Sarah Dauchy

Quality of Life of Patients Operated on for Low Rectal Cancer: Impact of the Type of Surgery and Patients’ Characteristics

PURPOSEThis study was designed to compare the impact of a permanent colostomy and sociodemographic characteristics on the quality of life of patients operated on for low rectal cancer.METHODSA cross-sectional study was performed by use of the European Organization for Research and Treatment of Cancer QLQ-C30 and CR-38 questionnaires. Patients came to the hospital to fill out the self-administered questionnaire or were sent the questionnaire by mail, followed by a live or telephone interview. All patients had undergone one of four operations: low anterior resection with colorectal or coloanal anastomosis (non-stoma group), or abdominoperineal resection with pseudocontinent perineal colostomy (nonstoma group) or left lower quadrant colostomy (stoma group).RESULTSA total of 132 patients were included for analysis and there were no missing data. For the majority of quality of life scores (26/29), there was no significant difference between stoma and nonstoma patients. However, stoma patients complained of diminished body image (P = 0.0022), and this was especially true for married (P = 0.0073) and less educated (P = 0.0014) patients at subgroup analysis. Stoma patients experienced greater financial worries (P = 0.0029), whereas nonstoma patients had greater gastrointestinal concerns (P = 0.0098).CONCLUSIONSAlthough most quality of life scores between stoma and nonstoma patients were similar, significant differences regarding body image, finance, and gastrointestinal symptoms, especially for married and less educated patients, were noticed. These factors should be taken into account, along with oncologic criteria, to better tailor treatments to patients.

Changes in psychological adjustment over the course of treatment for breast cancer: the predictive role of social sharing and social support.

Although research on social sharing suggests it could be an important factor in subsequent adjustment, it has rarely been examined in combination with the nature of the support received by patients. The goal of this study was to determine whether and to what extent social sharing concerning the disease and perceived social support after breast surgery explain psychological adjustment at the end of the treatment.

The long-term impact of hyperthermic intraperitoneal chemotherapy on survivors treated for peritoneal carcinomatosis: a cross-sectional study

BackgroundHyperthermic intraperitoneal chemotherapy (HIPEC) after complete surgical resection is currently accepted as a therapeutic option for peritoneal carcinomatosis. However, considerable morbidity is reported after HIPEC.ObjectiveWe aimed to evaluate the impact of HIPEC on the quality of life (QoL) of survivors without recurrences of disease according to socio-demographic and medical variables. For that purpose, HIPEC was used as a global concept including the surgical procedure effects.Materials and methodsA cross-sectional study was performed by analyzing questionnaires concerning socio-demographic data, the psychological status, and general and specific QoL scores.ResultsSixty-eight patients (86% of those contacted) completed and returned mailed questionnaires. For 19/21 QoL dimensions explored, survivors reported good to very good QoL with a median score ≥67%. The two adversely affected dimensions were future prospects and sexual functioning with a mean score of 57% and 23%, respectively. The burden of carcinomatosis, evaluated by a peritoneal index, was not correlated with statistically identified sequels in QoL. The extent of morbidity due to HIPEC, evaluated by the hospital stay, was statistically correlated with only one score, namely, embarrassment during social activities (p = 0.01) but not during familial life.ConclusionsEven though HIPEC is considered as an aggressive treatment, survivors reported good to very good QoL. However, specific care for the psychological aspect, as reflected by anxiety regarding future prospects and sexual activity, needs to be developed for survivors.

Depression in cancer patients

Depression is frequent in cancerology. Despite its clear impact on patients, it continues to be under-diagnosed and inadequately treated. There are many reasons for this, ranging from the underestimation of depressive symptoms by clinicians, their widespread presence in the context of cancer, the entanglement of depressive symptoms with those associated with the cancer and its treatment, or, indeed, the difficulty of clinicians in exploring emotional symptoms [1,2]. Beyond the fact that depression causes mental suffering that is not taken into consideration, even though it can be extremely intense in nature, this situation has a major impact on both morbidity and mortality through a number of different mechanisms [3,4]: • Deterioration of quality of life [5]. • Increased sensitivity to pain [6]. • Difficulties observing treatment [7]. • Difficulties communicating with carers, friends and family. • Significant burden placed on close relatives [8]. • Increased risk of suicide [9]. • Longer periods of hospitalisation [10]. • Reduced expectation of survival [11]. Depression also results in additional medico-economic costs, the extent of which we are only just beginning to understand [12,13]. There is also a risk of over-treatment, with antidepressants being systematically administered for what may only be an intense feeling of sadness, which may nevertheless be appropriate in the context and temporary in duration.

