Littérature scientifique sur le sujet « Cancer du sein – Patients »
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Articles de revues sur le sujet "Cancer du sein – Patients"
1
SAMI, Soraya. « Biphosphonates in the treatment of early breast cancer ». Batna Journal of Medical Sciences (BJMS) 8, no 2 (28 décembre 2021) : 140–44. http://dx.doi.org/10.48087/bjmsra.2021.8210.
Texte intégralRésumé :
Les biphosphonates sont utilisés en situation adjuvante en association aux inhibiteurs de l’aromatase, afin de prévenir la perte osseuse. Des études précliniques ont également démontré leur effet antitumoral. En effet, de larges essais randomisés de phase III ont confirmé que les biphosphonates permettent d’améliorer la survie des patientes ménopausées atteintes d’un cancer du sein au stade précoce. Actuellement, le clodronate et l’acide zoledronique sont recommandés dans cette indication. Les risques et les avantages du traitement doivent être discutés avec les patients.
2
Benabdelhafid, Zohir. « Neglected breast cancers : which reality?. A case report and literature review ». Batna Journal of Medical Sciences (BJMS) 6, no 2 (30 décembre 2019) : 136–38. http://dx.doi.org/10.48087/bjmscr.2019.6214.
Texte intégralRésumé :
Les cancers du sein dits "négligés", sont des tumeurs géantes, de diamètre habituellement supérieur à 10 cm et de longue durée d'évolution. Le cancer du sein négligé est une entité rare en occident alors qu’on continue de recevoir des patientes à un stade très avancé et/ou négligé dans notre pays malgré les avancés importantes les dernières années dans le diagnostic précoce du cancer du sein. Nous exposons le cas d’une patiente prise en charge au centre anti cancer de Batna qui avait un cancer du sein qui a évolué pendant 18 mois ; elle a vu son sein augmenter de volume avec des signes inflammatoires mais elle a préféré faire soigner son sein par un herboriste et elle n’a consulté le médecin que dans un état historique de cancer du sein localement avancé avec métastases pulmonaires, hépatiques et osseuses. Le but de notre publication est donc d’identifier dans notre pratique quotidienne, les facteurs qui amènent les patientes à consulter à des stades tardifs pour mieux sensibiliser la population et optimiser la prise en charge de ces patientes
3
Salisu, Waliu Jawula, Jila Mirlashari, Khatereh Seylani, Shokoh Varaei et Sally Thorne. « Fatalisme, méfiance et refus des traitements contre le cancer du sein au Ghana ». Canadian Oncology Nursing Journal 32, no 2 (21 avril 2022) : 206–13. http://dx.doi.org/10.5737/23688076322206213.
Texte intégralRésumé :
Grâce aux récentes avancées en science et technologie, les options de traitement contre le cancer se sont multipliées, et les taux de survivance, améliorés. Pourtant, certaines personnes qui reçoivent un diagnostic de cancer du sein refusent les traitements. Cette étude vise à explorer comment les croyances et idées personnelles des patientes atteintes d’un cancer du sein influencent leur décision de refuser les traitements médicaux. Ainsi, treize entrevues avec des participantes ont été sélectionnées parmi une cohorte de plus grande taille afin de mener une seconde analyse en utilisant l’approche basée sur la théorie ancrée. La décision de renoncer au traitement médical était principalement influencée par les croyances personnelles, qui se déclinent ainsi : 1. Triangle religion-superstitions-ignorance; 2. Système de croyances traditionnelles ghanéennes; 3. Conviction que c’est son destin; 4. Relations précaires entre patients et soignants; 5. Rendez-vous inutiles; et 6. Épreuves inutiles. On peut les regrouper en deux grands thèmes : fatalisme, et communication déficiente entre le personnel de la santé et les patients. Les croyances personnelles et les failles administratives du système de santé sont donc les deux principales influences qui expliquent le refus en hausse des traitements médicaux chez les patientes ayant un cancer du sein au Ghana. Ces conclusions mettent en relief les besoins de mieux sensibiliser au cancer du sein, d’offrir des consultations professionnelles et de donner accès à des services de soutien psychologique.
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SAMI, Soraya, et Kamel BOUZID. « Treatment of bone metastases by intravenous bisphosphonates and denosumab in breast cancer ». Batna Journal of Medical Sciences (BJMS) 6, no 1 (1 juillet 2019) : 18–21. http://dx.doi.org/10.48087/bjmsra.2019.6106.
Texte intégralRésumé :
Les métastases osseuses sont fréquentes dans le cancer du sein. Elles sont à l’origine d’une morbidité importante, entrainant des fractures, des douleurs osseuses, une compression médullaire ou une hypercalcémie. Les bisphosphonates intraveineux et le denosumab, associés aux différents traitements multidisciplinaires, améliorent la qualité de vie des patients. En effet, ils permettent une réduction des complications osseuses et la survenue des événements osseux.
5
Lanthaume, S., et B. Fleury. « Rémission, guérison… et rétablissement dans l'expérience du cancer du sein ». Psycho-Oncologie 11, no 4 (décembre 2017) : 227–32. http://dx.doi.org/10.3166/s11839-017-0636-8.
Texte intégralRésumé :
L'annonce de la fin des traitements signe l'entrée dans une période difficile pour les patients atteints de cancer. La transition de l'état de malade à celui de « survivant » constitue un nouveau changement suscitant à la fois enthousiasme mais aussi peurs diverses. Le passage vers la phase de rémission ne se fait donc pas de manière radicale ; il demande du temps et des réajustements. L'objectif de cet article consiste à présenter les termes employés lors de l'entrée dans cette période d'après-cancer, à décrire les conséquences de ces mots sur les patientes atteintes de cancer du sein et à fournir un langage différent qui permettrait à celle qui le reçoit de changer sa manière d'agir et de percevoir ce temps après-cancer. Ce langage concerne la relation entre la patiente et son médecin, mais aussi l'équipe soignante. Le terme de rémission, actuellement employé dans l'après-traitement, semble confiner les personnes atteintes de cancer dans un éternel statut de malade. Statut peu enviable et souvent stigmatisant. La proposition du mot « rétablissement » ne doit pas être comprise comme une « guérison » complète — celle-ci n'étant pas toujours possible dans le cancer —, mais comme un processus.
6
Ndiaye, M., S. Dieng, J. Thiam, AC Diallo, D. Diouf, S. Ka et A. Dem. « C102 : Evaluation des facteurs pronostiques dans le cancer du sein chez la femme au Sénégal : A propos de 288 cas ». African Journal of Oncology 2, no 1 Supplement (1 mars 2022) : S43. http://dx.doi.org/10.54266/ajo.2.1s.c102.fsgj6112.
Texte intégralRésumé :
INTRODUCTION : Au Sénégal, le cancer du sein représente le deuxième cancer féminin et pose un problème de santé public majeur. Le but de ce travail était d’évaluer les facteurs pronostiques dans l’évolution du cancer du sein chez la femme. MATERIELS ET METHODES : Il s'agit d'une étude rétrospective réalisée sur une période sur un an allant du 1er Janvier 2008 au 31 Décembre 2008 portant sur l'ensemble des femmes suivies pour cancer du sein au service de cancérologie à l'Institut Joliot Curie. Ainsi, 288 patientes atteintes de cancer du sein ont été colligés. RESULTATS : La moyenne d’âge de nos malades était de 47,32 ans. La parité moyenne était de 4,9 enfants par femme. Vingt-deux soit 7% des patientes avaient un antécédent de cancer. Cliniquement, la taille tumorale était classée T4 chez 180 patientes soit 81%. Une atteinte ganglionnaire chez 188 patientes (65,2%). Le type histologique le plus fréquent était le carcinome canalaire infiltrant avec 90,3% des cas. Une prédominance des grades SBRII et SBRIII a été observé (respectivement 41 et 46%). Les récepteurs hormonaux (RH) étaient positifs dans huit cas (24%). La surexpression du gène Her2 était retrouvée chez seulement quatre patientes sur 30. Les limites de la chirurgie étaient précisées chez 48 patientes avec des marges envahies chez sept patientes (14,5%). La présence d'emboles vasculaires était notée chez 18 patientes parmi les 29 dont la recherche a été effectuée chez 179 patientes soit 62%. Au moment du diagnostic initial, 45 patientes soit 19,7% des malades présentaient au moins une métastase distance. La majorité des patientes étaient reçues à un stade avancé (89%, classées entre stade III et IV). Une seule patiente était reçue au stade I. La survie globale pour les cancers du sein était à 72% à trois ans et 30% à cinq ans. La survie globale à cinq ans des patientes au stade localisé de la maladie était de 85% contre 5% pour les patientes au stade avancé. CONCLUSION : Les facteurs pronostiques sont multiples et souvent péjoratifs chez nos patients avec une prédominance des femmes jeunes, des cancers localement avancés et des formes biologiques agressifs.
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Sarr, FN, PM Gaye, MB Ba, F. Niang, M. Mané et FCA Chemega. « C71 : Métastases naso-sinusiennes du cancer du sein : A propos de deux cas ». African Journal of Oncology 2, no 1 Supplement (1 mars 2022) : S30—S31. http://dx.doi.org/10.54266/ajo.2.1s.c71.cchk6379.
