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Houpert R, Bendiane MK, Huiart L, Bouhnik AD, Alleaume C, Touzani R, Veronique-Baudin J, Mancini J, Joachim C, Chirpaz E. Socioeconomic and cultural factors associated with pap smear screening among French women living in Réunion Island. BMC Public Health 2024; 24:1125. [PMID: 38654197 DOI: 10.1186/s12889-024-18633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Réunion Island is a French overseas territory located in the southern Indian Ocean, with a challenging socioeconomic and multicultural context. Compared to mainland France, Réunion has an overincidence and overmortality of cervical cancer. In order to investigate these two issues, it is important to evaluate the barriers and potential levers to Pap smear screening among female inhabitants of the island. We aimed to identify the specific socio-demographic factors, cultural factors, and living conditions associated with Pap smear screening in Réunion, with a view to increasing uptake. METHODS We conducted a Knowledge Attitude Behavior and Practices (KABP) survey on cervical cancer screening practices among women aged between 25 and 65 years old living in Réunion Island, selected using random digit dialing sampling. Data were collected using Computer Assistant Telephone Interviews. Weighted chi-squared tests and Student's t-tests were used to compare women who had up-to-date Pap smear screening with women who did not. Weighted logistic models were used to identify the factors associated with not having up-to-date screening. RESULTS A total of 1000 women were included in the study. Of these, 88.1% had a Pap smear test during the previous three years. Factors independently associated with not being up to date were as follows: aged over 55 (AOR 2.3 [1.2-4.3]), no children (AOR 2.5 [1.4-4.3]), having free universal health coverage (AOR 1.7 [1.1-2.7]), an income per unit consumption lower than 1500€ per month (AOR 2.0 [1.1-3.7]), low health literacy (AOR 2.7 [1.7-4.1]), not consulting a general practitioner in the prior 12 months (AOR 3.6 [2.0-6.5]), and a BMI > 30 (AOR 2.6 [1.5-4.4]). CONCLUSIONS This is the first large-scale survey focusing on recommended Pap smear screening uptake in Réunion Island. Although self-reported screening incidence was higher than in mainland France, national screening policies must take into account the island's diverse social and cultural characteristics (e.g., an ageing population, low health literacy), while implementing actions to fight against poverty and increase general access to healthcare.
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Affiliation(s)
- Rémi Houpert
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Research & Development in Oncology (UF3596), Oncology Hematology Urology department, University Hospital of Martinique, Fort-de-France Martinique, Martinique
| | - Marc-Karim Bendiane
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France
| | - Laetitia Huiart
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Santé Publique France, Paris, France
| | - Anne-Deborah Bouhnik
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Caroline Alleaume
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Santé Publique France, Paris, France
| | - Rajae Touzani
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Jacqueline Veronique-Baudin
- Research & Development in Oncology (UF3596), Oncology Hematology Urology department, University Hospital of Martinique, Fort-de-France Martinique, Martinique
| | - Julien Mancini
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- APHM, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
| | - Clarisse Joachim
- General Cancer Registry (UF 1441), Oncology Hematology Urology department, University Hospital of Martinique, Fort-de-France Martinique, Martinique
| | - Emmanuel Chirpaz
- Reunion cancer Registry - Clinical Investigation Center (INSERM CIC-1410), University Hospital FR, Saint Pierre Cedex, France
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Almont T, Sougué PO, Houpert R, Beaubrun-Renard M, Montabord C, Joachim C, Véronique-Baudin J, Bouhnik AD, Bendiane MK, Mancini J, Huyghe É. Communication and sexual function and frequency in breast cancer patients 2 years after diagnosis: results from the VICAN 2 study. J Sex Med 2024; 21:333-341. [PMID: 38410031 DOI: 10.1093/jsxmed/qdae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 12/18/2023] [Accepted: 12/30/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Breast cancer treatments may have impacts on several aspects of sexual health, including psychological, psychosexual, physiological, physical, and relational. AIM In this study we sought to assess sexual function and sexual frequency in breast cancer patients 2 years after diagnosis. METHODS We selected all breast cancer participants from the the French national VIe après le CANcer 2 (VICAN 2) longitudinal study. Data sources included patient and medical questionnaires, along with medico-administrative databases. OUTCOMES Outcomes assessed were the dimensions of sexual function and frequency from the Relationship and Sexuality Scale and communication about sexuality with healthcare providers. RESULTS Out of 1350 participating women, 60.2% experienced a decrease in sexual desire, 61.4% reported a lower frequency of intercourse, and 49.5% faced decreased ability to orgasm. In contrast, 64.8% had engaged in sexual intercourse in the previous 2 weeks, 89.5% were "Somewhat" to "Very much" satisfied with the frequency of intimate touching and kisses with their partner, and 81.6% expressed satisfaction with their intercourse frequency. However, a mere 15% of women discussed sexuality with the healthcare providers. Independent factors associated with increased communication about sexuality included age younger than 50 years (OR = 1.90 95% CI [1.28-2.82], P = .001), being in a partner relationship (OR = 2.53 95% CI [1.28-2.82], P = .003), monthly income above 1,500 euros (OR = 1.73 95% CI [1.15-2.60], P = .009), and absence of diabetes (OR = 6.11 95% CI [1.39-26.93], P = .017). CLINICAL TRANSLATION The study findings underscore the need for continuing education in oncosexology and dedicated sexual health interventions that should involve a holistic approach that takes into consideration age, treatments, relationship status, and whether the patient has diabetes. STRENGTHS AND LIMITATIONS Strengths of the study are the sample size, the national representativeness, and data reliability. However, the cross-sectional design could introduce potential recall, recency, or social desirability biases. Also, social determinants influencing sexual health, such as ethnicity or geographic locations, have not been considered in the analyses. CONCLUSIONS This study revealed that sexual disorders persist 2 years after a breast cancer diagnosis, with a noticeable communication gap regarding sexuality between patients and medical teams. These findings underscore the necessity for tailored sexual health interventions, particularly designed for women who are single, older aged, and diabetes patients.
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Affiliation(s)
- Thierry Almont
- RESEARCH on Cancer Unit UF3596, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- General Cancer Registry of Martinique UF1441, Oncology Departmxent, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- Oncosexology Unit, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, INSERM, Université de Montpellier, CHRU 34295 Montpellier, Université Toulouse 3 Paul Sabatier, CHU 31300, Toulouse, Occitanie, France. https://www.defe.fr
| | - Prisca Ouowéné Sougué
- RESEARCH on Cancer Unit UF3596, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
| | - Rémi Houpert
- RESEARCH on Cancer Unit UF3596, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- General Cancer Registry of Martinique UF1441, Oncology Departmxent, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
| | - Murielle Beaubrun-Renard
- Oncosexology Unit, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
| | - Christelle Montabord
- RESEARCH on Cancer Unit UF3596, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
| | - Clarisse Joachim
- RESEARCH on Cancer Unit UF3596, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- General Cancer Registry of Martinique UF1441, Oncology Departmxent, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- Oncosexology Unit, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
| | - Jacqueline Véronique-Baudin
- RESEARCH on Cancer Unit UF3596, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- General Cancer Registry of Martinique UF1441, Oncology Departmxent, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- Oncosexology Unit, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, INSERM, Université de Montpellier, CHRU 34295 Montpellier, Université Toulouse 3 Paul Sabatier, CHU 31300, Toulouse, Occitanie, France. https://www.defe.fr
| | - Anne-Déborah Bouhnik
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ, INSERM, IRD, ISSPAM, 13385, Marseille, France
| | - Marc-Karim Bendiane
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ, INSERM, IRD, ISSPAM, 13385, Marseille, France
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, 270 Boulevard de Sainte Marguerite, 13009 Marseille, France
- ORS PACA, Observatoire Régional de la Santé, 27 Bd Jean Moulin, 13005 Marseille, Provence-Alpes-Côte d'Azur, France
| | - Julien Mancini
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ, INSERM, IRD, ISSPAM, 13385, Marseille, France
- Public Health Department, Service Biostatistique et Technologies de l'Information et de la Communication (BIOSTIC), hôpital Timone, APHM, 13005 Marseille, France
| | - Éric Huyghe
- Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, INSERM, Université de Montpellier, CHRU 34295 Montpellier, Université Toulouse 3 Paul Sabatier, CHU 31300, Toulouse, Occitanie, France. https://www.defe.fr
- Urology Department, Centre Hospitalier Universitaire de Toulouse, 1, avenue du Professeur Jean Poulhès - TSA 50032 - 31059 Toulouse, France
- Francophone Association for Supportive Care in Cancer (AFSOS), 33130 Bègles, France
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Magnani C, Smith AB, Rey D, Sarradon-Eck A, Préau M, Bendiane MK, Bouhnik AD, Mancini J. Fear of cancer recurrence in young women 5 years after diagnosis with a good-prognosis cancer: the VICAN-5 national survey. J Cancer Surviv 2023; 17:1359-1370. [PMID: 35318569 DOI: 10.1007/s11764-022-01193-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Fear of cancer recurrence (FCR) is frequent in survivors, but less is known about FCR in long-term survivors with very low risk of relapse. Our aim was to estimate the prevalence and clinical and socio-behavioural factors associated with FCR in young women 5 years after diagnosis of a good-prognosis cancer. METHODS Using data from the VICAN-5 survey, conducted in 2015-2016 amongst a national representative French sample of cancer survivors, we included women with non-metastatic melanoma, breast, or thyroid cancer, aged 55 years or under at diagnosis, who experienced no disease progression in the 5 years post-diagnosis. Multinomial logistic regression was used to identify factors associated with FCR, characterised using a three-level indicator: no, mild, and moderate/severe FCR. RESULTS Amongst the 1153 women included, mean age was 44 years at diagnosis, and 81.8% had breast cancer, 12.5% thyroid cancer, and 5.8% melanoma. Five years after diagnosis, 35.4% reported no FCR, 46.0% mild FCR, and 18.6% moderate/severe FCR. Women with thyroid cancer were less likely to suffer from mild or moderate/severe FCR, while cancer-related treatment sequelae, fatigue, and anxiety were more likely. Limited health literacy was associated with mild FCR. Women who reported only occasionally consulting a general practitioner (GP) for the management of their cancer had a higher probability of FCR. CONCLUSION Moderate/severe FCR affected nearly 20% of young female long-term survivors diagnosed with a good-prognosis cancer, particularly those reporting cancer-related sequelae, suffering from fatigue or anxiety, with breast cancer or melanoma (versus thyroid cancer), and consulting a GP only occasionally for cancer management. IMPLICATIONS FOR CANCER SURVIVORS Given the recognised impact of FCR on quality of life, it is essential to detect it as early as possible, and to implement targeted interventions in routine care.
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Affiliation(s)
| | - Allan Ben Smith
- Ingham Institute for Applied Medical Research, New South Wales, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Liverpool, Australia
| | - Dominique Rey
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
| | - Aline Sarradon-Eck
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
- Institut Paoli-Calmettes, SESSTIM, Marseille, France
| | - Marie Préau
- Unité UMR 1296 «Radiations: Défense, Santé, Environnement», Lyon, France
- Institut de Psychologie, Université Lumière Lyon 2, Bron, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France.
| | - Julien Mancini
- Aix Marseille Univ, APHM, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
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Dieng S, Adebayo-Ojo TC, Kruger T, Riddin M, Trehard H, Tumelero S, Bendiane MK, de Jager C, Patrick S, Bornman R, Gaudart J. Geo-epidemiology of malaria incidence in the Vhembe District to guide targeted elimination strategies, South-Africa, 2015-2018: a local resurgence. Sci Rep 2023; 13:11049. [PMID: 37422504 PMCID: PMC10329648 DOI: 10.1038/s41598-023-38147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 07/04/2023] [Indexed: 07/10/2023] Open
Abstract
In South Africa, the population at risk of malaria is 10% (around six million inhabitants) and concern only three provinces of which Limpopo Province is the most affected, particularly in Vhembe District. As the elimination approaches, a finer scale analysis is needed to accelerate the results. Therefore, in the process of refining local malaria control and elimination strategies, the aim of this study was to identify and describe malaria incidence patterns at the locality scale in the Vhembe District, Limpopo Province, South Africa. The study area comprised 474 localities in Vhembe District for which smoothed malaria incidence curve were fitted with functional data method based on their weekly observed malaria incidence from July 2015 to June 2018. Then, hierarchical clustering algorithm was carried out considering different distances to classify the 474 smoothed malaria incidence curves. Thereafter, validity indices were used to determine the number of malaria incidence patterns. The cumulative malaria incidence of the study area was 4.1 cases/1000 person-years. Four distinct patterns of malaria incidence were identified: high, intermediate, low and very low with varying characteristics. Malaria incidence increased across transmission seasons and patterns. The localities in the two highest incidence patterns were mainly located around farms, and along the rivers. Some unusual malaria phenomena in Vhembe District were also highlighted as resurgence. Four distinct malaria incidence patterns were found in Vhembe District with varying characteristics. Findings show also unusual malaria phenomena in Vhembe District that hinder malaria elimination in South Africa. Assessing the factors associated with these unusual malaria phenome would be helpful on building innovative strategies that lead South Africa on malaria elimination.
