Cancer du sein et obésité, une liaison dangereuse [Breast cancer and obesity, a dangerous relation].

Obesity is associated with different cancers including breast cancer, whose incidence is increased in postmenopausal women. It has an adverse impact on the prognosis of the patients, regardless of their menopausal status. The fact of receiving a systemic adjuvant therapy does not neutralize the prognostic role of obesity. Moderate weight loss after cancer diagnosis could improve the outcome of the patients, while a weight gain during treatment seems without significant effect. Currently available data are still too incomplete to justify systematic programs to lose weight with an oncologic therapeutic aim. However, it is worth to encourage and support our patients to have an optimal diet, physical activity, and to lose weight as promotion of general health.

Circulating sex steroids during pregnancy and maternal risk of non-epithelial ovarian cancer.

BACKGROUND: Sex steroid hormones have been proposed to play a role in the development of non-epithelial ovarian cancers (NEOC) but so far no direct epidemiological data are available.METHODS: A case-control study was nested within the Finnish Maternity Cohort, the world's largest bio-repository of serum specimens from pregnant women. Study subjects were selected among women who donated a blood sample during a singleton pregnancy that led to the birth of their last child preceding diagnosis of NEOC. Case subjects were 41 women with sex-cord stromal tumors (SCST) and 21 with germ cell tumors (GCT). Three controls, matching the index case for age, parity at the index pregnancy, and date at blood donation were selected (n=171). Odds ratios (OR) and 95% confidence intervals (CI) associated with concentrations of testosterone, androstenedione, 17-OH-progesterone, progesterone, estradiol and sex hormone binding globulin (SHBG) were estimated through conditional logistic regression.RESULTS: For SCST, doubling of testosterone, androstenedione and 17-OH-progesterone concentrations were associated with about 2-fold higher risk of SCST [ORs and 95% CI of 2.16 (1.25-3.74), 2.16 (1.20-3.87), and 2.62 (1.27-5.38), respectively]. These associations remained largely unchanged after excluding women within 2, 4 or 6 years lag-time between blood donation and cancer diagnosis. Sex steroid hormones concentrations were not related to maternal risk of GCT.CONCLUSIONS: This is the first prospective study providing initial evidence that elevated androgens play a role in the pathogenesis of SCST. Impact: Our study may note a particular need for larger confirmatory investigations on sex steroids and NEOC.

Transitoriness in cancer patients: a cross-sectional survey of lung and gastrointestinal cancer patients.

Despite earlier diagnosis and advancements in treatment, cancer remains a leading cause of death in the world (13% of all deaths according to the World Health Organization) among men and women. Cancer accounts for approximately 20% of the deaths in the USA every year. Here, we report the findings from a cross-sectional survey of psychosocial factors in lung and gastrointestinal cancer patients. The aim of the study was to explore the associations among transitoriness, uncertainty, and locus of control (LOC) with quality of life. Transitoriness is defined as a person's confrontation with life's finitude due to a cancer diagnosis. A total of 126 patients with lung or gastrointestinal cancer completed eight self-reporting questionnaires addressing demographics, spiritual perspective, symptom burden, transitoriness, uncertainty, LOC, and quality of life. Transitoriness, uncertainty, and LOC were significantly associated with one another (r = 0.3267, p = 0.0002/r = 0.1994, p = 0.0252, respectively). LOC/belief in chance has a significant inverse relationship with patients' quality of life (r = -0.2505, p = 0.0047). Transitoriness, uncertainty, and LOC were found to have a significant inverse relationship with patients' quality of life (transitoriness state: r = -0.5363, p = 0.0000/trait: r = -0.4629, p = 0.0000/uncertainty: r = -0.4929, p = 0.0000/internal LOC: r = 0.1759, p = 0.0489/chance LOC: r = -0.2505, p = 0.0047). Transitoriness, uncertainty, and LOC are important concepts as they adversely influence patients' quality of life. Incorporating this finding into the care of cancer patients may provide them with the support they need to cope with treatment and maintenance of a positive quality of life.

