The MonarchE trial explored the use of abemaciclib, a CDK4/6 inhibitor, as an adjuvant treatment in high-risk early-stage luminal-like breast cancer. The study's inclusion criteria, especially the N2 ...status, may require revisiting surgical interventions, including invasive axillary lymph node dissection (ALND)-a procedure that current guidelines generally do not recommend.
We conducted a single-centre, retrospective, observational cohort study on non-metastatic breast cancer patients managed from 2002 to 2011, at the Institut Curie. Data collection involved clinical and histological characteristics plus treatment follow-up.
Out of 8715 treated patients, 721 met the inclusion criteria. Overall, 12% (87) were classified as N2 ( ≥ 4 positive lymph nodes), thus eligible for abemaciclib per "node criterion." Tumour size, positive sentinel lymph nodes, and lobular histology showed a significant correlation with N2 status. Approximately 1000 ALNDs would be required to identify 120 N2 cases and prevent four recurrences.
The MonarchE trial may significantly affect surgical practices due to the need for invasive procedures to identify high-risk patients for adjuvant abemaciclib treatment. The prospect of unnecessary morbidity demands less invasive N2 status determination methods. Surgical decisions must consider patient health and potential treatment benefits.
Purpose
To evaluate the dynamics of the determinants of returning to work (RTW) in a population of patients treated for breast cancer (BC) in a real-world setting.
Method
We conducted a retrospective ...study including 1278 BC patients working or looking for work at the time of diagnosis. We performed a focused principal component analysis to highlight the dimensions of a persistent decline in work capacity. Logistic regression analyses were performed to identify correlates of non-RTW 1 and 2 years after treatment.
Results
One-third (31%,
n
= 389) of patients continued working during treatment. At study inclusion, 1100 patients had returned to work (89%). Three-quarters (
n
= 508, 75%) of the women reported a decline in work capacity 1 year after RTW and 22% (
n
= 148) presented a persistent decline in work capacity 2 years after the diagnosis. The odds ratio for non-RTW at 1 year was significantly higher for patients treated with a combination of chemotherapy and trastuzumab (OR = 1.72, 95% CI 1.07–2.76), manual workers (OR = 3.99, 95% CI 1.54–10.81), patients with lower incomes (OR = 2.33, 95% CI 1.29–4.19), and patients experiencing fatigue (OR = 1.81, 95% CI 1.34–2.48). The odds ratio for non-RTW at 2 years was higher for various occupational categories (OR = 3.49, 95% CI 1.89–6.74 for clerks, OR = 4.58, 95% CI 1.48–12.82 for self-employed workers, OR = 8.98, 95% CI 2.69–27.89 for manual workers), patients with comorbidities (OR = 2.80, 95% CI 1.61–4.93), and patients experiencing anxiety symptoms (OR = 2.54, 95% CI 1.18–5.76), while the impact of the type of treatment was no longer significantly associated with RTW.
Conclusion
The determinants of RTW change over time. Patients should be offered supportive interventions tailored to risk factors and time from diagnosis.
Fetal megacystis has a poor prognosis. During the first trimester, it is frequently associated with chromosomal abnormalities or multiple malformations, but can also be isolated and resolve ...spontaneously. In this study, our main objective was to determine the fetal and pediatric prognosis in this particular situation.
This was a retrospective multicenter study. We describe the cases referred to our fetal medicine centers and also cases previously reported in the international literature.
Five cases were referred to our fetal medicine centers. After spontaneous resolution of megacystis, close ultrasound follow-up revealed urinary tract abnormalities in all cases. These abnormalities were all transient. After birth, 1 of the children developed a mild ureteropelvic junction obstruction. Pediatric follow-up was normal for the other children. Our 5 cases plus 79 in the literature mean that 84 cases of isolated first-trimester fetal megacystis with spontaneous resolution have been reported to date. The risk of chromosomal abnormality was 2.4% (2/84) and pediatric follow-up was normal in 96.4% of cases (81/84).
