ObjectiveTo compare the risk of malignancy between patients with rheumatoid arthritis (RA) initiating their first biological disease-modifying antirheumatic drug (bDMARD) and those continuing ...conventional synthetic DMARDs (csDMARDs).MethodsNine-year historical Propensity Score (PS) matched cohort study within the French national healthcare database (87% of the French population; ~57 million people), including adults RA without malignancy. Exposures started with the first use of any systemic treatment (csDMARDs and/or bDMARDs). Incident users of bDMARDs were matched on a dynamic PS to patients continuing csDMARDs. Their risk of malignancy was compared by Cox model.ResultsFrom 1 January 2007 to 31 December 2014, 83 706 patients with RA started their first systemic treatment (63 837 remained on csDMARDs and 19 869 initiated a bDMARD during follow-up). After dynamic PS matching, 19 727 bDMARD initiators were compared with 19 727 RA remaining on csDMARDs. They did not statistically differ in risk of overall malignancies (HR 0.99 (95% CI 0.86 to 1.14)), solid cancer (HR 0.95 (95% CI 0.82 to 1.11)), nor lymphoma (HR 1.35 (95% CI 0.72 to 2.53)). Results were similar when bDMARDs were given as monotherapy or in association with csDMARDs. Analyses restricted to patients starting TNF inhibitor as first bDMARD compared with matched RA remaining on csDMARDs, provided similar results (HR for overall malignancy 1.03 (95% CI 0.88 to 1.21)). Sensitivity analyses, varying carry-over periods (up to 5 years) to define risk periods, provided similar results.ConclusionsIn this historical cohort study within the French nationwide healthcare database, the risk of overall, solid or haematological malignancies did not significantly differ between patients with RA initiating bDMARD and those continuing csDMARDs.
Return to work (RTW) after breast cancer is associated with improved quality of life. The link between household characteristics and RTW remains largely unknown. The aim of this study was to examine ...the effect of the family situation on women’s RTW two years after breast cancer. We used data of a French prospective cohort of women diagnosed with stage I-III, primary breast cancer (CANTO, NCT01993498). Among women employed at diagnosis and under 57 years old, we assessed the association between household characteristics (living with a partner, marital status, number and age of economically dependent children, support by the partner) and RTW. Logistic regression models were adjusted for age, household income, stage, comorbidities, treatments and their side effects. Analyzes stratified by age and household income were performed to assess the association between household characteristics and RTW in specific subgroups. Among the 3004 patients included, women living with a partner returned less to work (OR = 0.63 0.47–0.86) and decreased their working time after RTW. Among the 2305 women living with a partner, being married was associated with decreased RTW among women aged over 50 (OR = 0.57 0.34–0.95). Having three or more children (vs. none) was associated with lower RTW among women with low household income (OR = 0.28 0.10–0.80). Household characteristics should be considered in addition to clinical information to identify vulnerable women, reduce the social consequence of cancer and improve their quality of life.
Adverse effects of breast cancer treatment can negatively affect survivors' work ability. Previous reports lacked detailed clinical data or health-related patient-reported outcomes (PROs) and did not ...prospectively assess the combined impact of treatment and related sequelae on employment.
We used a French prospective clinical cohort of patients with stage I-III breast cancer including 1,874 women who were working and ≥ 5 years younger than legal retirement age (≤ 57 years) at breast cancer diagnosis. Our outcome was nonreturn to work (non-RTW) 2 years after diagnosis. Independent variables included treatment characteristics as well as toxicities (Common Toxicity Criteria Adverse Events CTCAE v4) and PROs (European Organization for Research and Treatment of Cancer EORTC Quality of life Questionnaires, Breast cancer module QLQ-BR23 and Fatigue module QLQ-FA12, Hospital Anxiety and Depression Scale) collected 1 year after diagnosis. Logistic regression models assessed correlates of non-RTW, adjusting for age, stage, comorbidities, and socioeconomic covariates.
Two years after diagnosis, 21% of patients had not returned to work. Odds of non-RTW were significantly increased among patients treated with combinations of chemotherapy and trastuzumab (odds ratio OR
chemotherapy-hormonotherapy: for chemotherapy-trastuzumab, 2.01; 95% CI, 1.18 to 3.44; for chemotherapy-trastuzumab-hormonotherapy, 1.62; 95% CI, 1.10 to 2.41). Other significant associations with non-RTW included grade ≥ 3 CTCAE toxicities (OR
no, 1.59; 95% CI, 1.15 to 2.18), arm morbidity (OR
no, 1.59; 95% CI, 1.19 to 2.13), anxiety (OR
no, 1.47; 95% CI, 1.02 to 2.11), and depression (OR
no, 2.29; 95% CI, 1.34 to 3.91).
