[Psycho-oncological interventions: What type of psychotherapeutic innovations?] / Interventions psycho-oncologiques : quelles approches innovantes ?

Psycho-oncology is evolving in line with oncology progress and increasing complexity, but also with change in cancer care organization. Alongside the more traditional psycho-oncological interventions, such as the support or verbal psychotherapy of various inspirations (psychodynamic, integrative, systemic, existential) and body-mediated approaches, that allow the patient to be accompanied throughout his/her cancer care trajectory, psycho-oncology is now benefiting from the development of more structured interventions, often brief and targeted at a specific situation or symptom. This article reviews three of these new psychotherapeutic approaches, which are largely developed in the Anglo-Saxon world: the management of fear of recurrence by CBT third wave strategies, ACT therapy or, more recently, EMDR to answer to psychotraumatic situations. We describe here the principles, the main indications in oncology patients and the expected clinical benefits. It also presents tools such as Questionnaire Prompt Lists for optimizing the communication between patients and health professionals, which constitute a psychotherapeutic intervention by itself.

[Alopecia and cancers: From basics to clinical practice]. / Alopécie et cancers : de la physiopathologie à la pratique clinique.

Alopecia, although long considered an unavoidable consequence of cancer therapy, currently presents a multifaceted challenge. The knowledge of the physiology of the hair and consequently of the pathophysiology of alopecia has led to show that there is not one but several types of alopecia. Transposed to the world of oncology, different types of alopecia and subsequently molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. Thus, in patients with cancer, alopecia can be iatrogenic (chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy, surgery) or directly the consequence of the disease itself (malnutrition, scalp metastases, paraneoplastic syndromes). Knowledge of the incriminated mechanism(s) could thus make it possible to deploy an appropriate care component, whether on the preventive or curative sides or in terms of supportive care. These are particularly essential regarding the psychological repercussions caused by alopecia, with significant consequences on the quality of life of patients and with a potential impact on treatment compliance. On the preventive side, the last few years have seen the advent of the automated scalp cooling therapy, supported by several randomized clinical trials. On the curative side, several therapeutic proposals are currently deployed or under development in order to provide relevant treatments.

[What do chemotherapy specialists expect of lung cancer?] / Qu'attendent les médecins spécialistes de la chimiothérapie des cancers du poumon ?

OBJECTIVE: In an attempt to understand physicians' expectations of chemotherapy, a group of lung cancer specialists was involved in an online survey investigating their opinions by a self-questionnaire. The questionnaire described five different chemotherapy prescription situations for lung cancer patients (stages IIIB or IV). METHOD: A total of 30 expert specialists were invited; 22 responded (73%). For each of the clinical situations, the expert was asked for his opinion on 3 items: cure, prolongation of survival and alleviation of symptoms. Each item was judged on a Likert scale with categories between -2 "not at all probable" and +2 "quite likely". RESULTS: For "cure", the percentage of -2 responses differed significantly according to the clinical situation (Fisher test: P<0.00001). The trend test showed a relationship between the percentage of -2 responses and the suspected order of the clinical situations (Cochran-Armitage trend test: P<0.0001). For symptom alleviation, the percentage of responses +2 and +1 differed significantly according to the clinical situation (Fisher test: P=0.00013, trend test: P<0.0001). CONCLUSION: What specialist physicians expect of chemotherapy in terms of curability and symptom relief differs according to the actual statistical prognosis of each situation as presented in the literature. The worst prognostic situation leads to the strongest expectation in terms of symptom relief and, conversely, the lowest for curability.

[Screening psychological distress in breast cancer patients on treatment]. / Dépistage de la détresse psychologique chez les patientes en cours de traitement du cancer du sein.