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Affiliation(s)
- Sokhna Dieng
- Aix Marseille Univ, IRD, INSERM, ISSPAM, SESSTIM, 13005, Marseille, France.
| | | | - Taneshka Kruger
- School of Health Systems and Public Health (SHSPH), University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), University of Pretoria, Pretoria, South Africa
| | - Megan Riddin
- School of Health Systems and Public Health (SHSPH), University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), University of Pretoria, Pretoria, South Africa
| | - Helene Trehard
- Aix Marseille Univ, IRD, INSERM, ISSPAM, SESSTIM, 13005, Marseille, France
| | - Serena Tumelero
- Aix Marseille Univ, IRD, INSERM, ISSPAM, SESSTIM, 13005, Marseille, France
| | | | - Christiaan de Jager
- School of Health Systems and Public Health (SHSPH), University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), University of Pretoria, Pretoria, South Africa
| | - Sean Patrick
- School of Health Systems and Public Health (SHSPH), University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), University of Pretoria, Pretoria, South Africa
| | - Riana Bornman
- School of Health Systems and Public Health (SHSPH), University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), University of Pretoria, Pretoria, South Africa
| | - Jean Gaudart
- Aix Marseille Univ, IRD, INSERM, ISSPAM, SESSTIM, APHM, Hop. La Timone, BioSTIC, Biostatistic & ICT, 13005, Marseille, France
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Patrick SM, Bendiane MK, Kruger T, Harris BN, Riddin MA, Trehard H, de Jager C, Bornman R, Gaudart J. Household living conditions and individual behaviours associated with malaria risk: a community-based survey in the Limpopo River Valley, 2020, South Africa. Malar J 2023; 22:156. [PMID: 37189177 DOI: 10.1186/s12936-023-04585-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Over the past decade, implementation of multiple malaria control strategies in most countries has largely contributed to advance the global malaria elimination agenda. Nevertheless, in some regions, seasonal epidemics may adversely affect the health of local populations. In South Africa, Plasmodium falciparum malaria is still present, with the Vhembe District experiencing an incidence rate of 3.79 cases/1000 person-years in 2018, particularly in the Limpopo River Valley, bordering Zimbabwe. To elucidate the complexity of the mechanisms involved in local regular malaria outbreaks, a community-based survey was implemented in 2020 that focused on the relationship between housing conditions and malaria risky behaviours. METHODS The community-based cross-sectional survey was conducted among the population of three study sites in the Vhembe District, which were selected based on malaria incidence rate, social and health characteristics of inhabitants. The household survey used a random sampling strategy, where data were collected through face-to-face questionnaires and field notes; to described the housing conditions (housing questionnaire), and focus on individual behaviours of household members. Statistical analyses were performed combining hierarchical classifications and logistic regressions. RESULTS In this study, 398 households were described, covering a population of 1681 inhabitants of all ages, and 439 adults who participated in community-based survey. The analysis of situations at risk of malaria showed that the influence of contextual factors, particularly those defined by the type of habitat, was significant. Housing conditions and poor living environments were factors of malaria exposure and history, regardless of site of investigation, individual preventive behaviours and personal characteristics of inhabitants. Multivariate models showed that, considering all personal characteristics or behaviours of inhabitants, housing conditions such as overcrowding pressures were significantly associated with individual malaria risk. CONCLUSIONS The results showed the overwhelming weight of social and contextual factors on risk situations. Considering the Fundamental Causes Theory, malaria control policies based on health behaviour prevention, should reinforce access to care or promoting health education actions. Overarching economic development interventions in targeted geographical areas and populations have to be implemented, so that malaria control and elimination strategies can be efficiently and effectively managed.
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Affiliation(s)
- Sean M Patrick
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa.
| | - Marc-Karim Bendiane
- Economics & Social Sciences Applied to Health & Medical Information Processing, Aix Marseille University, INSERM, IRD, ISSPAM, SESSTIM, 13005, Marseille, France
| | - Taneshka Kruger
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Bernice N Harris
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Megan A Riddin
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Helene Trehard
- Economics & Social Sciences Applied to Health & Medical Information Processing, Aix Marseille University, INSERM, IRD, ISSPAM, SESSTIM, 13005, Marseille, France
| | - Christiaan de Jager
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Riana Bornman
- UP Institute for Sustainable Malaria Control & MRC Collaborating Centre for Malaria Research, School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Hatfield, Pretoria, 0028, South Africa
| | - Jean Gaudart
- Aix Marseille University, INSERM, IRD, APHM, ISSPAM, SESSTIM, UMR1252, Hospital La Timone, BioSTIC, Biostatistics & ICT, 13005, Marseille, France
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Landier J, Bassez L, Bendiane MK, Chaud P, Franke F, Nauleau S, Danjou F, Malfait P, Rebaudet S, Gaudart J. Social deprivation and SARS-CoV-2 testing: a population-based analysis in a highly contrasted southern France region. Front Public Health 2023; 11:1162711. [PMID: 37250096 PMCID: PMC10213643 DOI: 10.3389/fpubh.2023.1162711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Background Testing was the cornerstone of the COVID-19 epidemic response in most countries until vaccination became available for the general population. Social inequalities generally affect access to healthcare and health behaviors, and COVID-19 was rapidly shown to impact deprived population more drastically. In support of the regional health agency in Provence-Alpes-Côte d'Azur (PACA) in South-Eastern France, we analyzed the relationship between testing rate and socio-demographic characteristics of the population, to identify gaps in testing coverage and improve targeting of response strategies. Methods We conducted an ecological analysis of SARS-CoV-2/COVID-19 testing rate in the PACA region, based on data aggregated at the finest spatial resolution available in France (IRIS) and by periods defined by public health implemented measures and major epidemiological changes. Using general census data, population density, and specific deprivation indices, we used principal component analysis followed by hierarchical clustering to define profiles describing local socio-demographic characteristics. We analyzed the association between these profiles and testing rates in a generalized additive multilevel model, adjusting for access to healthcare, presence of a retirement home, and the age profile of the population. Results We identified 6 socio-demographic profiles across the 2,306 analyzed IRIS spatial units: privileged, remote, intermediate, downtown, deprived, and very deprived (ordered by increasing social deprivation index). Profiles also ranged from rural (remote) to high density urban areas (downtown, very deprived). From July 2020 to December 2021, we analyzed SARS-CoV-2/COVID-19 testing rate over 10 periods. Testing rates fluctuated strongly but were highest in privileged and downtown areas, and lowest in very deprived ones. The lowest adjusted testing rate ratios (aTRR) between privileged (reference) and other profiles occurred after implementation of a mandatory healthpass for many leisure activities in July 2021. Periods of contextual testing near Christmas displayed the largest aTRR, especially during the last periods of 2021 after the end of free convenience testing for unvaccinated individuals. Conclusion We characterized in-depth local heterogeneity and temporal trends in testing rates and identified areas and circumstances associated with low testing rates, which the regional health agency targeted specifically for the deployment of health mediation activities.
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Affiliation(s)
- Jordi Landier
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Léa Bassez
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Pascal Chaud
- Santé Publique France Cellule Régionale Paca-Corse, Marseille, France
| | - Florian Franke
- Santé Publique France Cellule Régionale Paca-Corse, Marseille, France
| | - Steve Nauleau
- Agence Régionale de la Santé Provence Alpes Côte d’Azur, Marseille, France
| | - Fabrice Danjou
- Agence Régionale de la Santé Provence Alpes Côte d’Azur, Marseille, France
| | - Philippe Malfait
- Santé Publique France Cellule Régionale Paca-Corse, Marseille, France
| | - Stanislas Rebaudet
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
- Hôpital Européen Marseille, Marseille, France
| | - Jean Gaudart
- Aix Marseille Univ, APHM, Inserm, IRD, SESSTIM, ISSPAM, Hop Timone, BioSTIC, Marseille, France
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Couderc AL, Bouhnik AD, Rey D, Bendiane MK, Greillier L, Nouguerède É, Pille A, Montegut C, Rousseau F, Villani P, Mancini J. Quality of life in older French long-term lung cancer survivors: VICAN5 national survey. Lung Cancer 2023; 180:107197. [PMID: 37116376 DOI: 10.1016/j.lungcan.2023.107197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVES This study aimed to describe quality of life (QoL) five years after diagnosis, in a representative sample of lung cancer (LC) survivors, to compare the QoL of survivors aged 70 years or older with that of younger ones, and to identify factors associated with poorer long-term QoL in both age groups. MATERIALS AND METHODS Our study sample consists of all individuals with a LC diagnosed between January 2010 and December 2011, who participated in the French national survey VICAN 5. RESULTS A total of 371 participants had LC. At the time of the survey, 21.3% of the participants were 70 years or older. In this older age group, feeling self-conscious about appearance and suspected neuropathic pain were independently associated with physical QoL impairment and lower Post-Traumatic Growth Inventory score, and suspected neuropathic pain was associated with impaired mental QoL. In younger patients, impaired physical QoL was independently associated with male gender, metastatic cancer, suspected neuropathic pain, report of severe after-effects of LC and difficulty breathing at rest in the past 7 days, and impaired mental QoL was independently associated with male gender, impaired ECOG-PS, and anxiety. CONCLUSION Factors associated with an impaired QoL in LC survivors, varied according to patient age. In both populations, psychological support and adapted physical activity can be offered to improve mental QoL and physical symptomatology. For older survivors with neuropathic pain, analgesic therapies can be discussed to improve long-term QoL.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
| | - Dominique Rey
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, INSERM, CRCM, Marseille, France
| | - Émilie Nouguerède
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France
| | - Ariane Pille
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France
| | - Coline Montegut
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Oncology Department, Institut Paoli Calmettes, Marseille, France
| | | | - Patrick Villani
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France; APHM, BIOSTIC, Hop Timone, Marseille, France
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8
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Cissoko M, Landier J, Kouriba B, Sangare AK, Katilé A, Djimde AA, Berthé I, Traore S, Thera I, Hadiata M, Sogodogo E, Coulibaly K, Guindo A, Dembele O, Sanogo S, Doumbia Z, Dara C, Altmann M, Bonnet E, Balique H, Sagaon-Teyssier L, Vidal L, Sagara I, Bendiane MK, Gaudart J. SARS-CoV-2 seroprevalence and living conditions in Bamako (Mali): a cross-sectional multistage household survey after the first epidemic wave, 2020. BMJ Open 2023; 13:e067124. [PMID: 37080622 PMCID: PMC10123860 DOI: 10.1136/bmjopen-2022-067124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES In low-income settings with limited access to diagnosis, COVID-19 information is scarce. In September 2020, after the first COVID-19 wave, Mali reported 3086 confirmed cases and 130 deaths. Most reports originated from Bamako, with 1532 cases and 81 deaths (2.42 million inhabitants). This observed prevalence of 0.06% appeared very low. Our objective was to estimate SARS-CoV-2 infection among inhabitants of Bamako, after the first epidemic wave. We assessed demographic, social and living conditions, health behaviours and knowledges associated with SARS-CoV-2 seropositivity. SETTINGS We conducted a cross-sectional multistage household survey during September 2020, in three neighbourhoods of the commune VI (Bamako), where 30% of the cases were reported. PARTICIPANTS We recruited 1526 inhabitants in 3 areas, that is, 306 households, and 1327 serological results (≥1 years), 220 household questionnaires and collected answers for 962 participants (≥12 years). PRIMARY AND SECONDARY OUTCOME MEASURES We measured serological status, detecting SARS-CoV-2 spike protein antibodies in blood sampled. We documented housing conditions and individual health behaviours through questionnaires among participants. We estimated the number of SARS-CoV-2 infections and deaths in the population of Bamako using the age and sex distributions. RESULTS The prevalence of SARS-CoV-2 seropositivity was 16.4% (95% CI 15.1% to 19.1%) after adjusting on the population structure. This suggested that ~400 000 cases and ~2000 deaths could have occurred of which only 0.4% of cases and 5% of deaths were officially reported. Questionnaires analyses suggested strong agreement with washing hands but lower acceptability of movement restrictions (lockdown/curfew), and mask wearing. CONCLUSIONS The first wave of SARS-CoV-2 spread broadly in Bamako. Expected fatalities remained limited largely due to the population age structure and the low prevalence of comorbidities. Improving diagnostic capacities to encourage testing and preventive behaviours, and avoiding the spread of false information remain key pillars, regardless of the developed or developing setting. ETHICS This study was registered in the registry of the ethics committee of the Faculty of Medicine and Odonto-Stomatology and the Faculty of Pharmacy, Bamako, Mali, under the number: 2020/162/CA/FMOS/FAPH.
