Abstract P5-13-13: Enhancing compliance with national nutrition recommendations in breast cancer survivors. Experience in an underprivileged community

BACKGROUND: To enhance compliance with national nutrition recommendations in breast cancer survivors (BCS), a 3-year program granted by the Regional Health Authority began in 2013 in an area (Seine-Saint-Denis, SSD) which is among the poorest in France.

PATIENTS AND METHODS: Ac'Santé 93 is a non-profit organization whose aim is to provide supportive care, health education and individualized assistance to patients and families, and to facilitate timely access to quality medical and psychosocial care. Vulnerability was evaluated using an 11-item standardized score (EPICES) previously investigated by French Health Examination Centers. This score is more strongly related to health status than the administrative classification of poverty (Sass, Sante Publique 2006). Vulnerability was defined by a score >30 and considered as severe when >40. Given the high level of poverty in the area and the incidence of financial difficulties in cancer survivors, a particular attention was paid to comparing the costs of different foods in order to promote affordable dietary changes. Between March 2013 and December 2015, 109 BCS were enrolled in a 3-month education program including 3 sessions of a professionally led support group (with dieticians and social workers).

RESULTS: Ten BCS were lost for follow-up before the end of the program; 54 BCS attended all the sessions. Mean age was 52. Median vulnerability score was 51.8 (0-93.48) and 59% of patients had a score >30. Dietary intakes were assessed at baseline, and 1 and 6 mos. after the last session. At 1 mo. 65% BCS had knowledge of healthy dietary choices and 63% were ready to translate it into practice. Of note, 47% BCS decided to enroll in a tailored 1-year physical activity program or planned to do it, although it was not the aim of the study. At 6 mos. 52% of BCS still had knowledge of healthy diet and 49% of turned it into practice. However, only 12% were still practicing physical activity. Barriers were reported in 67% BCS and included asthenia or other treatment side effects (40%), anxiety or depression (27%), reluctance of relatives (20%), social isolation (20%) or cost (18%). Semi-directive interviews revealed unexpected benefits from this program such as empowerment, socialization or improvement of body image.

CONCLUSION: A short-term dietary intervention is feasible in vulnerable BCS living in an underserved area and improves adherence to higher quality diet in a meaningful number of patients. In spite of the attention paid to the affordability of dietary modifications, numerous barriers still exist in this population, the main one being treatment related side effects, including fatigue. Furthermore, compliance to a tailored physical activity program spontaneously decreases over time.

Citation Format: Zelek L, Festa A, Bodere C, Morello S. Enhancing compliance with national nutrition recommendations in breast cancer survivors. Experience in an underprivileged community [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-13-13.

Abstract P1-09-20: Patient navigation significantly improves vulnerability score after breast cancer. A pilot experience in an underprivileged community

BACKGROUND: We decided to evaluate the effect of patient navigation in an area (Seine-Saint-Denis, SSD) with an estimated population of 1.4 billion, which is among the poorest in France. Median household income is 68% lower than in Paris (+68%), a gap growing with time. In SSD, cancer is the leading cause of premature mortality. Whereas it is widely admitted in France that 25% of patients are faced with financial difficulties after breast cancer, this proportion reaches 40% in SSD.

PATIENTS AND METHODS: Oncologie 93 is a non-profit organization whose aim is to provide supportive care, health education and individualized assistance to patients and families, and to facilitate timely access to quality medical and psychosocial care. Vulnerability was evaluated using a 11-item standardized score (EPICES) previously investigated by French Health Examination Centers. Strictly speaking this score was aimed at measuring precarity, a concept referring to a social condition assumed to face worsening. This score is more strongly related to health status than the administrative classification of poverty (Sass, Sante Publique 2006). Vulnerability was defined by a score >30 and considered as severe when >40. In SSD two thirds of the population are affected by vulnerability. Patients included in the navigation program were scored after cancer diagnosis (E1) and 1 year after the beginning of cancer therapy (E2). Psychosocial comorbidities, demographic data, and treatments received were also recorded.

RESULTS: Over a 1-year period 74 breast cancer patients were included and had E1 and E2 scores, detail of therapy was available for 64 pts. The score significantly improved for the whole population (p = 0.04) but worsened in 23 pts (31%). Among all the variables studied, undergoing surgery was the only one to be significantly correlated with outcome. However, surprisingly, patients who did not undergo surgery had a significantly better evolution of the score than those who did (p = 0.04). E1 score was lower in patients eligible for surgery.

Evolution of median vulnerability score before (E1) and after (E2) breast cancer therapy, first and third quartiles (Q1-Q3) and minimal-maximal values. n =E1Q1-Q3min-maxE2Q1-Q3min-maxwhole population7439.615.8-63.53.17-92.232.87.1-45.81.6-92.1no surgery2447.925.8-57.83.17-75.115.13.6-40.22.7-78.7surgery403714.5-63.93.17-92.233.48-47.31.6-92.9

CONCLUSION: We showed that patient navigation significantly improves vulnerability score during cancer therapy. It emphasizes the importance of evaluating deprivation with standardized tools in cancer patients in order to propose appropriate interventions. The only factor correlated with the evolution of the score is surgery. Patients that were not eligible for surgery had higher E1 score but significantly better evolution during the following year. We hypothesize that deprivation leads to more advanced tumors or is associated with comorbidities contraindicating breast surgery. For unclear reasons, the magnitude of the benefit seems greater in this population. About one third of patients experience worsening of the vulnerability after breast cancer therapy and the underlying mechanisms remain to be determined.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-20.

An analysis of injuries resulting from professional horse racing in France during 1991-2001: a comparison with injuries resulting from professional horse racing in Great Britain during 1992-2001

BACKGROUND

It has been previously shown that professional jockeys suffer high rates of fatal and non-fatal injuries in the pursuit of their occupation. Little is known, however, about differences in injury rates between countries.

AIM

To determine the rate of fatal and non-fatal injuries in flat and jump jockeys in France and to compare the injury rates with those in Great Britain and Ireland Method: Prospectively collected injury data on professional jockeys were used as the basis of the analysis.

RESULTS

Limb fractures occur four times more often in both flat and jump racing in France than in Great Britain. Similarly dislocations are diagnosed 20 times more often in flat and three times more often in jump racing. This difference is surprising given that French jockeys have fewer falls per ride than their British counterparts in flat racing, although they do have more falls than the British in jump racing. Similarly concussion rates seem to be higher in French jockeys, although there may be a difference in the diagnostic methods used in the different countries. By contrast, soft tissue injuries account for a far smaller percentage of injuries than in Great Britain.

CONCLUSION

There are striking differences in injury rates between countries which may be explained in part by a difference in track conditions-for example, harder tracks in France-or different styles of racing--for example, larger fields of horses per race in France.