Sylvie Dolbeault

Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review

The assessment of supportive care needs is a crucial step in the development of appropriate interventions that may improve the quality of life of cancer patients. This review describes and analyzes the prevalence and predictors of the unmet supportive care needs of breast cancer (BC) patients and survivors and suggests paths for further research.

The effectiveness of a psycho‐educational group after early‐stage breast cancer treatment: results of a randomized French study

Background: Many women with breast cancer need psychological help to cope more effectively after treatment. Cognitive and behavioural techniques are not yet well established in France. A multi‐site randomized study was conducted to evaluate the effects of a psycho‐educational group intervention in this population.

Screening for psychological distress in two French cancer centers: Feasibility and performance of the adapted distress thermometer

OBJECTIVE Little is known about the prevalence of psychiatric disorders in French cancer patients. This study aimed to assess the feasibility of a screening procedure using the Psychological Distress Scale (PDS). The PDS is a French adaptation of the National Comprehensive Cancer Network Distress Thermometer. The screening performance of the PDS was assessed by comparison with the established clinical case threshold on the Hospital Anxiety and Depression Scale (HADS). METHODS Among 598 consecutive cancer outpatients recruited in two cancer centers in Paris, 561 (94%) agreed to complete the PDS, the HADS, the European Organisation for Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30), and study-specific psychosocial questions. RESULTS A receiver operating characteristic (ROC) analysis was performed, using a HADS cutoff score of 15 or greater to identify patients with psychological distress. This yielded a PDS cutoff score of 3, giving 76% sensitivity and 82% specificity. With this cutoff score, the prevalence of psychological distress was 38%. PDS scores were significantly related to scores from the HAD total scale (r=.64), HAD anxiety (r=.61) and HAD depression (r=.39) subscales, and EORTC QLQ-C30 emotional functioning (r=.56) and global health state (r=.44). In multivariate analyses, factors associated with psychological distress were female gender, taking analgesics, receiving professional psychological help, perceived psychosocial difficulties and lack of social support. SIGNIFICANCE OF RESULTS Using the PDS appeared feasible, acceptable and effective for psychological distress screening in French ambulatory cancer care settings.

Prevalence and associated factors of sexual problems after early-stage breast cancer treatment: results of a French exploratory survey.

Objective: The objective of this study was to assess the prevalence and associated factors of sexual activity, sexual problems or sexual satisfaction in French early‐stage breast cancer survivors (BCS).

Screening for distress and supportive care needs during the initial phase of the care process: a qualitative description of a clinical pilot experiment in a French cancer center

Objective: To provide a qualitative description of a clinical pilot experiment in a French cancer center, conducted by a nurse after the treatment decision consultation attended by new cancer patients during the initial phase of the care process.

Dialogue entre le radiologue et le patient atteint d’un cancer

Resume Avec les progres de la medecine et l’evolution de notre societe, on assiste a une augmentation du nombre de patients atteints de cancer et a un changement dans les relations medecin-malade. Les droits des malades sont desormais inscrits dans la Charte du Patient Hospitalise, la loi Huriet et la loi du 4 mars 2002. L’evolution des maladies cancereuses est ponctuee de nombreux examens d’imagerie et le radiologue est alors en premiere ligne. C’est souvent lui qui decouvre les anomalies et qui doit trouver les premiers mots. La tache est d’autant plus difficile qu’il n’a recu aucune formation specifique pour la gestion de situations difficiles telles que l’annonce d’une mauvaise nouvelle. Le risque est grand d’attitudes inadaptees, de mots maladroits qui marqueront negativement l’esprit des malades. Meme si nous avons le desir et la sensation de bien faire, nous pouvons tirer de grands benefices d’une reflexion sur nos modalites relationnelles pour les ameliorer et mieux repondre a la plus grande demande d’information des malades. Le radiologue doit savoir faire mais la technique n’est pas suffisante, il doit aussi savoir dire, ni trop ni trop peu et il doit savoir etre en s’appuyant sur sa competence clinique, ses qualites relationnelles avec les malades et le respect de leur volonte et de leurs droits.