Texte intégralRésumé :
INTRODUCTION : Le cancer du sein est un problème de santé publique majeur dont l'incidence a augmenté ces dernières années. L'amélioration des traitements a permis d'augmenter les taux de survie et de plus en plus de patients ont le temps de développer des localisations secondaires. Les métastases naso-sinusiennes du cancer du sein sont exceptionnelles. Seuls quelques cas de métastases paranasales du cancer du sein ont été publiés. Le mécanisme des métastases du sinus paranasal n'est pas clair. La propagation hématogène à travers la colonne vertébrale via le plexus veineux a été avancée. La manœuvre de Valsalva peut provoquer un flux rétrograde à travers un système à basse pression et sans valve, qui communique avec le système veineux du thorax et transporte les emboles tumoraux jusqu'au plexus ptérygoïde et les sinus paranasaux. Nous rapportons les données diagnostiques et thérapeutiques de deux patientes souffrant d'un cancer du sein et ayant présenté des métastases au niveau naso-sinusien au cours de leur maladie. MATERIELS ET METHODES : Nous rapportons les données diagnostiques et thérapeutiques de deux patientes souffrant de cancer du sein et présentant des métastases au niveau naso-sinusien, avec une mise en exergue sur l'intérêt de la radiothérapie en soins palliatifs. RESULTATS : Les deux patientes âgées de 56 et 60 ans ont présenté au cours de leur cancer du sein des localisations secondaires dans le sinus sphénoïdal et maxillaire confirmées par l'endoscopie et l'histologie. Tous les cas présentaient des lésions massives associées à d'autres localisations osseuses secondaires notamment. Après une radiothérapie locale et une chimiothérapie systémique, une patiente est décédée cinq mois après son diagnostic et l'autre était encore en vie 16 mois plus tard. CONCLUSION : Les métastases naso-sinusiennes du cancer du sein sont très rares mais possibles. Ce diagnostic doit être évoqué devant toute manifestation naso-sinusienne chez un patient ayant des antécédents de cancer du sein, ce qui permettrait de faire un diagnostic précoce et d'éviter autant que possible les complications locorégionales, d'éviter autant que possible les complications locorégionales. Malgré le mauvais pronostic généralement associé à ce tableau en raison de la généralisation de la maladie, la radiothérapie offre un bon contrôle local.
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Hamma, Amine, Meriem Djouadi et Nadia Djellouli. « A feeling of fog lifts the veil on a multi-metastatic breast cancer ». Batna Journal of Medical Sciences (BJMS) 7, no 1 (2 mai 2020) : 53–55. http://dx.doi.org/10.48087/bjmscr.2020.7113.
Texte intégralRésumé :
Le cancer du sein représente un véritable problème de santé publique de par la morbi-mortalité qu’il engendre. Bien que les stratégies de prise en charge précoce soient de mieux en mieux élaborées avec une curabilité en nette augmentation, le cancer métastatique demeure souvent incurable où seules des mesures palliatives peuvent être proposées. Nous rapportons le cas d’une patiente âgée de 59 ans qui consulte aux urgences ophtalmologiques pour une sensation de brouillard de son œil droit évoluant depuis une dizaine de jours environ, dont l’investigation clinique a décelé un carcinome mammaire canalaire infiltrant multi-métastatique. Une chimiothérapie palliative a été entamée dans les plus brefs délais dont les effets sur la tumeur primitive et sur les localisations secondaires étaient assez satisfaisants, notamment au niveau oculaire où une amélioration conséquente de l’acuité visuelle a été notée remontant jusqu’à 6/10. Cependant, après une certaine durée nous avons constaté une diminution de l’acuité visuelle faisant ainsi discuter d’autres alternatives thérapeutiques à savoir une radiothérapie externe de la métastase choroïdienne à laquelle la patiente s’y est farouchement opposée et ce, hormis de nombreuses séances de psychothérapie, puis une injection latéro-bulbaire de corticostéroïdes ayant donné une augmentation spectaculaire de l’acuité visuelle. L’association de métastases cutanées, oculaires, ganglionnaires et pulmonaires à une tumeur du sein bien visible à l’inspection est extrêmement rare et figure parmi les cas historiques auxquels on ne devrait plus assister au 21ème siècle. A cet effet, nous insistons sur le dépistage et la sensibilisation des populations au cancer du sein en mettant l’accent essentiellement sur le soutien psychologique.
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Somé, OR, A. Dembélé, V. Konségré, H. Belemlilga, N. Yabré, N. Keita, C. Zaré et S. Ouattara. « C101 : Place de la chirurgie dans la prise en charge du cancer du sein au CHU Sourô Sanou à Bobo Dioulasso ». African Journal of Oncology 2, no 1 Supplement (1 mars 2022) : S42—S43. http://dx.doi.org/10.54266/ajo.2.1s.c101.lzzp3550.
Texte intégralRésumé :
INTRODUCTION : Décrire les résultats de la chirurgie dans la prise en charge des cancers du sein. MATERIELS ET METHODES : Il s’est agi d’une étude descriptive transversale du 31 Juillet 2015 au 31 Mai 2020 au CHU Sourô Sanou à Bobo Dioulasso. Elle a porté sur 368 cas de cancer du sein dont huit chez l’homme. L’âge moyen était de 46,6 (15 – 90) ± 12,1 ans. La tumeur était T4 dans 77% (n=283). Les stades III et IV représentaient respectivement un effectif de 149 (40,5%) et 134 (36,4%) patients. On notait un cancer triple négatif dans 53% (18/34). Les données sur la chirurgie ont été étudiées. RESULTATS : Deux cent trois patients (55%) avaient été opérés. Les lésions étaient non résécables dans 81 cas (22%). On répertoriait 84 patients perdus de vue (23%). La chirurgie curative a été réalisée chez 138 patients (37,5%). Parmi eux, 84% (116/138) avaient réalisé une chimiothérapie néoadjuvante. La chirurgie a été conservatrice avec plastie et curage axillaire chez 12 patientes (3,7%) et radicale type mastectomie selon Madden chez 128 patients (34,2%). Le nombre moyen de ganglions ramenés était de 11 avec des extrêmes allant de trois à 29. La mastectomie de propreté avait été réalisée chez 65 (17,7%) patients. La morbidité était de 30% (cœlome, suppuration, retard de cicatrisation). La survie à un an était de 50%. Cette survie était liée au stade de la maladie avec une différence statistiquement significative (p=0,00074). CONCLUSION : Le stade localement avancé et le coût élevé de la chimiothérapie réduisent les indications de la chirurgie pour cancer du sein. Les résultats oncologiques du traitement conservateur et radical sont encourageants et devraient inciter à promouvoir la détection précoce.
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Ndiaye, Mamadou, Souleymane Dieng, Jaafar Thiam, Adja Coumba Diallo, Doudou Diouf, Sidy Ka et Ahmadou Dem. « Assessment of prognostic factors in breast cancer in women in Senegal : a review of 288 cases ». African Journal of Oncology 1, no 1 (1 janvier 2021) : 6–9. http://dx.doi.org/10.54266/ajo.1.1.6.6.
Texte intégralRésumé :
INTRODUCTION: In Senegal, breast cancer is the second female cancer and poses a major public health problem. The aim of this work was to assess prognostic factors in the progression of breast cancer in women. PATIENTS AND METHODS: This is a retrospective study carried out over a period of one year from January 1, 2008 to December 31, 2008 on all the women followed for breast cancer in the oncology department at the Joliot Curie Institute. Thus, 288 breast cancer patients were collected. RESULTS: The average age of our patients was 47.32 years. The average parity was 4.9 children per woman. Twenty-two or 7% of patients had a history of cancer. Clinically, the tumor size was classified as T4 in 180 patients, ie 81%. Lymph node involvement in 188 patients (65.2%). The most frequent histological type was invasive ductal carcinoma with 90.3% of cases. A predominance of grades SBRII and SBRIII was observed (respectively 41% and 46%). Hormone receptors (RH) were positive in eight cases (24%). Overexpression of the HER2 gene was found in only four out of 30 patients. The limits of the surgery were specified in 48 patients with invaded margins in seven patients (14.5%). The presence of vascular emboli was noted in 18 patients among the 29 whose research was carried out in 179 patients, ie 62%. At the time of the initial diagnosis, 45 patients or 19.7% of patients presented at least one distant metastasis. The majority of patients were received at an advanced stage (89%, classified between stage III and IV). Only one patient was received at stage I. Overall survival for breast cancer was 72% at 3 years and 30% at 5 years. The 5-year overall survival of patients with localized disease was 85% compared to 5% for patients with advanced stage. CONCLUSION: The prognostic factors are multiple and often pejorative in our patients with a predominance of young women, locally advanced cancers and aggressive biological forms.
Thèses sur le sujet "Cancer du sein – Patients"
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Lambert-Côté, Laurence. « Les trajectoires d'adhésion à l'hormonothérapie adjuvante au cours des cinq ans suivant l'initiation chez les femmes ayant eu un cancer du sein non-métastatique ». Master's thesis, Université Laval, 2019. http://hdl.handle.net/20.500.11794/66550.
Texte intégralRésumé :
Malgré les bénéfices de l’hormonothérapie adjuvante (HA) pour réduire les risques de récidive et de mortalité suite à un cancer du sein hormono dépendant, l’adhésion à l’HA est sous-optimale pour une grande proportion de femmes. Toutefois, les connaissances sur les patrons longitudinaux d’adhésion à l’HA demeurent limitées. Cette étude visait à : 1)identifier les trajectoires d’adhésion à l’HA pour les cinq ans suivant l’initiation; 2) décrire les trajectoires en utilisant des mesures traditionnelles d’adhésion (p.ex. la proportion de jours couverts (PJC)); 3) explorer les facteurs associés aux trajectoires. Une étude de cohorte a été réalisée à partir d’une enquête nationale française incluant des données administratives de dispensation d’HA. Les femmes ayant un diagnostic de cancer du sein non-métastatiqueet ≥1 dispensation d’HA au cours des 12 mois suivant le diagnostic ont été incluses. Le Group-based trajectory modeling a permis d’identifier les trajectoires d’adhésion en regroupant des patrons similaires de dispensations mensuelles d’HA. Des régressions logistiques polytomiques ont permis d’identifier les facteurs associés aux trajectoires. Parmi les 674 femmes incluses, cinq trajectoires d’adhésion à l’HA ont été identifiées : 1) déclin rapide et arrêt (5,2%), 2) déclin modéré et arrêt (6,4%), 3) déclin lent (17,2%), 4) adhésion élevée (30,0%), 5) maintien d’une adhésion très élevée (41,2%). La PJC moyenne pour les cinq ans était de 80%, mais variait de 10% à 97% selon les trajectoires. Les femmes n’ayant pas reçu de chimiothérapie ou de programme personnalisé de soins étaient plus susceptibles d’appartenir à des trajectoires présentant un déclin de l’adhésion suivi de l’arrêt de l’HA. Nos résultats fournissent des informations sur les patrons longitudinaux de l’adhésion à l’HA, les facteurs associés à ceux-ci et les moments critiques pour l’adhésion qui pourront être utilisés par les professionnels de la santé impliqués auprès de ces femmes.Despite the benefits of adjuvant endocrine therapy (AET) for reducing recurrence andmortality risks after hormone-sensitive breast cancer, AET adherence is sub-optimal for ahigh proportion of women. However, little is known about long-term patterns of AETadherence over the minimally recommended 5 years. Our objectives were to: 1) identify fiveyear AET adherence trajectory groups; 2) describe trajectory groups according to adherencemeasures traditionally used (i.e. the proportion of days covered (PDC)); 3) explore factorsassociated with trajectories. We conducted a five-year cohort study using data from a Frenchnational study that included AET dispensing administrative data. Women diagnosed withfirst non-metastatic breast cancer and having ≥1 AET dispensing in the 12 months afterdiagnosis were included. Group-based trajectory modeling was used to identify adherencetrajectory groups by clustering similar patterns of monthly AET dispensing. Multinomiallogistic regressions were used to identify factors associated with trajectories. Among 674women, five AET adherence trajectory groups were identified: 1) quick decline and stop(5.2% of women); 2) moderate decline and stop (6.4%); 3) slow decline (17.2%); 4) highadherence (30.0%); 5) maintenance of very high adherence (41.2%). Mean 5-year PDCvaried from 10% to 97% according to trajectories. Women who did not receive chemotherapyor a personalized care plan were more likely assigned to trajectories where AET adherencedeclined and stopped. Our results provide information on the diversity of longitudinal AETadherence patterns, the timing of decline and discontinuation and associated factors thatcould inform healthcare professionals.
