Urinary and sexual disorders following localised prostate cancer management

Management of adverse events related to cancer therapies are seen as tertiary prevention. Concerning prostate cancer, dealing with secondary effects of treatments is crucial. Indeed, if recent advances in cancer therapy have lead to an acceptable overall prognosis, these results face increasing cases of adverse events that can dramatically impact quality of life. Localized prostate cancer management (by radical prostatectomy, brachytherapy, external radiation therapy, hormonal treatment) leads to two main secondary effects: bladder and urinary sphincter dysfunction on one hand and sexual disorders on the other hand. Urinary disorders are stress urinary incontinence (mainly after radical prostatectomy), storage symptoms and overactive bladder, and outflow obstruction (mainly after radiation therapy). Stress urinary incontinence can be managed by pelvic floor muscle training and behavioural treatment. In case of failure, and after one year of evolution, surgical options are indicated (periurethral injections, artificial urinary sphincter, tapes and balloons). Storage symptoms respond to medical management (anticholinergics), and obstructive symptoms are treated by alpha-blockers, self-catheterization or surgery if necessary. Sexual disorders are erectile dysfunction, pelvic floor discomfort, orgasm disorder, and penile retraction and fibrosis. Available options gather medical treatment by phosphodiesterase-5 inhibitors, Vacuum, and penile prosthesis. Recent advances in this field point out the role of early penile rehabilitation and prevention of sexual disorders. Although often associated in the same patients, sexual and urinary disorders following prostate cancer management are often considered separately. Their combined treatment should be an objective for both clinical practice and research. New treatments for stress urinary incontinence management (latero-urethral balloons, new male slings) and for erectile dysfunction (penile rehabilitation, treatment penile retraction and optimal use of phosphodiesterase-5 inhibitors) will extend the therapeutic options in the next future, and improve the level of care for patients with prostate cancer.     

Quality of life and psychological state in patients with choroidal melanoma: longitudinal study

Treatments for choroidal melanoma (CM) generate largely unknown consequences on the level of the quality of life (QoL) and psychological state. Prospective published work is relatively rare and their results are not consistent. The objective of this study is to describe the QoL and psychological state's evolution in patients treated by conservative treatment for CM.PopulationSixty-nine patients treated for CM by conservative treatment (proton beam irradiation or iodine plaques).ToolsQoL (EORTC–QLQ-C30 + QLQ-OPT-30), anxiety and depression (HADS, STAI-B-trait).Data collectionProspective study comprising four evaluations T0: before the beginning of the treatment, T1: one month, T2: six month, T3: one year after the treatment. The preliminary results of the first two evaluations showed that the level of the QoL remained relatively good and stable with an exception for the social functioning, which decreased after the treatment. More than half of the patients had a moderated rate of anxiety before the beginning of the treatment, which decreased significantly a month later. The depressive symptoms were lower and remained stable one month after the treatment. These results confirmed the importance of exploration and screening the fear of cancer recurrence among choroidal melanoma patients.     

Insomnias in oncology: screening and management

Sleep disorders and more particularly insomnias are very frequently found in cancer patients. We notice a growing interest for this subject in the current literature. However, they still remain under diagnosed and thus mostly not taken into account. Nevertheless, these insomnias represent a real discomfort for these patients, with not insignificant repercussions on their quality of life. It is important to be able to screen these disorders with a detailed and precised interview allowing a global patient care including pharmacologic and non-pharmacologic treatment.     

Personality Traits and Coping Strategies Relevant to Posttraumatic Growth in Patients with Cancer and Survivors: A Systematic Literature Review

The possibility of positive psychological changes after cancer, namely, posttraumatic growth, is a growing field of research. Identifying personality traits and coping strategies related to posttraumatic growth may help find vulnerable individuals as well as promote helpful coping strategies to help more patients make positive changes at an early stage. The aim of this systematic literature review is to provide an overview of the quantitative data on coping strategies and personality traits associated with posttraumatic growth in patients with cancer and cancer survivors as well as the methods used in included studies. A systematic literature search was conducted using five databases (PubMed, PubPsych, PsycInfo, Web of Science, and PSYNDEXplus). The 70 reports of included studies assessed posttraumatic growth using questionnaires in a sample of patients with cancer or survivors. In addition, associations with a personality trait or coping strategy had to be examined cross-sectionally or longitudinally. All 1698 articles were screened for titles and abstracts by two authors, after which disputed articles were reviewed by a third author. Afterwards, articles were screened for full texts. Most studies had a cross-sectional design and used a sample of patients with breast cancer. Coping strategies have been researched more than personality factors. The personality traits of resilience, hardiness, dispositional positive affectivity, and dispositional gratitude seem to be related to posttraumatic growth, while the Big Five personality traits (openness to experience, conscientiousness, extraversion, agreeableness, neuroticism) have been less researched and/or seem to be unrelated. The use of social support, religious coping, positive reframing, and reflection during illness as coping strategies seems to be related to posttraumatic growth. The findings can be used for the development of interventions. Future studies should investigate associations longitudinally.     

