician who initiated cancer treatment, and information from the national medicoadministrative database on reimbursement data and hospital discharge records. First data collection, 2 years after diagnosis, occurred between March and December 2012. Second data collection, 5 years after diagnosis, will be conducted in 2015. Analyses will be conducted on various outcomes: quality of life, health status and psychosocial conditions, with a particular focus on the impact of cancer diagnosis on the labour market. The variety of measurements included in the survey will enable us to control a wide range of factors. Ethics and dissemination The methodology of the VICAN survey was approved by three national ethics commissions. Results of the study will be disseminated through national and international research conferences, and in articles published in international peer-reviewed journals.

Self-Reported Cognitive Impairment After Breast Cancer Treatment in Young Women from the ELIPPSE40 Cohort: The Long-Term Impact of Chemotherapy

Abstract:  Cognitive impairment (CI) is common after cancer treatments, but little is known about the long‐term evolution of CI, especially in premenopausal women. Since September 2005, all consecutive women included in the French National Health Insurance Fund registry with a diagnosis of primary breast cancer, aged 18–40 years and living in South Eastern France, were asked to participate in a cohort study, including telephone interviews, medical data, and prescription refills of psychotropic drugs and adjuvant endocrine therapy. At each interview, CI is defined as self‐report of frequent memory loss and attention deficits. As of February 2010, 222 women with available medical data had taken part in the 10‐, 16‐, and 28‐month telephone interviews, with CI being reported by 37.4%, 36.5%, and 42.3% of participants, respectively. Tranquilizers’ dispensation was associated with CI self‐report at all three interviews; chemotherapy was reported only at the 28‐month interview. At 28 months, besides chemotherapy and tranquilizer’s dispensation, having a low educational level and not being a native French woman were also independently associated with CI. Reports of CI were common in young women and primarily related to psycho‐social vulnerabilities and cancer treatment. As they affect quality of life, long‐term CI complaints deserve greater consideration.

Chemotherapy in Old Women with Breast Cancer: Is Age Still a Predictor for Under Treatment?

Breast cancer affects mostly older women but there are no guidelines especially devoted to adjuvant chemotherapy for this population. In this context, this study was carried out in a population‐based cohort of French elderly women with breast cancer, to check adherence to the existing national guidelines according to the womens age, taking into account the evolution of the situation over time for women requiring chemotherapy. Between October 2006 and December 2008, all consecutive women included in the French Health registry for a biopsy‐proven primary nonmetastatic breast cancer, aged 65–80 years at diagnosis, and living in South Eastern France, were asked to participate in a cohort study. Medical information was collected from physicians. The study population was restricted to the 223 women who were recommended adjuvant chemotherapy according to national guidelines. Those who received chemotherapy were compared to those who did not receive this treatment. Among these 223 women 55% had received chemotherapy. Only three women refused the treatment. Less than 8% have had a geriatric assessment before treatment decision and only two were proposed to participate in a clinical trial. After adjustment for comorbidity score, tumor characteristics, socio‐demographic characteristics, and year of diagnosis, increasing patient age was independently associated with decreased guideline concordance for adjuvant chemotherapy. Women aged 75–80 years received chemotherapy more than four times less often than women aged 65–74 years. However, the percentage of women who received chemotherapy increased from 33% to 58% between 2006 and 2008, in parallel with the setting up of Onco‐Geriatric Coordination Units in the area. In France, chronological age remains a barrier to receive chemotherapy for older breast cancer women but the establishment of a formal collaboration between oncologists and geriatricians seems to be an effective way to improve care delivery in this population.

Pain narratives in breast cancer survivors.

In-depth interviews were conducted with French breast cancer survivors 24 month after cancer diagnosis (N = 21 women). We documented their experience of chronic pain, compared their pain narratives with their answers to the WHOQOL-BREF questionnaire, and studied both the meaning they gave to their pain and how they dealt with it in their daily lives. Half of participants reported are suffering from iatrogenic chronic pain. Most of the time, this pain was not captured by the WHOQOL questionnaire and was not medically treated. Patients “normalized” their pain in various ways: they considered it either as a necessary step on the road to recovery, as the proof of treatment efficacy, or as a permanent condition one must learn to live with. They learned to deal with pain by taking precautions, giving up certain activities, and changing the way they performed others. Participants were also prone to compare themselves with other patients suffering worse pain. Breast cancer survivors should be better informed about chronic pain and how to alleviate it. Physicians should contribute to fighting pain-related beliefs which lead patients to conceal their pain. Techniques used by patients to cope with chronic pain in their daily lives should also be promoted.

