Quelle est la place des professionnels de santé dans l’adhésion aux programmes thérapeutiques en ligne de l’insomnie ? Éléments de réflexion issus de l’étude Sleep-4-All-1 et protocole de l’étude Sleep-4-All-2.0

La thérapie cognitivocomportementale de l’insomnie (TCC-I) demeure difficile d’accès pour les patients atteints de cancer. Sa digitalisation semble une solution prometteuse pour bénéficier au plus grand nombre. La faisabilité d’un programme TCC-I québécois a été démontrée en France, tout en révélant les limites d’un dispositif suivi en autonomie et à distance. L’enjeu reste de mieux comprendre le rôle des professionnels de santé dans l’accompagnement des patients dans ce type de programme. C’est l’objectif de l’étude Sleep-4-All-2.0 dont nous présenterons ici le protocole.

[Surgery or not on an atypical breast lesion? Taking anxiety into account in shared decision support from a prospective cohort of 300 patients]

INTRODUCTION

Organized and individual breast screening have been accompanied by an increase in the detection of "atypical breast lesions (ABL)". Recently, the NOMAT multicenter study proposed a predictive model of the risk of developing breast cancer after detection of an ABL in order to avoid surgical removal of "low-risk" lesions. It also aimed to provide information on psychological experience, in particularly anxiety, to assist in the shared medical decision process.

METHODS

Three hundred women undergoing surgery for ABL were included between 2015 and 2018 at 18 French centers. Women completed questionnaires before and after surgery assessing their level of anxiety (STAI-State, STAI-Trait), their level of tolerance to uncertainty, their perceived risk of developing a breast cancer, and their satisfaction with the management care.

RESULTS

One hundred nighty nine patients completed the STAI-Status before and after surgery. Overall, a decrease in anxiety level (35.4 vs 42.7, P<0.001) was observed. Anxious temperament and greater intolerance to uncertainty were significantly associated swith decreased anxiety (33%), whereas younger age was associated with increased anxiety (8%).

CONCLUSION

Surgery for ABL seems to be associated with only a few cases with an increase in anxiety and seems to increase the perception of the risk of developing breast cancer. Taking into account the psychological dimension remains in all cases essential in the process of shared therapeutic decision.

SFSPM 2018 — Congrès de la Société Française de Sénologie et de Pathologie Mammaire (Avignon, 7-9/11-2018)

Les 40es Journées de la SFSPM se sont tenues à Avignon du 7 au 9 novembre 2018. Le thème abordé—Cancer du sein : optimisation du parcours de soins — a réuni plus de 1 200 participants sous les voûtes du Palais des Papes. La fluidité de chaque segment du parcours a été analysée en termes de risques de rupture de continuité des soins tant au sein du segment lui-même qu’en amont et en aval. Dans un parcours par essence pluridisciplinaire et plurimétiers, la nécessité d’une réflexion globale et d’une coordination active réalisées par des professionnels formés a été rappelée à chaque session. Chacun des intervenants a esquissé de potentiels indicateurs de qualité tenant compte à la fois de son implication dans son segment d’intervention, mais tenant compte aussi d’une vision plus globale de ce que devrait être le parcours au travers de la maladie et des soins. La parole a été très largement partagée entre soignants et associations de malades, entre paramédicaux et acteurs en sciences humaines et sociales, entre responsables de la santé publique HAS, ARS, CNAM–CPAM 84 et représentants des différents modes d’hospitalisation publique/privée et ESPIC. La session grand public a été l’occasion d’échanges fructueux et instructifs sur la perception des difficultés comme des satisfactions rencontrées que nous ont fait partager les malades, leurs proches et les représentantes des associations. Au total, un congrès de réflexion partagé par de nombreux acteurs qui cherchent tous à améliorer le parcours de soins des malades atteintes de cancer du sein. La publication le 21 janvier par l’INCa de dix indicateurs de qualité du parcours de soins pour les malades atteints de cancer du sein est une étape importante qu’attendaient tous les participants d’Avignon — SFSPM 2018.

Abstract P5-11-06: BEAUTY and the breast: Is adjuvant chemotherapy the right time for a beauty boost? Results of a randomised controlled trial

This abstract was not presented at the symposium.

Abstract P3-10-03: Receipt of breast cancer risk assessment and personalized prevention information among women diagnosed with a benign breast lesion (BBL) in a one stop breast unit: A prospective assessment

Background: Women's awareness about their personal breast cancer (BC) risk in the general population is generally low. Mass screening and mass prevention interventions have as yet been moderately efficient in breast oncology. "Personalized prevention" including risk communication, personalized screening and primary prevention recommendations is a promising. A personal history of BBL slightly increases subsequent BC risk.

Objectives: the main objective was to evaluate the acceptability of a mathematical tool- based breast cancer risk assessment and subsequent proposal of a personalized BC prevention program in a BBL population. Secondary objectives were to evaluate information receipt, awareness, satisfaction, and anxiety.

Methods: Women were eligible for the study if aged 40-74, were recently diagnosed with a benign breast lesion at the one stop breast Unit of the center, had no personal history of cancer or atypical lesions and were not BRCA carriers. Women were proposed a personalized risk assessment using a mathematical tool (BCSC score adapted to the French population-Ragusa et al) together with personalized information on risk, BC screening and prevention, release of a personalized program and evaluation of their receipt. The main end point was the proportion of women willing to have a risk assessment and personalized counseling. A cut-off point of 70% was considered critical to consider acceptability. Secondary end points were perceived BC risk, satisfaction, anxiety and distress levels at day 2 using standardized questionnaires, as well as adherence with the proposed programs.

Results: Of 150 women proposed BC risk assessment and personalized prevention information between 02/2014 and 03/2015, 129 (86%) accepted. Median age: 53.6 years. 33% had a low BC risk (&lt; 1.1% at 5 yrs [mean risk of 50 yrs-old women in France]), 53% a moderate risk (1.1-1.66% at 5 yrs), while 14% were high risk (&gt; 1.66% at 5 yrs). 87% had never had any previous information on BC risk. 3 pts required a genetic assessment.

Participants were globally very satisfied with physicians' and nurses' interpersonal skills, availability and provision of information (mean score &gt; 4; range 2-5). The mean scores of clarity of the BC risk information (4.14±1;range 2-5) and screening program information (4.21±0.93; range 2-5) were high.

The mean score of perceived risk level was estimated to 33.5% (SD=21.9).

Mean scores of state anxiety (36.7±12.2; range 20-71), trait anxiety (39.5±8.9; range 23-59), depressive symptoms (3.4±3.3; range 0-12) and psychological distress indicated low levels of all. Higher level of state-anxiety was associated with lower scores of satisfaction with doctors and nurses human qualities (r = 0.26, p&lt;.05) and with lower scores of clarity of information about screening program (r = 0.25, p&lt;.05).

Conclusion: The receipt of breast cancer risk assessment and personalized prevention information among women diagnosed with BBL was high (86%). Information need is high given the low level of real risk awareness. Such population may benefit from personalized prevention. Anxiety and distress scores were low and satisfaction rates high.

Citation Format: Tlemsani C, Boinon D, Yung MF, Ragusa S, Mazouni C, Balleyguier C, Saghatchian M, Ghouadni A, Rivera S, Michiels S, Delaloge S. Receipt of breast cancer risk assessment and personalized prevention information among women diagnosed with a benign breast lesion (BBL) in a one stop breast unit: A prospective assessment. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-10-03.