Cancer incidence in Vaud (2003-2007)

CANCER CARE FACILITIES: In 2005, the registration area had about 3200 hospital beds available for cancer diagnosis and treatment (about 5 per 1000 residents). There were about 3600 hospital medical residents and private practitioners (1 per 180 residents). The canton has a major, multidisciplinary, public university oncology and radiotherapy centre and two private radiotherapy units (available to all residents), as well as several peripheral (mostly hospital-based) medical and surgical oncology facilities and specialists. REGISTRY STRUCTURE AND METHODS: The registry is part of the Cancer Epidemiology Unit of the Institute of Social and Preventive Medicine within the Faculty of Biology and Medicine of the University of Lausanne. Notiĺcation is voluntary. The registry's main sources of information are the University Institute of Pathology at the University of Lausanne and three major private pathology laboratories. Passive and active follow-up are conducted. Data on all deaths in the canton (including cancer deaths) are available. Other features of the registry are good registration of non-melanoma skin cancers, linkage of reports of selected preneoplastic conditions to the registry database (to study subsequent cancer risk), analysis.

Endometrial cancer and oral contraceptives : an individual participant meta-analysis of 27 276 women with endometrial cancer from 36 epidemiological studies.

BACKGROUND: Oral contraceptives are known to reduce the incidence rate of endometrial cancer, but it is uncertain how long this effect lasts after use ceases, or whether it is modified by other factors. METHODS: Individual participant datasets were sought from principal investigators and provided centrally for 27 276 women with endometrial cancer (cases) and 115 743 without endometrial cancer (controls) from 36 epidemiological studies. The relative risks (RRs) of endometrial cancer associated with oral contraceptive use were estimated using logistic regression, stratified by study, age, parity, body-mass index, smoking, and use of menopausal hormone therapy. FINDINGS: The median age of cases was 63 years (IQR 57-68) and the median year of cancer diagnosis was 2001 (IQR 1994-2005). 9459 (35%) of 27 276 cases and 45 625 (39%) of 115 743 controls had ever used oral contraceptives, for median durations of 3·0 years (IQR 1-7) and 4·4 years (IQR 2-9), respectively. The longer that women had used oral contraceptives, the greater the reduction in risk of endometrial cancer; every 5 years of use was associated with a risk ratio of 0·76 (95% CI 0·73-0·78; p<0·0001). This reduction in risk persisted for more than 30 years after oral contraceptive use had ceased, with no apparent decrease between the RRs for use during the 1960s, 1970s, and 1980s, despite higher oestrogen doses in pills used in the early years. However, the reduction in risk associated with ever having used oral contraceptives differed by tumour type, being stronger for carcinomas (RR 0·69, 95% CI 0·66-0·71) than sarcomas (0·83, 0·67-1·04; case-case comparison: p=0·02). In high-income countries, 10 years use of oral contraceptives was estimated to reduce the absolute risk of endometrial cancer arising before age 75 years from 2·3 to 1·3 per 100 women. INTERPRETATION: Use of oral contraceptives confers long-term protection against endometrial cancer. These results suggest that, in developed countries, about 400 000 cases of endometrial cancer before the age of 75 years have been prevented over the past 50 years (1965-2014) by oral contraceptives, including 200 000 in the past decade (2005-14). FUNDING: Medical Research Council, Cancer Research UK.

Continuous quantification of HER2 expression by microfluidic precision immunofluorescence estimates HER2 gene amplification in breast cancer.

Chromogenic immunohistochemistry (IHC) is omnipresent in cancer diagnosis, but has also been criticized for its technical limit in quantifying the level of protein expression on tissue sections, thus potentially masking clinically relevant data. Shifting from qualitative to quantitative, immunofluorescence (IF) has recently gained attention, yet the question of how precisely IF can quantify antigen expression remains unanswered, regarding in particular its technical limitations and applicability to multiple markers. Here we introduce microfluidic precision IF, which accurately quantifies the target expression level in a continuous scale based on microfluidic IF staining of standard tissue sections and low-complexity automated image analysis. We show that the level of HER2 protein expression, as continuously quantified using microfluidic precision IF in 25 breast cancer cases, including several cases with equivocal IHC result, can predict the number of HER2 gene copies as assessed by fluorescence in situ hybridization (FISH). Finally, we demonstrate that the working principle of this technology is not restricted to HER2 but can be extended to other biomarkers. We anticipate that our method has the potential of providing automated, fast and high-quality quantitative in situ biomarker data using low-cost immunofluorescence assays, as increasingly required in the era of individually tailored cancer therapy.