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Affiliation(s)
- Mady Cissoko
- SESSTIM UMR1252, Aix Marseille Univ, IRD, INSERM, ISSPAM, Marseille, France
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
| | - Jordi Landier
- SESSTIM UMR1252, Aix Marseille Univ, IRD, INSERM, ISSPAM, Marseille, France
| | - Bourema Kouriba
- Centre d'Infectiologie Clinique Charles Mérieux, Bamako, Mali
| | | | - Abdoulaye Katilé
- SESSTIM UMR1252, Aix Marseille Univ, IRD, INSERM, ISSPAM, Marseille, France
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
| | - Abdoulaye A Djimde
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
| | - Ibrahima Berthé
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
- Direction générale de la santé et de l'hygiène publique du ministère de la santé et du développement social, Bamako, Mali
| | - Siriman Traore
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
| | - Ismaila Thera
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
| | - Maiga Hadiata
- Centre d'Infectiologie Clinique Charles Mérieux, Bamako, Mali
| | | | - Karyn Coulibaly
- Centre d'Infectiologie Clinique Charles Mérieux, Bamako, Mali
| | - Abdoulaye Guindo
- Direction générale de la santé et de l'hygiène publique du ministère de la santé et du développement social, Bamako, Mali
| | - Ousmane Dembele
- Direction générale de la santé et de l'hygiène publique du ministère de la santé et du développement social, Bamako, Mali
| | - Souleymane Sanogo
- Direction régionale de Tombouctou et établissement public hospitalier de Tombouctou, Tombouctou, Mali
| | - Zoumana Doumbia
- Direction régionale de Tombouctou et établissement public hospitalier de Tombouctou, Tombouctou, Mali
| | - Charles Dara
- Direction régionale de Tombouctou et établissement public hospitalier de Tombouctou, Tombouctou, Mali
| | | | | | - Hubert Balique
- Direction générale de la santé et de l'hygiène publique du ministère de la santé et du développement social, Bamako, Mali
| | - Luis Sagaon-Teyssier
- SESSTIM UMR1252, Aix Marseille Univ, IRD, INSERM, ISSPAM, Marseille, France
- ARCAD Santé Plus/Centre Intégré de Recherche, de Soins et d'Action Communautaire (CIRSAC), Bamako, Mali
| | - Laurent Vidal
- SESSTIM UMR1252, Aix Marseille Univ, IRD, INSERM, ISSPAM, Marseille, France
| | - Issaka Sagara
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
| | | | - Jean Gaudart
- SESSTIM UMR1252, Aix Marseille Univ, IRD, INSERM, ISSPAM, Marseille, France
- Biostatictics & ICT, AP-HM, Marseille, France
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Tallet A, Rey D, Casanova C, Lecourtois D, Bergeaud M, Bendiane MK, Mancini J. Physicians’ Opinion on Intraoperative Radiotherapy as a Therapeutic De-Escalation Option in Older Women with Early Breast Cancer. Curr Oncol 2023; 30:2812-2824. [PMID: 36975427 PMCID: PMC10047225 DOI: 10.3390/curroncol30030214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
Background: Intraoperative radiotherapy (IORT) is a therapeutic de-escalation option in older women with low-risk early breast cancer (EBC). A qualitative study was implemented to describe EBC physicians’ points of view on IORT as a de-escalation option. Methods: Recorded face-to-face and telephone semi-structured interviews were conducted among diverse physicians from seven French comprehensive cancer centers. Interview transcripts were grouped as corpus to construct a typology. Thematic analysis was performed. Results: Positions toward IORT were contrasted between the 16 participating physicians. Five fully supported IORT as a de-escalation option, four were not in favor, and seven had a more reserved or neutral opinion. Points of divergence concerned treatment efficacy, treatment duration, side effects and sequelae, psychological impact, compliance with adjuvant endocrine therapy, logistical constraints, financial cost, and availability of other techniques of partial breast irradiation. Physicians in favor of IORT emphasized direct benefits for the patient, and those against pointed the lack of specific guidelines, risk of lost opportunity in older women with long life expectancy, and challenges of shared decision making. Conclusions: Despite national policies to preserve cancer patients’ quality of life and increase their participation in medical decision making, therapeutic de-escalation using IORT is not consensual among physicians. Further efforts are needed to promote patient-centered care.
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Affiliation(s)
- Agnès Tallet
- UNICANCER, Institut Paoli-Calmettes, Department of Radiation Oncology, 13009 Marseille, France
| | - Dominique Rey
- Aix-Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, 13009 Marseille, France
| | - Clémence Casanova
- Aix-Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, 13009 Marseille, France
| | - Delphine Lecourtois
- Aix-Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, 13009 Marseille, France
| | | | - Marc-Karim Bendiane
- Aix-Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, 13009 Marseille, France
| | - Julien Mancini
- Aix-Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, 13009 Marseille, France
- APHM, BIOSTIC, Hop Timone, 13005 Marseille, France
- Correspondence: ; Tel.: +33-4-91-22-34-87
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10
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Sypre D, Pignot G, Touzani R, Marino P, Walz J, Rybikowski S, Maubon T, Branger N, Salem N, Mancini J, Gravis G, Bendiane MK, Bouhnik AD. Impact of active surveillance for prostate cancer on the risk of depression and anxiety. Sci Rep 2022; 12:12889. [PMID: 35902716 PMCID: PMC9334351 DOI: 10.1038/s41598-022-17224-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/21/2022] [Indexed: 12/03/2022] Open
Abstract
Active surveillance (AS) is a standard treatment option for low risk localized prostate cancer. However, the risk of anxiety and depression compared to other curative strategies, namely radical prostatectomy (RP) and radiotherapy (RT), is controversial. This study consisted in a French representative sample of 4174 5-years cancer survivors. Self-reported data, including quality-of-life assessment, were prospectively collected through telephone interviews. Among the 447 survivors with PC, we selected 292 patients with localized prostate cancer, T1–T2 stage, Gleason score ≤ 7 and we compared anxiety and depressive symptoms according to treatment strategy. Among patients on AS, 14.9% received curative treatment during the 5 years of follow-up. Anxiety was reported in 34.3% of cases in the AS group versus 28.6% in the RP group and 31.6% in the RT group (p = 0.400), while depressive symptoms were reported in 14.9% of cases in the AS group versus 10.7% in the RP group and 22.8% in the RT group (p = 0.770). Consumption of anxiolytics reported did not vary significantly between the 3 groups (p = 0.330). In conclusion, patients managed with AS for localized prostate cancer do not report more anxiety or depressive symptoms than patients managed with curative treatment, encouraging the extended use of active surveillance.
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Affiliation(s)
- Davidson Sypre
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 232 boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Géraldine Pignot
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 232 boulevard de Sainte Marguerite, 13009, Marseille, France.
| | - Rajae Touzani
- SESSTIM, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Institut Paoli-Calmettes, Marseille, France.,INSERM, IRD, SESSTIM, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Aix Marseille Univ, Marseille, France
| | - Patricia Marino
- SESSTIM, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Institut Paoli-Calmettes, Marseille, France.,INSERM, IRD, SESSTIM, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Aix Marseille Univ, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 232 boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Stanislas Rybikowski
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 232 boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Thomas Maubon
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 232 boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Nicolas Branger
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 232 boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Naji Salem
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France
| | - Julien Mancini
- SESSTIM, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Institut Paoli-Calmettes, Marseille, France.,Public Health Department (BIOSTIC), APHM, Marseille, France
| | - Gwenaelle Gravis
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France
| | - Marc-Karim Bendiane
- INSERM, IRD, SESSTIM, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Aix Marseille Univ, Marseille, France
| | - Anne-Deborah Bouhnik
- INSERM, IRD, SESSTIM, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Aix Marseille Univ, Marseille, France
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11
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Evans C, Saliba-Serre B, Préau M, Bendiane MK, Gonçalves A, Signoli M, Bouhnik AD. Post-traumatic growth 5 years after cancer: identification of associated actionable factors. Support Care Cancer 2022; 30:8261-8270. [PMID: 35821449 DOI: 10.1007/s00520-022-07253-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The number of cancer survivors is growing increasingly worldwide. The long-term negative consequences of the disease are now better known. Cancer may also foster positive outcomes. Some survivors consider life after cancer as the start of a new life and experience positive changes called post-traumatic growth (PTG) measured by a scale developed by Tedeschi and Calhoun. OBJECTIVE The purpose of this article was to explore actionable factors affecting PTG, particularly those in relation with health care management and those that reflected health behavior changes. METHODS This study included the 1,982 participants in the VICAN cohort who responded to the questionnaire on living conditions 2 and 5 years after diagnosis. Factors associated with a moderate or high PTG (score ≥ 63) were identified using logistic regressions. RESULTS Factors positively associated with moderate or high PTG were being satisfied with the time spent by health care team on information (OR:1.35 [1.08;1.70]), increased physical activity (OR:1.42 [1.04;1.95]) and healthier diet (OR:1.85 [1.44;2.36]) since diagnosis, and having benefited from psychological support at diagnosis (OR:1.53 [1.16;2.01]). CONCLUSION High PTG is positively associated with health behavior and time spent on information. Our findings suggest that appropriate clinical and educational interventions can help foster growth after the experience of cancer. Even if we do not know what causes what, it is admitted that the interventions leading to an increase of physical activity, for example, are good from all points of view.
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Affiliation(s)
- Catherine Evans
- Institut Paoli Calmettes, 232 Bd Sainte Marguerite, 13 273, Cedex 9, Marseille, France.
- Faculté Des Sciences Médicales Et Paramédicales de Marseille, UMR 7268-ADÉS Aix-Marseille Université-EFS-CNRS, Marseille, France.
| | - Bérengère Saliba-Serre
- Faculté Des Sciences Médicales Et Paramédicales de Marseille, UMR 7268-ADÉS Aix-Marseille Université-EFS-CNRS, Marseille, France
| | - Marie Préau
- Institut de Psychologie, Université Lumière Lyon 2, Bron, France
| | - Marc-Karim Bendiane
- Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
| | - Anthony Gonçalves
- Centre de Recherche en Cancérologie de Marseille (CRCM), Inserm U1068, CNRS U7258, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Michel Signoli
- UMR 6578, CNRS-service d'anthropologie biologique, 13385, Cedex 5, Marseille, France
- Aix Marseille Univ, Marseille, France
| | - Anne-Déborah Bouhnik
- Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
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12
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Pignot G, Touzani R, Bendiane MK, Mancini J, Walz J, Marino P, Rybikowski S, Maubon T, Salem N, Gravis G, Bouhnik AD. Self-reported functional assessment after treatment for prostate cancer: 5-year results of the prospective cohort VICAN. Future Oncol 2022; 18:1733-1744. [PMID: 35172586 DOI: 10.2217/fon-2021-1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: We aimed to assess the long-term association of therapeutic strategies with urinary, sexual function and health-related quality of life (HR-QOL) for 5-year prostate cancer (PC) survivors. Materials & methods: The VICAN survey consisted of self-reported data prospectively collected, including living conditions, treatment side effects and quality of life (QOL) of cancer survivors. Results: Among the 434 PC survivors, 52.8% reported urinary incontinence (UI) and 55.8% reported erectile dysfunction (ED). Patients treated with radical prostatectomy with salvage radiotherapy reported significantly more UI (p = 0.014) and more ED (p = 0.012) compared with other strategies. UI was significantly associated with physical and mental health-related QOL (p = 0.045 and p = 0.049, respectively). Conclusion: Self-assessed functional outcomes 5 years after PC diagnosis remain poor and could have an impact on health-related QOL.