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Lewis, Florence. « Contribution à une meilleure évaluation et prise en charge de l'anxiété chez des patientes présentant un cancer du sein ». Doctoral thesis, Universite Libre de Bruxelles, 2015. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209165.
Texte intégralRésumé :
L’anxiété est très fréquente chez des patientes présentant un cancer du sein non-métastatique et peut avoir des répercussions importantes sur leur prise en charge médicale ainsi que sur leur bien-être physique et psychologique. S’il existe une littérature abondante sur le sujet, de nombreuses questions subsistent concernant l’évaluation et la prise en charge de l’anxiété durant la radiothérapie et dans la phase de rémission qui suit. Ce travail de thèse a investigué ces questions au travers de deux études empiriques répondant aux objectifs suivants: (a) l’évaluation de l’évolution et des prédicteurs de l’anxiété durant le traitement de radiothérapie et (b) le développement et l’évaluation de l’efficacité de deux interventions psychologiques de groupe sur la régulation de l’anxiété après la radiothérapie.
Les résultats de la première étude (a) montrent que les niveaux d’anxiété les plus élevés sont observés lors de la simulation et de la première séance de radiothérapie et diminuent, ensuite, rapidement jusqu’à la fin du traitement. Bien que les niveaux d’anxiété soient relativement faibles pour de nombreuses patientes et semblent être de nature anticipatoire, certaines patientes présentent des niveaux cliniquement significatifs d’anxiété. De plus, un niveau cliniquement significatif d’anxiété à la première séance de radiothérapie est prédit par des facteurs liés à la communication entre les patientes et l’équipe de radiothérapie. Les résultats de la seconde étude (b) indiquent qu’une intervention de groupe à composantes multiples qui combine le soutien, les techniques cognitivo-comportementales et l’hypnose est plus efficace qu’une intervention de groupe à composante unique basée sur le soutien pour aider les patientes à mieux réguler leur anxiété après la radiothérapie.
Les résultats de ce travail de thèse soulignent l’importance d’évaluer l’anxiété chez les patientes à des moments critiques de leurs parcours médical et d’identifier les patientes qui présentent des niveaux cliniquement significatifs d’anxiété pour leur offrir un soutien adapté. Ces résultats suggèrent également d’améliorer les prises en charge afin de réduire l’anxiété des patientes. Des prises en charge offertes par les équipes de radiothérapie nécessitent une personnalisation de la communication établie avec les patientes et l’utilisation de stratégies proactives d’évaluation, d’information et de soutien. Des prises en charge psychologiques de groupe nécessitent quant à elles de combiner les composantes thérapeutiques les plus optimales. Enfin, ce travail de thèse souligne l’importance de continuer à développer et à améliorer les méthodes d’évaluation et d’intervention.
Doctorat en Sciences Psychologiques et de l'éducation
info:eu-repo/semantics/nonPublished
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Alfonso-Fischbach, Anne-Lys. « Les sarcomes du sein : à propos de 26 patientes traitées à la fondation Bergognié ». Bordeaux 2, 1992. http://www.theses.fr/1992BOR23115.
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Thierry, Alexandra. « Les effets des réseaux sur les représentations du cancer : étude auprès de patientes atteintes d'un cancer du sein ». Lille 1, 2005. https://pepite-depot.univ-lille.fr/LIBRE/Th_Num/2005/50377-2005-1-1.pdf.
Texte intégralRésumé :
La recherche analyse la production des représentations du cancer dans la population particulière des femmes elles-mêmes atteintes d'un cancer du sein. On teste l'hypothèse générale de " convergence communicationnelle" de Rogers et Kincaid, et celle plus spécifique de Freidson sur l'existence et l'importance d'un système référentiel profane. Une enquête auprès de 100 patientes permet de restituer leurs trajectoires médicales, leurs représentations de la maladie, leurs opinions sur les praticiéns, ainsi que les opinions que chacune perçoit dans son réseau profane. On montre comment les patientes sélectionnent les personnes avec qui elles peuvent parler vraiment de la maladie. On met en évidence quatre types de représentations du cancer et on montre qu'ils sont peu liés à des attributs individuels des patientes, mais fortement aux opinions qui circulent dans leurs réseaux de confidence.
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Mathelin, Carole. « Etude comparative des profils protéiques circulants de patientes atteintes d'un cancer mammaire ». Université Louis Pasteur (Strasbourg) (1971-2008), 2005. https://publication-theses.unistra.fr/restreint/theses_doctorat/2005/MATHELIN_Carole_2005.pdf.
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Humphries, Brittany. « Pertes de salaire occasionnées par le cancer du sein non-métastatique aux conjoints des patientes ». Master's thesis, Université Laval, 2017. http://hdl.handle.net/20.500.11794/28170.
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Objectif: L’objectif de ce mémoire est d’évaluer les pertes de salaire occasionnées aux conjoints des femmes atteintes d’un cancer du sein non-métastatique et ce, au cours des six mois suivant le début du premier traitement à visée curative. Méthodologie: Ce mémoire s’inscrit dans l’étude « Coûts du cancer du sein pour la patiente et sa famille : ampleur, déterminants et relation avec la qualité de vie » incluant 829 femmes ayant eu un cancer du sein non-métastatique recrutées dans huit hôpitaux du Québec ainsi que 427 de leurs proches. Pour répondre à l’objectif de ce mémoire, nous avons retenu les proches étant les conjoints des femmes et ayant un emploi au diagnostic. Les informations pour le calcul des pertes de salaire des conjoints (salaire habituel, durée des absences, compensations reçues) ont été recueillies à partir d’entrevues téléphoniques réalisées avec les conjoints 1 et 6 mois après le début du premier traitement à visée curative de la femme. Résultats: Parmi les 279 conjoints ayant un emploi au moment du diagnostic, 219 (78,5%) ont eu au moins une absence du travail ou ont diminué leurs heures habituellement travaillées en raison du cancer du sein. En moyenne, les conjoints ont été compensés à 66,3% de leur salaire pendant ces absences et périodes de diminution d’heures (écart-type = 43,5%; médiane = 100%). En tentant compte de ces compensations, la valeur médiane des pertes de salaire durant les six mois suivant le diagnostic était de 0$ CAN 2003 (moyenne = 1 819$; écart-type = 5 247$). Conclusion: Les absences du travail touchent la plupart des conjoints des femmes atteintes d’un cancer du sein non-métastatique. Cependant, les pertes de salaire demeurent modestes pour la majorité d’entre eux en raison des compensations reçues.Objective: The objective of this master’s thesis is to evaluate the wage losses incurred among spouses of women diagnosed with non-metastatic breast cancer in the six months following start of treatment. Methods: This master’s thesis is part of the study “Costs of breast cancer: extent, determinants and relation with quality of life”, which includes 829 women with non-metastatic breast cancer recruited in 8 Quebec hospitals and 427 of their relatives. To meet the objective of this thesis, we retained the relatives who were the spouse of the woman and who were employed in the month prior to diagnosis. Information to calculate wage losses (usual salary, absence duration, compensation received) was collected by telephone interviews conducted 1 and 6 months after the start of the woman’s treatments. Results: Among the 279 employed spouses, 219 (78.5%) experienced at least one absence or reduction in work hours because of breast cancer. Spouses were compensated an average of 66.3% of their salary during these absences or reductions in work hours (standard deviation = 43.5%; median = 100%). Considering all sources of compensation received, the median wage loss in the six months after diagnosis was $0 CAN 2003 (mean = $1,819; standard deviation = $5,247). Conclusion: Work absences affected the majority of spouses of woman diagnosed with non-metastatic breast cancer. However, wage losses were modest for most spouses because of compensation received.
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Tastet, Sandrine. « Approche biopsychosociale des cancers du sein : stratégies d'ajustement et immunocompétence : une étude semi-prospective d'une cohorte de 85 patientes ». Bordeaux 2, 2001. http://www.theses.fr/2001BOR2A002.
