BRACAVENIR: an observational study of expectations and coping in young women with high hereditary risk of breast and ovarian cancer.

BACKGROUND: In families with high risk of hereditary breast/ovarian cancer (HBOC), women before age 30 do not yet undergo clinical screening, but they are exposed to contradictory information from diverse sources. They may be presented with surgical prevention options at a key moment of their identity construction, the start of a marital relationship and/or at the onset of procreation projects. We tested an original psychoeducational intervention to help these women better cope with these difficult issues. METHODS: Seven young female counselees (26.4 ± 2.9 years [23-30]) from the Oncogenetics Department at Jean Perrin Comprehensive Cancer Center were enrolled. A weekend group workshop composed of short conferences, group sharing and role playing activities was supervised by a psychotherapist. A longitudinal analysis of questionnaires over one year of follow-up was performed. The Herth Hope Inventory was evaluated, as well as self-esteem, anxiety, perceived control, coping, and quality of life. Participants' comments were collected by a genetic counselor throughout the workshop. RESULTS: All participants were BRCA mutation carriers and six had lived with a close relative affected by breast/ovarian cancer. Hope, self-esteem and quality of life increased during the year after the workshop (p = 0.0003). Coping by focus on the problem increased in the first 6 months (p = 0.011) and returned to baseline values at one year, while coping by focus on emotions decreased steadily (p = 0.021). Debriefing from the workshop highlighted the new medical opportunities proposed and the challenges these young women face, such as whether to have prophylactic surgery, and if so before or after having children, and how surgery might affect their relationship with their partner. CONCLUSION: A tailored two-day psychoeducational workshop may be sufficient to improve the way young women with BRCA mutations deal with the implications of HBOC risk. TRIAL REGISTRATION: BRACAVENIR was registered in ClinicalTrials.gov with no NCT02705924.

[Re-establishing access to care for the most disadvantaged in rural areas]. / Renouer avec l'accès aux soins des plus démunis en milieu rural.

Inhabitants of rural areas are not spared deprivation. In May 2013 Médecins du Monde created a Health and Coordination Support Network in Auvergne with the aim of reintegrating them into the general healthcare system.

Health and Fitness Benefits But Low Adherence Rate: Effect of a 10-Month Onsite Physical Activity Program Among Tertiary Employees.

OBJECTIVE: The aim of this study was to assess the effects of a 10-month structured physical activity intervention implemented within the workplace on overall health indicators among tertiary (office workers) employees. METHODS: In this quasi-experimental study, 224 employees followed a 10-month worksite physical activity program. Overall health was assessed at baseline, after 5 months, and by the end of the intervention. RESULTS: Fat mass percentage decreased significantly. There was a time effect favoring push-ups, abdominal strength, flexibility, heart rate postexercise, heart rate +30 seconds, and heart rate +60 seconds postexercise. Anxiety, depression, and eating habits also improved. In total, 45% of participants completed the whole intervention. CONCLUSION: Although a structured on-site physical activity program supports improved health indicators, adherence remains a concern and requires specialists to develop new strategies.

Effect of Work-Related Sedentary Time on Overall Health Profile in Active vs. Inactive Office Workers.

Objective: While public health strategies are developed to fight sedentary behaviors and promote physical activity, some professional activities, and especially tertiary ones, have been pointed out for their highly sedentary nature. Although workplace physical activity programs are increasingly proposed by companies to their employees in order to increase their physical activity levels, sitting and screen time remain extremely high. The main aim of this work was to compare health indicators between active and inactive tertiary employees with similar high levels of sedentariness. Secondly, we questioned the effects of a 5-month workplace physical activity program on overall health indicators among initially active and inactive tertiary employees. Methods: Anthropometric measurements, body composition (bio-impedance), physical fitness (cardiorespiratory and musculoskeletal fitness) and health-related quality of life and perception of health status (self-reported questionnaires) were assessed among 193 active and inactive tertiary employees before (T0) and after a 5-month workplace physical activity intervention (T1), composed of 2 physical sessions per week. Results: Significant improvements were found in performance of push-ups (p < 0.001), back muscle strength (p < 0.001) fat mass (p < 0.01) and waist circumference (p < 0.05) in active compared with inactive employees both at baseline and at the end of the program. Health perception (p < 0.001) was significantly different between groups at T0 but not at T1. However, no significant difference was observed for fat-free mass, BMI, workplace well-being and lower and upper limbs muscle strength. The variations between T0 and T1 demonstrate that, while all the studied parameters progressed positively during the 5-month program, health perception (p < 0.001), back muscle strength (p < 0.05) and BMI (tendency) showed a significantly higher progression in the inactive compared with the active group. Conclusion: Health indicators might not be improved among active tertiary employees compared with inactive ones, which might be due to the high level of sedentariness characterizing their occupational task.Structured on-site physical activity programs can improve health in both initially active and inactive employees.