Receipt of systemic therapy combinations including trastuzumab was associated with increased odds of non-RTW. Likelihood of unemployment was also higher among patients who reported severe physical and psychological symptoms. This comprehensive study identifies potentially vulnerable patients and warrants supportive interventional strategies to facilitate their RTW.
Nonadherence to long-term treatments is often under-recognized by physicians and there is no gold standard for its assessment. In breast cancer, nonadherence to tamoxifen therapy after surgery ...constitutes a major obstacle to optimal outcomes. We sought to evaluate the rate of biochemical nonadherence to adjuvant tamoxifen using serum assessment and to examine its effects on short-term, distant disease-free survival (DDFS).
We studied 1,177 premenopausal women enrolled in a large prospective study (CANTO/NCT01993498). Definition of biochemical nonadherence was based on a tamoxifen serum level < 60 ng/mL, assessed 1 year after prescription. Self-reported nonadherence to tamoxifen therapy was collected at the same time through semistructured interviews. Survival analyses were conducted using an inverse probability weighted Cox proportional hazards model, using a propensity score based on age, staging, surgery, chemotherapy, and center size.
Serum assessment of tamoxifen identified 16.0% of patients (n = 188) below the set adherence threshold. Patient-reported rate of nonadherence was lower (12.3%). Of 188 patients who did not adhere to the tamoxifen prescription, 55% self-reported adherence to tamoxifen. After a median follow-up of 24.2 months since tamoxifen serum assessment, patients who were biochemically nonadherent had significantly shorter DDFS (for distant recurrence or death, adjusted hazard ratio, 2.31; 95% CI, 1.05 to 5.06;
= .036), with 89.5% of patients alive without distant recurrence at 3 years in the nonadherent cohort versus 95.4% in the adherent cohort.
Therapeutic drug monitoring may be a useful method to promptly identify patients who do not take adjuvant tamoxifen as prescribed and are at risk for poorer outcomes. Targeted interventions facilitating patient adherence are needed and have the potential to improve short-term breast cancer outcomes.
Older studies uncovered an increased risk of cancer in patients with rheumatoid arthritis between 10% and 30% compared to the general population, with a lack of data concerning infrequent cancers. In ...recent year, major therapeutic breakthroughs might have affected this risk of cancer by mitigating disease activity or on the contrary by impairing antitumoral immune response. The objectives of this study are to compare cancer risk in patients with treated rheumatoid arthritis to the general population, in all treated patients and according to treatment exposure.
This is a nationwide population-based study within the French national claims database “Système National des Données de Santé” (SNDS) between January 1st 2010 and December 31st 2020, to estimate the age and sex-standardized incidence ratios of cancer (all sites and site specific) of treated rheumatoid arthritis patients, with the French population as reference (by use of the French Network of Population-Based Cancer Registries FRANCIM).
During the study period, 257,074 treated patients with rheumatoid arthritis contributed to a total of 2,098,238 person-years for the main analysis. The all-cancer risk was increased in rheumatoid arthritis patients, with a SIR (Standardized Incidence Ratio) of 1.20 (95%CI 1.17-1.23). This risk was increased particularly for lung (SIR 1.41, 95%CI 1.36-1.46, bladder (SIR 2.38 95%CI 2.25-2.51), cervix (SIR 1.80, 95%CI 1.62-2.01), prostate (SIR 1.08, 95% CI 1.04, 1.13) cancers, melanoma (SIR 1.37, 95% CI 1.29-1.46), diffuse large B cell lymphoma (SIR 1.79, 95% CI 1.63-1.96, multiple myeloma (SIR 1.42, 95% CI 1.27-1.60) and Hodgkin’s lymphoma (SIR 2.73, 95%CI 2.31-3.23). Some cancers were less frequent than in the general population such as pancreatic (SIR 0.90, 95%CI 0.83-0.97) as well as breast and endometrial cancers (SIR 0.91, 95%CI 0.88-0.94 and SIR 0.77, 95%CI 0.71-0.84 respectively). Although we observed a modest but significant relative increase of all-cancer risk over-time in rheumatoid arthritis patients, there was a trend towards a decrease in risk of non-Hodgkin’s lymphoma. Patients treated with rituximab were the patients displaying the highest risk of cancer.
Compared to the general population, treated rheumatoid arthritis patients were at greater risk of all-cancer and some site specific cancers, except for breast, pancreatic and endometrial cancers which were less frequent than in the general population.
This work was supported by unrestricted grants from the InCA (national institute against cancer) and AP-HP (Assistance Publique des Hôpitaux de Paris).