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Une recherche semi-prospective d'une durée d'un an a été menée sur un échantillon de 85 sujets présentant un 1er cancer du sein et traités par une chimiothérapie néo-adjuvante. Certains facteurs psycho-sociaux (antécédents psychologiques, sociobiogaphiques, médicaux et immunitaires) ont été mesurés avant l'annonce du diagnostic de cancer du sein (T1). Certains processus transactionnels ont été évalués 10 jours (T2) et 3 mois après le diagnostic (T3). Les critères ont été évalués soit à 3 mois (qualité de vie, T3) soit à 1 an (évolution de la maladie, T4). Les critères s'organisent en 2 dimensions distinctes : la qualité de vie et l'évolution défavorable de la maladie. Les processus transactionnels se structurent en 4 stratégies : une stratégies évaluative -contrôle perçu- et 3 stratégies d'ajustement spécifiques -impuissance-désespoir, stratégie combative et évitement cognitif. Certains antécédents (âge, Type C, contrôle de la colère, affectivité positive, TNFα. . . ) prédisent significativement ces stratégies. 4 antécédents (affectivité négative, changements, activités, réseau social familial) prédisent une bonne qualité de vie et 5 (IL-2, IFN-γ, nodules, séparations, réseau social familial) l'évolution défavorable de la maladie à un an. L'impuissance-désespoir (T2) prédit une mauvaise qualité de vie (T3). Le contrôle perçu (T3) exerce un effet direct sur l'évolution néoplasique (T4). La stratégie combative (T3) exerce un effet direct sur l'évolution néoplasique (T4). La stratégie combative (T3) module la relation entre IFN-γ et évolution défavorable de la maladie. Des relations significatives entre certaines variables immunitaires (IL-6) et certains processus transactionnels (contrôle interne, anxiété-état, contrôle perçu) suggèrent que des cofonctionnements biopsychosociaux sont impliqués dans l'évolution néoplastiqueA 12-month semi-prospective study was carried out on a sample of 85 patients receiving neo-adjuvant chematherapy treatment. Some psychosocial factors (e. G. Psychological, sociobiographic, medical and immunological antecedents) were mesured before diagnosis of breast cancer (T1). Some transactionnal processus were assessed ten days (T2) and 3 months after diagnosis (T3). . . (etc. )
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Dabakuyo-Yonli, Tienhan Sandrine Myriam. « Evolution de la prise en charge des cancers du sein : impacts sur la survie et la qualité de vie des patientes ». Dijon, 2009. http://www.theses.fr/2009DIJOMU02.
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Le contraste entre l’augmentation de l’incidence des cancers du sein et la stabilité de la mortalité observée depuis vingt cinq ans en France est en grande partie expliqué par l’amélioration de la prise en charge et le diagnostic précoce. Notre travail avait pour objectifs d’évaluer l’impact de l’évolution des modes de prise en charge diagnostique et thérapeutique sur les survies globale (OS) et relative (RS), ainsi que sur la qualité de vie (QdV) des patientes atteintes de cancer du sein. Une première étude nous a permis d’évaluer les OS et RS ainsi que de déterminer les facteurs pronostiques. Nos résultats montrent que les OS et RS sont influencées par le stade TNM, le grade SBR, les récepteurs hormonaux, le statut multifocal de la tumeur, l’extension locorégionale et la période de diagnostic. Une étude de QdV, prospective, multicentrique nous a permis d’évaluer l’impact de différentes techniques chirurgicales : ganglion sentinelle (SLNB), SLNB + curage axillaire complémentaire (ALND) et ALND sur la QdV des patientes atteintes de cancer du sein en Bourgogne. Les résultats de cette étude révèlent que la SLNB permet d’améliorer la QdV des patientes si elle n’est pas suivie par un curage complémentaire. Enfin, une étude évaluant l’impact du moment d'administration de la chimiothérapie sur les OS et RS des patientes atteintes du cancer du sein, nous a permis d’évaluer l’effet de la chimiothérapie néoadjuvante sur la survie en utilisant la RS comme critère de jugement principal. Malgré une tendance favorable, la chimiothérapie néoadjuvante comparativement à la chimiothérapie adjuvante n’améliore pas les OS et RS des patientes atteintes de cancer du seinThe contrast between the increase in the incidence of breast cancer rate and the stability of mortality rates seen in France during the past twenty five years may be due to advances in breast cancer management and early diagnosis. The aim of this work was to assess the impact of treatment advances on survival and quality of life (QoL) in breast cancer patients. The first study was undertaken to assess prognostic factors on overall (OS) and relative survival (RS) among patients with breast cancer. The results of this study showed that TNM stage, SBR grade, progesterone receptors status, tumour multifocal status, locoregional extension and the period of diagnosis were independent prognostic factors of OS and RS. The second study was a prospective multicenter study which aimed to assess the impact of different surgical procedures on QoL in breast cancer patients. The results of this study highlighted the beneficial effect of sentinel lymph node biopsy (SLNB) on breast cancer patients’ QoL as compared to axillary lymph node dissection (ALND) when SLNB is not followed by complementary ALND. SLNB should then be the treatment of choice for patients who have early-stage breast cancer with clinically negative nodes, and operating surgeons should have a high level of technical skill. The last study was undertaken to determine the efficacy of neoadjuvant chemotherapy compared with adjuvant chemotherapy using relative survival (RS) as the primary end point. Despite a favorable trend, this population-based study showed that neoadjuvant chemotherapy was no better than adjuvant chemotherapy in terms of OS and RS of breast cancer patients
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Ausseil, Michel. « Etude de la réactivité cutanée des patientes souffrant de néoplasie mammaire ». Montpellier 1, 1989. http://www.theses.fr/1989MON11209.
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Rey, Nicole. « Traitement conservateur du cancer du sein : extension aux tumeurs de plus de 3 cm de diamètre : à propos de 264 patientes traitées au C.R.L.C. de Montpellier, de 1973 à 1983 ». Montpellier 1, 1990. http://www.theses.fr/1990MON11135.
Texte intégralLivres sur le sujet "Cancer du sein – Patients"
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Picasso's woman, a breast cancer story. Vancouver : Douglas & McIntyre, 1994.
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Ferrandez, Jean-Claude. Rééducation et cancer du sein. 2e éd. Issy-les-Moulineaux : Elsevier Masson, 2006.
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Chart, Pamela. Breast cancer : A guide for patients. Toronto : Prospero Books, 2000.
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The cancer time : My story. [St. Thomas, Ont : A.D. Lounsbury], 2006.
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Survivante du cancer. St-Zénon, Québec : L. Courteau, 2005.
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Un sein en moins ! Et après ... : Témoignage. Chicoutimi (Québec) : Les Éditions JCL, 2014.
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Ma victoire sur le cancer du sein : Vue avec les yeux du coeur. Saint-Antonin, Québec : Merlin, 2003.
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Espérance et cancer. Charlesbourg, Québec : Éditions Le Renouveau, 1987.
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Levine, Tamara. But hope is longer : Navigating the country of breast cancer. Toronto : Second Story Press, 2012.
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Ma victoire sur le cancer du sein : Une saison de ma vie. Longueuil : Béliveau, 2012.
Trouver le texte intégralChapitres de livres sur le sujet "Cancer du sein – Patients"
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Sauvage, M., B. Trétarre, P. Grosclaude, F. Molinié, A. M. Aude, A. Danzon, A. V. Guizard et P. Arveux. « Sein ». Dans Survie des patients atteints de cancer en France, 225–32. Paris : Springer Paris, 2007. http://dx.doi.org/10.1007/978-2-287-39310-5_30.
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Fitoussi, A. « Prise en compte de tous les facteurs influençant la prise en charge des patientes à haut risque ». Dans Cancer du sein, 35–41. Paris : Springer Paris, 2012. http://dx.doi.org/10.1007/978-2-8178-0245-9_4.
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Falandry, C., et G. Freyer. « Traitement adjuvant du cancer du sein sans envahissement ganglionnaire de la patiente âgée de plus de 70 ans ». Dans Cancer du sein, 481–88. Paris : Springer Paris, 2012. http://dx.doi.org/10.1007/978-2-8178-0245-9_31.
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Chamorey, E., F. Ettore, R. Largillier, M. A. Mouret-Reynier, A. Courdi, J. Barrière, P. Follana et al. « Épidémiologie et diversité des cancers du sein N− Étude sur une cohorte de plus de 5 000 patientes traitées au Centre Antoine Lacassagne (Nice, France) ». Dans Cancer du sein, 441–56. Paris : Springer Paris, 2012. http://dx.doi.org/10.1007/978-2-8178-0245-9_28.
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Flipo, B., K. Clough, P. Alfonsi, M. Cohen, J. C. Darmon, S. Giard, G. Houvenaeghel et al. « Évaluation de la concordance entre le statut ganglionnaire et la biopsie du ganglion sentinelle avant une chimiothérapie néo-adjuvante chez les patientes atteintes d’un cancer du sein T2–T3 N0 ». Dans Cancer du sein, 117–26. Paris : Springer Paris, 2012. http://dx.doi.org/10.1007/978-2-8178-0245-9_9.
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Alran, S. « Quelle place pour le ganglion sentinelle après chimiothérapie néo-adjuvante ? Place d’un score clinico-biologique d’aide à la décision de ganglion sentinelle après chimiothérapie néo-adjuvante chez les patientes ayant un cancer du sein ». Dans Cancer du sein, 127–33. Paris : Springer Paris, 2012. http://dx.doi.org/10.1007/978-2-8178-0245-9_10.
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Bourgeois, H. P., S. Traoré, P. Solal-Celigny, O. Dupuis, P. Maillart, O. Capitain, R. Delva et al. « Évaluation d’un pronostic clinique de 2 mois chez des patients atteints d’un cancer du sein : les premiers résultats de l’étude Pronopall... » Dans Cancer du sein : surdiagnostic, surtraitement, 382–83. Paris : Springer Paris, 2012. http://dx.doi.org/10.1007/978-2-8178-0249-7_118.
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Largillier, R., E. Chamorey, J. Doyen, A. Courdi, F. Ettore, C. Maestro, I. Raoust, M. Lallement, M. Namer et J. M. Ferrero. « Évaluation des facteurs pronostiques déterminants pour la stratégie thérapeutique des patientes métastatiques après cancer du sein ». Dans Cancer du sein avancé, 127–28. Paris : Springer Paris, 2007. http://dx.doi.org/10.1007/978-2-287-72615-6_12.
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Borisch, B. « Informations aux patientes pour le dépistage par mammographie ». Dans Cancer du sein : surdiagnostic, surtraitement, 53–56. Paris : Springer Paris, 2012. http://dx.doi.org/10.1007/978-2-8178-0249-7_5.
