[Prevalence of cancer, health care and daily life assistance in people aged 75 or over living in the Tarn area (France)]. / Prévalence du cancer, recours aux soins et aide dans la vie quotidienne chez les personnes âgées de 75 ans et plus dans le Tarn (France).

The association between cancer and dependence was estimated using a cross-sectional study among persons 75 years of age or-older in Tarn county (area with a cancer registry recognized by the National Committee of Registries). A representative random sample stratified on age, sex, and size of district, was drawn using the electoral registers. Each person randomly selected answered the questions of a surveyor about previous history of cancer, aid in daily life activities and use of health care. Among 5,161, the questionnaire was filled for 3,368 persons (participation: 65.3%). Only 2.3% declared a past history of cancer (cancers diagnosed before 1982 and cancers of the skin excluded). After verification 12.6% of the men and 5.2% of the women in the sample were found in the registry. This result shows a very high tendency for people not to declare their disease. From 75 years of age, 1 man among 8, and 1 woman among 20 suffer or have suffered from a cancer during the last 12 years. Only a weak association between prevalence of cancer and aid in daily life activities could be found, probably explained by the important polymorbidity existing in this age group. The persons who suffered from cancer, are not more often confined in bed or in old people's home. Regarding use of health care, they see a nurse or their general practitioner more frequently, they have been operated or admitted in the hospital more frequently than persons without a past history of cancer. Persons with a past history of ear-nose-throat cancer differ from other cancers by needing more aid to go out of their home, and by taking medical advice more frequently. Except for the ear-nose-throat cases, cancer (aside from the acute stage) does not generate more dependence or hinder the quality of survival, in comparison to those of people of the same age.

Incidence and cost of adverse drug reactions in a French cancer institute.

OBJECTIVES: The incidence and the cost of adverse drug reactions (ADR) in patients treated by cancer chemotherapy were assessed using hospital database records from 1993 in a French regional cancer institute. METHODS: Patients with ADRs were identified using a list of ICD-9 codes describing potential adverse events. Direct medical costs for treating these ADRs were assessed according to the hospital system of claims data. RESULTS: Among the 3429 in-patients hospitalized in 1993, we found 171 patients (5% of the population) who presented at least one ADR (3.5% of the total number of hospital stays). A total of 313 ADRs occurred in 256 hospital stays (3.5% of the hospital stays in 1993). Of the patients with ADRs 60.2% were female and their mean age was 51.5 years; 106 patients presented with at least one "serious" ADR according to the WHO definition. These ADRs occurred during 130 hospitalizations. In 7 cases, ADRs led to death. There was no relationship between age or sex and the seriousness of the ADR. Of the ADRs 91% was type "A" (predictable). We estimated that the cost of "serious" ADRs was 1.8% of the global budget of the hospital. The average cost of ADRs leading to hospitalization was 33 037 French Francs at the current rate in 1993. This cost represented an additional cost of 32% of the overall cumulative yearly cost per patient in the institution. CONCLUSION: This study emphasizes the medical and economic impact of the management of ADR in anticancer treatments.

Prevalence of cancer in the elderly: discrepancies between self-reported and registry data.

Data on self-reported cancer by a sample of 3349 elderly persons in the south-west of France were validated against registry data in the same region: only 21% of the persons on the cancer registry reported occurrence of cancer. Breast cancer was found to be most frequently accurately reported.

Attitudes towards cancer predictive testing and transmission of information to the family.

Before the organisation of breast cancer predictive testing in France, consultands' attitudes towards this kind of testing and towards passing on information about the family cancer risk to their relatives were investigated. This survey was carried out from January 1994 to January 1995 at six specialised cancer genetic clinics located in different parts of France Female consultands who were first degree relatives of cancer patients and who had at least one case of breast cancer in their family, affecting either themselves or a first degree relative or both, participated in this study. Among the 248 eligible consultands attending the clinics during the study period, 84.3% answered a post-consultation questionnaire. Among the 209 respondents, 40.7% (n = 85) were cancer patients and 59.3% (n = 124) were healthy consultands. A high consensus in favour of genetic testing was noted, since 87.7% of the sample stated that they would ask for breast cancer gene testing if this test became available. The underlying assumption of 96.6% of the women was that their health surveillance would be improved after a positive test. A high awareness of the anxiety that would be generated in a family after a positive result was observed and found to be associated (p < 0.05) with the anxiety and depressive profiles of the patients. Half of the healthy respondents said they would not change their attitude towards screening if the results of predictive testing turned out to be negative. Only 13.7% of the 161 patients who stated that the oncogeneticists asked them to contact their relatives firmly refused to do so, mainly because of difficult family relationships.

Cancer genetics clinics: target population and consultees' expectations.

The aim of this study was to determine in healthy consultees attending cancer genetics clinics their risk status, their pathways leading to the clinics, their expectations and perception of cancer risk. In 1994, the consultees at six French centres completed a questionnaire before their first oncogenetic consultation. The oncogeneticists subsequently filled in a standardised form giving their risk assessment. Among the 206 healthy consultees, 91.3% were women, 92.2% had at least one cancer-affected first-degree relative and 73% had a "cancer family risk" as assessed by the oncogeneticist. Sixty-nine per cent of the consultees were referred to the clinics by a physician, 10.4% by their family and 18.8% on their own initiative: 83.5% of the sample perceived their family risk of cancer as being high and this belief was confirmed in 74.3% of the cases studied by the oncogeneticist. The families of self-referred consultees were less often at risk than those of consultees referred by a physician or by their family (P = 0.012). The majority (78%) expected to be informed about cancer prevention and screening, and this expectation depended on the consultee's level of education (P = 0.001). This study shows that medical pathways are more effective than the media as a means of reaching the members of the general population who are genuinely at risk, and shows that fuller information about prevention needs to be provided at cancer genetic consultations.