Philippe Tessier

Posttraumatic growth in long term breast cancer survivors: relation to coping, social support and cognitive processing

Post-traumatic growth (PTG) has rarely been studied in long term breast cancer survivors using open interviews. In order to address the issue of how women integrate PTG in their overall cancer experience, 28 open interviews concerning changes after cancer were carried out with 5- to 15-year survivors. The analysis of results, performed using Alceste software, revealed one thematic class of PTG which was specific to women with high coping and social support and active cognitive processing. PTG theme appeared most often as a conclusion of interviews rather than in response to the question about changes after cancer.

A comparison of the clinical determinants of health-related quality of life and subjective well-being in long-term breast cancer survivors.

Research concerning long-term breast cancer survivors (BCS) has primarily analysed their health-related quality of life (HRQoL). However, other dimensions of life considered important by patients might be affected by cancer treatments as well. The aim of this paper is thus to compare the clinical determinants of HRQoL and of overall quality of life as described by measures of subjective well-being (SWB) in long-term BCS. SWB represents a persons own evaluation of their overall situation. A total of 321 French BCS diagnosed 5 to 15 years ago participated in a cross-sectional mailed survey. Outcome measures were the physical and mental health scores of the 36-item Short-Form survey and measures of SWB (happiness, life satisfaction and the positive and negative affect scales). Multivariate regression analyses suggest that HRQoL and SWB measures provide different pictures of the experience of breast cancer. Treatment type has no impact on HRQoL but is correlated with all our SWB measures while time since diagnosis positively affects physical health but not SWB. We conclude that it could be fruitful to analyse SWB, alongside the traditional study of HRQoL, in order to enhance our understanding of the various long-lasting consequences of breast cancer.

A personalized follow-up of kidney transplant recipients using video conferencing based on a 1-year scoring system predictive of long term graft failure (TELEGRAFT study): protocol for a randomized controlled trial.

BackgroundNumerous well-established clinical parameters are taken into consideration for the follow-up adaptation of kidney transplant recipients, but there are important disparities between countries, centres and clinicians. Therefore, novel scoring systems have been developed, for instance the Kidney Transplant Failure Score (KTFS) which aims to stratify patients according to their risk of return to dialysis. We hypothesize that the efficiency of the follow-up after one year post-transplantation can be improved by adapting it to the risk of graft failure defined by the KTFS estimation.Methods/designWe propose a phase IV, open label, randomized, multicentric and prospective study. The study is registered with the Clinical Trials Registry NCT01615900. 250 patients will be allocated to one of two arms: the eHealth program versus the standard of care at hospital. In the standard group, patients classified at low-risk (KTFS ≤ 4.17) will be scheduled 4 visits at hospital per year, whilst high-risk patients will visit hospital 6 times. In the eHealth group, patients classified at low-risk will be interviewed 3 times by video conferencing and once at hospital, whilst 6 visits at hospital and 6 video conferencing will be scheduled for high-risk patients.DiscussionThe current study allows to scientifically evaluate the etiologic impact of a novel eHealth program. This is important to clarify the possible contribution of telemedicine in the improvement of medical follow-up. The proposed design based on 4 different sub-groups can be interesting to evaluate other personalized medicine programs.

Predicting Mental Quality of Life in Breast Cancer Survivors Using Comparison Participants

The objective of this research is to propose a comprehensive model for the prediction of long-term mental health in breast cancer survivors diagnosed 5 to 15 years earlier, compared to female participants referring to the most stressful event that occurred within the last 20 years. Nearly 300 survivors and 132 comparison participants were consulted using a questionnaire, which evaluated personality variables, transactional variables, and current mental quality of life. Structural equation modeling was used. The transactional proposed model was able to account for long-term mental health variance in both groups but was more relevant to women with breast cancer.

Does the relationship between health-related quality of life and subjective well-being change over time? An exploratory study among breast cancer patients

It has been suggested recently that measures of Subjective Well-Being (SWB) instead of preferences could be employed to determine relative weights for the dimensions of health-related quality of life (HRQol) with the aim of developing health utility indexes for economic evaluation purposes. In this context, this paper addresses the possibility of reprioritization response shift in SWB. It examines whether the association between dimensions of HRQol and SWB changes over time in chronically ill patients. 215 women newly diagnosed for breast cancer in a French hospital between 2010 and 2012 completed the Satisfaction with Life Scale (SWLS) and the EORTC QLQ-C30 HRQol questionnaires over a two-year period. We estimated hierarchical random coefficients models for the repeated SWLS measures while allowing for time-varying parameters for the scales of the QLQ-C30 to test for reprioritization. Our findings suggest that women adapt to breast cancer by giving greater weight over time to the social dimension of HRQol. This possibility of reprioritization response shift should be considered in researches trying to develop SWB-based health utility values to inform the allocation of resources in health care.