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Aide, N., O. Switsers, D. Allouache, C. Lévy, C. Delcambre-Lair, V. Huchet, T. Delozier, A. Hardouin et S. Bardet. « Influence de la concentration sérique de CA 15-3 sur les performances diagnostiques de la TEP FDG chez patientes ayant un cancer du sein avec imagerie négative ». Dans Cancer du sein avancé, 67–68. Paris : Springer Paris, 2007. http://dx.doi.org/10.1007/978-2-287-72615-6_7.
Texte intégralActes de conférences sur le sujet "Cancer du sein – Patients"
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Shukla, H., K. Batra, R. Sekhon, S. Giri et S. Rawal. « Over view of clinical presentation, management and outcome of cervical cancer : A tertiary cancer centre experience ». Dans 16th Annual International Conference RGCON. Thieme Medical and Scientific Publishers Private Ltd., 2016. http://dx.doi.org/10.1055/s-0039-1685265.
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Objectives: (a) To understand the profile of cervical cancer patients attending our hospital from January 2011 till January 2015. (b) To audit the type of care given to the patients with respect to their stage at presentation. (c) To compare the outcomes of open v/s robotic radical hysterectomy done for cervical cancer. Methods: We prospectively analyzed all cases of cervical cancer from January 2011 to January 2015 presenting at our institute. Data was retrieved from patient’s records and institute’s tumor registry. We compared all patients undergoing open v/s robotic RH. All the data were analysed using SPSS version 21. Results: A total of 562 patients were treated for cervical cancer during the time period between 2011-2015. Of these there were 316 (56%) cases taken up for surgery-212 robotic RH, 104 open radical hysterectomy and rest 246 (44%) patients received definitive CCRT. Most common age group was 40-54 yrs. IB1 stage was most common presenting stage. SCC was most common histology (75%). Immediate post op complication and oncological safety in terms of local recurrence was same in both groups. However length of stay and post operative blood requirement was significantly lower in robotic RH group. 45% of all patients who underwent surgery did not require adjuvant therapy in post op period while 35% patient required post op RT and 20% CCRT. 2.2% patient had local recurrence and most of the patients were in stage IIA1 at presentation. Conclusion: Cervical cancer is the most common gynecological cancer in our hospital registry. Mostly women were in the age group of 40-54 years. Most common stage at presentation was 1B and the histology being SCC. Not many differences seen in open v/s robotic techniques of radical hysterectomy except for shorter hospital stay and less need of blood transfusion in the robotic group. Local recurrence rates are comparable in both open and robotic groups.
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Melo, Maria Eduarda Bernardino Martins, Gabriela Prado Lopes, Darley Lima Ferreira Filho, Irnanda Layanna Gomes Oliveira et Maria Eduarda Vasconcelos Florêncio Cavalcanti. « MALE BILATERAL BREAST CANCER : CASE REPORT ». Dans Scientifc papers of XXIII Brazilian Breast Congress - 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s1077.
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Introduction: Breast cancer occurring bilaterally in men is extremely rare. Breast cancer represents 1% of all cancers, while bilateral cancer represents 5% of a total number of patients with breast cancer, which may be synchronic or metachronic. Many cases of breast cancer in men are detected between 60 and 70 years, with an average of 67 years of age. In men there is a tendency for late diagnosis at a more advanced stage than in women. Case report: A male patient, JSS, 68 years old, from Afogados da Ingazeira, state of Pernambuco, was seen with breast tumoration in June 2016. He arrived at the service with an existing diagnosis of breast cancer through core-biopsy examination. The physical exam presented bulging in the left retroareolar region and a hardened tumoration in palpation. Radical mastectomy was performed. The histopathological results confirmed an invasive mucinous carcinoma with histological grade I, nuclear grade II and mitotic grade I. Free margins. The most frequent histological type in men is ductal (85%–90%), followed by papillary in 4.5% and mucinous in 2.8% of the cases. Nineteen free axillary lymph nodes were dissected, with Estrogen and Progesterone + receptors, Her-2, negative and with Ki-67 of 5%. Breast cancers in men present with more positivity for hormone receptors and low expression for Her-2. The pathological staging was classified as II a. The patient was being followed by the clinical oncology department, where he was chosen not to do chemotherapy and only hormone therapy, with Tamoxifen 20 mg. However, over a period of six months he noticed the presence of a tumoration in the right breast. An image examination was performed with MG/USG, which confirmed the presence of a tumor in the right retro-areolar region (Birads IV). A core-biopsy of the lesion was requested, which confirmed an invasive breast cancer. The patient underwent right radical mastectomy, whose result confirmed an invasive ductal carcinoma with pathological staging II a. Conclusion: This pathology is extremely rare in men and the evaluation of the contralateral breast is of fundamental importance. Early diagnosis and compliance with treatment will reduce tumor recurrence and provide a better prognosis for these patients.
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Khosla, Muskaan, Raghavan Vidya, Kim Baek, Vinayagam R, Lydia Prusty, Mr Dinesh Thekkinkattil, Siobhan Laws et Stergios Douvetzemis. « MULTI-CENTRE PROSPECTIVE EVALUATION OF NEGATIVE PRESSURE WOUND THERAPY (NPWT) IN PATIENTS UNDERGOING ONCOPLASTIC BREAST SURGERY ». Dans Brazilian Breast Cancer Symposium 2022. Mastology, 2022. http://dx.doi.org/10.29289/259453942022v32s2012.
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Objective: Oncoplastic breast surgery is well-established but has a higher risk of wound complications. This may result in a delay in receiving adjuvant therapy, increased hospital visits with associated financial implications, and sub-optimal cosmetic outcomes. Negative pressure wound therapy (NPWT) has emerged as an additional tool to reduce wound complication rates, but further evaluation is required to evaluate its efficacy. This study investigated the prophylactic use of PICO® NPWT in patients undergoing oncoplastic breast surgery. We determined the rate of wound-related complications, including dehiscence, necrosis, implant loss, and infection. We compared our findings with data from the National Mastectomy and Breast Reconstruction Audit 2011 (NMBRA) and implant-based Breast Reconstruction Audit (iBRA). Methods: This was a prospective multi-centre national audit. The participating UK breast units routinely used NPWT for oncoplastic breast surgical procedures. Data collection included rates of wound dehiscence, wound necrosis, wound infection, and implant loss. The study findings were compared against the NMBRA and the iBRA studies. Results: Data from 267 patients were included in the study from 7 centres. The mean duration of PICO use was 6.6 [SD 1.9 days]. In all, 36 patients (13.5%) developed post-operative wound complications; 16 patients (6%) developed skin flap necrosis; wound dehiscence occurred in 13 patients (4.9%); and 15 patients (5.6%) developed post-operative wound infection. Of the whole cohort, 11 patients (4.1%) required further surgery due to wound complications, and 8 patients (3%) had a delay in the receipt of adjuvant therapy. A total of 158 patients underwent mastectomy with immediate implant-based breast reconstruction. The post-operative wound complication rate was comparable in this subgroup (n=22; 13.9%). Skin flap necrosis was seen in 10 patients (6.3%), wound dehiscence was seen in 7 patients (4.4%), and 8 patients (5.1%) developed wound infection. The implant loss rate was 3.8%. The estimated total cost savings were ￡84,613 and ￡316.90 per patient. Conclusion: This study suggests that prophylactic use of NPWT in oncoplastic breast surgery results in a low rate of wound-related complications with associated healthcare cost benefits. A prospective randomised controlled trial is required to further evaluate the prophylactic use of NPWT in oncoplastic breast surgery.
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Francisco, Alice Aparecida Rodrigues Ferreira, Jader Brito Ramos dos Santos, Otávio Augusto Soares Machado, João Luiz Lopes de Moura et Karen Y. Wonders. « IMPLEMENTING AN EXERCISE ONCOLOGY PROGRAM FOR BREAST CANCER PATIENTS IN BRAZIL : THE MAPLE TREE CANCER ALLIANCE EXPERIENCE ». Dans XXIV Congresso Brasileiro de Mastologia. Mastology, 2022. http://dx.doi.org/10.29289/259453942022v32s1045.
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Introduction: Breast cancer (BC) has already been extensively studied in the field of exercise oncology, with a 300% growth rate for publications in the past 12 years, after the American Society for Sports Medicine published the first roundtable for exercise in cancer survivors. However, even with numerous studies demonstrating effectiveness, there is a lack of information for health-care professionals, including breast surgeons and clinical oncologists, and also for patients and caregivers. Despite this, specialized programs and exercise professionals trained to support this population are rare, and it is not different in Brazil. Maple Tree Cancer Alliance (MTCA) is a nonprofit organization working with cancer patients since 2011 in the United States. In 2019, an international process was started, and the first unit outside the United States started operating in 2020 in Brazil. The exercise protocol developed by the MTCA includes resistance training and aerobic modalities, prescribed in a phase system, according to the kind of treatment the person is doing for cancer, and also according to cardiovascular fitness and previous experiences. Patients were followed for a period of 12–48 weeks, and assessments were done before starting, every 12 weeks. Objective: The aim of this study was to describe the first-year experience for MTCA in Brazil, until December 2021. Methods: Every patient starting the MTCA program performs an initial assessment, to get information about the disease, treatment, cardiovascular fitness, and corporal measures. The assessments are repeated in a 12-week interval. Parameters like weight, body mass index (BMI), body weight (with bioimpedance), muscle strength, flexibility, cardiovascular fitness, and postural evaluation are scored and compared with previous analysis during the patient’s participation. Results: During the first year of operating in Brazil, the MTCA performed 107 physical assessments. Of these, 86 were BC patients, either during (chemotherapy, radiotherapy, or hormone therapy) or post-treatment (80.37%). In all, 20 patients did not continue the exercise program (23.25%), and there were 2 deaths (2.32% — all patients in this group started the program as metastatic BC). The mean age was 50.69 years old (26– 79 years old). We observed in the BC patients, as reported in the literature, higher rates of overweight and obesity: mean BMI was 28.57 kg/m2 (ranging from 19.1 to 47 kg/m2 ). Overweight and obese patients correspond to 75.6% according to the first assessment measure. Comparing initial assessment and the first reassessment, 40 patients have completed the first phase of MTCA training, 45% lost weight, 47.5% gained, and 7.5% were stable. The mean weight gain was 3.49 kg and the mean weight loss was 1.9 kg. Treatment phase was not considered in this observation. We also observed some resistance for health-care professionals in authorizing the participation in exercise for metastatic patients. It is important to score that the same benefits are seen in this group of patients, especially with regard to treatment side effects, and we already have a recently published guideline for exercise in bone metastasis scenery. Conclusion: Many challenges were faced in the first-year experience for MTCA in Brazil. Despite legal bureaucracy, engaging patients, clinicians, and breast surgeons in exercise oncology is certainly difficult, especially for metastatic patients. We could observe a high rate of BC patients and survivors in overweight and obesity, and with resistance to nutritional education and to change their life habits. It is important that health-care professionals encourage their patients to participate in exercise protocols, but also in nutritional education. Patient reports are unanimous for a better quality of life and less side effects after engaging in the exercise program. As an ongoing work, we hope to decrease the dropout rate and improve weight loss and also deliver the standard exercise program from MTCA to other cities in Brazil.
