[Physical activity in the oncology care pathway: Expectations and perspectives]. / L'activité physique dans le parcours de soins en cancérologie : attentes et perspectives.

INTRODUCTION: Despite the benefits of an active lifestyle on health, there are still difficulties for patients, during and beyond cancer treatment, to initiate and maintain physical activity. A workshop was organized based on cooperation, coordination of the collective for and with the patient. METHODS: Ninety-six people - patients, relatives and professionals - were divided into five workgroups according to the cancer care continuum or according to specific clinical situations. Subgroups had to develop a common reflection around a representative fictive patient in order to (i) identify the factors that are in favor or not of physical activity practice, (ii) estimate at what extent it is possible to act on these factors, and (iii) to guide the fictive patient in the initiation and the maintenance of physical activity. Finally, the participants were asked to propose actions, strategies and tools to facilitate this process. The participants' writings and the moderators' summaries were collected and transcribed. RESULTS: Offers exist on the territory and their variety, plebiscited, is effective. However, their knowledge and the coordination allowing patients to access them must be reinforced through multidisciplinary network integrating patient-experts, training, digital technology use, and implementation research. DISCUSSION: The workshop has initiated a part of the conditions for collective empowerment which, if the process was created, could act on the structural determinants of patients' health.

A phase III randomized trial of weight loss to reduce cancer-related fatigue among overweight and obese breast cancer patients: MEDEA Study design.

BACKGROUND: Elevated body mass index (BMI) represents a risk factor for cancer-related fatigue (CRF). Weight loss interventions are feasible and safe in cancer survivors, leading to improved cardio-metabolic and quality of life (QOL) outcomes and modulating inflammatory biomarkers. Randomized data are lacking showing that a lifestyle intervention aimed at weight loss, combining improved diet, exercise, and motivational counseling, reduces CRF. Motivating to Exercise and Diet, and Educating to healthy behaviors After breast cancer (MEDEA) is a multi-center, randomized controlled trial evaluating the impact of weight loss on CRF in overweight or obese survivors of breast cancer. Herein, we described the MEDEA methodology. METHODS: Patients (N = 220) with stage I-III breast cancer and BMI ≥ 25 kg/m2, within 12 months of primary treatment, and able to walk ≥ 400 m are eligible to enroll. Participants are randomized 1:1 to health education alone vs. a personalized telephone-based weight loss intervention plus health education. Both arms receive a health education program focusing on healthy living. Patients in the intervention arm are paired with an individual lifestyle coach, who delivers the intervention through 24 semi-structured telephone calls over 1 year. Intervention goals include weight loss ≥ 10% of baseline, caloric restriction of 500-1000 Kcal/day, and increased physical activity (PA) to 150 (initial phase) and 225-300 min/week (maintenance phase). The intervention is based on the social cognitive theory and is adapted from the Breast Cancer Weight Loss trial (BWEL, A011401). The primary endpoint is the difference in self-reported CRF (EORTC QLQ-C30) between arms. Secondary endpoints include the following: QOL (EORTC QLQ-C30, -BR45, -FA12), anxiety, and depression (HADS); weight and BMI, dietary habits and quality, PA, and sleep; health care costs (hospital-admissions, all-drug consumption, sick leaves) and cost-effectiveness (cost per quality-adjusted life-year); and patient motivation and satisfaction. The primary analysis of MEDEA will compare self-reported CRF at 12 months post-randomization between arms, with 80.0% power (two-sided α = 0.05) to detect a standardized effect size of 0.40. DISCUSSION: MEDEA will test the impact of a weight loss intervention on CRF among overweight or obese BC survivors, potentially providing additional management strategies and contributing to establish weight loss support as a new standard of clinical care. TRIAL REGISTRATION: ClinicalTrials.gov NCT04304924.

[Feedback on a complementary care program combining physical activity, mindfulness-based meditation and socio-aesthetic care]. / Retour d'expérience sur un programme de soins complémentaires associant activité physique adaptée, méditation basée sur la pleine conscience et soins en socio-esthétique.

INTRODUCTION: Increasing physical activity among cancer patients is one of the priority recommendations in tertiary prevention; the level of physical activity is one of the determining factors in reducing the risk of relapse and mortality. However, many barriers to initiation and maintenance of regular physical activity have been identified. A program combining bi-weekly adapted physical activity sessions, mindfulness-based meditation and socio-aesthetic care was put together in 2015, in a Cancer Center, in order to facilitate adherence and sustainable attendance. METHODS: Data on patient participation of program components, patient satisfaction, and psycho-corporal changes, collected in ecological conditions between 2015 and 2017 from 144 participants, were retrospectively analyzed to provide a first assessment. RESULTS: Nearly 60% of the patients were in treatment, 17% were metastatic. The average participation time was 9 months, with an average of one physical activity session per week. Changes were observed, both quantitatively and qualitatively, in terms of emotional state, sleep and body image. The overall satisfaction rate was 96%. DISCUSSION: The conclusions of the study support the continuation of the program. The methodological limitations of this pilot format may be overtaken in future research, which will allow further in-depth investigations into the effects of combined approaches on sustainable physical activity.

[Interdisciplinarity in action: "trap-words" in interdisciplinary research]. / L'interdisciplinarité en action: les "mots-pièges" d'une recherche interdisciplinaire.

CONTEXT: Interdisciplinary work is essential to understand and address Social Inequalities in Health (SIH), but involves a number of practical difficulties. The AAPRISS programme, comprises project leaders and researchers from various disciplines in order to co-construct the reorientation of prevention projects, in order to more effectively reduce SIH. Certain challenges emerged during this project concerning the interdisciplinary work, especially misunderstanding of certain terms with different meanings according to various disciplines, within the same discipline, or even between British and US English. The objective is to identify these "trap-words" in order to create a glossary clearly explaining the various meanings, rather than rigidly defining a unique correct definition. METHODS: The words leading to misunderstandings were identified and several definitions were provided by participating researchers and literature searches. RESULTS: Five sets of words were defined: "politique, programme, projet et intervention"; "impact"; "ressortissant, public cible, population cible, bénéficiaire, et communauté"; "inégalités sociales de santé, disparités et iniquités"; and "protocole". DISCUSSION: Issues raised by the construction of this glossary, designed to support co-construction between researchers from different disciplines, allow reflection on the richness and difficulties of interdisciplinary research.