Impact of organised programs on colorectal cancer screening

PurposeColorectal cancer (CRC) screening has been shown to decrease CRC mortality. Organised mass screening programs are being implemented in France. Its perception in the general population and by general practitioners is not well known.MethodsTwo nationwide observational telephone surveys were conducted in early 2005. First among a representative sample of subjects living in France and aged between 50 and 74 years that covered both geographical departments with and without implemented screening services. Second among General Practionners (Gps). Descriptive and multiple logistic regression was carried out.ResultsTwenty-five percent of the persons(N = 1509) reported having undergone at least one CRC screening, 18% of the 600 interviewed GPs reported recommending a screening test for CRC systematically to their patients aged 50–74 years. The odds ratio (OR) of having undergone a screening test using FOBT was 3.91 (95% CI: 2.49–6.16) for those living in organised departments (referent group living in departments without organised screening), almost twice as high as impact educational level (OR = 2.03; 95% CI: 1.19–3.47).ConclusionCRC screening is improved in geographical departments where it is organised by health authorities. In France, an organised screening programs decrease inequalities for CRC screening.

Reasons of not having breast reconstruction: a historical cohort of 1937 breast cancer patients undergoing mastectomy.

BackgroundThe aims of the study were to investigate the factors associated with not having breast reconstruction following mastectomy and to assess patient satisfaction with information on reconstruction.Patients and methodsWe analysed a historical cohort of 1937 consecutive patients who underwent mastectomy at Institut Curie between January 2004 and February 2007. Their sociodemographic and clinicobiological characteristics were recorded in a prospective database. A questionnaire was sent to 10% of nonreconstructed patients.ResultsThe proportion of patients with invasive cancer was 82.7%. The rate of nonreconstruction in patients with in situ and invasive cancer was 34.6% and 74.9%, respectively. On multivariate analysis, only employment outside the home was associated with reconstruction in patients with in situ cancer (p < 0.001). In patients with invasive cancer, employment status (p < 0.001) and smoking (p = 0.045) were associated with reconstruction, while age > 50, ASA score >1, radiotherapy (p < 0.0001) and metastatic status (p = 0.018) were associated with nonreconstruction. For 80% of questionnaire responders, nonreconstruction was a personal choice, mainly for the following reasons: refusal of further surgery, acceptance of body asymmetry, risk of complications and advanced age. Information on reconstruction was entirely unsatisfactory or inadequate for 62% of patients.ConclusionBetter understanding the factors that influence decision of nonreconstruction can help us adapt the information to serve the patient’s personal needs.

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.

Short-term psychological impact of the BRCA1/2 test result in women with breast cancer according to their perceived probability of genetic predisposition to cancer

Background:The effect of BRCA1/2 gene test result on anxiety, depression, cancer-related thought intrusion or avoidance and perceived control over cancer risk was assessed in breast cancer (BC) patients, according to their perceived probability of genetic predisposition to cancer.Methods:Two hundred and forty-three (89% response rate) women with BC completed questionnaires after an initial genetic counselling visit (T1), of which 180 (66%) completed questionnaires again after receiving the BRCA1/2 results (T2). The discrepancy between women’s perceived probability of cancer genetic predisposition at T1 and the geneticist’s computed estimates was assessed.Results:In all, 74% of women received a negative uninformative (NU), 11% a positive BRCA1/2 and 15% an unclassified variant (UV) result. On hierarchical regression analysis, in women with a positive BRCA1/2 result (vs NU or UV), a lower perceived probability of cancer genetic predisposition than objective estimates at T1 predicted lower levels of anxiety at T2 (β=−0.28; P<0.01), whereas in women receiving a UV result (vs NU or positive BRCA1/2), a lower perceived probability of cancer genetic predisposition than objective estimates at T1 predicted higher levels of anxiety (β=0.20; P<0.01), depression (β=0.19; P<0.05) and intrusion (β=0.18; P<0.05) at T2.Conclusion:The type of BRCA1/2 test result differently affects distress according to women’s perceived probability of genetic predisposition before testing.