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Objective: The aim of our study was to evaluate emotional distress among women with breast cancer treated by radiotherapy, using a Visual Analogue Scale (an adaptation of the "Distress Thermometer" French version) associated with a Needs Scale with several items, in order to identify patients requiring psychological care., Method: Our sample is composed of 277 women treated for breast cancer with radiotherapy. Our psychological evaluation is made of a first enquiry using a visual analogue distress scale and complemented by a Needs Scale with several items. A grade above 3 on the visual analogue distress scale is a reliable indicator; a grade above 4 out of 20 leads us to propose the patient a consultation with a psychologist., Results: Two hundred and sixty-four female patients with a mean age of 61 years are the object of the study. Among them, 59.2% of patients display a disarray of low intensity (psychological suffering graded between 0 and 2) whereas 40% show a grade equal or superior to 3, considered as pathological on a psychological side: 30% of the patients have a grade between 3 et 5 and less than 2% of the patients display a grade reaching 9 or 10. Concerning the Needs Scale, more than 80% of the patients show a total score below 10 out of 20 and we observe a positive correlation between the total score of the Needs Scale with several items and the Visual Analogue Distress Scale score., Conclusion: Our results highlight the difficulty for most of the patients to cope with emotional distress linked to their disease. We discuss the necessity to increase awareness among caregivers on this psychological distress, through the use of simple tools such as a Visual Analogue Scale associated with a Needs Scale, so as to provide a holistic care for women with breast cancer., (Copyright © 2015 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

In France, there is an important interregional disparity concerning participation to cancer screening programs. The aim of this study was to assess oncologic screening practices in Loire, a French rural department, in women and in the elderly (over age 74 years). For this, two surveys were conducted. The first one was regarding screening for breast, cervical and colorectal cancer in women over age 18 years living in Loire. The second survey was regarding onco-geriatric screening through two questionnaires : one for the elderly and the other for general practitioner (GP) of the department, evaluating screening for breast, colorectal, prostate, cervical and lung cancer. One hundred sixty six women were included in the first investigation mean age of 47.6 years. Ninety three point six per cent were screening for breast cancer, 19% received Human Papilloma virus vaccine, 83.1% were screening by Papanicolau smear for cervical cancer and finally, 51.7% were screening for colorectal cancer, among the one entering screening program criteria. In the second survey, 44 patients and 28 GP were included. Thirty-eight point six per cent of patients over 74 years continue screening. Only 11.4% were reluctant to screening and in 80% because of anxiety du to the results. Among GP, 50 % continued screening on two major criteria : life expectancy and performans status. The present study shows heterogeneity of screening in this department both rural and working class and gives us a societo-medical photography.

The purpose of this study is to measure the impact of an educational program to raise awareness of the increased spending energy in two different population of patients with breast cancer by using the questionnaire POPAQ (Population Physical Activity Questionnaire). This is a prospective study including two groups of 15 consecutive breast cancer patients (≤ 50 years Group 1 and Group 2 > 50 and < 70 years) followed in the department of radiotherapy at the Institute of Cancer of the Loire from January to July 2011. A questionnaire of physical activity assessment was used at two different times before the diagnosis/treatment of breast cancer (t0) and at 6 months (t6) to measure the impact of the awareness method. Comparison of different measures of daily energy expenditure (t0) between groups 1 and 2 was statistically significant (1,1803 and 9434 kJ/24 h, respectively, p = 0.0005). Daily energy expenditure of professional activity was statistically different between the two groups (1437 and 457 kJ/24 h, in groups 1 and 2, respectively; p = 0.003). Between t0 and t6, we observed a significant decrease in total energy consumption in group 1 (1,1803 to 1,0876 kJ/24 h) while there was no significant change between the group 2, except energy expended at rest (basal metabolism). There were differences in daily energy expenditure based on age may influence behavioral patterns deal with energy expenditure in physical activities. Tomorrow's challenges are to provide re-entrainment programs tailored to targeted populations.

