An Integrated Cancer Prevention Strategy: the Viewpoint of the Leon Berard Comprehensive Cancer Center Lyon, France.

This article describes some of the key prevention services in the Leon Berard Comprehensive Cancer Center (CLB) Lyon, France, which are based on clinical prevention services, outreach activities, and collaboration with professional and territorial health communities. In addition, research is embedded at all stages of the prevention continuum, from understanding cancer causes through to the implementation of prevention interventions during and after cancer. Health promotion activities in the community and dedicated outpatient primary cancer prevention services for individuals at increased risk have been implemented. The CLB's experience illustrates how prevention can be integrated into the comprehensive mission of cancer centers, and how in turn, the cancer centers may contribute to bridging the current fragmentation between cancer care and the different components of primary, secondary, and tertiary prevention. With increasing cancer incidence, the shift toward integrated prevention-centered cancer care is not only key for improving population health, but this may also provide a response to the shortage of hospital staff and overcrowding in cancer services, as well as offer opportunities to reduce carbon emissions from cancer care.

Cost-effectiveness of an exercise and nutritional intervention versus usual nutritional care during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial.

We undertook a cost-effectiveness analysis (CEA) to compare an exercise and nutritional program with the usual nutritional care concomitant to adjuvant chemotherapy in localized breast cancer patients. The CEA was designed as part of the interventional, controlled, randomized, single-center, open-label PASAPAS study. Breast cancer patients receiving first-line adjuvant chemotherapy at a French Comprehensive Cancer Center were randomized 2:1 to a 6-month exercise program of supervised indoor and outdoor group sessions in addition to usual nutritional care (exercise arm) or a usual nutritional care group receiving dietary and physical activity counseling (control arm). Costs were assessed from the French national insurance perspective (in Euros, 2012). Incremental cost-effectiveness ratios (ICERs) were calculated for four criteria: body mass index, waist circumference, body fat percentage, and estimated aerobic capacity. Uncertainty around the ICERs was captured by a probabilistic analysis using a non-parametric bootstrap method. The analysis was based on 60 patients enrolled between 2011 and 2013. Average intervention costs per participant were €412 in the exercise arm (n = 41) and €117 (n = 19) in the control arm. Total mean costs were €17,344 (standard deviation 9,928) and €20,615 (standard deviation 14,904), respectively, did not differ significantly (p = 0.51). The 6-month exercise program was deemed to be cost-effective compared with usual care for the estimated aerobic capacity. Multicenter randomized studies with long-term costs and outcomes should be done to provide additional evidence. Clinical trial: The PASAPAS study is registered under ClinicalTrials.gov. Trial registration ID: NCT01331772.

[Life style and occupational factors and prevention of second primary cancers after childhood and adolescent cancer: Current state of knowledge]. / Facteurs comportementaux et professionnels et prévention des seconds cancers primitifs après un cancer dans l'enfance ou dans l'adolescence : état des connaissances.

CONTEXT: Survival of children, adolescents and young adults treated for cancer increased with improved treatments. But there is still an increased risk of second primary cancer (SPC) in the long term compared to the population of the same age, especially related to treatments. A reflection on the follow-up of this population and the prevention of SPC is an important issue. OBJECTIVES: To perform a synthesis of the available literature on SCP risk factors, related risk behaviors, occupational exposures and prevention strategies. METHODS: Literature search on PubMed from the following equation: "cancer [Tiab] AND young adult [Tiab] or teen [Tiab] or childhood [Tiab] AND prevention [Tiab] AND survivors [Mesh term]". RESULTS: Twenty-seven articles were included in this synthesis. Children, adolescents and young adults have similar risk behaviors than those of their peers regarding tobacco, diet and sun exposure; however, they have lower physical activity. There are few studies on prevention strategies focused on this population. Results of available studies remain inconclusive. No publication was found in relation to occupational exposure and risk of second cancer. CONCLUSIONS: Children, adolescents and young adults treated for cancer are a population at risk and require long-term follow-up and the implementation of effective prevention strategies tailored to this population.

[Identification of occupational exposures among patients with lung cancer]. / Repérage des expositions professionnelles chez les patients atteints de cancers bronchopulmonaires.