BRACAVENIR - impact of a psychoeducational intervention on expectations and coping in young women (aged 18-30 years) exposed to a high familial breast/ovarian cancer risk: study protocol for a randomized controlled trial.

BACKGROUND: Young women exposed to a high hereditary breast and ovarian cancer (HBOC) risk are particularly vulnerable. They are ignored by health prevention measures but exposed to a stream of contradictory information (medicine, media, Internet). They may feel concerned about surgical prevention issues at a key moment of their identity construction (self, relationship, sexuality). We designed a special psychoeducational intervention to help these women cope better with these difficulties. METHODS/DESIGN: The BRACAVENIR study consists of a prospective, randomized superiority phase II trial with a wait list control group. Participants are childless young female counselees (aged 18-30 years) seen at the oncogenetics department of the Centre Jean Perrin and belonging to HBOC families either with or without BRCA mutations. They will be invited to attend a weekend group session at a spa resort and to participate in short expert conferences and focus group activities (group sharing, Moreno role game) supervised by a psychotherapist. Two sessions separated by a 6-month delay (wait list) will enable us to evaluate the intervention's effect by comparing questionnaire scores between the 6-month time points. The main endpoint is an increase of the Herth Hope Index by at least 1 SD. Secondary endpoints are self-esteem, anxiety trait, anxiety state, coping, and quality of life. With a one-sided α = 0.05 and ß = 0.20, 12 participants will be needed by group, plus an additional 2 in anticipation of dropouts. Participants will be randomized 1:1 to the first or the second session so that the groups will be comparable. DISCUSSION: The intent of this trial is to bridge the gap on a psychosocial level in these young women with HBOC. A particularity of the design is the use of a waiting list, which should allow for avoiding major bias. The intervention consists of a short session that could be proposed to other young counselees if successful. The results may bring complementary information to facilitate the intervention and also influence the contents of the oncogenetic consultation. TRIAL REGISTRATION: Ethics committee CPP SUD-EST-6: IRB00008526. Registered on 18 March 2016. ClinicalTrials.gov identifier: NCT02705924 . Registered on 2 March 2016.

[Informing the family: emotions and attitudes of oncogenetic counselees for familial breast/ovarian and/or colon cancer risk]. / Informer la famille : émotions et attitudes du consultant en oncogénétique pour risque familial de cancer sein/ovaire ou côlon.

BACKGROUND: Transmission of oncogenetic information (TOI) by probands to their families is of major importance to organize medical prevention in his family. Little is known about the difficulties that the proband faces when he tries to endorse his "duty to warn". METHODS: To characterize the barriers to TOI, a survey was performed, previously to the bioethic law of 2011, on a representative sample of 337 counselees seen in the last 10 years at the Centre Jean-Perrin Oncogenetics Department. A questionnaire comprising 97 items was prepared by experts and validated by a group of patients and health professionals. Nineteen Lickert-scale questions specially concerned TOI. RESULTS: Analysis found two dimensions, one of emotions and one concerning communication attitudes. Both dimensions were negatively correlated (r=-0.34, P<10(-7)): high emotional levels limited communication attitudes. The probands' history of cancer was the main factor impacting TOI. TOI was more difficult for cancer patients than for healthy counselees (P=0.025). Delay since consultation and type of cancer risk had no bearing on TOI. CONCLUSION: Cancer and its treatments seem to deeply affect patient's relatives and limit his capacity to involve his family into the oncogenetic inquiry. Measures are suggested to help ex-patients improve TOI.

Permanence of the information given during oncogenetic counseling to persons at familial risk of breast/ovarian and/or colon cancer.

How long counselees retain the information given during their genetic consultation is of major importance. To address this issue, we conducted a survey among the 3500 families that have been offered genetic counseling at our Center since 1988. In August 2007, we mailed a questionnaire to a representative subset of 579 persons belonging to breast/ovarian or colon cancer families seen in the last 10 years, either carrying an identified mutation or not. Targeted topics included the meaning of hereditary predisposition, the medical prevention related to the familial risk, the steps to undertake for a new family member to enter the genetic testing program and general knowledge of hereditary predisposition to cancer. A total of 91 randomized non-respondents were sent a second, more inciting letter, in order to assess any non-response bias. Overall, 337 questionnaires were collected: response rate was 58%. Standardized average knowledge was 7.28±1.52 of 10. Scores were lowest concerning medical prevention. The level of knowledge decreased with age (P<10(-6)), but increased with educational level (P<10(-5)) and mutation status (P=0.01). Surprisingly, no erosion of patients' knowledge over the time was observed (P=0.41). Among persons at hereditary risk of colon cancer, the level of knowledge tended to improve with time, in contrast to the breast/ovarian group (P=0.017). Among persons with a familial risk of breast/ovarian or colon cancer, a renewal of oncogenetic counseling does not seem necessary to maintain the level of specific knowledge. Measures to help patients follow their medical prevention, as organizing or checking their medical examinations, seem indicated.