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Affiliation(s)
- Géraldine Pignot
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France
| | - Rajae Touzani
- Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | | | - Julien Mancini
- Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France
| | - Patricia Marino
- Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | | | - Thomas Maubon
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France
| | - Naji Salem
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Anne-Déborah Bouhnik
- Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
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13
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Gauna F, Bendiane MK, Aim MA, Rousseau F, Rey D, Lecourtois D, Bonnet N, Durand MA, Tallet A, Mancini J. Lived experience and perceived advantages of therapeutic De-escalation: A qualitative study of older patients with breast cancer. J Geriatr Oncol 2022; 13:600-605. [PMID: 35115271 DOI: 10.1016/j.jgo.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION One option for therapeutic de-escalation in older women with early breast cancer (EBC) is partial breast irradiation (PBI) instead of whole-breast irradiation (WBI) when the latter has no clear advantages. We aimed to explore the decision-making processes and the lived experiences of WBI and PBI from the perspectives of older women with EBC. MATERIALS AND METHODS Thematic content analysis was performed on qualitative data collected using narrative interviews. RESULTS Twenty-two women aged 65 and over participated (ten patients who underwent WBI and twelve who underwent PBI). We identified three themes from their narratives: 1) Acceptance of a paternalistic relationship with physicians, 2) Strong need for an informed choice, and 3) PBI can help people conceal cancer-related physical marks. Narratives underlined participants' preferences for each of the two treatments and their perceptions about therapeutic de-escalation. Misconceptions about therapeutic de-escalation were observed. DISCUSSION When providing information about EBC treatment options, patients' perceived burden of side effects should be considered. Moreover, eliciting the value older patients place on available breast cancer treatments, as well as their related goals and preferences, could foster their participation in the therapeutic de-escalation decision-making process.
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Affiliation(s)
- Fatima Gauna
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France
| | - Marie-Anastasie Aim
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France; LPS EA 849, Aix Marseille Univ, Aix-en-Provence, France; Delegation for Clinical Research and Innovation, APHM, Marseille, France
| | | | - Dominique Rey
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France
| | - Delphine Lecourtois
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France
| | | | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA; UMR 1027, University Toulouse III Paul Sabatier, Toulouse, France
| | | | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France; APHM, BIOSTIC, Hop Timone, Marseille, France.
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14
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Gay L, Melenotte C, Lakbar I, Mezouar S, Devaux C, Raoult D, Bendiane MK, Leone M, Mège JL. Sexual Dimorphism and Gender in Infectious Diseases. Front Immunol 2021; 12:698121. [PMID: 34367158 PMCID: PMC8339590 DOI: 10.3389/fimmu.2021.698121] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/08/2021] [Indexed: 12/19/2022] Open
Abstract
Epidemiological studies and clinical observations show evidence of sexual dimorphism in infectious diseases. Women are at less risk than men when it comes to developing most infectious diseases. However, understanding these observations requires a gender approach that takes into account an analysis of both biological and social factors. The host’s response to infection differs in males and females because sex differences have an impact on hormonal and chromosomal control of immunity. Estradiol appears to confer protective immunity, while progesterone and testosterone suppress anti-infectious responses. In addition, genetic factors, including those associated with sex chromosomes, also affect susceptibility to infections. Finally, differences in occupational activities, lifestyle, and comorbidities play major roles in exposure to pathogens and management of diseases. Hence, considering sexual dimorphism as a critical variable for infectious diseases should be one of the steps taken toward developing personalized therapeutic approaches.
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Affiliation(s)
- Laetitia Gay
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Cléa Melenotte
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France.,Aix-Marseille Univ, INSERM, IRD, SESSTIM, Economy and Social Science, Health Care Systems and Societies, Marseille, France
| | - Ines Lakbar
- Department of Anaesthesia and Intensive Care, Hôpital Nord, Aix-Marseille Univ, APHM, Marseille, France
| | - Soraya Mezouar
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Christian Devaux
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Marc-Karim Bendiane
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Economy and Social Science, Health Care Systems and Societies, Marseille, France
| | - Marc Leone
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France.,Department of Anaesthesia and Intensive Care, Hôpital Nord, Aix-Marseille Univ, APHM, Marseille, France
| | - Jean-Louis Mège
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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15
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Creff G, Jegoux F, Bendiane MK, Babin E, Licaj I. P-209 Social and Sexual Health of Thyroid Cancer Survivors Two and Five Years After Diagnosis: The VICAN Survey. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00492-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Creff G, Jegoux F, Bendiane MK, Babin E, Licaj I. P-208 Returning to work by thyroid cancer survivors 5 years after diagnosis: The VICAN Survey. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Delrieu L, Bouaoun L, Fatouhi DE, Dumas E, Bouhnik AD, Noelle H, Jacquet E, Hamy AS, Coussy F, Reyal F, Heudel PE, Bendiane MK, Fournier B, Michallet M, Fervers B, Fagherazzi G, Pérol O. Patterns of Sequelae in Women with a History of Localized Breast Cancer: Results from the French VICAN Survey. Cancers (Basel) 2021; 13:1161. [PMID: 33800346 PMCID: PMC7962808 DOI: 10.3390/cancers13051161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Breast cancer (BC) remains complex for women both physically and psychologically. The objectives of this study were to (1) assess the evolution of the main sequelae and treatment two and five years after diagnosis in women with early-stage breast cancer, (2) explore patterns of sequelae associated with given sociodemographic, clinical, and lifestyle factors. The current analysis was based on 654 localized BC patients enrolled in the French nationwide longitudinal survey "vie après cancer" VICAN (January-June 2010). Information about study participants was collected at enrollment, two and five years after diagnosis. Changes over time of the main sequelae were analyzed and latent class analysis was performed to identify patterns of sequelae related to BC five years after diagnosis. The mean age (±SD) of study participants at inclusion was 49.7 (±10.5) years old. Six main classes of sequelae were identified two years and five years post-diagnosis (functional, pain, esthetic, fatigue, psychological, and gynecological). A significant decrease was observed for fatigue (p = 0.03) and an increase in cognitive sequelae was reported (p = 0.03). Two latent classes were identified-functional and esthetic patterns. Substantial sequelae remain up to five years after BC diagnosis. Changes in patient care pathways are needed to identify BC patients at a high risk.
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Affiliation(s)
- Lidia Delrieu
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
| | - Liacine Bouaoun
- International Agency for Research on Cancer, 69372 Lyon, France;
| | - Douae El Fatouhi
- Center of Research in Epidemiology and Population Health, UMR 1018 Inserm, Institut Gustave Roussy, Paris-Sud Paris-Saclay University, 94807 Villejuif, France; (D.E.F.); (G.F.)
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
- MINES ParisTech, PSL Research University, CBIO-Centre for Computational Biology, 75006 Paris, France
| | - Anne-Deborah Bouhnik
- INSERM, IRD, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, 13007 Marseille, France; (A.-D.B.); (M.-K.B.)
| | - Hugo Noelle
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
| | - Emmanuelle Jacquet
- Oncology and Blood Diseases Department, University Hospital Center, Joseph Fourier University, CEDEX 9, 38043 Grenoble, France;
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
- Department of Medical Oncology, Institut Curie, 75005 Paris, France
| | - Florence Coussy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
- Department of Medical Oncology, Institut Curie, 75005 Paris, France
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France
| | - Pierre-Etienne Heudel
- Department of Medical Oncology, Léon Bérard Cancer Center, 69008 Lyon, France; (P.-E.H.); (M.M.)
| | - Marc-Karim Bendiane
- INSERM, IRD, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, 13007 Marseille, France; (A.-D.B.); (M.-K.B.)
| | - Baptiste Fournier
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
| | - Mauricette Michallet
- Department of Medical Oncology, Léon Bérard Cancer Center, 69008 Lyon, France; (P.-E.H.); (M.M.)
| | - Béatrice Fervers
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
- Cancer Research Center of Lyon, INSERM UA8, Léon Bérard Cancer Center, 69008 Lyon, France
| | - Guy Fagherazzi
- Center of Research in Epidemiology and Population Health, UMR 1018 Inserm, Institut Gustave Roussy, Paris-Sud Paris-Saclay University, 94807 Villejuif, France; (D.E.F.); (G.F.)
- Department of Population Health, Luxembourg Institute of Health (LIH), 1445 Strassen, Luxembourg
| | - Olivia Pérol
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
- Cancer Research Center of Lyon, INSERM UA8, Léon Bérard Cancer Center, 69008 Lyon, France
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18
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Dugué J, Humbert M, Bendiane MK, Bouhnik AD, Babin E, Licaj I. Head and neck cancer survivors' pain in France: the VICAN study. J Cancer Surviv 2021; 16:119-131. [PMID: 33635450 DOI: 10.1007/s11764-021-01010-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Pain is an increasing concern in the growing number of head and neck cancer survivors. This study aimed to analyze the 5-year prevalence of pain in French survivors of head and neck cancer and to identify associated factors. METHODS Analyses were performed among 296 5-year cancer survivors diagnosed in 2010. Using multivariable logistic regressions, we studied the associations between pain and factors collected in the French representative national "vie après le cancer" (VICAN) survey. Eligible participants were aged from 18 to 82 years; patients' living conditions, socioeconomic characteristics, and medical data were collected. RESULTS Pain was reported by 72.6% of the participants. In the multivariable analyses, decreasing level of physical activity was the only determinant of increased overall pain (OR= 2.77, CI= 1.48-5.17). The chronic pain prevalence was 62.3%. The main risk factors found were tumor localization in the oropharynx (OR= 2.49, CI= 1.27-4.88), education (at least a high school's degree) (OR= 0.33, CI= 0.13-0.9), and decreased physical activity (OR= 2.20, CI= 1.24-3.9). CONCLUSIONS Five years after diagnosis, pain is a very frequent sequelae that has a significant impact on quality of life in head and neck cancer survivors. Reduced physical activity, a low level of education, and tumor localization in the oropharynx are factors associated with pain. IMPLICATIONS FOR CANCER SURVIVORS Pain frequency and its impact on patients' lives imply that an adaptation must be made in terms of both pain diagnosis and management and the training of healthcare professionals. CLINICAL TRIAL REGISTRATION This is not a clinical trial. ISP number: INSERM C11-63.
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Affiliation(s)
- Justin Dugué
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France.
| | - Maxime Humbert
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Marc-Karim Bendiane
- Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM) Marseille, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Anne-Déborah Bouhnik
- Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM) Marseille, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Emmanuel Babin
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Idlir Licaj
- Clinipace Biostatistics, Morrisville, NC, 27560, USA.,Clinical Research Department, Centre François Baclesse, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
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19
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Seguin L, Touzani R, Bouhnik AD, Charif AB, Marino P, Bendiane MK, Gonçalves A, Gravis G, Mancini J. Deterioration of Sexual Health in Cancer Survivors Five Years after Diagnosis: Data from the French National Prospective VICAN Survey. Cancers (Basel) 2020; 12:cancers12113453. [PMID: 33233583 PMCID: PMC7699784 DOI: 10.3390/cancers12113453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
Little is known about cancer survivors' sexual health (SH)-particularly, from well after diagnosis and in cancers unrelated to sexuality. This study aimed to assess SH deterioration five years after diagnosis. We analyzed data from the French national VIe après le CANcer (VICAN) survey. Six items from the Relationship and Sexuality Scale were used to assess SH. Respondents were grouped according to an ascending hierarchical classification in four clusters: strong, moderate, and weak deterioration or stable (WD, SD, MD, or St). Out of 2195 eligible participants, 57.3% reported substantial SH deterioration as either SD (30.8%) or MD (26.5%), while WD and St accounted for 31.2% and 11.5% of respondents, respectively. Substantial deterioration was reported in all cancer sites (from 27.7% in melanoma to 83.1% in prostate). Treatment type, cancer sequelae, and pain, as well as psychological consequences (depression and anxiety, especially for younger patients) were associated with substantial SH deterioration. The same factors were identified after restricting the analysis to survivors of cancers unrelated to sexuality. Five years after diagnosis, the majority of cancer survivors reported SH deterioration. Interventions should be developed to improve SH regardless of cancer site. Particular attention should be paid to depression and anxiety, especially in younger survivors.
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Affiliation(s)
- Lorène Seguin
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, 13009 Marseille, France; (A.G.); (G.G.)
| | - Rajae Touzani
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
- Institut Paoli-Calmettes, SESSTIM U1252, 13009 Marseille, France
| | - Anne-Déborah Bouhnik
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
- Correspondence: ; Tel.: +33-(0)491-223-502
| | - Ali Ben Charif
- VITAM—Centre de recherche en santé durable Quebec, Quebec, QC G1J0A4, Canada;
| | - Patricia Marino
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
- Institut Paoli-Calmettes, SESSTIM U1252, 13009 Marseille, France
| | - Marc-Karim Bendiane
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, 13009 Marseille, France; (A.G.); (G.G.)
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, 13009 Marseille, France; (A.G.); (G.G.)
| | - Julien Mancini
- APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Hop Timone, BioSTIC, Biostatistique et Technologies de l’Information et de la Communication, Aix Marseille Univ, 13005 Marseille, France;
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20
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Rey D, Touzani R, Monet A, Bendiane MK, Bouhnik AD, Mancini J. Physical activity and body weight of breast cancer survivors – VICAN national survey. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cancer recurrence and poor quality of life are major challenges of the growing population of breast cancer (BC) survivors. International guidelines encourage survivors to engage in regular physical activity (PA) and to maintain a healthy body weight (BW), as both have a proven benefit on survival. Our aims were (1) to describe PA and BW 5 years after a BC diagnosis and (2) to define the predictors of long-term engagement in healthy lifestyle, in a representative sample of French survivors.