Factors Associated with Altered Long-Term Well-Being After Prophylactic Salpingo-Oophorectomy Among Women at Increased Hereditary Risk for Breast and Ovarian Cancer

BACKGROUND Prophylactic bilateral salpingo-oophorectomy (PBSO) might alter several components of well-being, such as sexual functioning and endocrine symptoms, in women at high risk for hereditary breast and/or ovarian cancer, compared with the general population. We searched for factors associated with altered long-term well-being in this population (lower quality of life [QOL], altered sexual functioning, greater anxiety, more endocrine symptoms). METHODS All high-risk women who had undergone PBSO during the past 15 years in a single cancer center were contacted by mail. Upon acceptance, they were sent five questionnaires: (a) general social questions, (b) the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, (c) Sexual Activity Questionnaire, (d) Functional Assessment of Cancer Therapy - Endocrine Symptom, and (5) State-Trait Anxiety Inventory. Logistic analyses were used to identify factors associated with altered results. Because of multiple testing, only p-values ≤ .01 were considered significant. RESULTS One hundred twelve of 175 women (64%) returned the completed questionnaires at a mean duration (standard deviation) of 6.0 (5.1) years after PBSO. QOL was positively influenced by two baseline factors: a high educational level and occupying an executive position. However, younger age at PBSO was associated with lower social functioning and greater anxiety. At the time of the study, practicing a sport and the avoidance of weight gain (≥10%) were highly related to QOL, sexual pleasure, endocrine symptoms, and anxiety in the univariate analysis and predictive of better QOL and lower anxiety in the multivariate analysis. CONCLUSIONS Younger women and women with a low educational level and no occupation appear to be at higher risk for altered long-term well-being. After surgery, practicing a sport and stable weight may help maintain overall well-being.

Synthèse des résultats

A l’issue de ces deux etudes, un certain nombre de resultats ont pu etre mis en evidence; certains viennent confirmer des donnees anterieures, d’autres permettent d’ouvrir des perspectives cliniques ou de recherche, en particulier ceux qui mettent en lumiere des besoins non ou insuffisamment pris en charge ou ceux qui rendent compte des liens entre l’adolescent et sa mere autour de l’expression conjointe de leurs difficultes ou de leurs souhaits d’aide.

Frequency and Intensity of Pain Related to Thyroid Nodule Fine-Needle Aspiration Cytology

BACKGROUND Quality of life is an important issue in endocrine tumors because of the high prevalence of benign tumors and the indolent course of most malignant tumors. OBJECTIVE To evaluate the frequency and the intensity of pain and anxiety in patients undergoing thyroid nodule fine-needle aspiration cytology (FNAC) and to identify factors associated with pain. METHODS Single center prospective study in the setting of a one-stop outpatient diagnostic clinic for thyroid nodules. Pain was evaluated using a 100-mm visual analogue scale (VAS) immediately following (VAS1) and 30 minutes after (VAS2) FNAC and was considered significant if ≥ 30. Anxiety symptoms were assessed prior to FNAC using a self-report measure questionnaire: the state form of Spielberger State-Trait Anxiety Inventory (STAI, form Y-A). FNAC was performed with a 25-gauge needle and a moderate aspiration and two passes for each nodule. RESULTS Two hundred eighteen consecutive patients (163 females, 55 males; mean age 53 years, range 12-84 years) undergoing FNAC of one to three nodules were included. VAS1 was ≥ 30 in 24% of the patients and VAS(2) was ≥ 30 in 13% of the patients. Independent significant factors correlated to a VAS1 of ≥ 30 were age under 25 years and the number of nodules being biopsied. Independent significant factors correlated to a VAS2 of ≥ 30 were VAS1 ≥ 30 and female sex. No correlation was found between pain and nodule size or nodule depth, nor the duration of application of the eutectic mixture of local anesthetics (EMLA) patch prior to FNAC. The mean STAI score for anxiety was 37 ± 12. The average STAI score was significantly higher in women (39) than in men (33; p = 0.01). There was no significant correlation between STAI score and age under 25 years, previous FNAC, number of nodules biopsied, or acetaminophen administration, but the STAI score was significantly correlated to VAS1 and VAS2. CONCLUSIONS FNAC-related pain is frequent and correlates with the number of nodules biopsied, age under 25 years, female sex, and anxiety.

Prospective Evaluation of the Impact of Antiangiogenic Treatment on Cognitive Functions in Metastatic Renal Cancer

