[Lung cancer, how to deal with critical situations?]. / Cancer bronchique, la gestion des situations critiques.

The management of a patient with cancer, including lung cancer requires the investment of many health caregivers. The development of surgical techniques as well as targeted therapies requires a specialization of each. In order to optimize the actions of each, coordination of support is required from the diagnosis of cancer. This coordination can reduce iatrogenic toxicity and improve quality of life during the disease. It may also enhance quality of accompaniment of the patient, his family and a fortiori the health care team. The development of this coordination of supportive care in oncology, as part of a department of cancerology including care of patients with lung cancer is described. This organization allows to limit the toxicities of cancer treatment, but also to improve the suffering of patients by focusing on maintaining the patient at home.

[Decision process in oncology: the importance of multidisciplinary meeting]. / La réunion de concertation pluridisciplinaire : quelle place dans la décision médicale en cancérologie ?

Multidisciplinary meeting (MDM) in oncology has been institutionalised in France by the Cancer Plan. This study aims to determine the place of MDM in the decision process. From November 2004 to July 2005, we observed 29 meetings at the Tours Hospital and 324 case presentations, 80 in orthopaedics, 151 in gastroenterology and 93 in chest medicine. Forty physicians attending the meetings answered a questionnaire exploring their opinions on MDM and the collegial decision. We found that MDM is mostly the place for technical discussions and that patients' wishes are rarely addressed. The different medical specialities are well represented but we observed that only physicians attend MDM. Decisions for straightforward cases are rapidly validated. For more complex clinical situations (25 to 40% of case presentations), the multidisciplinary approach allows to adapt guidelines or to choose alternative treatments. All the physicians interviewed express that MDM legitimates the medical decision. It occurs that they disagree with the RCP decision. We discuss how MDM impacts on the medical decision as well as the shift from the individual decision to the collective one, particularly in term of responsibility.

[Psychosocial distress and communication about cancer in ill partners and their spouses]. / Détresse psychosociale et communication à propos du cancer chez le partenaire malade et son conjoint.

INTRODUCTION: Each cancer can have a psychological impact not only on the patient himself/herself, but also on his/her spouse. OBJECTIVE: Our study concerned 30 couples encompassing a member treated for a cancer, non related to gender. It was aimed at determining the links between the levels of psychosocial distress measured in both members of each couple, patients' sociodemographic and clinical characteristics, as well as communication skills about cancer in both members of the couples. METHODS: Psychosocial distress and communication about cancer were measured by the general health questionnaire (GHQ-28) and the openness to discuss cancer in the nuclear family (ODCF), with an additional version adapted for the spouse on the occasion of this study. RESULTS: A positive correlation was found between the respective scores of the two members of the couples, for the GHQ-28 (r=0.53; p=0.005) as well as for the ODCF (r=0.44; p=0.024). GHQ-28 scores were not associated with the sociodemographic characteristics of the patients, nor with the stage of cancer, the number of months elapsed since the diagnosis of cancer, or the ODCF personal or spouse's score. On the other hand, when the communication within each couple was classified into concordant (insufficient or, on the contrary, open for both members) or discordant (insufficient for one of the two members and open for the other), and after controlling for gender, higher levels of psychosocial distress were found in patients (p=0.038) as well in spouses (p=0.052) belonging to discordant compared with concordant couples. CONCLUSION: These results suggest an effect of contamination or a mutual reinforcement of the distress of each member of such couples, as well as the presence of relatively similar styles of communication in the two partners of each couple. They also underline the possible adaptive function of a restricted style of communication about cancer, if such a restriction is shared by both the members of the couple, and incites particular attention to be paid to couples where one of the partners, but not the other, adopt an open style of communication about cancer.

[Influence of the communication about one parent's cancer on children's suffering]. / Influence de la communication à propos du cancer d'un parent sur la souffrance des enfants.

INTRODUCTION: Factors contributing to children's distress when a parent is affected with a cancer are still insufficiently known. This study aimed at searching for associations between psychosocial distress in children living with a parent suffering from cancer, the severity of parental cancer, the levels of psychosocial distress in both parents and the openness to discuss cancer in the family. METHODS: Thirty families encompassing a parent treated for cancer and 54 children aged four to 16 were examined. Each parent's psychosocial distress was assessed by the General Health Questionnaire (GHQ-28) and the distress of the children living within the family by the Child Behavior Check List (CBCL) filled out by both parents. Each parent's communication ability about cancer was assessed by the Openness to Discuss Cancer in the nuclear Family questionnaire (ODCF). RESULTS: No association was found between children's distress and objective cancer characteristics. Higher externalized disorders scores at CBCL (aggression) were found when the ill parent was the mother (P=0.018). After controlling for cancer parent's gender, CBCL total score and internalized disorders (anxiety, depression) score were higher in families characterized by an "open" style of communication, defined on the parental couple as a whole (respectively p=0.007 and 0.024), such an effect being present only when the ill parent was the mother (interaction effect: p<0.001). CONCLUSION: These results underline the importance of family characteristics for understanding the suffering observed in children living with a parent affected with a cancer in comparison with objective cancer characteristics.