Methods
The French National VICAN surveys were implemented in 2012 and 2015 among cancer survivors. This analysis focused on 723 women with BC, without progression at 5 years, and who participated in both surveys. The questionnaires dealt with several topics including socioeconomic status, treatments and side effects, psychometric scales and lifestyle habits.
Results
Five years after diagnosis, 26% of women reported regular PA, 61% occasional PA and 14% no PA. Moreover, 27% reported a weight gain ≥5kg, and 10% a weight loss ≥5kg. Half of the women had decreased or stopped PA since diagnosis. In logistic regression, long-term regular PA was associated with better mental quality of life (aOR=1.04; 1.01-1.07), no depression (aOR=3.42; 1.21-9.65), higher Post Traumatic Growth Inventory score (aOR=1.02; 1.01-1.04), normal arm mobility (aOR=3.7; 1.6-8.4) and healthy and stable BW since diagnosis (aOR=4.47; 1.61-12.37). Weight gain ≥5kg was associated with younger age (aOR=0.96; 0.93-0.99), higher BW at diagnosis (aOR=1.02; 1.01-1.04), and lymphedema 5 years after diagnosis (aOR=1.69; 1.02-2.83).
Conclusions
For BC survivors, mental well-being is essential for successful long-term investment in healthy habits. More psychological and dietary support, and a better management of sequelae are needed in this population.
Key messages
For breast cancer survivors, mental well-being is essential for successful long-term investment in healthy habits. More psychological and dietary support, and better sequelae management are needed to help breast cancer survivors to persist in healthy lifestyle.
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Affiliation(s)
- D Rey
- SESSTIM, Aix-Marseille Univ, Inserm, IRD, Marseille, France
| | - R Touzani
- SESSTIM, Aix-Marseille Univ, Inserm, IRD, Marseille, France
- SESSTIM, Institut Paoli-Calmettes, Marseille, France
| | - A Monet
- SESSTIM, Aix-Marseille Univ, Inserm, IRD, Marseille, France
| | - M K Bendiane
- SESSTIM, Aix-Marseille Univ, Inserm, IRD, Marseille, France
| | - A D Bouhnik
- SESSTIM, Aix-Marseille Univ, Inserm, IRD, Marseille, France
| | - J Mancini
- SESSTIM, Aix-Marseille Univ, Inserm, IRD, Marseille, France
- BIOSTIC, APHM, Marseille, France
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21
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Memoli V, Lailler G, Le-Bihan C, Bendiane MK, Lauzier S, Mancini J, Bousquet PJ, Bouhnik AD. Trajectories of adherence to adjuvant endocrine therapy for 5 years in women with breast cancer. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adjuvant endocrine therapy (AET) is a daily oral medication prescribed for women with hormone-sensitive breast cancer (BC) to reduce recurrence and mortality risks. However, many women do not take AET daily or do not persist with AET for the recommended duration of at least 5 years. Our aims were to identify: 1) trajectories of AET adherence for the 5 years; 2) factors associated with these trajectories.
Methods
The French Cancer Cohort includes data on hospitalizations, ambulatory care and drug claims for all cancers diagnosed in France (SNDS database). Women diagnosed with a 1st non-metastatic BC in 2011 who had ≥ 1 AET claim within 12 months of surgery were included. For each woman, we estimated the monthly proportion of days covered (PDC) by an AET for 5 years after the first AET. Monthly PDCs were used to model AET adherence trajectories using group-based trajectory modeling. Statistical criteria were used to assess the suitability of the selected model. The factors associated with the trajectories were identified using multinomial logistic regressions.
Results
33,260 women were included. A 6-trajectory model was selected: 1) Stop of AET in the 1st year (6.6%), 2) Adherence for 1 year and stop (5.7%), 3) Adherence for 2.5y and stop (6.3%), 4) High adherence for 4.5y and stop (8.3%), 5) Sub-optimal adherence for 5y (4.3%), 6) Very high adherence for 5y (68.8%). Factors associated with non-adherence trajectories are mainly extreme age (>70y) and switch in AET.
Conclusions
About 70% of women had an optimal adherence for 5 years. Our results showed that women who changed AET during the treatment course were at higher risk of non-adherence. Among non-adherent women, the switch in AET is frequent and probably often related to the management of side effects. Interventions to detect and manage these side effects may help to support women with AET use. Effective management of these effects during all the 5 years could be needed to maintain adherence.
Key messages
About 70% of women had an optimal adherence for 5 years. Women who changed AET during the treatment course were at higher risk of non-adherence.
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Affiliation(s)
- V Memoli
- U1252, SESSTIM-CanBioS, Marseille, France
| | - G Lailler
- Health data and assessment department Survey, Institut National du Cancer, Boulogne Billancourt, France
| | - C Le-Bihan
- Health data and assessment department Survey, Institut National du Cancer, Boulogne Billancourt, France
| | | | - S Lauzier
- CHU de Québec-Université Laval Research Center, Axe Santé des Populations et Pratiques Optimales en Santé, Quebec, Canada
| | - J Mancini
- U1252, SESSTIM-CanBioS, Marseille, France
| | - P J Bousquet
- Health data and assessment department Survey, Institut National du Cancer, Boulogne Billancourt, France
| | - AD Bouhnik
- U1252, SESSTIM-CanBioS, Marseille, France
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22
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Janah A, Le Bihan-Benjamin C, Mancini J, Bouhnik AD, Bousquet PJ, Bendiane MK. Access to inpatient palliative care among cancer patients in France: an analysis based on the national cancer cohort. BMC Health Serv Res 2020; 20:798. [PMID: 32847565 PMCID: PMC7448507 DOI: 10.1186/s12913-020-05667-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/18/2020] [Indexed: 01/26/2023] Open
Abstract
Background Closely linked to the concept of supportive care, the integrated model of palliative care (PC) implies identifying, assessing and treating physical and psychological suffering as early as needed, irrespective of patient characteristics. In France, as in the most southern European countries, little is known about the proportion of cancer patients who have access to PC. Accordingly, we aimed in this study to estimate the proportion of cancer patients in France who have access to inpatient PC, and to explore associated factors. We carried out a nationwide retrospective cohort study using data from the French national health system database (SNDS) for all individuals diagnosed with cancer in 2013 and followed between 2013 and 2016. We compared patients who had inpatient PC with those who did not. Results Of the 313,059 cancer patients included in the national French cancer cohort in 2013, 53,437 (17%) accessed inpatient PC at least once between 2013 and 2016, ranging from 2% in survivors to 56% in the deceased population. Multivariate logistic regression revealed that women and younger patients (18–49 years old) were less likely to access inpatient PC while patients with a greater number of comorbidities, metastatic cancer, or cancer of the nervous system, were more likely to have done so. Conclusions A negligible proportion of cancer survivors accessed inpatient PC. More research and training are needed to convince healthcare providers, patients, and families about the substantial benefits of PC, and to promote better integration of PC and oncology.
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Affiliation(s)
- Asmaa Janah
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 27 Boulevard Jean Moulin, Marseille, France.
| | - Christine Le Bihan-Benjamin
- Department of Health Data and Assessment, Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 52 Avenue André Morizet, Boulogne-Billancourt, France
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 27 Boulevard Jean Moulin, Marseille, France.,APHM, La Timone Hospital, BiosTIC, 264 Rue Saint-Pierre, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 27 Boulevard Jean Moulin, Marseille, France
| | - Philippe-Jean Bousquet
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 27 Boulevard Jean Moulin, Marseille, France.,Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 52 Avenue André Morizet, Boulogne-Billancourt, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 27 Boulevard Jean Moulin, Marseille, France
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Ousseine YM, Bouhnik AD, Peretti-Watel P, Sarradon-Eck A, Memoli V, Bendiane MK, Durand MA, Mancini J. The impact of health literacy on medico-social follow-up visits among French cancer survivors 5 years after diagnosis: The national VICAN survey. Cancer Med 2020; 9:4185-4196. [PMID: 32329183 PMCID: PMC7300405 DOI: 10.1002/cam4.3074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 12/18/2022] Open
Abstract
Background Long‐term medico‐social follow‐up of cancer survivors is a challenge because of frequent subsequent troubles. In particular survivors with lower health literacy (HL) have poorer health and might more often use primary care services. However, the impact of HL on cancer survivors’ medico‐social follow‐up visits is not known. Our aim was to study medico‐social follow‐up and its associated determinants with a focus on HL 5 years after diagnosis. Methods VICAN is a national survey of French adult cancer survivors 5 years after a primary cancer. The Single‐Item Literacy Screener was used to define functional HL in this sample. We also asked patients to report the frequency of follow‐up visits with a general practitioner (GP) and/or social worker (SW) regarding their cancer disease. Results The 4045 participants were 57.4 ± 12.9 years old at diagnosis (range 20‐82) and 1495 (37%) were classified as having inadequate HL. Most cancer survivors (66.7%) were followed up by a GP regarding their cancer while only 14.5% had contact with a SW. After adjustment for sociodemographic, medical, and psychosocial characteristics, medico‐social follow‐ups (GP and SW visits) were more frequent among survivors with low HL. Furthermore, low income, unemployment, impaired mental health, treatment by chemotherapy, and perception of sequelae and fatigue were also associated with more frequent medico‐social follow‐up. Cancer localization association with medico‐social follow‐up was heterogeneous. Conclusion French cancer survivors with limited HL, lower socioeconomic status, and more severe cancer were more likely to use GP care and social services. Raising awareness and training GPs and SWs on medico‐social follow‐up for patients with limited HL seem necessary to support these vulnerable survivors.
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Affiliation(s)
- Youssoufa M Ousseine
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | | | - Aline Sarradon-Eck
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,Institut Paoli-Calmettes, UMR1252 SESSTIM CANBIOS, Marseille, France
| | - Victoria Memoli
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,APHM, Hop Timone, BIOSTIC, Marseille, France
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Janah A, Bouhnik AD, Touzani R, Bendiane MK, Peretti-Watel P. Underprescription of Step III Opioids in French Cancer Survivors With Chronic Pain: A Call for Integrated Early Palliative Care in Oncology. J Pain Symptom Manage 2020; 59:836-847. [PMID: 31707070 DOI: 10.1016/j.jpainsymman.2019.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Chronic pain (CP) is a major concern in cancer survivors. Often under-reported by patients, it is both underassessed and undertreated by care providers. OBJECTIVES To assess CP prevalence and related treatment in cancer survivors five years after diagnosis and to identify factors associated with prescribing opioids among survivors with CP, focusing on access to palliative care (PC). METHODS In 2015-2016, we interviewed 4174 French patients diagnosed with cancer five years previously. Combining patient-reported and clinical-reported outcomes together with medicoadministrative data, we studied factors associated with Step II and Step III opioid prescriptions in cancer survivors with CP. We performed multinomial logistic regression adjusting for various covariates, including self-reported health status variables and inpatient PC. RESULTS Five years after cancer diagnosis, 63.5% of the respondents reported current CP (i.e., pain lasting three months or more). Of these, 64.6% and 14.4% were prescribed at least one Step II or Step III opioid, respectively. Only 1.9% had had inpatient PC since diagnosis. After adjustment for age, gender, clinical and self-reported variables, we found that the latter were more likely to receive Step III opioids (adjusted relative risk ratio 5.33; 95% CI 1.15, 24.58). CONCLUSION This study showed a high prevalence of CP five years after cancer diagnosis. Step III opioids were underprescribed but positively associated with inpatient PC. PC access in France remains limited, especially among cancer survivors. Integrating PC in oncology is essential to provide the best cancer-related symptoms management.