Even when isolated first-trimester fetal megacystis resolves spontaneously, fetal karyotype analysis and close prenatal ultrasound follow-up should be performed. When there is no chromosomal abnormality, the renal pediatric prognosis seems to be good.
Du travail éprouvant aux éprouvés du travail Girard, Noémie; Joud, Charlyne; Duret, Isabelle
Cahiers de psychologie clinique,
10/2018, Letnik:
n° 51, Številka:
2
Journal Article
Recenzirano
À partir de situations cliniques issues de nos travaux de recherche, nous avons interrogé la souffrance portée par la voix des psychologues exerçant en clinique traumatique. S’intéresser à ce qui se ...vit et s’éprouve dans la relation thérapeutique nous a amenées à proposer la métaphore de l’infusion. Nous avons établi un parallèle entre l’infusion de thé et le cadre thérapeutique, partant du constat que le psychologue en clinique traumatique peut être réceptacle d’infusions troublantes. La rencontre peut devenir source de vécus douloureux et émerge alors la nécessité de trouver une échappatoire, une voie d’issue à cette situation complexe pour le clinicien.
The treatment of breast cancer, the leading cause of cancer and cancer mortality among women worldwide, is mainly on the basis of surgery. In this study, we describe the use of a medical image ...visualization tool on the basis of virtual reality (VR), entitled DIVA, in the context of breast cancer tumor localization among surgeons. The aim of this study was to evaluate the speed and accuracy of surgeons using DIVA for medical image analysis of breast magnetic resonance image (MRI) scans relative to standard image slice-based visualization tools.
In our study, residents and practicing surgeons used two breast MRI reading modalities: the common slice-based radiology interface and the DIVA system in its VR mode. Metrics measured were compared in relation to postoperative anatomical-pathologic reports.
Eighteen breast surgeons from the Institut Curie performed all the analysis presented. The MRI analysis time was significantly lower with the DIVA system than with the slice-based visualization for residents, practitioners, and subsequently the entire group (
< .001). The accuracy of determination of which breast contained the lesion significantly increased with DIVA for residents (
= .003) and practitioners (
= .04). There was little difference between the DIVA and slice-based visualization for the determination of the number of lesions. The accuracy of quadrant determination was significantly improved by DIVA for practicing surgeons (
= .01) but not significantly for residents (
= .49).
This study indicates that the VR visualization of medical images systematically improves surgeons' analysis of preoperative breast MRI scans across several different metrics irrespective of surgeon seniority.
Breast cancer (BC) is the leading cause of cancer and cancer mortality among women worldwide. Surgery is the primary therapeutic strategy of BC in most of the cases. Efficient carcinologic and ...aesthetic resection requires breast surgeons to accurately understand medical images. Virtual reality (VR) is a promising avenue to improve surgical diagnosis and planning by producing high-precision images. Hereafter we report three cases of patients for which using AVATAR medical device for 3D visualization with VR would have helped to decide surgical strategy and adapt surgical procedure. The three cases are real-life examples of using the VR-AVATAR medical device for breast cancer surgery treatment: evaluation of the tumor response to neoadjuvant chemotherapy, decision for breast conservative or radical treatment, decision for loco-regional treatment in metastatic setting. Through these three real-life cases, we describe the potential impact of VR-AVATAR medical device use in clinical daily practice in breast cancer surgery. It seems like a useful tool, easy to use, providing high-quality images, helping with surgery planning and decisions.