Health Related Quality of Life after Childhood Cancer - A Finnish Nationwide survey

The purpose of this Finnish epidemiological nationwide cross-sectional study was to evaluate the Health Related Quality of Life (HRQL) of young people that have survived childhood cancer at least four years after cancer diagnosis. The study aims were (1) to increase knowledge and understanding about the relationship between childhood cancer and its treatment and HRQL of childhood cancer survivors and (2) to identify survivors who need and could benefit from ongoing long-term follow-up, as well as (3) to identify what kind of aftercare the childhood cancer survivors will possibly need. HRQL and fatigue of currently still young survivors of extracranial childhood malignancies were evaluated with self-reports and parent proxy reports. HRQL was measured with age-appropriate generic instruments: PedsQL™, SF-36, 15D, 16D and 17D. Fatigue for children and adolescents aged below 18 years was measured with the PedsQL™ Multidimensional Fatigue Scale Finnish version. PedsQL™ parent-proxy and the PedsQL™ Multidimensional Fatigue Scale Parentproxy instruments were used to assess the perception of the parents on HRQL and fatigue of their children and adolescents. Postal-survey questionnaires were mailed to 852 childhood cancer survivors aged 11-27 years and their randomly selected gender-, age and living-place matched controls, as well as under 18-year-old children´s parents. A total of 474 survivors, 595 controls, 209 survivor’s parent and 253 control’s parent replied. The mean age of survivors at the time of the study was 18.4 years. The mean length of survival was 12.3 years, and the mean age at diagnosis 5.5 years. The most of the Finnish childhood cancer survivors evaluated that their HRQL as good. Survivors rated their HRQL equal or higher than their controls. The only dimension where the survivors scored poorer than the controls was the 15D mobility dimension. Survivors of childhood cancer did not suffer from significant fatigue. There were subgroups of childhood cancer survivors who had poorer level of HRQL, and suffered from fatigue more than the reference group. The demographic factors that associated with poorer HRQL were female gender, greater weight, living alone, need of remedial education, an additional non-cancer diagnosis, survivors with siblings, and self-reported unhappiness. Disease-related factors that associated with poorer HRQL were higher age at the time of diagnosis, the diagnosis of Wilms tumor, neuroblastoma, or osteosarcoma, and treatment with stem cell transplantation. The factors associated with more fatigue in survivors were male gender, older age at evaluation, the need of remedial education at school, lower overall average grade in the latest school marks report, length of survival more than 10 years, lower HRQL-scores, and a sarcoma diagnosis. However, all the used demographic and disease related factors explained only about one third of the variation in the HRQL scores. In open questions, the survivors were most worried about their physical health, but were also worried about their mental health, cancer inheritance, late-effects, and fertility and relapse issues. It seems that there are subgroups of survivors who need and could benefit from ongoing long-term follow-up. In the future, the survivors of childhood cancer need more information about their physical and mental health, as well as on their cancer inheritance, possible late-effects including fertility issues, and on the risk of relapse.

The efficacy of YKL-40 and CA125 as biomarkers for epithelial ovarian cancer

Our objective was to estimate the efficacy of the measurement of serum YKL-40 alone or with CA125 as biomarkers for the diagnosis of epithelial ovarian cancer (EOC) using the YKL-40 ELISA kit. An experimental group of 49 ovarian cancer patients included 42 patients with EOC (53 ± 15 years, range: 19-81 years) and 7 patients (48 ± 13 years, range: 29-36 years) with borderline epithelial ovarian tumor. A control group of 88 non-malignant cases included 42 patients (43 ± 10 years, range: 26-77 years) with benign gynecological disease and 46 healthy women (45 ± 14 years, range: 30-68 years) at a teaching hospital. Both YKL-40 (220.1 ± 94.1 vs 61.6 ± 48.4 and 50.1 ± 41.2 ng/mL) and CA125 (524.9 ± 972.5 vs 13.4 ± 7.6 and 28.5 ± 29.6 U/mL) levels were significantly higher (P < 0.05) in patients with ovarian cancer compared to the healthy and non-malignant groups. YKL-40 had 92.9% sensitivity and 94.4% specificity for the diagnosis of EOC. When YKL-40 and CA125 were tested in parallel, the sensitivity was increased to 98.2%, but the specificity was decreased to 81.3%. The correlations between serum YKL-40 and tumor stage, grade histology, performance status, patient age, and extension of debulking surgery were tested. With increasing stage and grade of EOC, preoperative serum YKL-40 levels were significantly increased (P = 0.029, P = 0.05, respectively). Serum YKL-40 alone or with serum CA125 levels are useful, although with some limitations, to diagnose ovarian cancer. Our study showed that YKL-40 may not be an independent prognostic factor for ovarian cancer. This prospective study may be a new trend in looking for biomarkers that optimize diagnosis of ovarian cancer.