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Affiliation(s)
- Asmaa Janah
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, France
| | - Anne-Déborah Bouhnik
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, France
| | - Rajae Touzani
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, France; Institut Paoli Calmettes, SESSTIM, Marseille, France
| | - Marc-Karim Bendiane
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, France.
| | - Patrick Peretti-Watel
- IRD, AP-HM, SSA, VITROME, Aix Marseille University, Marseille, France; IHU-Méditerranée Infection, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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25
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Alleaume C, Bendiane MK, Peretti-Watel P, Bouhnik AD. Inequality in income change among cancer survivors five years after diagnosis: Evidence from a French national survey. PLoS One 2019; 14:e0222832. [PMID: 31581224 PMCID: PMC6776327 DOI: 10.1371/journal.pone.0222832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/08/2019] [Indexed: 11/30/2022] Open
Abstract
Worldwide, around 18 million people receive a cancer diagnosis each year, most of whom survive long enough to face additional cancer-related costs. In France, most costs directly related to cancer are covered by the National Health Insurance Fund, and cancer patients can receive treatments without paying advance fees. In this context, the costs faced by cancer survivors are mostly social costs. Drawing on fundamental cause theory, this study aimed to explore the socially-differentiated evolution of cancer survivor’s income five years after diagnosis. Our study draws on the findings of VICAN5, a French national survey that was conducted in 2015/2016 in a representative sample of 4,174 cancer survivors to obtain information on living conditions five years after diagnosis, and that was restricted to 12 tumour sites accounting for 88% of global cancer incidence in France. We used the multiple imputation method and the Heckman selection model to identify the factors associated with a decrease in household income per consumption unit (HICU), while accounting for missing data. Among survivors still working five years after diagnosis, 17.6% reported lower income at survey than at diagnosis. After adjustment for socio-demographic and medical characteristics, the decrease in HICU was more frequent in women, singles, low educated survivors, and survivors with reduced working time. Finally, subjective measures of income variation and economic well-being were a useful complement to objective measures since 31.6% of cancer survivors still working five years after diagnosis reported a perceived decrease in household income. In conclusion, inequalities in economic well-being persist long after diagnosis in France, and this despite the fact that most cancer-related costs are covered by the French National Health Insurance Fund. Consequently, more attention should be paid to cancer patients with low socio-economic status to help reduce inequalities in post-diagnosis living conditions.
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Affiliation(s)
- Caroline Alleaume
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- * E-mail:
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26
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Janah A, Gauthier LR, Morin L, Bousquet PJ, Le Bihan C, Tuppin P, Peretti-Watel P, Bendiane MK. Access to palliative care for cancer patients between diagnosis and death: a national cohort study. Clin Epidemiol 2019; 11:443-455. [PMID: 31239783 PMCID: PMC6559764 DOI: 10.2147/clep.s198499] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/02/2019] [Indexed: 12/13/2022] Open
Abstract
Background and purpose: Introducing palliative care earlier in the disease trajectory has been found to provide better management of physical and psychological suffering. In France, the proportion of cancer patients who receive palliative care is unclear. This study aimed primarily to measure the prevalence of access to inpatient palliative care and associated patient-level factors, and to identify the time between access to palliative care and death. Patients and methods: A nationwide retrospective cohort study using data from the French national health system database (SNDS). All those diagnosed with cancer in 2013 who died between 2013 and 2015 were included. Access to inpatient palliative care was the main outcome. Results: Of the 313,059 patients diagnosed with cancer in 2013 in France, 72,315 (23%) died between 2013 and 2015. Overall, 57% had access to inpatient palliative care. The following groups were the most likely to have access to palliative care: women (adjusted odds ratio, aOR: 1.15; 95% CI: 1.11-1.20), people aged 18-49 (aOR: 1.38; 95% CI: 1.26-1.51), individuals with metastatic cancer (aOR: 2.04; 95% CI: 1.96-2.13), and patients with cancer of the nervous system (aOR: 1.80; 95% CI: 1.62-2.01). The median time between palliative care and death was 29 (interquartile range: 13-67) days. Conclusion: More than half of cancer patients who died within 2 years after diagnosis had access to inpatient palliative care. Access to palliative care occurs late in the disease trajectory, often during the final month of life. Further research and guidelines are warranted to optimize access to early, standardized palliative care.
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Affiliation(s)
- Asmaa Janah
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
| | - Lynn R Gauthier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval - Centre Hospitalier Universitaire de Québec-Université Laval Research Centre, Oncology Division and Équipe de recherche Michel-Sarrazin en oncologie psychosociale et soins palliatifs, Université Laval Cancer Research Centre, Québec, Canada
| | - Lucas Morin
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Philippe Jean Bousquet
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
- Survey, Monitoring and Assessment Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute - INCa), Boulogne Billancourt, France
| | - Christine Le Bihan
- Survey, Monitoring and Assessment Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute - INCa), Boulogne Billancourt, France
| | - Philippe Tuppin
- Département des études sur les pathologies et les patients (DEPP), Caisse Nationale d’Assurance Maladie, Paris, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, and ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
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27
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Alleaume C, Bousquet PJ, Bouhnik AD, Peretti-Watel P, Bendiane MK. [Return to work after a cancer diagnosis]. Rev Prat 2019; 69:449-453. [PMID: 31626505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Given the chronicity of cancer, its related treatments and sequalae, more attention has been paid to questioning the living conditions of cancer survivors. In the early 2000s, research have highlighted the occupational difficulties faced by cancer survivors in the first two years after diagnosis. In the line of these, this article aims to provide clinicians with information on the situation within the five years following cancer diagnosis, based on results of the VICAN5 survey. We explored three main themes: the differences between salaried and self-employed workers, the main sequelae related to the disease or the treatments, having an impact on the working lives of people concerned, and finally, the workstation layouts and their effect on job retention. The main objective is to make clinicians, who may be involved in supporting professionally active patients, aware of the difficulties that these later may encounter. Clinicians need to keep in mind the specific constraint faced by self-employed individuals since they are more likely to reduce their sick leave for financial reasons or for the functioning of their company. They also need to pay more attention to the patient-reported sequalae in order to ensure an adequate care, especially for fatigue and chronic neuropathic pain that can strongly affect his/her professional life. Finally, the clinician who is aware of the effectiveness of workstation layouts will be able to inform and to support his/her patient more precisely.
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Affiliation(s)
- Caroline Alleaume
- Aix-Marseille Université, Inserm, IRD, Sciences économiques et sociales de la santé et traitement de l'information médicale -SESSTIM-, Marseille, France
| | - Philippe-Jean Bousquet
- Aix-Marseille Université, Inserm, IRD, Sciences économiques et sociales de la santé et traitement de l'information médicale -SESSTIM-, Marseille, France. - Département observation, veille, évaluation, Pôle santé publique et soins, Institut national du cancer, Boulogne- Billancourt, France
| | - Anne-Déborah Bouhnik
- Aix-Marseille Université, Inserm, IRD, Sciences économiques et sociales de la santé et traitement de l'information médicale -SESSTIM-, Marseille, France. - Département observation, veille, évaluation, Pôle santé publique et soins, Institut national du cancer, Boulogne- Billancourt, France
| | - Patrick Peretti-Watel
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHUMéditerranée Infection, Observatoire régional de la santé Provence-Alpes-Côte d'Azur -ORS PACA-, Marseille, France
| | - Marc-Karim Bendiane
- Aix-Marseille Université, Inserm, IRD, Sciences économiques et sociales de la santé et traitement de l'information médicale -SESSTIM-, Marseille, France
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28
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Almont T, Bouhnik AD, Ben Charif A, Bendiane MK, Couteau C, Manceau C, Mancini J, Huyghe É. Sexual Health Problems and Discussion in Colorectal Cancer Patients Two Years After Diagnosis: A National Cross-Sectional Study. J Sex Med 2019; 16:96-110. [DOI: 10.1016/j.jsxm.2018.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/07/2018] [Accepted: 11/11/2018] [Indexed: 11/30/2022]
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Girodet M, Bouhnik AD, Mancini J, Peretti-Watel P, Bendiane MK, Ray-Coquard I, Preau M. Sexual desire of French representative prostate cancer survivors 2 years after diagnosis (the VICAN survey). Support Care Cancer 2018; 27:2517-2524. [PMID: 30411238 DOI: 10.1007/s00520-018-4536-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The prostate cancer impacts on the future life of survivors. The complexity of sexual health problems in prostate cancer survivors is underestimated or often reduced to the erectile dysfunction. Especially, factors influencing sexual desire of patients have to be more explored. This study aims to describe the therapeutic management of patients with prostate cancer and assess their sexual desire 2 years after diagnosis. METHODS This study is part of the National VICAN survey (Vie après le CANcer) implemented in France in 2012. This analysis was performed on a population of 414 men who had prostate cancer. The questionnaire dealt with several topics including socioeconomic status, treatments received, and sexual desire. RESULTS Prostatectomy (42.8%), radiotherapy + hormonotherapy (17.6%), and radiotherapy alone (12.8%) were the main treatments used. 41.3% of men stated that their sexual desire was all gone since disease. The "satisfying" perceived financial situation was significantly associated to a sexual desire loss (p = 0.008). Radiotherapy + hormonotherapy treatment only is significantly associated with a loss of sexual desire (P = 0.003). CONCLUSIONS Two years after diagnosis, the sexual desire of prostate cancer survivors is deteriorated with the cancer experience. However, clinical characteristics do not seem to be decisive unlike a "satisfying" financial situation. Research about the impact of socio economics characteristics on sexual health should probably be engaged. Programs have to be developed in France to have personalized sexual support progressed for survivors and take spouses into consideration in this context.
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Affiliation(s)
- Magali Girodet
- HESPER EA 7425, University of Lyon, 8 avenue Rockefeller, 69373 Cedex 8, Lyon, France. .,EMS department, Cancer Centre Leon Berard, 28 rue Laennec, 69373 Cedex 8, Lyon, France.
| | - Anne-Déborah Bouhnik
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, 27 boulevard Jean Moulin, 13385, Marseille Cedex 5, France
| | - Julien Mancini
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, 27 boulevard Jean Moulin, 13385, Marseille Cedex 5, France.,BiosTIC, AP-HM, La Timone Hospital, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, France
| | - Patrick Peretti-Watel
- ORS PACA, Southeastern Health Regional Observatory, 27 boulevard Jean Moulin, 13385 Cedex 5, Marseille, France.,Aix Marseille University, IRD, AP-HM, SSA, IHU-Méditerranée Infection, VITROME: Tropical and Mediterranean Vectors - Infections, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, 27 boulevard Jean Moulin, 13385, Marseille Cedex 5, France
| | - Isabelle Ray-Coquard
- HESPER EA 7425, University of Lyon, 8 avenue Rockefeller, 69373 Cedex 8, Lyon, France.,EMS department, Cancer Centre Leon Berard, 28 rue Laennec, 69373 Cedex 8, Lyon, France
| | - Marie Preau
- GREPS, Psychology Institute, Lyon 2 University, 5 avenue P. Mendès-France, 69676, Bron, France
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Janah A, Rey D, Bouhnik AD, Mancini J, Sarradon-Eck A, Verger P, Peretti-Watel P, Bendiane MK. Opioid Analgesics Prescription to End-of-Life Cancer Patients: Characteristics, Attitudes, and Practices of French General Practitioners. J Palliat Med 2018; 21:1741-1748. [PMID: 30183469 DOI: 10.1089/jpm.2018.0222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Pain management, especially at the end of life, varies depending on the prescriber's characteristics and attitudes. Little is known about the practices of general practitioners (GPs) regarding end-of-life management for patients with cancer. Objectives: To provide an overview of the characteristics associated with GPs' attitudes and practices regarding opioids prescribing and to explore GPs' perceived role and difficulties in managing end-of-life care for patients with cancer. Design: A cross-sectional study (December 2015 to March 2016). Subjects and Analyses: Data were collected from a representative sample of 376 GPs in southeastern France recruited to participate in a survey on medical practices and opinions regarding cancer patient management. Descriptive analyses and multivariate logistic regressions were conducted to study the characteristics, attitudes, and practices associated with GPs' opioids prescribing attitudes. Results: Almost 97% of GPs stated that they prescribe opioids to end-of-life cancer patients. Among these, 77% said that they prescribe opioids on their own initiative, while 23% declared doing so in coordination with a specialist team. Female GPs, GPs working in solo practices, and GPs reporting more difficulties in managing end-of-life cancer patients were significantly less likely to prescribe opioids on their own initiative. Conclusion: Our results suggest that GPs' characteristics and practices influence the prescribing attitudes at the end of life. Given the dearth of studies on this topic, further research is recommended to better understand the impact of GPs' characteristics on their prescriptive attitudes. The possible interactions between patients' and physicians' characteristics-in particular gender-should also be investigated.