Place of axillary radiotherapy in the management of patients with breast cancer remains debated. While the prognostic value of axillary lymph node extension has been largely demonstrated, the benefit of axillary treatment is more uncertain. Large clinical trials having demonstrated the benefit of adjuvant radiotherapy in advanced breast cancer comprised large nodal irradiation, including axillary area. Analyzing the true benefit of axillary radiotherapy is rendered difficult by heterogeneity of series, particularly when focusing on the extent of lymph node dissection. Although adjuvant axillary radiotherapy is usually recommended in patients with insufficient lymph node dissection or with bulky axillary involvement, the prognosis in these patients remains poor by metastatic evolution and such strategy exposes to increased toxicity and functional sequels. Further assessments should better define the optimal indications and the true benefit of axillary radiotherapy.

Purpose: The aim of the present investigation was to evaluate the prognostic significance of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) tissue contents in primary breast adenocarcinoma., Patients and Methods: Patients from 3 medical centers were included between 1994 and 2001. Biologic factors in tumor extracts were all assayed in the same laboratory. PAI-1 and uPA were treated as continuous or dichotomized variables. Metastasis-free survival analyses were performed using the Cox model and the classification algorithm and regression tree (CART) in the whole population and in the subsets of node-negative (pN0) or positive (pN+) cases. Kaplan curves of metastasis-free survival were designed for different groups in relation to uPA/PAI-1 combinations. Urokinase-type plasminogen activator tumor level appears related to the anatomic degree of extension; conversely, PAI-1 tumor content is independent of tumor size and nodal extension., Results: In univariate analysis, adjusted on usual prognostic factors, the metastasis risk increased with PAI-1 level in all patients (HR [hazard ratio], 3.1; P < .001), in pN0 (HR, 4.3; P < .001), and pN+ patients (HR, 2.3; P = .019). It increased also with uPA in all patients (HR, 2.6; P = 0.006). In multivariate analysis, when both variables were included, PAI-1 remained significant in all patients (HR, 2.4; P = .002) and pN0 patients (HR, 3.2; P = .003) but not uPA. CART analyses confirmed that the best partitioning factor was PAI-1., Conclusion: There was no evidence for any additional impact of uPA. PAI-1 is an independent prognostic factor in particular in pN0 breast ductal carcinoma.

Purpose: A cancer network of general or private hospitals of a French region was started in 1995 for improving quality of care and rationalizing medical prescriptions. The impact of implementing a clinical practice guidelines (CPG) project assessed conformity with guidelines in medical practice; significant changes were observed within the network, whereas no changes were observed in a control region without cancer network. In the present study, we evaluated the persistence of conformity to guidelines through a new medical audit., Patients and Methods: In 1999, the hospitals of the previously compared experimental and control groups accepted to reassess the impact of CPG. A controlled transversal study was performed in the experimental group (cancer network) and in the control group (no regional cancer network). In 1996 (first audit) and in 1999 (present audit), all new patients with colon cancer (177 and 200 in experimental group and 118 and 100 in control group, respectively) and early breast cancer (444 and 381 in experimental group and 172 and 204 in control group, respectively) were selected., Results: In the experimental group, the compliance of medical decisions with CPG was significantly higher in 1999 than in 1996 for colon cancer (73%; 95% CI, 67% to 79% v 56%; 95% CI, 49% to 63%, respectively; P = .003) and similar for the two periods for breast cancer (36%; 95% CI, 31% to 41% v 40%; 95% CI, 35% to 44%, respectively; P = .24). In the control group, compliance was significantly higher in 1999 than in 1996 for colon cancer (67%; 95% CI, 58% to 76% v 38%; 95% CI, 29% to 47%, respectively; P < .001) and identical for the two periods for breast cancer (4%; 95% CI, 1% to 7% v 7%; 95% CI, 3% to 11%, respectively; P = .19)., Conclusion: The CPG program for cancer management produced persistent changes in medical practice in our cancer network in terms of conformity with CPG.