Evaluation of a stage II screening protocol for prostate cancer

In 2003, prostate cancer (PCa) is estimated to be the most commonly diagnosed cancer and third leading cause of cancer death in Canada. During PCa population screening, approximately 25% of patients with a normal digital rectal examination (DRE) and intermediate serum prostate specific antigen (PSA) level have PCa. Since all patients typically undergo biopsy, it is expected that approximately 75% of these procedures are unnecessary. The purpose of this study was to compare the degree of efficacy of clinical tests and algorithms in stage II screening for PCa while preventing unnecessary biopsies from occurring. The sample consisted of 201 consecutive men who were suspected of PCa based on the results of a DRE and serum PSA. These men were referred for venipuncture and transrectal ultrasound (TRUS). Clinical tests included TRUS, agespecific reference range PSA (Age-PSA), prostate specific antigen density (PSAD), and free-to-total prostate specific antigen ratio (%fPSA). Clinical results were evaluated individually and within algorithms. Cutoffs of 0.12 and 0.15 ng/ml/cc were employed for PSAD. Cutoffs that would provide a minimum sensitivity of 0.90 and 0.95, respectively were utilized for %fPSA. Statistical analysis included ROC curve analysis, calculated sensitivity (Sens), specificity (Spec), and positive likelihood ratio (LR), with corresponding confidence intervals (Cl). The %fPSA, at a 23% cutoff ({ Sens=0.92; CI, 0.06}, {Spec=0.4l; CI, 0.09}, {LR=1.56; CI, O.ll}), proved to be the most efficacious independent clinical test. The combination of PSAD (cutoff 0.15 ng/ml/cc) and %fPSA (cutoff 23%) ({Sens=0.93; CI, 0.06}, {Spec=0.38; CI, 0.08}, {LR=1.50; CI, 0.10}) was the most efficacious clinical algorithm. This study advocates the use of %fPSA at a cutoff of 23% when screening patients with an intermediate serum PSA and benign DRE.

Signification de l’expérience de la phase palliative du cancer, pour des personnes atteintes et leurs familles des Baléares, alors que le pronostic leur est connu

Le cancer est considéré comme l’une des principales causes de morbidité et de mortalité et, en Espagne, représente à lui seul 25% du taux de mortalité globale. Lorsqu’une personne et sa famille font l’expérience de traverser la phase avancée du cancer, celles-ci vivent un grand choc émotionnel où les souffrances physique, psychique et spirituelle peuvent être présentes. L’information donnée par les professionnels de la santé aux membres de la famille, incluant la personne atteinte, en ce qui concerne le diagnostic et le pronostic du cancer est maintenant plus fréquente dans le contexte méditerranéen. Il n'est pas clair, toutefois, comment cette nouvelle approche est vécue par les familles. C’est pourquoi, le but de cette recherche qualitative de type phénoménologique est d’explorer la signification de l’expérience de familles dont l’un des membres est atteint d’un cancer terminal, alors que tous connaissent le pronostic de la maladie. Les résultats obtenus reposent sur l’analyse en profondeur d’entrevues réalisées auprès de quatre couples. L’analyse des données, à l’aide de la méthode phénoménologique de Giorgi (1997), fait émerger deux thèmes centraux caractérisant la signification de cette expérience de la phase palliative de cancer, alors que l’information sur le mauvais pronostic est connue tant par la personne atteinte que sa famille. Le premier thème central est celui de vivre intensément la perte de la vie rêvée et comporte le vécu suite au choc du pronostic fatal, le fait de vivre constamment des sentiments et des émotions liés à différentes pertes telles que la tristesse, la frustration, l’inquiétude et l’incertitude, et l’espoir de ne pas souffrir. Le deuxième thème central qui ressort est le développement de stratégies par les couples participants afin de rendre leur vie plus supportable. Ces stratégies sont les suivantes : accueillir l’information et le soutien professionnel, retrouver une certaine normalité dans la vie quotidienne, profiter de la vie, recevoir l’aide de la famille et des amis, maintenir une communication cognitive et instrumentale ouverte, se protéger au niveau émotionnel et envisager l’avenir sans la personne aimée. Tous ces éléments, dans le contexte individuel de vie de chaque famille transforment chacun de ces vécus en une expérience unique qui doit être comprise et respectée comme telle par tous les professionnels de la santé impliqués. Les connaissances développées par cette recherche permettront aux infirmières de mieux comprendre l’expérience de la phase palliative du cancer pour des couples dont le diagnostic et le pronostic fatal sont connus par tous, ceci afin d’améliorer leur qualité des soins. Afin de poursuivre le développement du savoir infirmier, il est recommandé de poursuivre des études afin d’explorer plus en profondeur la communication au sein des couples.