Opioid analgesics prescription in people with and without cancer in France

INTRODUCTION AND OBJECTIVES According to World Health Organization recommendations, opioids prescription is a key aspect of improvement in cancer pain relief. However, studies on opioids prescription in France are scarce. This study aimed principally to investigate the impact of cancer on opioids prescription and then to identify factors associated with this prescription, focusing on patients& characteristics impact. METHODS We matched the following two cohorts: cancer survivors (N = 6,760) and individuals without cancer (N = 6,760). Using French health insurance databases, we compared the prevalence of prescribed opioids in 2009-2015 in people with and without cancer and we applied afterwards conditional Poisson regressions to estimate relative risks for monthly opioids prescription. For cancer survivors only (N = 3,055), multivariate negative binomial regressions were performed to identify factors associated with opioids prescription. RESULTS Cancer was associated with a higher analgesics prescription in the cancer population. While Step II and III opioids prescription decreased over time, the latter remained marginal and tended to stabilize. Older people were most adversely affected by underprescription of opioids, especially Step III opioids. Furthermore, although the matched case/control study suggested that men were prescribed opioids more often than women, multivariate analysis did not support this finding. CONCLUSION The inconsistency between our findings and existing literature regarding both opioids prescription trends and postdiagnosis pain chronicity in cancer survivors over the medium term suggests possible changes in pain perception and the evolution of cancer pain management strategies. Further research should explore these hypotheses and investigate patient characteristics& effect in cancer pain management.

Fertility status perception, fertility preservation and desire to have children in cancer survivors: French VICAN survey

Aim: To report fertility status perception, fertility preservation and desire to have children in French cancer survivors 2 and 5 years after diagnosis. Methods: A total of 427 women and 115 men self-reported treatment-induced infertility, fertility status, access to gamete conservation, desire to have children and pregnancy/live births. Results: A total of 96.5% of men and 92.9% of women were thought to be fertile at diagnosis and 38% desired to have children. A total of 57.8% of men and 67.4% of women declared that no fertility preservation had been discussed before treatment. After 2 years, 26.8% of patients still desired to have children. After 5 years, 18 live births have been reported. Conclusion: Despite a legal obligation and technical progress, there is a lack of information given to patients.

628 PAIN NARRATIVES AMONG WOMEN BREAST CANCER SURVIVORS

626 THE INFLUENCE OF DEPRESSION AND OF PAIN INTENSITY ON THE SEXUAL FUNCTION OF WOMEN WITH CHRONIC PELVIC PAIN A. Romão *, P. Souza, O. Poli Neto, J. Rosa-e Silva, F. Reis, R. Gorayeb, G. Romão, A. Nogueira. Department of Gynecology and Obstetrics, University Hospital, Faculty of Medicine of Ribeirão Preto-USP, Ribeirão Preto, Brazil; Department of Surgery and Anatomy, University Hospital, Faculty of Medicine of Ribeirão Preto-USP, Ribeirão Preto, Brazil; Department of Neurosciences and Behavioral Sciences, University Hospital, Faculty of Medicine of Ribeirão Preto-USP, Ribeirão Preto, Brazil; Department of Medicine, Federal University of São Carlos, São Paulo, Brazil, São Carlos, São Paulo, Brazil

76 PAIN KNOWLEDGE OF FRENCH DISTRICT AND HOSPITAL NURSES ACCORDING TO PERSONAL AND PROFESSIONAL CHARACTERISTICS

6 months after initiation of multidisciplinary pain therapy. Both patient groups showed lower cold and warm pain thresholds than healthy controls during the first 3 weeks meaning they were more sensitive to cold and warm than healthy subjects in back area. These significant changes disappeared 6 months after therapy in the patient group without opioids withdral but not in the withdraw group. Conclusion: We conclude that a peripheral pain sensitization do exit in patients with low back pain and fibromyalgia as the results by QST showed. Opioid intake delayed the pain perception in these patients. The multidisciplinary pain therapy may improve the pain perception during and after withdraw of opioids.