OBJECTIVE: The aim of our study was to evaluate emotional distress among women with breast cancer treated by radiotherapy, using a Visual Analogue Scale (an adaptation of the "Distress Thermometer" French version) associated with a Needs Scale with several items, in order to identify patients requiring psychological care. METHOD: Our sample is composed of 277 women treated for breast cancer with radiotherapy. Our psychological evaluation is made of a first enquiry using a visual analogue distress scale and complemented by a Needs Scale with several items. A grade above 3 on the visual analogue distress scale is a reliable indicator; a grade above 4 out of 20 leads us to propose the patient a consultation with a psychologist. RESULTS: Two hundred and sixty-four female patients with a mean age of 61 years are the object of the study. Among them, 59.2% of patients display a disarray of low intensity (psychological suffering graded between 0 and 2) whereas 40% show a grade equal or superior to 3, considered as pathological on a psychological side: 30% of the patients have a grade between 3 et 5 and less than 2% of the patients display a grade reaching 9 or 10. Concerning the Needs Scale, more than 80% of the patients show a total score below 10 out of 20 and we observe a positive correlation between the total score of the Needs Scale with several items and the Visual Analogue Distress Scale score. CONCLUSION: Our results highlight the difficulty for most of the patients to cope with emotional distress linked to their disease. We discuss the necessity to increase awareness among caregivers on this psychological distress, through the use of simple tools such as a Visual Analogue Scale associated with a Needs Scale, so as to provide a holistic care for women with breast cancer.

Selection of ultimately ill cancer patients able to fulfill a questionnaire: Identification of inherent biases.

AIM: Physical or psychological well-being is an essential component of quality care assessment in palliative unit. This assessment is mainly based on self-assessment (questionnaires or interviews). The aim of this study is to compare the clinical characteristics of patients able to fulfill a questionnaire and those not able to do that. METHODS: The clinical characteristics of 166 cancer patients admitted in palliative care unit from December 2006 to February 2008 have been collected. Characteristics of patients able to fulfill a questionnaire (80, 48.2%) have been compared to other patients (86, 51.8%). Moreover, functional independence measure (FIM) had been evaluated by nurses. RESULTS: Median age (60 versus 62) and sex ratio (40/40 versus 42/44) are similar in both groups. Lung primaries are significantly less frequent in patients able to fulfill the questionnaire (4% versus 17%, P=0.005). Patients able to fulfill the questionnaire had had better performance status (Karnofsky Index≤30%: 54% versus 21%, P<0.0001). The total score of FIM (56.0 versus 91.5, P<0.00001) and the median overall survivals (2.3 weeks versus 6.6 weeks, P=0.0001) were significantly lower in the group of patients non able to fulfill the questionnaire. CONCLUSIONS: Patients able to fulfill a questionnaire represent only 48.2% of all consecutive admitted patients. These patients are not representative of all patients since they had better performance status, they are less dependent and they display significant better survival. We have to think about new methods to avoid the biases generated by the use of patient-reported outcomes.

Psico-Oncologia: atuação do psicólogo no Hospital de Câncer de Barretos / Psycho-oncology: the psychologist in the Barretos Cancer Hospital / Psico-oncología: el psicólogo en el Hospital del Cáncer de Barretos / La psycho-oncologie: le psychologue à L' Hôspital des Cancers de Barretos

A Psico-Oncologia surgiu a partir da necessidade do acompanhamento psicológico ao paciente com câncer, a sua família e à equipe que o acompanha. O papel do psicólogo em oncologia propõe o apoio psicossocial e psicoterapêutico diante do impacto do diagnóstico e de suas consequências e mostra a possibilidade de auxílio para melhor enfrentamento e qualidade de vida do doente e de seus familiares. O objetivo deste relato consiste em descrever a atuação desenvolvida por psicólogos do Serviço de Psicologia do Hospital de Câncer de Barretos/Fundação Pio XII - SP, uma instituição médica especializada em oncologia.(AU)

Psycho-oncology arose from the need of psychological intervention for patients with cancer, their families and medical staff. The role of the psychologist in this field is to provide psychosocial support and psychotherapy in face of the impact of the diagnosis and its aftermath. It aims at facilitating better coping and quality of life for patients and their families. The objective of this report is to describe the actions developed by the psychologists of the Department of Psychology at the Barretos Cancer Hospital/ Pio XII Foundation - SP, a medical institution specialized in oncology.(AU)