Le processus d'adaptation de conjoints dont la femme est atteinte d'un cancer de l'ovaire

Le but de cette étude est de cerner, à partir de leur propre point de vue, la trajectoire d’adaptation de conjoints dont l’épouse est atteinte d’un cancer de l’ovaire. Une approche qualitative, la théorisation ancrée, a été utilisée dans le cadre de cette recherche. Les données ont été recueillies à l’aide d'entretiens semi-structurés effectués auprès de neuf conjoints qui accompagnaient leur épouse lors de leurs traitements dans une unité montréalaise ultra-spécialisée de soins pour les cancers gynécologiques. Nos résultats font ressortir qu’une fois passé le choc de l’annonce du diagnostic, nos répondants se ressaisissent et élaborent toute une série de stratégies de protection pour leur épouse et eux-mêmes, puis d’attaque de la maladie. Au bilan, pour eux, le cancer se révèle une expérience « transformante» aux plans personnel, conjugal et social. Les contrastes observés entre nos résultats et ceux des études antérieures, qui insistent sur le désarroi de conjoints, peuvent être expliqués par la prise en charge efficace de la femme par le réseau de la santé, qui valorise le rôle du conjoint et qui l’outille pour accompagner son épouse. S’ajoutent à cela la force du lien conjugal, trempé par les épreuves passées, certains traits de personnalité des conjoints et l'action du réseau de soutien personnel. En regard de la pratique infirmière, notre recherche met en évidence le bien-fondé des politiques soutenant l’intégration des familles dans les plans de soins et les retombées positives d’une approche concertée entre tous les intervenants de la santé. Répéter une telle étude dans d'autres institutions du réseau de la santé permettrait de cerner encore plus finement son impact sur l’adaptation de conjoints à la maladie.

Un pilote avec groupe témoin : effets de la méditation de pleine conscience sur la qualité de vie, le sommeil et l’humeur chez des adolescents atteints de cancer