Background: Older studies uncovered an increased risk of cancer in patients with rheumatoid arthritis between 10% and 30% compared to the general population, with a lack of data concerning infrequent ...cancers. In recent year, major therapeutic breakthroughs might have affected this risk of cancer by mitigating disease activity or on the contrary by impairing antitumoral immune response. The objectives of this study are to compare cancer risk in patients with treated rheumatoid arthritis to the general population, in all treated patients and according to treatment exposure. Methods: This is a nationwide population-based study within the French national claims database “Système National des Données de Santé” (SNDS) between January 1st 2010 and December 31st 2020, to estimate the age and sex-standardized incidence ratios of cancer (all sites and site specific) of treated rheumatoid arthritis patients, with the French population as reference (by use of the French Network of Population-Based Cancer Registries FRANCIM). Findings: During the study period, 257,074 treated patients with rheumatoid arthritis contributed to a total of 2,098,238 person-years for the main analysis. The all-cancer risk was increased in rheumatoid arthritis patients, with a SIR (Standardized Incidence Ratio) of 1.20 (95% CI 1.17–1.23). This risk was increased particularly for lung (SIR 1.41, 95% CI 1.36–1.46, bladder (SIR 2.38 95% CI 2.25–2.51), cervix (SIR 1.80, 95% CI 1.62–2.01), prostate (SIR 1.08, 95% CI 1.04, 1.13) cancers, melanoma (SIR 1.37, 95% CI 1.29–1.46), diffuse large B cell lymphoma (SIR 1.79, 95% CI 1.63–1.96, multiple myeloma (SIR 1.42, 95% CI 1.27–1.60) and Hodgkin's lymphoma (SIR 2.73, 95% CI 2.31–3.23). Some cancers were less frequent than in the general population such as pancreatic (SIR 0.90, 95% CI 0.83–0.97) as well as breast and endometrial cancers (SIR 0.91, 95% CI 0.88–0.94 and SIR 0.77, 95% CI 0.71–0.84 respectively). Although we observed a modest but significant relative increase of all-cancer risk over-time in rheumatoid arthritis patients, there was a trend towards a decrease in risk of non-Hodgkin's lymphoma. Patients treated with rituximab were the patients displaying the highest risk of cancer. Interpretation: Compared to the general population, treated rheumatoid arthritis patients were at greater risk of all-cancer and some site specific cancers, except for breast, pancreatic and endometrial cancers which were less frequent than in the general population. Funding: This work was supported by unrestricted grants from the InCA (national institute against cancer) and AP-HP (Assistance Publique des Hôpitaux de Paris).
Unhealthy behaviors among childhood cancer survivors increase the risks for cancer treatment adverse effects. We aimed to assess tobacco and cannabis use prevalence in this population and to identify ...factors associated with these consumptions.
This study involved 2,887 5-year survivors from the French childhood cancer survivor study (FCCSS) cohort. Data on health behaviors were compared with those of controls from the general population. Associations of current smoking and cannabis use with clinical features, sociodemographic characteristics, and health-related quality of life (QOL) were investigated using multivariable logistic regressions.
Prevalence for tobacco use was lower in survivors (26%) than in controls (41%,
< 0.001). Among current smokers, survivors smoked more cigarettes per day and started at a younger age than controls. Women, college graduates, older, married, and CNS tumor survivors, as well as those who received chemotherapy and thoracic radiation therapy, were less likely to be smokers and/or cannabis consumers than others. Participants with a poor mental QOL were more likely to smoke.
Preventive interventions and cessation programs must be carried out as early as possible in survivors' life, especially among young males with low educational level and poor mental health.
This study brings new insights to health behaviors among childhood cancer survivors from a population with high rates of smoking and cannabis use.
Objective
Health risk behaviors (HRB) of childhood cancer survivors (CCS) are generally studied separately, despite the evidence suggesting that HRB are not independent. To our knowledge, few studies ...have examined HRB profiles in the former pediatric cancer patients. In this study, we identified HRB profiles and examined predictors engaging in unhealthy behaviors in CCS.
Methods
We used data from a French cohort of CCS that includes five‐year survivors diagnosed between 1945 and 2000 and treated before reaching age 18, in five centers in France. A total of 2961 adult CCS answered a self‐reported questionnaire pertaining to HRB. Latent class analysis was used to identify HRB profiles combining physical activity, smoking, cannabis use, and alcohol drinking. Multinomial logistic analyses examined predictors for engaging in unhealthy behaviors.
Results
Three HRB patterns emerged: “Low‐risk” (n = 1846, 62.3%) included CCS who exhibited the highest frequency for usual physical activity and the lowest probabilities for current smoking or cannabis use, but most drank at least moderately; “Moderate‐risk behaviors” (n = 291, 9.8%), and “High‐risk behaviors” (n = 824, 27.8%) for CCS who exhibited the highest frequencies for current smoking, cannabis use, and heavy drinking. The multivariable regression revealed that male CCS, less educated or not married were significantly more likely to be in the high‐risk behaviors group than the low‐risk group.
Conclusions
As CCS remain a vulnerable population, screening for HRB should be routinized in long‐term follow‐up care and interventions targeting multiple HRB simultaneously among survivors should be developed.
