["Standards, Options and Recommendations 2001" for radiotherapy in patients with non-metastatic infiltrating breast cancer. Update. National Federation of Cancer Campaign Centers (FNCLCC)]. / Standards, Options et Recommandations 2001 pour la radiothérapie des patientes atteintes d'un cancer du sein infiltrant non métastatique, mise à jour. Fédération nationale des centres de lutte contre le cancer (FNCLCC).

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of french cancer centers (FNCLCC), the 20 french cancer centers, and specialists from french public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines for non metastatic breast cancer patients according to the definitions of the Standards, Options and Recommendations project. METHODS: Data were identified by searching Medline, web sites, and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 148 independent reviewers. RESULTS: This article presents the chapter radiotherapy resulting from the 2001 update of the version first published in 1996. The modified 2001 version of the standards, options and recommendations takes into account new information published. The main recommendations are: (1) Breast irradiation after conservative surgery significantly decrease the risk of local recurrence (level of evidence A) and the decrease in the risk of local recidive after chest wall irradiation is greater as the number of risk factors for local recurrence increases (level of evidence A). (2) After conservative surgery, a whole breast irradiation should be performed at a minimum dose of 50 Gy in 25 fractions (standard, level of evidence A). (3) A boost in the tumour bed should be performed in women under 50 years, even if the surgical margins are free (standard, level of evidence B). (4) Internal mammary chain irradiation is indicated for internal or central tumours in the absence of axillary lymph node involvement (expert agreement) and in the presence of lymph node involvement (standard, level of evidence B1). (5) Sub- and supra-claviculr lymph node irradiation is indicated in patients with axillary node involvement (standard, level of evidence B1).

[Incidence, risk factors and adequation of early readmission among the elderly]. / Incidence, facteurs de risque et adéquation des réhospitalisations à court terme de personnes âgées.

BACKGROUND: The objectives of the study were to estimate the incidence of readmission one month after discharge, to determine the proportion of planned readmissions and of those avoidable, and to identify risk factors associated with early readmissions in elderly admitted to an acute geriatric unit. METHODS: A prospective study was conducted on a sample of 322 patients, 75 years of age or older, discharged from an acute geriatric service. A phone follow-up was realized one month after discharge. A multivariate logistic regression model was used to identify risk factors for readmission. RESULTS: Global incidence of early readmission was 16.2% (that is 50 rehospitalizations), 18.0% of which were planned. Among the 21 readmissions to the same service, five were avoidable according to the Appropriateness Evaluation Protocol. Logistic regression analysis identified three patient characteristics that were independent predictors of early readmission, which were: a need of help for locomotion (OR=4.38, p=0.002), a negative answer to the question "do you feel that your life is empty?" (OR=2.22, p=0.02) and a short length of stay (p<0.02). CONCLUSION: A better knowledge of risk factors should allow targeting patients at high risk of early hospital readmission, which should profit by preventive interventions during the first hospitalization. Two domains of possible action were identified in this study: a sufficient length of stay and a better attention to patients with reduced autonomy, especially for those who go back home after discharge.

[Evaluation of the first social consultation in oncology: a series of 200 cases. Groupe de recherche de l'action médico-sociale en Aquitaine (Gramsa)]. / Evaluation d'une première consultation sociale en cancérologie: à propos de 200 situations. Groupe de recherche de l'action médico-sociale en Aquitaine (Gramsa).

The aim of the present study is to evaluate the clinical social work in oncology. We present a series of 137 men and 63 women treated for cancer (mean age: 57 y; 20-90) who were addressed (65%) or came spontaneously (35%) for a first social consultation; 45 consultations concerned the family at the day of death of the patient. The collected data (expressed requests, evaluated real difficulties, orientations of the social work, necessity of network) are correlated with the medical data and the time between diagnosis and social consultation. The social intervention is often brief (95%) and focused (66%). A medical and social network is used in 70% of cases. The administrative and psychosocial problems predominate with an important discordance between the requests and the evaluated difficulties. The metastatic status increases psychosocial, legal difficulties and problems of the organisation of home-care. The delay of the social consultation has great influence upon the legal difficulties. The family's difficulties, after the patient's death are administrative (93.3%), psychosocial (84.4%) and legal (68.9%). Clinical social work is part of the global management of patients and their families; its quality has direct implication on their daily life during and after treatment.

[Does the professional image of the social worker in oncology correspond to the current challenges of the job? Apropos of a survey of patients and care professionals]. / L'image professionnelle de l'assistante sociale en cancérologie correspond-elle aux défis actuels de sa pratique? A propos d'une enquête auprès de patients et de partenaires institutionnels.

Care professionals (physicians and nurses), administrative staff and hospitalised patients were interviewed to find out the necessary qualities for social workers in oncology, as well as the roles and tasks that they must fulfil. On the one hand, the results of this study show that the needs of the interested parties are indeed met by social service from an empirical perspective of psychosocial support and expert advice. On the other hand, they bring to light the fact that the current status of the social worker is hardly recognized. Confronted with new occupational challenges, the social worker should rethink his/her profession and reevaluate his/her practice. Furthermore, he/she should develop professional links intra- and extramural and participate in social research programs whose aim is to improve the rehabilitation of patients and their families.