Breast cancer time to treatment in Martinique: predictive factors and effect on survival.

BACKGROUND: Martinique is the second French Region with the lowest physician-to-population ratio, which may affect waiting times for access to care. OBJECTIVES: To assess (i) factors influencing waiting times from diagnosis to cancer-related treatments in breast cancer women in Martinique, and (ii) the impact of waiting times on patients' survival. STUDY DESIGN: Retrospective observational study. METHODS: Data on women diagnosed with invasive breast cancer between 1st January 2013 and 31st December 2017 and initially treated by surgery were extracted from the Martinique population-based registry. A cox model was performed to find predictive factors for waiting times. A log-rank test was used to compare time-to-treatment between groups. RESULTS: In total, 713 patients were included (mean age: 58 ± 13). Median time from diagnosis to surgery was 40 [25-60] days. Age at diagnosis was found to predict variations in waiting times. Patients > 75 had longer waiting time to surgery than those < 40 or [40-50] (P = 0.016 and P < 0.001, respectively). Women with a time-to-treatment ≥ 4 months had a significant lower survival (P < 0.01). CONCLUSIONS: Specific interventions are needed to improve waiting time from diagnosis to initial treatment, as they are longer than recommended and affect survival time.

[Prenatal diagnosis and management of isolated bladder exstrophy]. / Diagnostic anténatal et prise en charge des extrophies vésicales isolées.

The isolated bladder extrophy is a major congenital malformation which prenatal diagnosis is essential. It is based on the non-visualization of the bladder during the first trimester ultrasound but in most cases, it is confirmed by the morphological ultrasound of the second trimester. For the baby, the prognosis of life quality depends on the accurate identification of the malformation, the foetal sex and the associated pathologies. Thus, a detailed ultrasound evaluation is necessary and requires an operator experienced in the search of malformations. As this abnormality has important aesthetic and functional consequences, a multidisciplinary management is required for a good information of the couple. The continuation of pregnancy is currently possible but the couple should be informed that after surgery, often a major one, more than 75% of children will have a urinary continence by reconstruction or bypass. Furthermore, their ability of reproduction will need to be medically improved.

Identification of factors influencing the decision-to-delivery interval in emergency caesarean sections.

BACKGROUND: In a life-threatening context, the American College of Obstetrics and Gynecology and the Royal College of Obstetrics and Gynaecology recommend a maximum delay of 30 min between the decision to perform an emergency caesarean and the infant's birth. Our objectives were to estimate the rate of prolonged intervals and identify the factors influencing the decision-to-delivery interval. METHODS: All women who had given birth at Saint-Etienne University Hospital by a non-prophylactic caesarean section between September 1 and November 1, 2007 were included in a prospective cohort study. A linear regression analysis was performed to identify the factors influencing the decision-to-delivery interval. RESULTS: 68 women were included in the study. Regardless of the degree of emergency, the decision-to-delivery interval exceeded the recommended interval in 50% of the cases. In extremely urgent caesarean sections, the optimal interval of 15 min was exceeded in 85.7% of cases. We found that two factors contributed to delayed patient care: urgent and extremely urgent caesareans and hospitalization in a pathological pregnancy unit. This delay leads to more paediatric reanimations. CONCLUSION: This study highlights the difficulty to reach the recommended target interval. One solution is to improve the identification of the degree of urgency and the communication between the various members of the healthcare team.