Les apports des Plans cancer à la cancérologie

French Cancer Plans, supported at the highest level of the State by successive Presidents of the Republic, promote an integrated approach of the fight against the disease that covers the areas of research, prevention, care and survivorship. As a first comprehensive cancer strategy, the Cancer Plan 2003–2007 both structured the field of oncology and ensured quality and safety of care for patients across the country. It also led to coordinate actors at regional and interregional levels, specifically in care and research areas. The Cancer Plan 2009–2013 focused on personalized care and deployed therapeutic innovations, particularly for precision medicine. The latter also launched the fight against cancer health inequalities, which is the priority of the Cancer Plan 2014–2019, pursued through three main objectives: reduce cancer incidence, lower mortality, and improve the quality of life of patients and survivors.     

À propos des regards en cancérologie

Résumé: La complexité des situations en cancérologie induit des regards différents selon le sujet patient-soignant, psycho–oncologue et autres. Lauteur les interroge dans leurs diversités et leurs fonctions face à la maladie grave. Peuton voir et percevoir à la fois, quen est–il des regards extérieurs, associations, société civile qui nous sollicitent.     

Perspectives en cancérologie pour les médecins généralistes : enquête interrégionale 2010

Between February 1, 2010 and May 1, 2010, a mailed survey in Champagne Ardenne region and the Aisne Department was carried out toward 1 957 general practitioners (GP) listed by the different Boards of Medical Doctors. Following this one-shot mailing, 705 GP's filled and returned the questionnaire (36,6% answer rate). GPs clearly stated their concern in the care of cancers: screening and prevention, early diagnosis and orientation of the patient, per- and post-therapeutic surveillance, backing during the terminal course of the disease. Main observed difficulties consisted of psychological burden, lack of available time and postgraduate training deficiency. Poor communication with oncologists and weakness of close oncologic structures were reported by 24% of GPs. However, it is obvious that the mostly involved physicians did answer. This survey allows however to target specific needs in training for both home caring of modern therapy side effects and the whole course of the terminal phase including supportive care. The theoretical benefits brought to the patients with cancer are emphasized and discussed. Practical propositions and evaluations aiming to give perspectives over on-ground-actions for the GPs are considered.     

Évolution des traitements en cancérologie: aspect psychologique

Sans résumé     

Le suicide en cancérologie : un tabou ?

It is classic to assert that cancer patients are less intended to commit suicide. Numbers of clinicians often report the empirical experience according to which patients with cancer commit suicide rather less than the others. It seems that this classical idea, this preconceived idea, or rather this impression (linked with the empirical experience) that cancer could act as a protection factor for suicidal risk, resists in the oncologic field against the scientific studies published on this topic that clearly indicate the opposite. Teams working in this specific context of oncology within the question of death arises inescapably, must learn from literature data and learn to know and dread the differential clinic from the suicidal crisis (wishing death, acting out). There is an emergency to clear up on these questions while this problematic is nowadays blurred by the social speech about suicide help and physician-assisted suicide.     

Les traitements des cancers Précis à l’usage des médecins généralistes

The aim of this article is to help the general practioners in their everyday practice by giving the minimum information necessary to provide care for patients with cancer. This article discusses the various types of cancer therapy (surgery, radiotherapy, chemotherapy, and hormone therapy) and their main expected side effects.     

Les attentes des professionnels de santé sur les r?les et fonctions des psychologues en cancérologie

The aim of this study was to understand their expectations regarding the roles and functions of the psychologist taking part in clinical activity in these healthcare units. A questionnaire was sent to 3,304 professionals in 27 Units of Bordeaux University Hospital receiving at least 200 new cancer patients per year. Statistical analysis was carried out through ??² or the Fisher??s exact test, followed by treatment with SAS software version 9.1.3. 730 professionals responded (or 22%). For patients, 3/4 expected them to have a supportive and counselling role, 2/3 thought they should lessen the emotional burden, and 1/2 though their role was to provide a psychological evaluation (50%). For the healthcare teams, 3/4 were expecting them to understand the behaviour or patients and/or their immediate family, about 1/2 wanted them to clarify their role in working in a multidisciplinary team, with a multidisciplinary understanding and participate in discussions and delivering decisions. More than 1/3 expected that the psychologist would support the teams on an individual basis, and also participate in group discussions... With regard to institutions, the participation of psychologists in institution based projects was expected by close to 1/2 of those responding. This investigation invited the psychologist to communicate more about their practices, reaffirm with teams the ideas of a supportive and counselling role. The management of the painful aspects of the disease for both the patient and their immediate family, preparing the family for bereavement, a real ??giving of meaning?? necessitates finesse from the psychologist and thus requires continuous training, supervision and an investigative approach. The oncology psychologist is also concerned with the suffering of healthcare professionals, through the support mechanisms already in place (occupational medicine, group analysis of practices), or by implementing such facilities. In this respect, the continuing education of healthcare professionals is vital.     

Les mesures de la qualité de vie en cancérologie peuvent-elles hanger la pratique des cliniciens?

Résumé: Les mesures de la qualité de vie sont susceptibles de modifier la pratique des cliniciens impliqués dans le domaine du cancer, car elles les aident à choisir un traitement ou une procédure médicale en prenant en compte le point de vue des patients, à mieux informer leurs malades à partir des expériences acquises par dautres, à les faire accéder au traitement qui leur est le mieux adapté (ou quils préfèrent) et à leur assurer un suivi de routine plus approprié. Plus généralement, lévaluation de la qualité de vie peut modifier la pratique médicale traditionnelle, dans le sens où elle participe à un processus tendant globalement à replacer le malade au centre du système de soins. Nous illustrerons ce qui est énoncé ci-dessus en prenant des exemples tirés de la littérature ou de notre propre expérience, en particulier, dans le cancer du sein.     

La métabolomique: un nouvel outil pour la recherche translationnelle en cancérologie

Development and validation of novel diagnostic and prognostic tools for cancer patients are a clinically unmet need, especially to help predicting survival or treatment response and toxicity. Metabolomics provides a dynamic portrait of the metabolic state of a tumour in response to pathophysiological stimuli (such as tumour growth or tumour shrinkage) and helps us understand the molecular mechanism sustaining these phenomena. Recent literature presented encouraging data on potential applications of metabolomics in translational research. Analysis of alterations of the metabolic network may lead to identify novel biomarkers and/or therapeutic target.     

La recherche clinique en cancérologie digestive: de la cible à la véritable personnalisation du traitement?

From the strategic use of biology in clinical practice to new diagnostic tools, from the new targeted therapies associated with chemotherapy with controlled side effects, to increasingly accurate radiotherapy associated with increasingly optimised surgery, research in digestive oncology has clearly become multidisciplinary. The challenge now is to develop all these improvements at the same time and with a critical eye, and try to extend the recognized progress made in colorectal metastatic cancer to other digestive localisations whose prognoses are much less positive. In this respect, prevention, optimisation of treatment using predictive factors, management of elderly patients with digestive cancer, and economic optimisation of treatment are some of the challenges we must take up in the next few years if we are to obtain the main objective: truly personalised medicine.