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Richard, Amélie, Karen Reilly et Sophie Jacquin-Courtois. « Que révèlent les disfluences sur le manque du mot rapporté par les patientes ayant un cancer du sein ». Dans XXXIVe Journées d'Études sur la Parole -- JEP 2022. ISCA : ISCA, 2022. http://dx.doi.org/10.21437/jep.2022-38.
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Freitas, Laura Rabelo de, Lilian Cristina Silva da Costa, Maria Gabriela Ferreira da Silva, Luiza Rodrigues Batista et Rafael Henrique Szywanski Machado. « EPIDEMIOLOGICAL CHARACTERISTICS AND INCIDENCE OF BREAST CANCER IN MALE PATIENTS IN A TERTIARY HEALTH INSTITUTION ». Dans XXIV Congresso Brasileiro de Mastologia. Mastology, 2022. http://dx.doi.org/10.29289/259453942022v32s1030.
Texte intégralRésumé :
Introduction: Despite the rare incidence of malignant breast pathologies in men, it is extremely important to pay attention to any complaints related to breast alterations in men. Benign and malignant breast diseases are uncommon in men. In addition, most of the male population can be careless when it comes to their own health, especially in breast diseases, commonly seen as an exclusive condition for women. Objective: The aim of this study was to analyze the epidemiological profile of male patients treated at the Mastology Clinic in Rio de Janeiro, Lagoa’s Federal Hospital (HFL), a tertiary health institution. Methods: In total, 40 medical records of patients who were assisted during 2020 and 2021 were evaluated. Results: The majority of patients were between 30 and 70 years old, and the major complaints (97%) were related to a tumor or to breast volume increase. Sixty percent of the patients were diagnosed with gynecomastia and, as a consequence, have been regularly observed throughout appointments since then. Some of these patients (12.5%) have reported the use of anabolic substances before the discovery. The breast cancer incidence in this male population was 22.5% during this period, and the patients affected by malignant tumors were between 47 and 74 years old. Most patients with breast cancer smoked (55%) and drank alcohol (22%). No patient had breast cancer in family history and only one patient was related to a family history of prostate cancer. A total of 66.6% of the male breast cancer in this study population was positive for hormone receptors, and the papillary carcinoma of the breast was the predominant histological type (44.4%). Conclusion: As other studies indicate, all of the patients were in an advanced stage of the disease since the first appointment at HFL. Low educational level, no knowledge about possible male breast cancer, insecurity, shyness and fear of possible social judgments about breast increase (especially in older patients), and carelessness when it comes to their own health were the preponderant factors for a clinically advanced disease among the patients at HFL. These factors were also relevant for a bad adaptation to the treatment, as well as emotional shakiness during therapy and follow-up: some patients showed symptoms such as apathy, deep sadness, and even depression. The male population assisted by the Mastology Clinic at HFL has similar features as the ones in equivalent studies. This research confirms the necessity of an increase in male’s Health Care Education, family participation during treatment, and interdisciplinary care, considering the physical and emotional consequences of such diagnosis.
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Ruiz, M. A., A. Estellés, I. Marugán, I. Navarro, J. Aznar et J. García-Conde. « ALTERATIONS IN COAGULATION AND FIBRINOLYSIS IN LUNG CANCER PATIENTS ». Dans XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643188.
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Lung cancer has commonly been associated with to both clinical problems of thromboembolism and to biological alterations in -coagulation and fibrinolysis.We evaluated some coagulation and fibrinolytic parameters of the plasmatic coagulation and fibrinolytic system (Fibrinopeptide A (-FPA-) for enzimoimmunoassay, immunological tissue plasminogen activator (t-PA) for enzimoimmunoassay, functional (t-PA) for -chromogenic substrate and functional t-PAinhibitor (PAI) in 40 non-operable lung cancer patients (Table I) comprising 39 males and one female, aged 45 to 67 (average 59). The results are compared with those from a control group of 20 healthy male volun-ters aged 32 to 58 (average 48).Table II shows the results obtained (mean ± SD) for the parameters found to be significantly different to those of the control group. An increase is seen in the levels of FPA, functional t-PA and PAI in the lung cancer group. In the case of the extensive -lung tumor patients, FPAfpa and t-PA levels are significantly higher than for the group of locally advanced neoplasmas.The plasma of lung cancer patients therefore shows fibrinolytic alterations and an increase in thromboplastin activity.
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Soares, Leonardo Ribeiro, Victor Domingos Lisita Rosa, Maysa Vilbert, Jéssica Lopes de Oliveira, Mariana Moreira de Deus et Ruffo Freitas-Júnior. « Incidence of interstitial lung disease and cardiotoxicity with trastuzumab deruxtecan in breast cancer patients : A systematic review and single-arm meta-analysis ». Dans Brazilian Breast Cancer Symposium 2023. Mastology, 2023. http://dx.doi.org/10.29289/259453942023v33s1015.
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Objective: We performed a systematic review and meta-analysis to assess the incidence and severity of those adverse events (AEs) in metastatic breast cancer (mBC) patients treated with trastuzumab deruxtecan (T-DXd). Methodology: We comprehensively searched PubMed, Cochrane, and Scopus databases for randomized clinical trials (RCTs) and observational cohort studies, including mBC patients with HER2-low or -positive expression who have received at least one dose of T-DXd. The DESTINY-Breast02 study was also included after its presentation at the SABCS 2022. Our meta-analysis followed the Cochrane Reviews and PRISMA statement guidelines. The statistical analysis was performed using the R software, and the results are presented as pooled analysis in forest plots. Results: We included nine studies: three phase III RCTs, three phase II and two phase I non-RCTs, and one retrospective cohort comprising 1,443 patients with a mean follow-up of 14.9 months. The median age of our population ranged from 53 to 59 years. Most were non-Asian (40.5%) and presented with hormone-receptor-positive mBC (66.8%). In a pooled analysis, the incidence of ILD was 13.0% (179 patients; 95%CI 11.0–13.0). Patients enrolled in phase III clinical trials had an ILD rate of 12.0%, while the observational cohort reported a numerically higher rate of 18.0%. Most ILD cases, 84.9% (152 patients), were mild (grade 1 or 2). Grade 3 or 4 AEs were reported in 13 (7.3%) patients, and grade 5 in 14 (7.8%) patients. We assessed cardiotoxicity by the reduction of left ventricular ejection fraction (LVEF) compared with baseline measures. Decreased LVEF was seen in 3.6% (95%CI 3.0–5.0%), and most patients were asymptomatic. A total of 11 patients developed prolonged QT interval, and four had left ventricular dysfunction and cardiac failure. Conclusion: Our meta-analysis reinforces the importance of close vigilance for pulmonary and cardiac toxicities in mBC patients on treatment with T-DXd. Early detection and management by a multidisciplinary team following the most recent guidelines may improve patient outcomes.
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Irakleidis, Foivos, Ashutosh Tondare, Hisham Hamed et Ashutosh Kothari. « MANAGEMENT OF THE AXILLA IN PATIENTS WITH BREAST CANCER AND ONE OUT OF ONE POSITIVE SENTINEL LYMPH NODE. CAN WE OMIT AXILLARY LYMPH NODE CLEARANCE ? » Dans Abstracts from the Brazilian Breast Cancer Symposium - BBCS 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s2063.
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Background: Over the past three decades, the treatment of the axilla in breast cancer management continues to change. Current treatment strategies aim to achieve regional nodal control associated with reduced incidence of lymphedema and other long-term complications. In this study, we analyzed our tertiary center’s database of patients who had a single retrieved sentinel node (SN) that was positive for macrometastatic disease. We focused on AMAROS trial outcomes and the future view of treating this cohort of patients with axillary radiotherapy (RT) instead of axillary node clearance (ANC). Methods: Both the literature review and the 5-year retrospective analysis of our database were performed, focusing on the management of the axilla in patients with breast cancer with one-in-one positive SN. Results: A total of 24 patients who had surgery as primary treatment had one-in-one positive SN. All patients had the clinical and radiological assessment of their axilla prior to their sentinel lymph node biopsy (SNB). In all, 92% of these patients had a complete ANC, 50% of them had zero additional positive nodes, 21% had only one additional positive node, and a further 21% had more than one additional positive node. One patient was planned for ANC but died from chemotherapy-related complications and one more patient had alternative axillary RT instead of ANC. Of note, 80% of patients who had three or more positive axillary lymph nodes following ANC had indeed evidence of advanced locoregional disease and thus would not be eligible for alternative axillary RT, as compared with one patient who had a multifocal disease, could have axillary RT but had a heavy axillary burden on ANC. Finally, 71% of patients could have been offered alternative axillary RT but had ANC instead. Fourteen patients from this group had chest wall and supraclavicular fossa RT after their initial surgery, and thus, the addition of axillary RT instead of ANC could have been offered. Conclusion: In patients with early breast cancer and clinically node-negative axilla, disease burden in non-SN is limited and ANC may entail overtreatment. In view of low recurrence and complication rates seen in the AMAROS trial, axillary irradiation appears to be a valid and safe alternative when compared with ANC in patients with one-in-one positive SN.