L’annonce d’un diagnostic de cancer provoque souvent une forte réaction émotionnelle et un stress important tant chez les adultes que chez les adolescents et leurs parents. Certains d’entre eux cherchant à soulager cette détresse se tournent vers des méthodes alternatives positives de gestion de stress, dans le but d’atténuer les effets psychologiques indésirables du cancer. Les thérapies ciblant à la fois le corps et l’esprit gagnent en popularité dans ces populations. Une avenue prometteuse est la méditation de pleine conscience (MPC), inspirée de la philosophie bouddhiste et adaptée dans le cadre d’interventions thérapeutiques pour améliorer la qualité de vie des patients souffrant de maladies chroniques. À ce jour, des études dans le domaine de la santé ont suggéré que la MPC pouvait avoir des effets bénéfiques sur les symptômes et la gestion de plusieurs maladies chroniques dont le cancer, faisant d’elle une avenue thérapeutique intéressante dans le traitement des effets psychologiques indésirables liés à ces maladies. La recherche émergente en pédiatrie suggère des effets comparables chez les enfants et adolescents. L’objectif de la présente thèse a été de développer un essai clinique randomisé visant à évaluer les effets de la MPC sur la qualité de vie, le sommeil et l’humeur chez des adolescents atteints de cancer, en documentant les étapes d’implantation du projet, les embuches qui ont été rencontrées durant son implantation et les résultats obtenus. La thèse est présentée sous la forme de deux articles scientifiques. Le premier article présente la méthodologie qui avait été planifiée pour ce projet mais qui n’a pu être réalisée en raison d’embuches rencontrées dans la complétion de ce pilote. Ainsi, les étapes préliminaires du développement de ce projet de recherche, en accordant une place prépondérante au manuel d’intervention rédigé à cette fin. La mise en place et la structure de ce projet, nommément le devis méthodologique employé, la taille d’échantillon visée, les méthodes de recrutement mises en place et les stratégies de randomisation prévues, sont décrites en détail dans cet article. Pour les fins de ce projet, un manuel d’intervention de MPC a été rédigé. L’intervention en MPC, menée par deux instructeurs formés en MPC, s’est échelonnée sur une durée de huit semaines, à raison d’une séance d’une heure trente par semaine. Une description détaillée de chaque séance est incluse dans cet article, dans un but de dissémination du protocole de recherche. Des analyses intragroupe serviront à évaluer l’impact de l’intervention en méditation de pleine conscience sur la qualité de vie, le sommeil et l’humeur pré-à-post intervention et au suivi à six mois. Des analyses intergroupes prévues sont décrites afin de comparer les effets de l’intervention entre les participants du groupe contrôle et du groupe expérimental. Les limites potentielles de ce projet, notamment la participation volontaire, le risque d’attrition et la petite taille d’échantillon sont décrites en détail dans cet article. Le deuxième article présente, dans un premier temps, le déroulement du projet de recherche, en mettant en lumière les embuches rencontrées dans son implantation. Ainsi, les leçons à tirer de l’implantation d’un tel essai clinique en milieu hospitalier au Québec sont décrites selon trois axes : 1) les défis liés au recrutement et à la rétention des participants; 2) l’acceptabilité et la compréhensibilité de l’intervention en pleine conscience; et 3) le moment où l’intervention s’est déroulée (timing) et l’impact sur l’engagement requis des participants dans le projet. Durant une période de recrutement de neuf mois, 481 participants potentiels ont été filtrés. 418 (86,9 %) d’entre eux ont été exclus. 63 participants potentiels, vivant à moins d’une heure de Montréal, ont été approchés pour prendre part à ce projet. De ce nombre, seulement 7 participants (1,4%) ont accepté de participer aux rencontres de MPC et de compléter les mesures pré-post intervention. Un bassin d’éligibilité réduit, ainsi que des taux de refus élevés et des conflits d’horaire avec les activités scolaires ont eu un impact considérable sur la taille d’échantillon de ce projet et sur l’absentéisme des participants. Malgré l’intérêt manifeste des équipes médicales pour la recherche psychosociale, les ressources requises pour mener à terme de tels essais cliniques sont trop souvent sous- estimées. Les stratégies de recrutement et de rétention des participants méritent une attention spéciale des chercheurs dans ce domaine. Dans un deuxième temps, le deuxième article de cette thèse a pour objectif de présenter les résultats de l’intervention en MPC chez des jeunes ayant le cancer, en examinant spécifiquement l’impact de l’intervention sur la qualité de vie, le sommeil et l’humeur des jeunes pré-post intervention et lors du suivi à six mois. Faisant écho aux embuches décrites préalablement décrites, les analyses statistiques n’ont permis de déceler aucun effet statistiquement significatif de notre intervention. Aucune différence significative n’est notée entre les participants du groupe expérimental et les participants du groupe contrôle. Les difficultés rencontrées dans de la complétion des devoirs et de la pratique de techniques de méditation entre les séances, décrites en détail cet article, expliquent en partie ces résultats. Globalement, le contexte développemental spécifique à l’adolescence, ayant possiblement eu un impact sur l’adhérence des participants à la thérapie proposée et à leur motivation à prendre part aux rencontres, les scores sous-cliniques lors du premier temps de mesure, l’impact du soutien social inhérent au contexte de thérapie de groupe, ainsi que les caractéristiques personnelles des thérapeutes, pourraient avoir influencé les résultats de ce pilote. Les résultats de ce projet pilote nous laissent croire que la prudence est de mise dans la généralisation des bienfaits et de l’efficacité de la pleine conscience observés chez les adultes atteints de cancer dans son application aux adolescents en oncologie. En conclusion, la présente thèse contribue à enrichir la recherche dans le domaine de la MPC chez les jeunes en questionnant néanmoins la pertinence d’une telle intervention auprès d’une population d’adolescents souffrant de cancer. Ainsi, il convient d’analyser les résultats obtenus en tenant compte des limites méthodologiques de ce projet et de poser un regard critique sur la faisabilité et la reproductibilité d’un projet d’une telle envergure auprès d’une même population. Les leçons tirées de l’implantation d’un tel projet en milieu hospitalier pédiatrique se sont avérées d’une importance centrale dans sa complétion et feront partie intégrante de toute tentative de réplication. D’autres essais cliniques de cette nature seront inévitablement requis afin de statuer sur l’efficacité de la MPC chez des adolescents atteints cancer et sur la faisabilité de l’implantation de cette méthode d’intervention auprès d’une population pédiatrique hospitalière.