The Jenner vaccine in Portugal (18th-19th centuries) – The discovery of the smallpox vaccine caused very important changes in medications. With this new drug came the preventive medication. In this ...article the authors make a brief history of the Jenner vaccine in Portugal : the protagonists ; the publications (Preservativo das bexigas (1801), M. J. Henriques de Paiva ; Indagaçaõ sobre as causas, e effeitos das Bexigas da Vacca (1803), João António Monteiro ; Reflexoens, e observaçoens, sobre a pratica da inoculaçaõ da Vaccina (1808), H. J. de Araújo Carneiro) and the institutions (Instituição Vaccinica de l’Académie Royale des Sciences de Lisbonne ; Instituto Vacínico Bourquin e Campos ; Instituto Vacínico Portuense ; Parque Vacinogénico de Lisboa).
La découverte du vaccin contre la variole par Edward Jenner en 1796 a provoqué un changement dans la conception de la thérapeutique médicamenteuse, la médication préventive. Dans cet article, les auteurs font une planification du parcours du vaccin de Jenner au Portugal : les protagonistes ; les publications portugaises sur le vaccin contre la variole Preservativo das bexigas (1801), de M. J. Henriques de Paiva ; Indagaçaõ sobre as causas, e effeitos das Bexigas da Vacca (1803), par João António Monteiro ; Reflexoens, e observaçoens, sobre a pratica da inoculaçaõ da Vaccina (1808), de H. J. de Araújo Carneiro) ; les institutions liées au vaccin de Jenner, créées au XIXe siècle (Instituição Vaccinica de l’Académie Royale des Sciences de Lisbonne ; Instituto Vacínico Bourquin e Campos ; Instituto Vacínico Portuense ; Parque Vacinogénico de Lisboa).
Pinto Sandrine Martins,Léonor Pereira Anna,Rui Pita João. Le vaccin de Jenner au Portugal (XVIIIe-XIXe siècles). In: Revue d'histoire de la pharmacie, 105e année, N. 397, 2018. pp. 31-44.
O reconhecimento de objetos está presente em tudo o que nos rodeia. De entre inúmeras classes de objetos existentes encontram-se as faces, sendo que o seu reconhecimento é extremamente importante no ...papel social do ser humano. Os estudos sugerem que o desempenho em aspetos cognitivos (por exemplo, a memória utilizada nos processos de reconhecimento) pode ser influenciado pela hora-do-dia e pelo ritmo circadiano. O ritmo circadiano é uma característica individual que se traduz, entre outras coisas, em diferentes cronótipos (matutino, intermédio, vespertino). O que diferencia estas três tipologias é o momento do dia em que o indivíduo atinge o seu pico de energia/atividade. Quando existe sincronia entre o pico de ativação circadiana individual e a hora-do-dia em que o indivíduo desempenha determinadas atividades cognitivas, observa-se um efeito de sincronia, sendo que os matutinos tendem a exibir um desempenho melhor de manhã e os vespertinos da parte da tarde.A presente investigação objetivou analisar o impacto da hora-do-dia no reconhecimento de faces e de carros e a sua relação com o cronótipo, apontando como hipótese que a performance do individuo deverá ser otimizada quando a hora-do-dia em que a tarefa é realizada e o cronótipo do indivíduo correspondem. Isto devido ao efeito de sincronia que se verifica ao nível da memória (domínio cognitivo avaliado nesta investigação). Procurou-se também verificar se a hora-do-dia tem um efeito sobre o desempenho independentemente do cronótipo. Deste modo, 40 participantes realizaram o Cambridge Face Memory Test (CFMT) e o Cambridge Car Memory Test (CCMT), divididos por quatro horários ao longo do dia. Os resultados sugerem que não existem diferenças significativas nas percentagens de respostas corretas, nos diferentes horários. Em contrapartida, no que concerne aos tempos de resposta, observa-se um efeito da hora de realização da sessão na fase 1 do CFMT e do CCMT. Observa-se ainda uma correlação significativa negativa forte entre a pontuação num questionário de cronótipo (MEQ) e a percentagem de respostas certas na fase 2 do CFMT, no horário das 11h30 às 14h. Estes resultados sugerem que a hora-do-dia em que a tarefa é realizada parece ter mais impacto no desempenho das tarefas do que propriamente o cronótipo, ou seja, o seu efeito parece sobrepor-se ao efeito do cronótipo.Esta investigação proporciona um contributo relevante acerca do impacto da hora-do-dia sobre o reconhecimento facial e de objetos, sobretudo ao perceber qual a relação desta variável com o cronótipo. Mesmo tendo uma amostra pequena, os resultados deste estudo deixam em aberto a existência de um possível efeito de assincronia no desempenho deste tipo de tarefas, servindo como base para estudos futuros sobre este tema.
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