Research on body image in oncology: a methodological synthesis

Cancer and its treatments induce important physical transformations, which could be source of psychological and social difficulties. Since about 15 years, interest for cancer and treatments consequences on body image had grown in oncology. Nevertheless studying body image remains complex because of conceptual and methodological limits. This article aims at a clarification about the methods employed in the field of cancer to assess body image, in order to make accessible reference marks about adapted instruments for every person who would like to study this theme.     

Being resident in hematological and pediatric oncology department: attraction and difficulties

Pediatric oncology is a medical specialty, which implies strong emotions. Because of the huge clinical variety of diseases, the multi-disciplinary aspects of this specialty and the innovative therapies used, paediatric oncology is definitely an attractive specialty. Care and empathy that follows creates a special relationship between them and the child with his family. These emotions might be pleasant or unpleasant but are always at the centre of the resident's day to day life. The resident's route is sometimes difficult since it includes not only diagnostic announcement and various therapeutic strategies, but also relapses, palliative care and child's death, which is sometimes unavoidable. This article sheds light on the personal experience throughout various departments of pediatric oncology and hematology.     

Comparison of epidemiological factors between serous and mucinous borderline ovarian tumors: therapeutic implications

The goals of this multicenter French retrospective study were to compare epidemiological factors within borderline ovarian tumors (BOT) according to their serous (SBOT) or mucinous (MBOT) type and according to the presence of pejorative histological criteria. We analysed 224 SBOT and 164 MBOT diagnosed between 1990 and 2009. The patients mean age was not different according to serous or mucinous type (46.9 ± 16.7 years and 44.6 ± 17.6 years). Women with SBOT, had more frequently history of infertility (17.2% versus 3.9%, P < 0.0001) than women with MBOT. SBOT were more often asymptomatic (52.3% versus 33.5%, P < 0.001), bilateral (26.4% versus 4.3%, P = 0.0001), smaller (9.1 cm versus 14.5 cm, P = 0.0001) and diagnosed at advanced stage (81.2% of stage I versus 95.1%, P < 0.0001) than MBOT. The micropapillary pattern found in 10.3% of SBOT was observed at younger age (38 ± 15.4 years versus 47.9 ± 16.6 years, P = 0.007) and was more often associated with peritoneal implants (26.1% versus 6.5%, P = 0.02). The intraepithelial carcinoma found in 6.7% of MBOT, was more often associated with micro-invasion (36.4% versus 4.6%, P = 0.003). The existence of epidemiologic differences between SBOT and MBOT underlines that the BOT series analysis can not be considered without taking into account this parameter.     

Trimodalities for bladder cancer in elderly: Transurethral resection,hypofractionated radiotherapy and gemcitabine

Purpose

A prospective phase II study carried out to evaluate hypofractionated radiotherapy with concurrent gemcitabine for bladder preservation in the elderly patient with bladder cancer.

Brachytherapy boost (BT-boost) or stereotactic body radiation therapy boost (SBRT-boost) for high-risk prostate cancer (HR-PCa)

Systematic review for the treatment of high-risk prostate cancer (HR-PCa, D’Amico classification risk system) with external body radiation therapy (EBRT) + brachytherapy-boost (BT-boost) or with EBRT + stereotactic body RT-boost (SBRT-boost). In March 2020, 391 English citations on PubMed matched with search terms “high risk prostate cancer boost”. Respectively 9 and 48 prospective and retrospective studies were on BT-boost and 7 retrospective studies were on SBRT-boost. Two SBRT-boost trials were prospective. Only one study (ASCENDE-RT) directly compared the gold standard treatment [dose-escalation (DE)-EBRT + androgen deprivation treatment (ADT)] versus EBRT + ADT + BT-boost. Biochemical control rates at 9 years were 83% in the experimental arm versus 63% in the standard arm. Cumulative incidence of late grade 3 urinary toxicity in the experimental arm and in the standard arm was respectively 18% and 5%. Two recent studies with HR-PCa (National Cancer Database) demonstrated better overall survival with BT-boost (low dose rate LDR or high dose rate HDR) compared with DE–EBRT. These recent findings demonstrate the superiority of EBRT + BT-boost + ADT versus DE–EBRT + ADT for HR-PCa. It seems that EBRT + BT-boost + ADT could now be considered as a gold standard treatment for HR-PCa. HDR or LDR are options. SBRT-boost represents an attractive alternative, but the absence of randomised trials does not allow us to conclude for HR-PCa. Prospective randomised international phase III trials or meta-analyses could improve the level of evidence of SBRT-boost for HR-PCa.     