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Affiliation(s)
- Asmaa Janah
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
| | - Dominique Rey
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France.,BiosTIC, La Timone Hospital, APHM, Marseille, France
| | - Aline Sarradon-Eck
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France.,Inst Paoli Calmettes, SESSTIM, Marseille, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Patrick Peretti-Watel
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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Janah A, Bouhnik AD, Cortaredona S, Mancini J, Bousquet PJ, Peretti-Watel P, Bendiane MK. Opioid analgesics prescription in people with and without cancer in France. J Opioid Manag 2018; 14:245-256. [PMID: 30234921 DOI: 10.5055/jom.2018.0456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES According to World Health Organization recommendations, opioids prescription is a key aspect of improvement in cancer pain relief. However, studies on opioids prescription in France are scarce. This study aimed principally to investigate the impact of cancer on opioids prescription and then to identify factors associated with this prescription, focusing on patients& characteristics impact. METHODS We matched the following two cohorts: cancer survivors (N = 6,760) and individuals without cancer (N = 6,760). Using French health insurance databases, we compared the prevalence of prescribed opioids in 2009-2015 in people with and without cancer and we applied afterwards conditional Poisson regressions to estimate relative risks for monthly opioids prescription. For cancer survivors only (N = 3,055), multivariate negative binomial regressions were performed to identify factors associated with opioids prescription. RESULTS Cancer was associated with a higher analgesics prescription in the cancer population. While Step II and III opioids prescription decreased over time, the latter remained marginal and tended to stabilize. Older people were most adversely affected by underprescription of opioids, especially Step III opioids. Furthermore, although the matched case/control study suggested that men were prescribed opioids more often than women, multivariate analysis did not support this finding. CONCLUSION The inconsistency between our findings and existing literature regarding both opioids prescription trends and postdiagnosis pain chronicity in cancer survivors over the medium term suggests possible changes in pain perception and the evolution of cancer pain management strategies. Further research should explore these hypotheses and investigate patient characteristics& effect in cancer pain management.
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Affiliation(s)
- Asmaa Janah
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
| | - Anne-Déborah Bouhnik
- Research Engineer and Biostatistician, Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
| | - Sébastien Cortaredona
- Research Engineer and Biostatistician, Aix Marseille Univ, INSERM, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, and ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France; BiosTIC, La Timone Hospital, APHM, Marseille, France
| | - Philippe Jean Bousquet
- Data Monitoring, Survey and Assessment Department, French National Cancer Institute (INCa), Boulogne Billancourt, France
| | - Patrick Peretti-Watel
- Researcher and Sociologist, Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, and ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Marc-Karim Bendiane
- Researcher and Sociologist, Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France; ORS PACA, South-Eastern Health Regional Observatory, Marseille, France
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Nordmann S, Vilotitch A, Lions C, Michel L, Mora M, Spire B, Maradan G, Bendiane MK, Morel A, Roux P, Carrieri P. Pain in methadone patients: Time to address undertreatment and suicide risk (ANRS-Methaville trial). PLoS One 2017; 12:e0176288. [PMID: 28520735 PMCID: PMC5435132 DOI: 10.1371/journal.pone.0176288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 04/07/2017] [Indexed: 12/21/2022] Open
Abstract
Background Pain in opioid-dependent patients is common but data measuring the course of pain (and its correlates) using validated scales in patients initiating methadone treatment are sparse. We aimed to assess pain and its interference in daily life, associated correlates, and undertreatment before and during methadone treatment. Methods This is a secondary analysis using longitudinal data of a randomized trial comparing two methadone initiation models. We assessed the effect of methadone initiation and other correlates on pain intensity and interference (using the Brief Pain Inventory) at months 0, 6 and 12 using a mixed multinomial logistic regression model. Results The study group comprised 168 patients who had data for either pain intensity or interference for at least one visit. Moderate to severe pain was reported in 12.9% of patients at M0, 5.4% at M6 and 7.3% at M12. Substantial interference with daily functioning was reported in 36.0% at M0, 14.5% at M6 and 17.1% at M12. Of the 98 visits where patients reported moderate to severe pain or substantial interference, 55.1% reported no treatment for pain relief, non-opioid analgesics were reported by 34.7%, opioid analgesics by 3.1% and both opioid and non-opioid analgesics by 7.1%. Methadone was associated with decreased pain intensity at 6 months (OR = 0.29, p = 0.04) and 12 months (OR = 0.30, p = 0.05) of follow-up and tended to be associated with substantial pain interference. Suicide risk was associated with both pain intensity and pain interference. Conclusions Methadone in opioid-dependent patients can reduce pain. However, undertreatment of pain in methadone patients remains a major clinical concern. Patients with pain are at higher risk of suicide. Adequate screening and management of pain in this population is a priority and needs to be integrated into routine comprehensive care.
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Affiliation(s)
- Sandra Nordmann
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Antoine Vilotitch
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Caroline Lions
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Laurent Michel
- INSERM, UMR-S 669, Paris, France
- Université Paris-Sud and Université Paris Descartes, UMR-S 669, Paris, France
- Centre Pierre Nicole, Paris, France
| | - Marion Mora
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Bruno Spire
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Gwenaelle Maradan
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Perrine Roux
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Patrizia Carrieri
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
- * E-mail:
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Sarradon-Eck A, Bouhnik AD, Rey D, Bendiane MK, Huiart L, Peretti-Watel P. Use of non-conventional medicine two years after cancer diagnosis in France: evidence from the VICAN survey. J Cancer Surviv 2017; 11:421-430. [PMID: 28150122 DOI: 10.1007/s11764-017-0599-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to assess the use of non-conventional medicine (NCM) in a representative sample of French patients 2 years after cancer diagnosis. METHODS The study was based on data obtained in the VICAN survey (2012) on a representative sample of 4349 patients 2 years after cancer diagnosis. Self-reported data were collected at telephone interviews with patients. The questionnaire addressed the various types of non-conventional treatments used at the time of the survey. RESULTS Among the participants, 16.4% reported that they used NCM, and 45.3% of this group had not used NCM before cancer diagnosis (new NCM users). Commonly, NCMs used were homeopathy (64.0%), acupuncture (22.1%), osteopathy (15.1%), herbal medicine (8.1%), diets (7.3%) and energy therapies (5.8%). NCM use was found to be significantly associated with younger age, female gender and a higher education level. Previous NCM use was significantly associated with having a managerial occupation and an expected 5-year survival rate ≥80% at diagnosis; recent NCM use was associated with cancer progression since diagnosis, impaired quality of life and higher pain reports. CONCLUSION This is the first study on NCM use 2 years after cancer diagnosis in France. In nearly half of the NCM users, cancer diagnosis was one of the main factors which incited patients to use NCM. Apart from the NCM users' socioeconomic profile, the present results show that impaired health was a decisive factor: opting for unconventional approaches was therefore a pragmatic response to needs which conventional medicine fails to meet during the course of the disease. IMPLICATIONS FOR CANCER SURVIVORS Better information of patients and caregivers is needed to allow access to these therapies to a larger population of survivors.
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Affiliation(s)
- Aline Sarradon-Eck
- Aix Marseille Univ, INSERM, IRD, SESSTIM, "Economics & Social Sciences Applied to Health & Analysis of Medical Information", Marseille, France. .,Inst Paoli Calmettes, SESSTIM, Marseille, France.
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, SESSTIM, "Economics & Social Sciences Applied to Health & Analysis of Medical Information", Marseille, France
| | - Dominique Rey
- Aix Marseille Univ, INSERM, IRD, SESSTIM, "Economics & Social Sciences Applied to Health & Analysis of Medical Information", Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, SESSTIM, "Economics & Social Sciences Applied to Health & Analysis of Medical Information", Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Laetitia Huiart
- Aix Marseille Univ, INSERM, IRD, SESSTIM, "Economics & Social Sciences Applied to Health & Analysis of Medical Information", Marseille, France.,CHU de la Réunion, Unité de Soutien Méthodologique, Saint Denis, France.,CHU de la Réunion, INSERM, CIC 1410, Saint-Pierre, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, INSERM, IRD, SESSTIM, "Economics & Social Sciences Applied to Health & Analysis of Medical Information", Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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Meresse M, Bouhnik AD, Bendiane MK, Retornaz F, Rousseau F, Rey D, Giorgi R. Chemotherapy in Old Women with Breast Cancer: Is Age Still a Predictor for Under Treatment? Breast J 2016; 23:256-266. [DOI: 10.1111/tbj.12726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mégane Meresse
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Anne-Déborah Bouhnik
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
| | - Marc-Karim Bendiane
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Frédérique Retornaz
- Departemental Geriatric Center; Polyvalent Geriatric Center; Marseille France
- Unit of Care and Research in Internal Medicine; Hôpital Européeen; Marseille France
| | - Frédérique Rousseau
- Pilot Unit of Research and Coordination in Geriatric Oncology; Department of Medicine; Institut Paoli-Calmettes; Marseille France
| | - Dominique Rey
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Roch Giorgi
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- Biostatistics & Information and Communication Technology Unit; APHM Timone hospital; Marseille France
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Verger P, Cortaredona S, Tournier M, Rey D, Bendiane MK, Peretti-Watel P, Verdoux H. Psychotropic drug dispensing in people with and without cancer in France. J Cancer Surviv 2016; 11:92-101. [DOI: 10.1007/s11764-016-0569-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/09/2016] [Indexed: 12/11/2022]
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Ben Charif A, Bouhnik AD, Courbière B, Rey D, Préau M, Bendiane MK, Peretti-Watel P, Mancini J. Sexual health problems in French cancer survivors 2 years after diagnosis—the national VICAN survey. J Cancer Surviv 2015; 10:600-9. [DOI: 10.1007/s11764-015-0506-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/06/2015] [Indexed: 01/23/2023]
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Bouhnik AD, Bendiane MK, Cortaredona S, Sagaon Teyssier L, Rey D, Berenger C, Seror V, Peretti-Watel P. The labour market, psychosocial outcomes and health conditions in cancer survivors: protocol for a nationwide longitudinal survey 2 and 5 years after cancer diagnosis (the VICAN survey). BMJ Open 2015; 5:e005971. [PMID: 25805526 PMCID: PMC4386221 DOI: 10.1136/bmjopen-2014-005971] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Today, a growing need exists for greater research into cancer survivorship, focusing on different spheres of the day-to-day life of diagnosed patients. This article describes the design and implementation of VICAN (VIe après le CANcer), a national survey on French cancer survivors. METHOD AND ANALYSIS The target population included patients aged 18-82, diagnosed with cancer between January and June 2010, and registered in one of the three main French Health Insurance Schemes. It was restricted to 12 tumour sites. Sampling was stratified using a non-proportional allocation, based on age at diagnosis (18-52 and 53-82) and tumour site. Data were collected from telephone interviews with patients 2 and 5 years after diagnosis, a medical survey completed by the physician who initiated cancer treatment, and information from the national medicoadministrative database on reimbursement data and hospital discharge records. First data collection, 2 years after diagnosis, occurred between March and December 2012. Second data collection, 5 years after diagnosis, will be conducted in 2015. Analyses will be conducted on various outcomes: quality of life, health status and psychosocial conditions, with a particular focus on the impact of cancer diagnosis on the labour market. The variety of measurements included in the survey will enable us to control a wide range of factors. ETHICS AND DISSEMINATION The methodology of the VICAN survey was approved by three national ethics commissions. Results of the study will be disseminated through national and international research conferences, and in articles published in international peer-reviewed journals.
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Affiliation(s)
- Anne-Deborah Bouhnik
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
| | - Marc-Karim Bendiane
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Sebastien Cortaredona
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Luis Sagaon Teyssier
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Dominique Rey
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Cyril Berenger
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Valerie Seror
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
| | - Patrick Peretti-Watel
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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Rey D, Bouhnik AD, Mancini J, Bendiane MK, Séror V, Viens P. Self-reported cognitive impairment after breast cancer treatment in young women from the ELIPPSE40 cohort: the long-term impact of chemotherapy. Breast J 2012; 18:406-14. [PMID: 22827555 DOI: 10.1111/j.1524-4741.2012.01275.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cognitive impairment (CI) is common after cancer treatments, but little is known about the long-term evolution of CI, especially in premenopausal women. Since September 2005, all consecutive women included in the French National Health Insurance Fund registry with a diagnosis of primary breast cancer, aged 18-40 years and living in South Eastern France, were asked to participate in a cohort study, including telephone interviews, medical data, and prescription refills of psychotropic drugs and adjuvant endocrine therapy. At each interview, CI is defined as self-report of frequent memory loss and attention deficits. As of February 2010, 222 women with available medical data had taken part in the 10-, 16-, and 28-month telephone interviews, with CI being reported by 37.4%, 36.5%, and 42.3% of participants, respectively. Tranquilizers' dispensation was associated with CI self-report at all three interviews; chemotherapy was reported only at the 28-month interview. At 28 months, besides chemotherapy and tranquilizer's dispensation, having a low educational level and not being a native French woman were also independently associated with CI. Reports of CI were common in young women and primarily related to psycho-social vulnerabilities and cancer treatment. As they affect quality of life, long-term CI complaints deserve greater consideration.