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Siqueira, Bárbara Danielle Silva, Bianca Nataliene Carvalho de Camargos, Ana Luiza de Freitas, Paulo Guilherme de Oliveira Salles, Clécio Ênio Murta de Lucena, Letícia da Conceição Braga et Luciana Maria Silva Lopes. « MIR-26A AND MIR-181C PROFILE HIGHLIGHT AS POTENTIAL PROGNOSIS BIOMARKERS IN TRIPLENEGATIVE BREAST CANCER PATIENTS ». Dans Brazilian Breast Cancer Symposium 2022. Mastology, 2022. http://dx.doi.org/10.29289/259453942022v32s2020.
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Objective: This retrospective cohort study aims to investigate the relative expression profiles of microRNAs (miR 26a, 125b, 181a, 181c, and 340-5p) in patients with triple-negative breast cancer (TNBC) and their relationship with clinical outcome. Methods: We included 10 patients with TNBC, treated at the Mário Penna Institute, Brazil, and 5 patients without TNBC evidence, considered as control. This study was approved by the research ethics committee (CAAE protocol: 39741820.4.0000.9507). The total RNA extraction was performed from the formalin-fixed, paraffin-embedded (FFPE) tissues using the All Prep FFPE (Qiagen™). The RNA concentration was evaluated by the GE NanoVue Plus Spectrophotometer and complementary DNA (cDNA) for each target was synthesized, as appropriate. To analyze the transcripts, the TaqMan real-time PCR technique was used. The small nucleolar RNA RNU6-6P was used as an endogenous control. Changes in miRNA expression were measured by method 2(-ΔΔCq). Results: The expression profile of microRNAs showed a great variability among the TNBC patients, who reinforces the intratumoral heterogeneity of TNBC patients. One of 10 patients showed overexpression of all miRNA evaluated, while 2/10 had underexpression from all of them. An underexpressed profile of miR 181c and 26a was seen in those samples that had a tumor histopathological grade II (3/4) and the overall survival at 1–3 years. In contrast, the overexpression for both miRNAs was seen in 2/10 patients, independent of tumor histopathological grade, with the overall survival at 5–6 years. According to the literature, miR-26a and miR-181c suppressed the expression of MTDH and MAP4K4 genes, respectively, inhibiting the tumor-promoting effects in tumors. Conclusion: Our data appear to highlight the clinical evidence to use miRNAs as new prognosis biomarkers, allowing better stratification of patients. Studies are in progress to evaluate more patients and identify a molecular signature able to predict TNBC prognosis.
Rapports d'organisations sur le sujet "Cancer du sein – Patients"
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Corkum, Eleanor, Tiffanie Perrault et Erin C. Strumpf. Améliorer les parcours de diagnostic du cancer du sein au Québec. CIRANO, octobre 2023. http://dx.doi.org/10.54932/tlak9928.
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Les retards de diagnostic du cancer du sein peuvent aggraver la maladie et renforcer les inégalités. Fondé sur des renseignements tirés de la littérature scientifique sur les soins du cancer, de rapports gouvernementaux et d’entretiens avec des experts, ce rapport analyse les capacités et performances du Québec en matière de diagnostic. La première section décrit les types de données sur le cancer du sein recueillies par le Québec et l’impact de la disponibilité de ces données sur la mesure des indicateurs de performance. La deuxième section explique en quoi les facteurs socioéconomiques et le manque de clarté des normes de prise en charge des patientes et patients hors programme de dépistage organisé au Québec entravent le diagnostic. Nous examinons également dans quelle mesure l’absence de soins standardisés et intégrés, ainsi que l’obsolescence du Registre du cancer du Québec contribuent à accroître les délais et les inefficacités. La dernière section du rapport compare les innovations en matière de diagnostic du cancer du sein au Québec à celles de l’Alberta et de l’Ontario, où les délais de diagnostic sont plus courts. Il ressort de cette comparaison que le Québec devrait inclure les personnes à risque élevé dans son programme de dépistage, émettre des recommandations de dépistage personnalisées, moderniser les technologies d’imagerie et de tests génétiques disponibles, ainsi qu’améliorer les méthodes de communication. Nous discutons également des études et initiatives pertinentes pour accroître l’adhésion au dépistage au sein des groupes dont les taux de dépistage sont faibles. Dans l’ensemble, ce document présente des stratégies tangibles pour raccourcir l’intervalle diagnostique du cancer du sein et rationaliser le processus, et dirige le lecteur vers des ressources clés pour des recherches plus approfondies.
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Smit, Amelia, Kate Dunlop, Nehal Singh, Diona Damian, Kylie Vuong et Anne Cust. Primary prevention of skin cancer in primary care settings. The Sax Institute, août 2022. http://dx.doi.org/10.57022/qpsm1481.
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Overview Skin cancer prevention is a component of the new Cancer Plan 2022–27, which guides the work of the Cancer Institute NSW. To lessen the impact of skin cancer on the community, the Cancer Institute NSW works closely with the NSW Skin Cancer Prevention Advisory Committee, comprising governmental and non-governmental organisation representatives, to develop and implement the NSW Skin Cancer Prevention Strategy. Primary Health Networks and primary care providers are seen as important stakeholders in this work. To guide improvements in skin cancer prevention and inform the development of the next NSW Skin Cancer Prevention Strategy, an up-to-date review of the evidence on the effectiveness and feasibility of skin cancer prevention activities in primary care is required. A research team led by the Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW, was contracted to undertake an Evidence Check review to address the questions below. Evidence Check questions This Evidence Check aimed to address the following questions: Question 1: What skin cancer primary prevention activities can be effectively administered in primary care settings? As part of this, identify the key components of such messages, strategies, programs or initiatives that have been effectively implemented and their feasibility in the NSW/Australian context. Question 2: What are the main barriers and enablers for primary care providers in delivering skin cancer primary prevention activities within their setting? Summary of methods The research team conducted a detailed analysis of the published and grey literature, based on a comprehensive search. We developed the search strategy in consultation with a medical librarian at the University of Sydney and the Cancer Institute NSW team, and implemented it across the databases Embase, MEDLINE, PsycInfo, Scopus, Cochrane Central and CINAHL. Results were exported and uploaded to Covidence for screening and further selection. The search strategy was designed according to the SPIDER tool for Qualitative and Mixed-Methods Evidence Synthesis, which is a systematic strategy for searching qualitative and mixed-methods research studies. The SPIDER tool facilitates rigour in research by defining key elements of non-quantitative research questions. We included peer-reviewed and grey literature that included skin cancer primary prevention strategies/ interventions/ techniques/ programs within primary care settings, e.g. involving general practitioners and primary care nurses. The literature was limited to publications since 2014, and for studies or programs conducted in Australia, the UK, New Zealand, Canada, Ireland, Western Europe and Scandinavia. We also included relevant systematic reviews and evidence syntheses based on a range of international evidence where also relevant to the Australian context. To address Question 1, about the effectiveness of skin cancer prevention activities in primary care settings, we summarised findings from the Evidence Check according to different skin cancer prevention activities. To address Question 2, about the barriers and enablers of skin cancer prevention activities in primary care settings, we summarised findings according to the Consolidated Framework for Implementation Research (CFIR). The CFIR is a framework for identifying important implementation considerations for novel interventions in healthcare settings and provides a practical guide for systematically assessing potential barriers and facilitators in preparation for implementing a new activity or program. We assessed study quality using the National Health and Medical Research Council (NHMRC) levels of evidence. Key findings We identified 25 peer-reviewed journal articles that met the eligibility criteria and we included these in the Evidence Check. Eight of the studies were conducted in Australia, six in the UK, and the others elsewhere (mainly other European countries). In addition, the grey literature search identified four relevant guidelines, 12 education/training resources, two Cancer Care pathways, two position statements, three reports and five other resources that we included in the Evidence Check. Question 1 (related to effectiveness) We categorised the studies into different types of skin cancer prevention activities: behavioural counselling (n=3); risk assessment and delivering risk-tailored information (n=10); new technologies for early detection and accompanying prevention advice (n=4); and education and training programs for general practitioners (GPs) and primary care nurses regarding skin cancer prevention (n=3). There was good evidence that behavioural counselling interventions can result in a small improvement in sun protection behaviours among adults with fair skin types (defined as ivory or pale skin, light hair and eye colour, freckles, or those who sunburn easily), which would include the majority of Australians. It was found that clinicians play an important role in counselling patients about sun-protective behaviours, and recommended tailoring messages to the age and demographics of target groups (e.g. high-risk groups) to have maximal influence on behaviours. Several web-based melanoma risk prediction tools are now available in Australia, mainly designed for health professionals to identify patients’ risk of a new or subsequent primary melanoma and guide discussions with patients about primary prevention and early detection. Intervention studies have demonstrated that use of these melanoma risk prediction tools is feasible and acceptable to participants in primary care settings, and there is some evidence, including from Australian studies, that using these risk prediction tools to tailor primary prevention and early detection messages can improve sun-related behaviours. Some studies examined novel technologies, such as apps, to support early detection through skin examinations, including a very limited focus on the provision of preventive advice. These novel technologies are still largely in the research domain rather than recommended for routine use but provide a potential future opportunity to incorporate more primary prevention tailored advice. There are a number of online short courses available for primary healthcare professionals specifically focusing on skin cancer prevention. Most education and training programs for GPs and primary care nurses in the field of skin cancer focus on treatment and early detection, though some programs have specifically incorporated primary prevention education and training. A notable example is the Dermoscopy for Victorian General Practice Program, in which 93% of participating GPs reported that they had increased preventive information provided to high-risk patients and during skin examinations. Question 2 (related to barriers and enablers) Key enablers of performing skin cancer prevention activities in primary care settings included: • Easy access and availability of guidelines and point-of-care tools and resources • A fit with existing workflows and systems, so there is minimal disruption to flow of care • Easy-to-understand patient information • Using the waiting room for collection of risk assessment information on an electronic device such as an iPad/tablet where possible • Pairing with early detection activities • Sharing of successful programs across jurisdictions. Key barriers to performing skin cancer prevention activities in primary care settings included: • Unclear requirements and lack of confidence (self-efficacy) about prevention counselling • Limited availability of GP services especially in regional and remote areas • Competing demands, low priority, lack of time • Lack of incentives.