The personalized health care process in oncosexology: a new health care offer in the service of both patients and health carers

The sexual problematic linked to both cancers and their treatments remains underestimated by health carers especially since patients dare not speak about it. The oncosexology is a new offer of health care responding to an epidemiological reality, a strong demand, a care quality process and a societal demand of ethical, technical and humanist medicine. It aims at conciliating the oncological and quality of life objectives because sexual health belongs to oncological care and quality of life belongs to well-being for a majority of people/couple. By comparison to the pain situation of 20 years ago, a proactive politics is necessary to change the individual level to a collective one by modifying the attitudes of patients and… health carers, that is, by breaking the silence, by legitimating the demand and by allowing all the actors to be open about it. The optimal strategy for actualizing the "software" of physicians, who are the main factor of resistance, consists in simplifying and professionalizing the oncosexology by responding to the needs for information and offer visibility for all, and training for the most sensitized or involved carers. The term oncosexology should not shock. This new competence in supportive care corrects a real inequality of access to health care and fits in with a medical humanism by promoting a more personalized approach as much initially as in follow-up: a) to inform about sexual risks and sequels is an ethical and legal duty, b) the therapeutic strategy may be influenced by the iatrogenic sexual risk, which is frequently treatment-dependant, c) the impact and demand evolve throughout the health care process, d) multidisciplinary solutions exist according to the demand and its simple or complex nature, e) the impact is often positive for the patient/couple.     

Les tumeurs rares de l’ovaire : stratégies thérapeutiques en 2010, Observatoire francophone des tumeurs rares de l’ovaire et émergence des centres de références

Majorities of the rare ovarian cancer were represented by Germ cell tumours and sex cords ovarian tumours with borderline tumours, clear cell carcinoma and mucinous carcinoma and are extremely rare malignant diseases of the ovaries. Tumors of the stromal (Leydig cells) and/or sex cords (Sertoli cells) represent approximately 7% of ovarian cancers and develop from the conjunctive tissue (respectively, interstitial and nurse cells) of the ovaries. All together, they represented less than 5% of the adult malignant and non malignant ovarian tumours. Treatment of rare ovarian tumors is currently as follows. Surgery is the same as that for ovarian adenocarcinoma, with one major difference: conservation of reproductive function in women of reproductive age is usual case for this type of tumor. Chemotherapy for germ cell and sex cords tumors, based on data reported in the literature is the same as that prescribed for testicular germ-cell tumors. For rare epithelial carcinoma, carboplatine plus paclitaxel remains the standard attitude with a well-known less efficiency than for other epithelial subtypes. Surgery, chemotherapy and possible surgical intervention for residual lesions are highly complex. Too rare to be included in randomized studies, treatment of these tumors has benefited from the therapeutic advancements made against testicular germ-cell tumors or with publications using retrospective data. Effectively, some prognostic factors such stage, histology, number of managed patients seems to be prognostic for survival. Because of the rarity of these tumours a specialized website (www.ovaire-rare.org) was developed in France in 2002. Objectives were: to delineate prognostic factors of these very rare diseases, to favour patient inclusion in a clinical trial available online, to provide access to online medical expert forum (disease-related) for complex cases, and finally to demonstrate the impact of these tools on improving medical practice. The website provides very interesting data for a better knowledge of these rare tumors and will possibly help improve medical practice. Since 2008, referent centers were delineated to promote optimal management of these tumors, organization of clinical and molecular research at a national or international level and to elaborate guidelines. The other new scientific data concern surgical procedures for sex cords tumors, evidence for presence of FOXL2 mutation in adult granulosa cell tumors, the use of paclitaxel plus carboplatine for sex cords tumors.     