Background: Gender-based disparities in health-care are common and can affect access to care. We aimed to investigate the impact of gender and socio-environmental indicators on health-care access in ...oncology in France. Methods: Using the national health insurance system database in France, we identified patients (aged ≥18 years) who were diagnosed with solid invasive cancers between the 1st of January 2018 and the 31st of December 2019. We ensured that only incident cases were identified by excluding patients with an existing cancer diagnosis in 2016 and 2017; skin cancers other than melanoma were also excluded. We extracted 71 socio-environmental variables related to patients' living environment and divided these into eight categories: inaccessibility to public transport, economic deprivation, unemployment, gender-related wage disparities, social isolation, educational barriers, familial hardship, and insecurity. We employed a mixed linear regression model to assess the influence of age, comorbidities, and all eight socio-environmental indices on health-care access, while evaluating the interaction with gender. Health-care access was measured using absolute and relative cancer care expertise indexes. Findings: In total, 594,372 patients were included: 290,658 (49%) women and 303,714 (51%) men. With the exception of unemployment, all socio-environmental indices, age, and comorbidities were inversely correlated with health-care access. However, notable interactions with gender were observed, with a stronger association between socio-environmental factors and health-care access in women than in men. In particular, inaccessibility to public transport (coefficient for absolute cancer care expertise index = −1.10 −1.22, −0.99, p < 0.0001), familial hardship (−0.64 −0.72, −0.55, p < 0.0001), social isolation (−0.38 −0.46, −0.30, p < 0.0001), insecurity (−0.29 −0.37, −0.21, p < 0.0001), and economic deprivation (−0.13 −0.19, −0.07, p < 0.0001) had a strong negative impact on health-care access in women. Interpretation: Access to cancer care is determined by a complex interplay of gender and various socio-environmental factors. While gender is a significant component, it operates within the context of multiple socio-environmental influences. Future work should focus on developing targeted interventions to address these multifaceted barriers and promote equitable health-care access for both genders. Funding: None.
Gender-based disparities in health-care are common and can affect access to care. We aimed to investigate the impact of gender and socio-environmental indicators on health-care access in oncology in ...France.
Using the national health insurance system database in France, we identified patients (aged ≥18 years) who were diagnosed with solid invasive cancers between the 1st of January 2018 and the 31st of December 2019. We ensured that only incident cases were identified by excluding patients with an existing cancer diagnosis in 2016 and 2017; skin cancers other than melanoma were also excluded. We extracted 71 socio-environmental variables related to patients' living environment and divided these into eight categories: inaccessibility to public transport, economic deprivation, unemployment, gender-related wage disparities, social isolation, educational barriers, familial hardship, and insecurity. We employed a mixed linear regression model to assess the influence of age, comorbidities, and all eight socio-environmental indices on health-care access, while evaluating the interaction with gender. Health-care access was measured using absolute and relative cancer care expertise indexes.
In total, 594,372 patients were included: 290,658 (49%) women and 303,714 (51%) men. With the exception of unemployment, all socio-environmental indices, age, and comorbidities were inversely correlated with health-care access. However, notable interactions with gender were observed, with a stronger association between socio-environmental factors and health-care access in women than in men. In particular, inaccessibility to public transport (coefficient for absolute cancer care expertise index = −1.10 −1.22, −0.99, p < 0.0001), familial hardship (−0.64 −0.72, −0.55, p < 0.0001), social isolation (−0.38 −0.46, −0.30, p < 0.0001), insecurity (−0.29 −0.37, −0.21, p < 0.0001), and economic deprivation (−0.13 −0.19, −0.07, p < 0.0001) had a strong negative impact on health-care access in women.
Access to cancer care is determined by a complex interplay of gender and various socio-environmental factors. While gender is a significant component, it operates within the context of multiple socio-environmental influences. Future work should focus on developing targeted interventions to address these multifaceted barriers and promote equitable health-care access for both genders.
None.
Cet article propose une réflexion sur l’identité professionnelle de personnes travaillant dans le domaine du soin psychique, au départ d’une recherche doctorale. Nous nous y interrogeons sur les ...effets identitaires d’un tel métier et sur ses risques éventuels. Certains cliniciens rencontrés présentent des éprouvés paradoxaux, se montrant optimistes et centrés sur les ressources dans leur vie professionnelle, mais méfiants et inquiets dans leur vie privée. Nous proposons que cette dynamique – nécessaire mais éprouvante – offre des bénéfices pour l’identité professionnelle du clinicien, conforté dans son sentiment de compétence et dans l’illusion de sa stabilité identitaire mais au prix d’un « déplacement de zone », souvent inconscient, vers la sphère privée.
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