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Affiliation(s)
- Dominique Rey
- INSERM, U912 "Economic & Social Sciences, Health Systems & Societies" (SE4S), Marseille, France
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Peretti-Watel P, Bendiane MK, Galinier A, Lapiana JM, Favre R, Pegliasco H, Obadia Y. Opinions toward pain management and palliative care: Comparison between HIV specialists and oncologists. AIDS Care 2010; 16:619-27. [PMID: 15223531 DOI: 10.1080/09540120410001716414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the introduction of HAART, pain is still a common symptom in people living with HIV/AIDS. For these persons, pain management supplied by palliative care teams may support standard HIV care. This study compares opinions toward palliative care of 83 HIV specialists and 217 oncologists (French national survey: Palliative Care 2002). Data were collected by phone questionnaire. A cluster analysis was carried out in order to identify contrasted profiles of opinions toward palliative care. A logistic regression was performed to test the relationships between identified clusters and physicians' characteristics. With a two-cluster partition, we observed a profile corresponding to a restrictive conception of palliative care. Within this profile, physicians were more prone to consider that palliative care should be used only for terminally-ill patients, and only after all curative treatments have failed, with a restrained prescriptive power for physicians providing palliative care. This conception was associated with reluctance toward morphine analgesia. Once controlled for other physicians' characteristics, HIV specialists were more likely than oncologists to endorse this restrictive conception (OR=1.9, CI 95% [1.1; 3.3]). Thus French HIV specialists should be more informed about the utility of providing palliative care, even for patients who are not in terminal stage.
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Affiliation(s)
- P Peretti-Watel
- Regional Centre for Disease Control of South-Eastern France, and Health and Medical Research National Institute, Research Unit 379, Social Sciences Applied to Medical Innovation, Institut Paoli Calmettes, Marseilles, France.
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Bendiane MK, Bouhnik AD, Galinier A, Favre R, Obadia Y, Peretti-Watel P. French hospital nurses' opinion about euthanasia and physician-assisted suicide: a national phone survey. J Med Ethics 2009; 35:238-244. [PMID: 19332581 DOI: 10.1136/jme.2008.025296] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Hospital nurses are frequently the first care givers to receive a patient's request for euthanasia or physician-assisted suicide (PAS). In France, there is no consensus over which medical practices should be considered euthanasia, and this lack of consensus blurred the debate about euthanasia and PAS legalisation. This study aimed to investigate French hospital nurses' opinions towards both legalisations, including personal conceptions of euthanasia and working conditions and organisation. METHODS A phone survey conducted among a random national sample of 1502 French hospital nurses. We studied factors associated with opinions towards euthanasia and PAS, including contextual factors related to hospital units with random-effects logistic models. RESULTS Overall, 48% of nurses supported legalisation of euthanasia and 29%, of PAS. Religiosity, training in pallative care/pain management and feeling competent in end-of-life care were negatively correlated with support for legalisation of both euthanasia and PAS, while nurses working at night were more prone to support legalisation of both. The support for legalisation of euthanasia and PAS was also weaker in pain treatment/palliative care and intensive care units, and it was stronger in units not benefiting from interventions of charity/religious workers and in units with more nurses. CONCLUSIONS Many French hospital nurses uphold the legalisation of euthanasia and PAS, but these nurses may be the least likely to perform what proponents of legalisation call "good" euthanasia. Improving professional knowledge of palliative care could improve the management of end-of-life situations and help to clarify the debate over euthanasia.
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Affiliation(s)
- M K Bendiane
- INSERM U, Université Aix Marseille, IRD, UMR, ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, France
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Peretti-Watel P, Bendiane MK, Galinier A, Favre R, Ribiere C, Lapiana JM, Obadia Y. District nurses' attitudes toward patient consent: the case of mechanical ventilation on amyotrophic lateral sclerosis patients: results from a French national survey. J Crit Care 2008; 23:332-8. [PMID: 18725037 DOI: 10.1016/j.jcrc.2007.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 10/12/2007] [Accepted: 11/01/2007] [Indexed: 11/27/2022]
Abstract
PURPOSE In France, a recent law emphasizes patient rights and prohibits unwanted therapies in end-of-life care. As end-of-life home care is increasing, we aimed to assess French district nurses' attitudes toward terminally ill patients' autonomy. MATERIALS AND METHODS We used data from a nationwide telephone survey conducted in 2005 among a random sample of French district nurses (n = 602). Nurses' attitudes were assessed with a clinical case describing a patient (randomly defined as a male or a female aged 50 years) having amyotrophic lateral sclerosis (ALS) who urgently needs mechanical ventilation. Nurses were asked whether patient consent was necessary before performing intubation/tracheotomy, and the analysis took into account various covariates, including nurses' religiosity, nurses' attitudes toward living wills, and patient sex. RESULTS Overall, 44% of nurses considered that an ALS patient with respiratory failure should always be intubated (53% for a female patient, 40% for a male patient, P < .01), and after intubation, 27% upheld tracheotomy without considering patient consent as a necessary prerequisite (39% among male nurses, 30% among female nurses, P < .05). Poor communication with terminal patients and hostility toward living will were also predictive of willingness to perform both mechanical ventilation and tracheotomy without patient consent. CONCLUSIONS A significant part of French district nurses may have a disturbing propensity to support intubation and tracheotomy with insufficient attention paid to the patient's will. Further research should investigate potential causal factors (such as increased workload) as well as sex-related attitudes in nurse-patient relationship.
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Affiliation(s)
- Patrick Peretti-Watel
- INSERM, UMR379, Institut Paoli-Calmettes, Epidemiology and Social Sciences Unit, F-13000 Marseille, France
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Bendiane MK, Galinier A, Obadia Y, Favre R, Ribiere C, Moatti JP, Peretti-Watel P. Connaissances et attitudes des infirmiers libéraux face à la douleur en fin de vie. Presse Med 2007; 36:1196-202. [PMID: 17363210 DOI: 10.1016/j.lpm.2007.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 10/26/2006] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nurses play a crucial role in end-of-life care, especially for outpatients. It is important to assess their knowledge and attitudes regarding pain management during the end-of-life period. METHODS A random national sample of 602 French nurses providing home care responded to a telephone survey. The questionnaire included a scale of knowledge about pain and a short clinical case related to severe pain management, requiring WHO level 3 analgesia, for a dying patient. RESULTS The pain knowledge score depended on nurses' training and was higher for those living with another health professional. For the clinical case, only 60% of nurses favored the prescription of the analgesia recommended by international guidelines. This support depended on objective skills in pain management, but was less frequent for elderly or women patients. DISCUSSION Attitudes toward pain management at the end of life do not depend only on book learning. They are also influenced by more subjective factors that may cause inequality in care for women and the elderly. Nurse training programs should take such factors into account.
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Affiliation(s)
- Marc-Karim Bendiane
- Observatoire régional de la santé Provence Alpes Côte d'Azur (ORS Paca), Marseille.
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Peretti-Watel P, Bendiane MK, Moatti JP. Attitudes toward palliative care, conceptions of euthanasia and opinions about its legalization among French physicians. Soc Sci Med 2005; 60:1781-93. [PMID: 15686809 DOI: 10.1016/j.socscimed.2004.08.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We assume that actors of the professionalization process of palliative care make a special effort to demarcate it from euthanasia, and that such an effort has a significant impact on beliefs and attitudes toward euthanasia among the whole medical profession. We investigated concurrently attitudes toward palliative care, conceptions of euthanasia and opinion toward its legalization among a sample of 883 French general practitioners, oncologists and neurologists. We found four contrasted profiles of attitudes toward palliative care, which were closely correlated with being in touch with palliative care providers. Attitudes toward palliative care were closely correlated with beliefs about which medical practices should be labelled euthanasia, and these beliefs were in turn strongly associated with opinions toward euthanasia legalization. Our results suggest that the relationship between palliative care and euthanasia mixes semantic and strategic aspects, beyond cognitive and conative ones.
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Affiliation(s)
- P Peretti-Watel
- Regional Center for Disease Control of South-Eastern France, Marseille, France.
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Peretti-Watel P, Bendiane MK, Obadia Y, Lapiana JM, Galinier A, Pegliasco H, Favre R, Moatti JP. Disclosure of Prognosis to Terminally Ill Patients: Attitudes and Practices Among French Physicians. J Palliat Med 2005; 8:280-90. [PMID: 15890039 DOI: 10.1089/jpm.2005.8.280] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Disclosure of the prognosis to terminally ill patients is a strong prerequisite for integrating the physical, psychological, spiritual, and social aspects of end-of-life care. OBJECTIVE This study aimed to assess French physicians' general attitudes and effective practices (with patients followed up to death recently) toward such disclosure. DESIGN/SUBJECTS We used data from a cross-sectional survey conducted among a national sample of 917 French general practitioners, oncologists, and neurologists. RESULTS A majority of respondents opted for prognosis disclosure only at patients' request, very few opted for systematic disclosure without patient's request, and a significant minority opted for systematic concealment. Concerning deceased patients described by respondents, 44.5% of competent patients were informed of prognosis by their physician, 27.3% were informed by someone else, 9.0% refused to be informed, and 19.2% were simply not informed. Concealment was more frequent for older patients, and physicians involved in a nongovernmental organization (NGO) for patients' support were more likely to disclose the prognosis, even without patient's request. CONCLUSIONS Disclosure of the prognosis to terminally ill patients is still far from systematic in France. Further research is needed to better understand the motivations of French physicians' disclosure practices, which are probably culturally shaped.
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Affiliation(s)
- P Peretti-Watel
- Regional Center for Disease Control of South-Eastern France, 23 rue Stanislas Torrents, 13006 Marseille, France.
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Peretti-Watel P, Bendiane MK, Obadia Y, Favre R, Lapiana JM, Moatti JP. The prescription of opioid analgesics to terminal cancer patients: impact of physicians' general attitudes and contextual factors. Palliat Support Care 2003; 1:345-52. [PMID: 16594224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE This study aimed to examine factors associated with the prescription of opioid analgesics to terminal cancer patients, including physicians' general attitudes toward morphine and contextual factors. METHODS A survey was conducted among a sample of French general practitioners (GPs) and oncologists. Respondents were asked to describe the last three terminally ill patients they had followed up to death. RESULTS Overall, 526 GPs and oncologists (global response rate: 57%) described 1,082 cancer patients, among whom 85.4% received opioid analgesics. Among other significant predictors (patient age, cancer type, family assistance), this prescription was less frequent for female patients followed by male physicians (OR = 0.53), and more frequent for patients followed by physicians trained in palliative care (OR = 2.70). On the other hand, physicians' attitudes toward morphine were not associated with prescription of morphine and other opioid analgesics. SIGNIFICANCE OF RESULTS Although nonprescription of opioid analgesics is only a crude proxy measure for undertreatment of cancer pain, our findings suggest the need to develop training in palliative care in order to standardize practices among GPs and specialists. Our results also highlight the necessity to study pain assessment as an interaction between the physician and the patient, and to consider patients' and physicians' respective genders as a key variable within this interaction.
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Affiliation(s)
- P Peretti-Watel
- Regional Centre for Disease Control of South-Eastern France, Marseilles.
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Peretti-Watel P, Bendiane MK, Pegliasco H, Lapiana JM, Favre R, Galinier A, Moatti JP. Doctors' opinions on euthanasia, end of life care, and doctor-patient communication: telephone survey in France. BMJ 2003; 327:595-6. [PMID: 12969926 PMCID: PMC194087 DOI: 10.1136/bmj.327.7415.595] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P Peretti-Watel
- Regional Center for Disease Control of South-Eastern France, 13006 Marseille, France.
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Rey D, Bendiane MK, Moatti JP, Wellings K, Danziger R, MacDowall W. Post-exposure prophylaxis after occupational and non-occupational exposures to HIV: an overview of the policies implemented in 27 European countries. AIDS Care 2000; 12:695-701. [PMID: 11177447 DOI: 10.1080/09540120020014228] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this survey, which was part of an English-French project supported by the Commission of the European Communities, was to compare access to HIV post-exposure prophylaxis (PEP) in the occupational and non-occupational contexts in 27 European countries. A protocol was designed in May 1998 in collaboration with all country consultants. Data were collected at country level by each consultant through interviews, review of local and national recommendations and results of national or local surveys. The final comparative analysis was carried out from the individual country reports and a review of the literature. The large majority of European countries have detailed procedures regarding occupational PEP: 20/27 have produced national guidelines, three have adopted the US CDC recommendations and only four have no official recommendations. Although no standard protocol exists, the more common one is a four-week implementation of a triple combination therapy. In the context of non-occupational exposure to HIV, only five countries have guidelines with specific recommendations and one country has adopted the CDC recommendations. In the majority of cases (13 countries), PEP is never recommended but is only available in a few circumstances, sometimes with major limitations. In the last eight countries, such PEP is not currently available. Although the estimations of HIV transmission risks in occupational and non-occupational contexts are really comparables, easy access to PEP after accidental sexual or blood exposures is not guaranteed for the general population in the majority of European countries.
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Affiliation(s)
- D Rey
- Regional Center for Disease Control of South Eastern France, ORS PACA, Marseille, France.
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