Embed Size (px)
Citation preview
Cancers gyneacutecologiques et sexualiteacute
Les fondamentaux agrave connaitre par tout professionnel de santeacute
Dr Pierre BONDILurologue-oncologue-sexologue
Centre soins de support ERMIOSCH Chambeacutery 73011
pierrebondilch-metropole-savoiefr
OncobretagneJourneacutees Laurence Leroyer
8e Actualiteacutes et controverses3 avril 2015 Saint Malo
Pourquoi cancer et sexualiteacute (1)
bull Vie sexuelle = paramegravetre pertinent et valideacute QdV et bien-ecirctre
ndash laquohelliptoute ameacutelioration des troubles de la vie sexuelle concourt au bien-ecirctre de lrsquoindividuhellip raquo
ndash large variabiliteacute inter et intra individuelle
ndash agrave tout acircge
bull Demandes fortes et leacutegitimes de preacuteservation retour des
fonctions y comprishellip sexuelles = objectif contemporain prise en charge du cancer
bull Preacutevalence trop eacuteleveacutee de soins de support non satisfaits dans ce domaine
Beaulieu EE et Montagut J CCNE rapport ndeg62 Bondil P et al La Lettre canceacuterologie 201221 165-70 Colson MH et al Prog urol
201222S72-S92 Habold D et al La presse meacutedicale 2014431120-4 Harden H et alJ Cancer Surviv 2008284-94 Matthew AG J
Urol 2005174(6)2105-10 Mulhall et al J Sex Med 201310195-203 Tuppin P et al BMC Urology 2014 14 48-56
Pourquoi cancer et sexualiteacute (2)
bull Iatrogeacutenie sexuelle majeure +++
ndash tous traitements et toutes fonctions sexuelles
ndash tregraves deacutependante
bull cancer lui-mecircme (stade et pronostic)
bull patient (comorbiditeacutes souhaits partenaire environnement socioculturel)
ndash large variabiliteacute morbiditeacute sexuelle (immeacutediate ou diffeacutereacutee transitoire ou durable
leacutegegravere ou seacutevegravere)
bull Malades couples mal preacutepareacutes agrave faire face agrave perte de lrsquointimiteacute sexuelle (surtout laquo jeunes raquo)
bull Importance information communication + eacuteducation theacuterapeutique (preacutevention du risque deacutesinsertion intimiteacute sexuelle raquo)
Bondil P et al La Lettre canceacuterologie 201221 165-70 Chartier-Kastler E et al JSex Med 2008 5(3)693-704 Colson MH et al Prog urol 201222S72-
S92 Habold D et al La presse meacutedicale 2014431120-4 Harden H et alJ Cancer Surviv 2008284-94 Messaoudi R et al prog urol 201121 48-52
Mulhall et al J Sex Med 201310195-203 Tuppin P et al BMC Urology 2014 14 48-56 Wagner L et al Prog urol 200919 (suppl 4)S168-S172
Testicule
Thyroiumlde
Prostate
Meacutelanome
SeinHodgkin
Syndr Myeloprol Chron
Endomegravetre
ReinCol uteacuterus
LMNH
Cocirclon-rectum
VessieLarynx
Myeacutelodysplasie
Ovaire
Estomac
LAM
PoumonŒsophageFoie Pancreacuteas
0
25
50
75
100
0 10 000 20 000 30 000 40 000 50 000
Su
rvie
de
s ca
s d
iag
no
stiq
ueacute
s d
e 1
98
9 agrave
20
04
amp s
uiv
is
jusq
ue
n 2
00
7
Bo
ssa
rd B
EH
20
13
Nombre de cas diagnostiqueacutes en 2012 INVS
Survie nette agrave 10 ans et nombre de cas en 2012
Cancer = de plus en plus une maladie chronique (ovaire 32 vulve vagin 35 col
uteacuterin 59 corps uteacuterin 68)
Pas un mais des cancers
Preacutevalence eacuteleveacutee Kcgeacutenitaux = 40
Concilier parcours de soins ET de vie +++
Qualiteacute vs quantiteacute de vie ni
contradictoire ni neacutegligeable
mais hellip
Axe majeur 3e
Plan Cancer ET obligation
meacutedicale eacutethique et deacuteontologique
Cancer et sexualiteacute
Cancer et sexualiteacute de quoi parle-t-on
La femme la plus sexy du monde en 2014 est une megravere de famille de 40 ans
Deacutefinitions OMS
bull laquo La santeacute est un eacutetat de complet bien-ecirctre physique mental etsocial et ne consiste pas seulement en une absence de maladie oudrsquoinfirmiteacute raquo OMS 1946
bull laquo La santeacute sexuelle est lrsquointeacutegration des aspects somatiquesaffectifs intellectuels et sociaux de lrsquoecirctre sexueacute de faccedilon agraveparvenir agrave un enrichissement et un eacutepanouissement de lapersonnaliteacute humaine de la communication et de lrsquoamour raquo OMS
1975
Organisation Mondiale de la Santeacute (OMS) Deacutefinition de la santeacute de lrsquoOMS [en ligne] Disponible sur http www whointaboutdefinitionfrprinthtml (consulteacute en 2014)bien
Cinq dimensions pour approche soignante moderne = personnaliseacutee
1 santeacute physique 2 santeacute mentale 3 santeacute sexuelle 4 mode de vie5 bien-ecirctre QdV
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal
and cervical cancer a comparison to national norms Gynecol Oncol 2007106413-8
Paramegravetre patient partenaire couple
La vie sexuelle quelle importance
- larges variations inter et intra-individuelle
- multifactorielle (fonction partenaire eacutetat de santeacute temporaliteacute)
29
39
3213
considegravere leur sexualiteacute comme essentielle outregraves importante