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Wang, Hao, et Yulai Xu. Chemopreventive Effects of Immunotrophic Preparations in the Development of Prostate Cancer : A Network Meta-Analysis of Randomized Controlled Trials. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, août 2022. http://dx.doi.org/10.37766/inplasy2022.8.0037.
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Review question / Objective: After successful treatment with ADT, most patients with advanced disease eventually develop resistance and progress to castration-resistant PCa (CRPC), which remains an incurable disease.Low survival and high mortality of PCa are associated with the appearance of CRPC and subsequent metastatic disease. To advance the fight against PCa, it is necessary to continue basic and clinical research to improve testing, prevention and treatment practices. However, under current treatments, prevention should be seen as a basic strategy to reduce PCa morbidity and mortality. Epidemiological studies have shown that a healthy diet may significantly affect the occurrence and progression of prostate cancer. After promising preclinical testing, several natural compounds have been evaluated in the clinic. In this study, we compared data from clinical trials on several natural chemopreventive drugs as well as chemopreventive agents that have been tested for PCa chemoprevention. Provides some grounding support for preventing the progression of prostate cancer.
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Dy, Sydney M., Julie M. Waldfogel, Danetta H. Sloan, Valerie Cotter, Susan Hannum, JaAlah-Ai Heughan, Linda Chyr et al. Integrating Palliative Care in Ambulatory Care of Noncancer Serious Chronic Illness : A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), février 2020. http://dx.doi.org/10.23970/ahrqepccer237.
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Objectives. To evaluate availability, effectiveness, and implementation of interventions for integrating palliative care into ambulatory care for U.S.-based adults with serious life-threatening chronic illness or conditions other than cancer and their caregivers We evaluated interventions addressing identification of patients, patient and caregiver education, shared decision-making tools, clinician education, and models of care. Data sources. We searched key U.S. national websites (March 2020) and PubMed®, CINAHL®, and the Cochrane Central Register of Controlled Trials (through May 2020). We also engaged Key Informants. Review methods. We completed a mixed-methods review; we sought, synthesized, and integrated Web resources; quantitative, qualitative and mixed-methods studies; and input from patient/caregiver and clinician/stakeholder Key Informants. Two reviewers screened websites and search results, abstracted data, assessed risk of bias or study quality, and graded strength of evidence (SOE) for key outcomes: health-related quality of life, patient overall symptom burden, patient depressive symptom scores, patient and caregiver satisfaction, and advance directive documentation. We performed meta-analyses when appropriate. Results. We included 46 Web resources, 20 quantitative effectiveness studies, and 16 qualitative implementation studies across primary care and specialty populations. Various prediction models, tools, and triggers to identify patients are available, but none were evaluated for effectiveness or implementation. Numerous patient and caregiver education tools are available, but none were evaluated for effectiveness or implementation. All of the shared decision-making tools addressed advance care planning; these tools may increase patient satisfaction and advance directive documentation compared with usual care (SOE: low). Patients and caregivers prefer advance care planning discussions grounded in patient and caregiver experiences with individualized timing. Although numerous education and training resources for nonpalliative care clinicians are available, we were unable to draw conclusions about implementation, and none have been evaluated for effectiveness. The models evaluated for integrating palliative care were not more effective than usual care for improving health-related quality of life or patient depressive symptom scores (SOE: moderate) and may have little to no effect on increasing patient satisfaction or decreasing overall symptom burden (SOE: low), but models for integrating palliative care were effective for increasing advance directive documentation (SOE: moderate). Multimodal interventions may have little to no effect on increasing advance directive documentation (SOE: low) and other graded outcomes were not assessed. For utilization, models for integrating palliative care were not found to be more effective than usual care for decreasing hospitalizations; we were unable to draw conclusions about most other aspects of utilization or cost and resource use. We were unable to draw conclusions about caregiver satisfaction or specific characteristics of models for integrating palliative care. Patient preferences for appropriate timing of palliative care varied; costs, additional visits, and travel were seen as barriers to implementation. Conclusions. For integrating palliative care into ambulatory care for serious illness and conditions other than cancer, advance care planning shared decision-making tools and palliative care models were the most widely evaluated interventions and may be effective for improving only a few outcomes. More research is needed, particularly on identification of patients for these interventions; education for patients, caregivers, and clinicians; shared decision-making tools beyond advance care planning and advance directive completion; and specific components, characteristics, and implementation factors in models for integrating palliative care into ambulatory care.
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Tummala, Rohan, Andrew de Jesus, Natasha Tillett, Jeffrey Nelson et Christine Lamey. Clinical and Socioeconomic Predictors of Palliative Care Utilization. University of Tennessee Health Science Center, janvier 2021. http://dx.doi.org/10.21007/com.lsp.2020.0006.
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INTRODUCTION: Palliative care continues to gain recognition among primary care providers, as patients suffering from chronic conditions may benefit from use of this growing service. OBJECTIVES: This single-institution quality improvement study investigates the clinical characteristics and socioeconomic status (SES) of palliative care patients and identifies predictors of palliative care utilization. METHODS: Retrospective chart review was used to compare clinical and SES parameters for three groups of patients: (1) palliative care patients who attended at least one visit since the inception of the University Clinical Health Palliative Care Clinic in Memphis, TN in October 2018 (n = 61), (2) palliative care patients who did not attend any appointments (n = 19), and (3) a randomized group of age-matched primary care patients seen by one provider from May 2018 to May 2019 (n = 36). A Poisson regression model with backward conditional variable selection was used to determine predictors of palliative care utilization. RESULTS: Patients across the three care groups did not differ in demographic parameters. Compared to palliative care-referred non-users and primary care patients, palliative care patients tended to have lower health risk (p < 0.001). Palliative care patients did not differ from primary care patients in socioeconomic status but did differ in comorbidity distribution, having a higher prevalence of cancer (𝜒2 = 14.648, df = 7, p = 0.041). Chance of 10-year survival did not differ across risk categories for palliative care patients but was significantly lower for very high-risk compared to moderate-risk primary care patients (30% vs. 78%, p = 0.019). Significant predictors of palliative care use and their corresponding incidence rate ratios (IRR) were hospital referral (IRR = 1.471; p = 0.039), higher number of prescribed medications (IRR = 1.045; p = 0.003), lower Charlson Comorbidity Index (IRR = 0.907; p = 0.003), and lower systolic blood pressure (IRR = 0.989; p = 0.004). CONCLUSIONS: Patients who are expected to benefit from and of being high utilizers of palliative care may experience greater clinical benefit from earlier referral to this service.
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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, juillet 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.
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As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.
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Novinger, Leah. Identification of Autoantibodies to Breast Cancer Antigens in Breast Cancer Patients. Fort Belvoir, VA : Defense Technical Information Center, octobre 2011. http://dx.doi.org/10.21236/ada555908.
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Fisher, Richard. Early Diagnosis, Treatment and Care of Cancer Patients. Fort Belvoir, VA : Defense Technical Information Center, septembre 2008. http://dx.doi.org/10.21236/ada494164.
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Dy, Sydney M., Arjun Gupta, Julie M. Waldfogel, Ritu Sharma, Allen Zhang, Josephine L. Feliciano, Ramy Sedhom et al. Interventions for Breathlessness in Patients With Advanced Cancer. Agency for Healthcare Research and Quality (AHRQ), novembre 2020. http://dx.doi.org/10.23970/ahrqepccer232.
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Objectives. To assess benefits and harms of nonpharmacological and pharmacological interventions for breathlessness in adults with advanced cancer. Data sources. We searched PubMed®, Embase®, CINAHL®, ISI Web of Science, and the Cochrane Central Register of Controlled Trials through early May 2020. Review methods. We included randomized controlled trials (RCTs) and observational studies with a comparison group evaluating benefits and/or harms, and cohort studies reporting harms. Two reviewers independently screened search results, serially abstracted data, assessed risk of bias, and graded strength of evidence (SOE) for key outcomes: breathlessness, anxiety, health-related quality of life, and exercise capacity. We performed meta-analyses when possible and calculated standardized mean differences (SMDs). Results. We included 48 RCTs and 2 retrospective cohort studies (4,029 patients). The most commonly reported cancer types were lung cancer and mesothelioma. The baseline level of breathlessness varied in severity. Several nonpharmacological interventions were effective for breathlessness, including fans (SMD -2.09 [95% confidence interval (CI) -3.81 to -0.37]) (SOE: moderate), bilevel ventilation (estimated slope difference -0.58 [95% CI -0.92 to -0.23]), acupressure/reflexology, and multicomponent nonpharmacological interventions (behavioral/psychoeducational combined with activity/rehabilitation and integrative medicine). For pharmacological interventions, opioids were not more effective than placebo (SOE: moderate) for improving breathlessness (SMD -0.14 [95% CI -0.47 to 0.18]) or exercise capacity (SOE: moderate); most studies were of exertional breathlessness. Different doses or routes of administration of opioids did not differ in effectiveness for breathlessness (SOE: low). Anxiolytics were not more effective than placebo for breathlessness (SOE: low). Evidence for other pharmacological interventions was limited. Opioids, bilevel ventilation, and activity/rehabilitation interventions had some harms compared to usual care. Conclusions. Some nonpharmacological interventions, including fans, acupressure/reflexology, multicomponent interventions, and bilevel ventilation, were effective for breathlessness in advanced cancer. Evidence did not support opioids or other pharmacological interventions within the limits of the identified studies. More research is needed on when the benefits of opioids may exceed harms for broader, longer term outcomes related to breathlessness in this population.
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Jordan, Craig T., et Richard I. Fisher. Early Diagnosis, Treatment, and Care of Cancer Patients. Fort Belvoir, VA : Defense Technical Information Center, septembre 2010. http://dx.doi.org/10.21236/ada541190.
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