MS-based clinical proteomics: biomarker discovery in men’s cancer

Importance of biomarker discovery in men’s cancer diagnosis and prognosis Each year around 10,000 men in the UK die as a result of prostate cancer (PCa) making it the 3rd most common cancer behind lung and breast cancer; worldwide more than 670,000 men are diagnosed every year with the disease [1]. Current methods of diagnosis of PCa mainly rely on the detection of elevated prostate-specific antigen (PSA) levels in serum and/or physical examination by a doctor for the detection of an abnormal prostate. PSA is a glycoprotein produced almost exclusively by the epithelial cells of the prostate gland [2]. Its role is not fully understood, although it is known that it forms part of the ejaculate and its function is to solubilise the sperm to give them the mobility to swim. Raised PSA levels in serum are thought to be due to both an increased production of PSA from the proliferated prostate cells, and a diminished architecture of affected cells, allowing an easier distribution of PSA into the wider circulatory system.

Polymer-drug conjugates: towards a novel approach for the treatment of endrocine-related cancer

The last decade has seen successful clinical application of polymer–protein conjugates (e.g. Oncaspar, Neulasta) and promising results in clinical trials with polymer–anticancer drug conjugates. This, together with the realisation that nanomedicines may play an important future role in cancer diagnosis and treatment, has increased interest in this emerging field. More than 10 anticancer conjugates have now entered clinical development. Phase I/II clinical trials involving N-(2-hydroxypropyl)methacrylamide (HPMA) copolymer-doxorubicin (PK1; FCE28068) showed a four- to fivefold reduction in anthracycline-related toxicity, and, despite cumulative doses up to 1680 mg/m2 (doxorubicin equivalent), no cardiotoxicity was observed. Antitumour activity in chemotherapy-resistant/refractory patients (including breast cancer) was also seen at doxorubicin doses of 80–320 mg/m2, consistent with tumour targeting by the enhanced permeability (EPR) effect. Hints, preclinical and clinical, that polymer anthracycline conjugation can bypass multidrug resistance (MDR) reinforce our hope that polymer drugs will prove useful in improving treatment of endocrine-related cancers. These promising early clinical results open the possibility of using the water-soluble polymers as platforms for delivery of a cocktail of pendant drugs. In particular, we have recently described the first conjugates to combine endocrine therapy and chemotherapy. Their markedly enhanced in vitro activity encourages further development of such novel, polymer-based combination therapies. This review briefly describes the current status of polymer therapeutics as anticancer agents, and discusses the opportunities for design of second-generation, polymer-based combination therapy, including the cocktail of agents that will be needed to treat resistant metastatic cancer.

Is communication guidance mistaken? Qualitative study of parent-oncologist communication in childhood cancer

background: Guidance encourages oncologists to engage patients and relatives in discussing the emotions that accompany cancer diagnosis and treatment. We investigated the perspectives of parents of children with leukaemia on the role of paediatric oncologists in such discussion. methods: Qualitative study comprising 33 audio-recorded parent–oncologist consultations and semi-structured interviews with 67 parents during the year following diagnosis. results: Consultations soon after the diagnosis were largely devoid of overt discussion of parental emotion. Interviewed parents did not describe a need for such discussion. They spoke of being comforted by oncologists’ clinical focus, by the biomedical information they provided and by their calmness and constancy. When we explicitly asked parents 1 year later about the oncologists’ role in emotional support, they overwhelmingly told us that they did not want to discuss their feelings with oncologists. They wanted to preserve the oncologists’ focus on their child’s clinical care, deprecated anything that diverted from this and spoke of the value of boundaries in the parent–oncologist relationship. conclusion: Parents were usually comforted by oncologists, but this was not achieved in the way suggested by communication guidance. Communication guidance would benefit from an enhanced understanding of how emotional support is experienced by those who rely on it.