A mini-review of quality of life as an outcome in prostate cancer trials: patient-centered approaches are needed to propose appropriate treatments on behalf of patients

BackgroundPatients with prostate cancer (PC) may be ready to make trade-offs between their quantity and their quality of life. For instance, elderly patients may prefer the absence of treatment if it is associated with a low-risk of disease progression, compared to treatments aiming at preventing disease progression but with a substantial deterioration of their Health-Related Quality of Life (HRQoL). Therefore, it seems relevant to compare the treatments by considering both survival and HRQoL. In this mini-review, the aim was to question whether the potential trade-offs between survival and HRQoL are considered in high impact factor journals.MethodsThe study was conducted from the PubMed database for recent papers published between May 01, 2013, and May 01, 2015. We also restricted our search to nine medical journals with 2013 impact factor > 15.ResultsAmong the 30 selected studies, only six collected individual HRQoL as a secondary endpoint by using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire. In four studies, the time to HRQoL change was analyzed, but its definitions varied. In two studies, the mean changes in HRQoL between the baseline and the 12- or 16-week follow-up were analyzed. None of the six studies reported in a single endpoint both the quantity and the quality of life.ConclusionsOur mini-review, which only focused on recent publications in journals with high-impact, suggests moving PC clinical research towards patient-centered outcomes-based studies. This may help physicians to propose the most appropriate treatment on behalf of patients. We recommend the use of indicators such as Quality-Adjusted Life-Years (QALYs) as principal endpoint in future clinical trials.

Is the debate about single or double embryo transfer following in vitro fertilisation really an ethical dilemma

In vitro fertilisation (IVF) daily practice reveals that couples are willing to take greater risks than doctors if there is a higher chance of pregnancy. Arising from this is a frequently addressed issue regarding the embryo transfer strategy: single or double embryo transfer? The dilemma is faced by patients, as well as physicians, who are caught between the possibility of no pregnancies at all and facing the prospect of iatrogenic twin gestation. How could the couples preferences concerning how many children they would like be taken into account in determining the number of embryos transferred? How should the physician exercise his medical responsibility towards his patients and the unborn child? An effective approach could be to enhance a couple’s autonomy by advocating a medical beneficence that incorporates patients’ values. This can be achieved through a case-by-case approach in a deliberative process of decision-making which includes real patient-centred communication.

Optimal threshold estimator of a prognostic marker by maximizing a time-dependent expected utility function for a patient-centered stratified medicine:

Defining thresholds of prognostic markers is essential for stratified medicine. Such thresholds are mostly estimated from purely statistical measures regardless of patient preferences potentially leading to unacceptable medical decisions. Quality-Adjusted Life-Years are a widely used preferences-based measure of health outcomes. We develop a time-dependent Quality-Adjusted Life-Years-based expected utility function for censored data that should be maximized to estimate an optimal threshold. We performed a simulation study to compare estimated thresholds when using the proposed expected utility approach and purely statistical estimators. Two applications illustrate the usefulness of the proposed methodology which was implemented in the R package ROCt (www.divat.fr). First, by reanalysing data of a randomized clinical trial comparing the efficacy of prednisone vs. placebo in patients with chronic liver cirrhosis, we demonstrate the utility of treating patients with a prothrombin level higher than 89%. Second, we reanalyze the data of an observational cohort of kidney transplant recipients: we conclude to the uselessness of the Kidney Transplant Failure Score to adapt the frequency of clinical visits. Applying such a patient-centered methodology may improve future transfer of novel prognostic scoring systems or markers in clinical practice.

Does freedom make a difference

Perceived capabilities—a subjective operationalization of Sen’s concept of capability—and subjective well-being are increasingly regarded as relevant information about individual well-being to guide resources allocation in healthcare. Although they refer to different notions, both types of measures rely on self-reported information and little is known as to how they compare together empirically. The aim of this paper is to investigate differences between measures of subjective well-being and of perceived capabilities in terms of their correlation with dimensions of health-related quality of life using panel data concerning a sample of 293 breast cancer and melanoma patients. Regression analyses suggest that the measures capture quite different aspects of the patients’ welfare. Differences in the correlation with dimensions of health also seem consistent with the underlying notions to which these measures refer. However, our findings also suggest that future researches should aim at determining how measures of perceived capabilities may be influenced by individual personality traits.