BACKGROUND Little is known about the cognitive effects of antiangiogenic therapies (AATs) in metastatic renal cell carcinoma (mRCC) and their relation with fatigue. OBJECTIVE To evaluate the impact of AATs on cognition and its connection with fatigue and quality of life (QoL) in patients with mRCC. DESIGN, SETTING, AND PARTICIPANTS This prospective study enrolled 75 patients starting AAT as first or second line for mRCC and assessed them at 3 mo (n=58) and 6 mo (n=50). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We assessed objective cognitive decline with a neuropsychological battery of tests and cognitive complaint, fatigue, and QoL with validated self-reported questionnaires using the Fisher exact test, Wilcoxon test, and Spearman correlation coefficient. RESULTS AND LIMITATIONS A decline of cognitive functions was observed in 18 patients (31%) including 13 without cognitive impairment at baseline. The score of fatigue was increased in all patients except one. A relationship between cognitive complaints and fatigue was observed (p<0.05) but not with objective cognitive decline. Cognitive complaints and fatigue had a significant impact on most of the domains of QoL (p<0.01). A positive correlation was found between fatigue and inflammatory markers but not with cognition. The main limitation of this study is the absence of a control group. CONCLUSIONS AAT induced cognitive decline in patients with mRCC independently of fatigue. These side effects affecting QoL should be better assessed in clinical trials and taken into account in routine practice. PATIENT SUMMARY Fatigue is a well-known effect of antiangiogenic therapies (AATs) of cancer. The study performed in patients with treated metastatic renal cancer shows a decline of cognitive functions induced by AATs, such as information-processing speed or working memory, in a third of patients, independently of fatigue. Patients on AATs should be informed of these possible adverse effects.

The Quality of Life of Young Women with Nonmetastatic Breast Cancer and their Partners’: Specific Needs Require Development of Specific Questionnaires for Each of them

To the Editor: In developed countries, approximately 13% of women with breast cancer are younger than 45 years of age. Improved therapy in expectation of cure highlights these young women’s specific problems (1,2). These, like the wish to have children, are sometimes incompatible with the treatments. Furthermore, children’s education, family responsibilities, sexuality, marital relationship, body image, and professional activity are also sources of concern. Some studies seem to indicate that young women (< 45–50 years) have a worse quality of life and are more vulnerable to the negative effects of the disease than older ones (3–5). Patients are in search of social and emotional support which is most frequently provided by a member of the family and particularly the partner (6). Life and daily tasks can be upset. This correlates directly and ⁄ or indirectly with depression, anxiety and the physical state of health called ‘‘subjective burden’’ (7). The deterioration of the quality of life and sexual problems in women with breast cancer can affect the marital relationship. This can result in a break up of married life, especially if marital difficulties were present previously. On the other hand, it can bring the couple closer. Thus, it appears essential for women with breast cancer to involve their partner (8,9). The objectives of the study were to measure the impact of breast cancer on the quality of life of young women (< 45 years of age) with nonmetastatic disease and the quality of life of their partners; to study the convergent and ⁄ or divergent points between the patients and partners in the course of treatment; and to create specific tools to deal with these issues. The psychological, emotional, family, and social effects of cancer on the patient and her partner were analyzed by the verbatim of nondirective talks. Patients younger than 45 years of age at the time of the diagnosis, with nonmetastatic breast cancer, in treatment by chemotherapy and their partner ⁄ spouse took part. Each couple must have been living together for at least 6 months. Open conversations, without directive questions, were conducted by expert psychologists. From February 2007 to June 2008, 69 couples were interviewed: 24 during chemotherapy, 11 during Trastuzumab treatment, 15 during hormonotherapy and 19 during follow up. The patients’ median age was 39 (range: 27–52) and 41 (range: 28–60) for the partners. The couple per se and the psychological dimensions were specifically mentioned by, respectively, 79% and 78% of the participants. Family matters were raised by 64%, and 51% mentioned professional and physical repercussions. Forty three percent, 24%, and 12% spoke of, respectively, social, domestic, and economic spheres. However, spiritual and medical aspects were under represented (less than 5% of the participants). The analysis of the subjective quality of life of the patient compared with the partner’s showed significant differences in five areas: the patients spoke more often about the psychological, familial, physical, professional and social impact than their partners (p < 0.05) (Fig. 1). Globally, the subjective feelings were comparable between the treatment periods (chemotherapy, Trastuzumab, hormonal therapy, and follow up). Nevertheless, Address correspondence and reprint request to: Dr. Laurence Vanlemmens, MD, 3 rue Frederic Combemale, BP 307, F-59020 Lille Cedex, or e-mail: l-vanlemmens@o-lambret.fr. Proposed by Medical Centre Oscar Lambret Supported by the Institut National Contre le Cancer, Ligue Nationale Contre le Cancer, Roche, Novartis Pharma, and Sanofi-Aventis, France

L’annonce du cancer bronchique

Although the teaching of communication techniques have begun, albeit slowly, in the schools of medicine, the announcement of bad news remains one of the hardest moment in medical practice. For the physician, whose primary mission is to bring relief, knowing that he may cause psychological distress is a difficult task, especially when considering that the limited therapeutic choices make it impossible for him to promise hope for recovery. This article aims to offer the clinician a pragmatic help for the announcement of the diagnosis of bronchial carcinoma by drawing on recent data in the literature. The data enable improvement of the recommendations issued from more fundamental knowledge relative to the transmission of information and the main emotional and adaptive reactions of the patient. Thus, the announcement can be better adapted to each patient, his expectations and his abilities.