Despite the rising number of lung cancers recognized as occupational disease, occupational lung cancers are still under-reported. To improve the recognition of occupational lung cancer, we implemented at the Léon-Bérard Cancer Centre, a questionnaire-based process to identify occupational exposures in these patients and improve compensation. Between January 2010 and December 2011, 91 lung cancer patients responded to a questionnaire. An "occupational cancer" consultation was proposed to patients reporting exposure to carcinogens or jobs with risk of exposure. Fifty-one patients were seen in consultation (34 following the questionnaire and 17 directly addressed by the oncologist). A suspicion of high or average imputability was identified in 31 (60.8%) patients and a compensation process seemed possible for 27 (61.4%). Asbestos was the most common carcinogen identified. Among 17 compensation processes engaged, 12 succeeded and one is ongoing. The complexity of the administrative process seems to be an obstacle for patients and perpetuates inequality. The implementation of our approach increased the identification and the compensation of occupational lung cancer. Our approach responds to the objectives of the National Cancer Plan and helps to improve the overall care of patients with cancer. This approach has been awarded by the national label in 2011 "Year of the patients and their rights".

[Breast cancer screening in France]. / Le dépistage du cancer du sein en France: bilan et limites.

From a general review of the literature on breast cancer screening, authors appointed by the parliament office for healthcare policy assessment (Office Parlementaire d'Evaluation des Politiques de Santé, OPEPS) demonstrate that, despite recent controversies, screening is both medically and economically effective. The organisation and specifications of screening are considered. The French situation is examined in the light of European recommendations and compared to other systems in place. After analysing the outcome of screening, particularly the results of the 2003 Cancer Plan, the authors considered the risks of screening, and the type of information given to women.

[The cost of cancer in France: macroeconomic and microeconomic approaches, evolution towards a prospective payment system]. / Le coût du cancer en France: approches macro et micro-économiques, évolution vers la tarification à l'activité.

In this article we have reviewed the cost of cancer in France, based on a literature review. The cost of the treatment of cancer is estimated to be 10 thousand million euros for 75,000 lives saved annually. The increasing number of economic evaluations of cancer use both a macro economic approach, based on DRG data, and a micro economic approach, based on cost result analysis. These cost studies provide the elements for a decision aid in the context of social demands, budget constraints and the evolution towards a DRG's prospective payment system which characterises present organisation of health care in France.

[A study based on national DRG data to evaluate work load, practice and cost relating to paediatric oncology in French hospitals]. / Un essai d'exploitation de la base nationale du PMSI pour évaluer la spécificité et le coût de la prise en charge hospitaliére des cancers pédiatriques en France.

OBJECTIVES: To assess if our methodology previously used for all cancers remains valid when only 1% of cancers are analysed, we used childhood cancer in French hospitals based on national DRG data. MATERIALS AND METHODS: With a specific algorithm we extracted from the 1999 national DRG data (16,539,352 hospitalisations) the cancer data (2,947,471 hospitalisations) and the reduced cancer data (2,711,025 hospitalisations). We used this reduced cancer data to identify the 77 350 hospitalisations for childhood cancers. RESULTS: The majority of hospitalisations (83%) and the Activity Synthetic Index (ISA) for childhood cancers are concentrated on University hospitals and regional cancer centres. The cost of childhood cancers was estimated to be 136 million euros, with haematology costing 60 million euros. Chemotherapy, which accounted for almost 50% of the ISA is the predominant therapy. DISCUSSION AND CONCLUSION: Our results appear to be consistent with the incidence and the clinical practices described by the population registries and the registry of the French Society for Paediatric Oncology. They correspond also with the organisation of the care of those patients which converges towards the global care of the patient in which the concept of health networks and patient's trajectories are pivotal. However, an investigation inside the hospitals is required to see if our results correspond with the reality. This is the objective of our next study.

[Adjuvant therapy for breast cancer patients: treatment decision tree from a French cancer network]. / Traitement adjuvant du cancer du sein: création d'un arbre de décision thérapeutique au sein d'un réseau de soins.

Although the benefit of adjuvant therapy has largely been demonstrated for patients with local breast cancer, therapeutic indications remain controversial. The French regional cancer network Oncora investigated the decision-making process for this disease. Based on a thorough review of the literature, the risk of relapse and the potential benefit of adjuvant treatments for each group of patients were evaluated. A consensus decision-tree was drawn in which chemotherapy is proposed only to patients in whom it is expected to decrease the risk of relapse by at least 5 %. This approach, based on a widely accepted decision-making model, makes it possible to offer all patients of the network homogeneous treatment options. However, due to the subjectivity of risk/benefit estimations, patients themselves should become more involved in the decision-making process.

[Public health: a true concern in the French political scene]. / La santé publique doit devenir un enjeu du débat politique français.

A recent report of the Senate revealed the difficulties of elaborating an effective cancer policy in France. Senators particularly pointed to the necessity of establishing cancer care priorities and to the tremendous need for medical coordination. This paper will develop the annual state debate on social security funding. The authors will show that health policy is entirely dependent on health economics. We believe that health priorities and health outcomes should be defined before any financial decision is made, this preliminary debate being an essential contribution to evidence-based policy-making in public health.