Salvage surgery: cancer of the esophagus

Neoadjuvant chemoradiotherapy is the gold standard of the treatment of advanced oesophageal cancer. The role of surgery after chemoradiotherapy is still debated. Feasibility of curative resection depends on dose of radiotherapy, morbimortality rates, and nutrition status at the end of the protocol especially for non-responders patients. Adding surgery to radiochemotherapy improves local tumour control but does not increase overall survival of patients with advanced oesophageal cancer. According to the two randomised trials published on the subject, surgery is not recommended after chemoradiotherapy for responders. Recommendations of French National Thesaurus are: exclusive chemoradiotherapy as reference, esophagectomy for residual tumour as alternative for operable patients. Surgery may be proposed for selected non-responders patients and some complete pathological response in expert center.     

Adjuvant chemotherapy for breast cancer and fertility: estimation of the impact, options of preservation and role of the oncologist

Fifty-two thousand new breast cancers occur each year in France, 7% in patients less than 40 years. The standard regimens of adjuvant chemotherapy for breast cancer now include anthracyclines and taxanes. These therapeutics advances have significantly improved the prognosis of these young women who may later wish to become mother and have biological offspring. The impact of chemotherapy on reproductive function should be accurately assessed and the ovarian reserve has to be taken into account. The estimated risk of chemo-induced amenorrhea and infertility has to be balanced with the expected results and risks of methods of fertility preservation. The place of different options for fertility preservation depends on patient age, presence or not of a partner and the time available before the initiation of treatment. For these breast cancer patients who will receive chemotherapy, new techniques of in vitro oocyte maturation seem promising. Even if some ethical and technical issues are unresolved, fertility preservation must now be part of the management of these young patients receiving adjuvant chemotherapy for breast cancer. This new approach must be multidisciplinary and complex.     

Traitement du cancer de la prostate : comment les patients font-ils leur choix ?

Prostate cancer remains a public health concern in France for men between 50 and 70 years old. Low-risk or intermediate-risk localised prostate cancer can be treated by a number of therapeutic options. Objective. Identify, in patients’ discourse, the mechanisms and the logic involved in therapeutic decision-making. Method. Qualitative study involving 15 men aged between 53 and 70 years, treated for early-stage prostate cancer, via interviews examining diagnosis pathway, how patients perceive and cope with the illness, and how they choose a treatment. Results. The men made their choices using their own initiative during a multiple-stage process. The determining factors were: quality of relationship with physicians, wish to benefit from the available technological advances in medical care, and minimum impairment to their sexual and reproductive identity. Chances of survival did not appear to be their primary concern. Conclusion. This qualitative study reveals that men make their own decisions in terms of choice of therapy, whether encouraged by their physicians to participate or not.     

Préservation de la fertilité chez les enfants et adolescents traités pour un cancer

Given the excellent survival rate of children and teenagers treated for cancer, careful should be given in order to minimize long-term late effects of treatments and to improve quality of life. In this regard, fertility preservation is particularly important. Age, sex and concomitant therapies have an impact on the level of risk of hypofertility, with a stronger risk for chemotherapeutic regimens including alkylating agents, and gonads or hypothalamo-pituitary axis radiotherapy. Assessment of gonadotoxic impact of treatment strategy and fertility preservation techniques are crucial for limiting late effects. The objective of this literature review is to develop guidance for pediatric oncologists and hematologists relative to fertility preservation methods, in children and teenagers receiving gonadotoxic treatment. Specific follow-up after treatment is also proposed.     

Prostate-specific antigen use among men without prostate cancer in France (2008-2010)

This study evaluated the rate of prostate-specific antigen (PSA) dosage in men age 40 or older, affiliated to the general social security system in France between 2008 and 2010: 10.9 million men, excluding those with known prostate cancer. In 2010, 30.7% of this male population had at least one dosage of PSA, i.e. 12.3% of those between 40 and 54, 47.7% of those between 55 and 74, and 47.6% of those 75 years old or older. Percentages of men who had at least one dosage in the three-year period were 26.2%, 77.3% and 75.6% for the same age brackets, respectively. Overall, 13% of men age 40 or older, and in particular 21% of men 75 years old or older had more than three PSA dosages during the three-year time period. Eighty-eight percent of PSA dosages performed in 2010 were prescribed by a general practitioner and 3.2% by an urologist. Conflicting with French and internationally published recommendations regarding PSA dosage, the present results demonstrate a shift toward chaotic mass screening of prostate cancer particularly in men aged 75 or older.     

Effects of health education intervention on negative emotion and quality of life of patients with laryngeal cancer after postoperative radiotherapy

Purpose

The study aimed to explore and analyze the effects of health education intervention on patients with laryngeal cancer and evaluate negative emotions and quality of life after receiving postoperative radiotherapy. Furthermore the relationship between health education intervention methods and its correlation to complications and relapse rates require greater understanding.