La Psico-oncología surgió de la necesidad del acompañamiento psicológico al paciente con cáncer, su familia y el personal que lo acompaña. El papel del psicólogo en oncología ofrece apoyo psicosocial y psicoterapéutico contra el impacto del diagnostico y sus consecuencias, y muestra la posibilidad de una ayuda a un mejor afrontamiento y calidad de vida de los pacientes y sus familias. El propósito de este informe es describir el papel desarrollado por psicólogos del Servicio de Psicología del Hospital de Cáncer de Barretos/Fundación Pio XII - SP - Brasil, una institución médica especializada en oncología.(AU)

La psycho-oncologie aborde la nécessité de l`accompagnemente psychique des patients avec le cancer, sa famille et l'équipe qui lui accompagnent. Le rôle du psychologue qui travaille dans le service d'oncologie propose un appui psychosocial et psychothérapeutique devant l'impacte de la diagnostique et ses consequences, et montre la possibilité d'une aide pour le meilheur affaire face à la qualité de la vie du pacient et de ses familliers. L'object de ce rapport c'est la description de la performance du psycologue de l'Hôpital des Cancers de Barretos - Fondaction Pio XII - São Paulo - Brésil, une institution médicale specialisée en oncologie.(AU)

Psico-Oncologia: atuação do psicólogo no Hospital de Câncer de Barretos / Psycho-oncology: the psychologist in the Barretos Cancer Hospital / Psico-oncología: el psicólogo en el Hospital del Cáncer de Barretos / La psycho-oncologie: le psychologue à L' Hôspital des Cancers de Barretos

A Psico-Oncologia surgiu a partir da necessidade do acompanhamento psicológico ao paciente com câncer, a sua família e à equipe que o acompanha. O papel do psicólogo em oncologia propõe o apoio psicossocial e psicoterapêutico diante do impacto do diagnóstico e de suas consequências e mostra a possibilidade de auxílio para melhor enfrentamento e qualidade de vida do doente e de seus familiares. O objetivo deste relato consiste em descrever a atuação desenvolvida por psicólogos do Serviço de Psicologia do Hospital de Câncer de Barretos/Fundação Pio XII - SP, uma instituição médica especializada em oncologia.

Psycho-oncology arose from the need of psychological intervention for patients with cancer, their families and medical staff. The role of the psychologist in this field is to provide psychosocial support and psychotherapy in face of the impact of the diagnosis and its aftermath. It aims at facilitating better coping and quality of life for patients and their families. The objective of this report is to describe the actions developed by the psychologists of the Department of Psychology at the Barretos Cancer Hospital/ Pio XII Foundation - SP, a medical institution specialized in oncology.

La Psico-oncología surgió de la necesidad del acompañamiento psicológico al paciente con cáncer, su familia y el personal que lo acompaña. El papel del psicólogo en oncología ofrece apoyo psicosocial y psicoterapéutico contra el impacto del diagnostico y sus consecuencias, y muestra la posibilidad de una ayuda a un mejor afrontamiento y calidad de vida de los pacientes y sus familias. El propósito de este informe es describir el papel desarrollado por psicólogos del Servicio de Psicología del Hospital de Cáncer de Barretos/Fundación Pio XII - SP - Brasil, una institución médica especializada en oncología.

La psycho-oncologie aborde la nécessité de l`accompagnemente psychique des patients avec le cancer, sa famille et l'équipe qui lui accompagnent. Le rôle du psychologue qui travaille dans le service d'oncologie propose un appui psychosocial et psychothérapeutique devant l'impacte de la diagnostique et ses consequences, et montre la possibilité d'une aide pour le meilheur affaire face à la qualité de la vie du pacient et de ses familliers. L'object de ce rapport c'est la description de la performance du psycologue de l'Hôpital des Cancers de Barretos - Fondaction Pio XII - São Paulo - Brésil, une institution médicale specialisée en oncologie.