Breast cancer survivors' opinion on personalizing endocrine therapy and developing informative tools.

Understanding breast cancer survivors' perspectives is critical to personalizing endocrine therapy (ET) in the adjuvant setting. A nationwide survey among breast cancer survivors was proposed in France, in collaboration with patient advocacy organizations, to assess their perspectives on personalizing ET and developing dedicated informative tools. This survey explored patients' preferences regarding ET intake schedule, formulation, presentation (color, taste, shape, size, design, and packaging), combination with agents targeting ET-related adverse events, and a mobile application to support them during ET. Of the 1103 individuals who started the survey, 939 (85.1%) were eligible for enrollment and completed the survey. The majority of the participants considered that a personalized ET should take into consideration the intake schedule (n = 974, 90.7%) and swallowable tablet formulation (n = 606, 64.5%), without a preference for ET presentation (n = 619; 65.9%). The majority of the participants expressed a willingness to participate in a potential clinical trial evaluating the combination of ET with agents targeting ET-related adverse events at the start of ET (n = 752, 80.1%) or in the case of major ET-related adverse events (n = 778, 82.8%). The primary considerations were to have an uncompromised ET efficacy and a guaranteed reduction of adverse events. Last, a dedicated mobile application was considered helpful by 665 participants (70.8%). Informative tools should focus on the recommendations for dealing with adverse events (n = 593, 63.2%), the impact on the patient's daily life (n = 515, 54.9%), benefits (n = 504, 53.7%), and adverse events (n = 494, 52.6%) of ET. This survey paves the way for multimodal strategies that can include a personalized ET (e.g., ET in combination with agents targeting ET-related adverse events) and dedicated mobile applications to ultimately improve adherence.

[Semantic analysis of online conversations on lung cancer: The WE-Lung research]. / Analyse sémantique de conversations sur le web portant sur le cancer du poumon : étude Web Ethnography-Lung.

INTRODUCTION: Today, patients with lung cancer and their relatives can easily search information on the Internet and express themselves online. METHODS: Within this web-ethnographic research, we found, based on 246 search terms related to lung cancer, and collected, a sample of 136 online conversations that were published between January 2004 and September 2018, including 1220 messages by 762 authors. RESULTS: The authors of messages, many of them close relatives of patients (35%), share their experience (34%). Seven areas of worrying concern, each of them prominent in 10 to 24% of the corpus, can be grouped under three headings: accepting the disease in order for the patient or their caregiver to fight it ("decide on the prognosis", "managing the treatments", "stopping the progression"), conjuring fate ("naming the guilty ones", "conjuring powerlessness"), asserting resilience ("adopt the right attitude" and "telling one's story in order to survive"). The question of time - disrupted, lost, to be caught up with or controlled - runs through all the issues. DISCUSSION: The patients' and caregivers' concerns go beyond the pace of medical treatment and beyond death. Their mental representations of the disease influence their adherence to the care pathway. Welcoming them in our care and dialogue goes hand in hand with personalized treatment.

[Adapted physical activity and metastatic cancer: What needs and expectations?] / Activité Physique Adaptée et cancer métastatique : quels besoins et quelles attentes ?

This French study aimed to evaluate oncologists' and patients' perception of physical activity, particularly adapted physical activity, in order to identify the obstacles and levers to its practice in patients with metastatic cancer. METHOD: Between October 2019 and March 2020, 60 medical oncologists and 305 patients with metastatic cancer were asked to fill in a self-completed questionnaire. RESULTS: The benefits of physical activity are recognised by most oncologists and patients. These benefits were perceived more by oncologists in prevention (78%) or in the early stage (72%) of the disease than in the metastatic stage (55%) (P=0.01). Patient's physical condition (45%) and age (37%) but also the lack of time during the consultation to explain supportive care (35%) are the main obstacles identified by the oncologist to the integration of physical activity into patient care. Furthermore, lack of knowledge of adapted programmes is the main reason given by the physicians who have never prescribed physical activity (51%). On the patient side, while 88% of them had heard of the benefits of physical activity, only 11% had received a prescription. Most oncologists and patients were very interested in receiving information on where and what types of activities to practice, as well as what to avoid. CONCLUSION: Efforts in terms of information for both oncologists and patients seem necessary to increase the level of physical activity prescription and practice for patients followed for metastatic cancer.

[An updated synthesis of the international recommendations about the use of non-pharmacological interventions in the treatment of fatigue]. / Synthèse actualisée des recommandations internationales sur le traitement de la fatigue par des interventions non pharmacologiques.

INTRODUCTION: Fatigue is a frequent and disturbing symptom in oncology but remains undertreated. Given the absence of effective drug treatment, non-pharmacological interventions have a prominent place in the treatment of fatigue. However, they are relatively unknown by professionals who lack of clear points of reference to refer patients with confidence. This article aims to improve the knowledge about this therapeutic field through an updated synthesis of the levels of recommendations and available evidence. METHODS: A three-step approach was conducted, including (1) a synthesis of international guidelines on non-pharmacological interventions in the treatment of fatigue among adults in oncology, (2) a systematic review of recent data in the literature, (3) a comparison between the synthesis of guidelines and the systematic review with the aim of updating the levels of evidence. RESULTS: Five guidelines were synthesized; 111 systematic reviews were analyzed. Their comparison mainly showed: (1) a convergence in favor of the use of physical activity, educational interventions and cognitive-behavioral therapies, with levels of evidence ranging from moderate to high; (2) a consolidation of short-term efficacy evidence to support the use of mindfulness-based approaches and yoga; 3) the persistence of a lack of sufficiently reliable data to establish the efficacy of other types of intervention. DISCUSSION: Supported by international guidelines and recent data, the use of non-pharmacological interventions in the treatment of fatigue is critical and has to become better known.