13assez important
13peu ou pas important
Les points cardinaux de la sexualiteacute enquecircte Lilly-IPSOS 2004 eacutechantillon 1000 Hgt 34 ans (acircge moyen 52) 8O ayant un(e)
partenaire sexuel
Reacutesultats identiques dans population adulte
atteintes de cancer et de maladies chroniques
+++
Morbiditeacute sexuelle (effets indeacutesirables) varie grade 0 agrave
3 selon individus couples meacutedecins ethellip
temps
Cancer et sexualiteacuteTrois dimensions essentielles
Biologique Identitaire
Relationnelle
Pathologies sexuelles = 1 2 ou 3 dysfonctionnement(s)ET souffrance mal-ecirctre lieacutes au(x) dysfonctionnement(s)
Couple = dimension essentielle de la vie sexuelle
bull Toutes les dimensions de la sexualiteacute = concerneacutees mais 3 principales
1 physique = dyspareunie modification vaginale et diminution activiteacute sexuelle
2 psychologique = baisse deacutesir alteacuterations image corporelle anxieacuteteacute lieacutee
performance sexuelle
3 sociale = difficulteacute conserver rocircle social anteacuterieur distanciation eacutemotionnelle
du partenaire sentiment modification de lrsquointeacuterecirct sexuel du partenaire
bull Majoriteacute de eacutetudes srsquointeacuteressent surtout agrave la dimension physique de la sexualiteacute tregraves
peu sur aspects psycho-eacuteducationnels
bull Les professionnels de santeacute doivent ecirctre plus attentifs aux besoins psychologiques
et sociaux
Quid des preacuteoccupations sexuelles des patientesatteintes de cancers gyneacutecologiques
Que dit la litteacuterature
Abbott-Anderson K Kwekkeboom KL A systematic review of sexual concerns reported by gynecological cancer survivorsGynecol Oncol2012124477-89
Vie sexuelle intime = multifactoriel
Cancers et sexualiteacuteQui est potentiellement concerneacute
bull Tous les patient(e)s = oui (directement ou non )
bull Peu de cancers laquo asexueacutes raquo et trop de cancers laquo orphelins raquo (ORL digestifs heacutemopathieshellip)
bull A tout acircge = souvent (y compris seniors +++)
bull Mais aussi tregraves souvent tous les proches
partenaire +++ parents enfants
bull Soit pregraves de 5 millions drsquoadultes en France
Eton et al Cancer 2005 Beck et al Urol Oncol 2009 Street et al Eur J Cancer Care 2O1O Bondil Habold La Lettre du canceacuterologue 2012 Colson MH et al Prog Urol 2012
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Pourquoi cancer et sexualiteacute (1)
bull Vie sexuelle = paramegravetre pertinent et valideacute QdV et bien-ecirctre
ndash laquohelliptoute ameacutelioration des troubles de la vie sexuelle concourt au bien-ecirctre de lrsquoindividuhellip raquo
ndash large variabiliteacute inter et intra individuelle
ndash agrave tout acircge
bull Demandes fortes et leacutegitimes de preacuteservation retour des
fonctions y comprishellip sexuelles = objectif contemporain prise en charge du cancer
bull Preacutevalence trop eacuteleveacutee de soins de support non satisfaits dans ce domaine
Beaulieu EE et Montagut J CCNE rapport ndeg62 Bondil P et al La Lettre canceacuterologie 201221 165-70 Colson MH et al Prog urol
201222S72-S92 Habold D et al La presse meacutedicale 2014431120-4 Harden H et alJ Cancer Surviv 2008284-94 Matthew AG J
Urol 2005174(6)2105-10 Mulhall et al J Sex Med 201310195-203 Tuppin P et al BMC Urology 2014 14 48-56
Pourquoi cancer et sexualiteacute (2)
bull Iatrogeacutenie sexuelle majeure +++
ndash tous traitements et toutes fonctions sexuelles
ndash tregraves deacutependante
bull cancer lui-mecircme (stade et pronostic)
bull patient (comorbiditeacutes souhaits partenaire environnement socioculturel)
ndash large variabiliteacute morbiditeacute sexuelle (immeacutediate ou diffeacutereacutee transitoire ou durable
leacutegegravere ou seacutevegravere)
bull Malades couples mal preacutepareacutes agrave faire face agrave perte de lrsquointimiteacute sexuelle (surtout laquo jeunes raquo)
bull Importance information communication + eacuteducation theacuterapeutique (preacutevention du risque deacutesinsertion intimiteacute sexuelle raquo)
Bondil P et al La Lettre canceacuterologie 201221 165-70 Chartier-Kastler E et al JSex Med 2008 5(3)693-704 Colson MH et al Prog urol 201222S72-
S92 Habold D et al La presse meacutedicale 2014431120-4 Harden H et alJ Cancer Surviv 2008284-94 Messaoudi R et al prog urol 201121 48-52
Mulhall et al J Sex Med 201310195-203 Tuppin P et al BMC Urology 2014 14 48-56 Wagner L et al Prog urol 200919 (suppl 4)S168-S172
Testicule
Thyroiumlde
Prostate
Meacutelanome
SeinHodgkin
Syndr Myeloprol Chron
Endomegravetre
ReinCol uteacuterus
LMNH
Cocirclon-rectum
VessieLarynx
Myeacutelodysplasie
Ovaire
Estomac
LAM
PoumonŒsophageFoie Pancreacuteas
0
25
50
75
100
0 10 000 20 000 30 000 40 000 50 000
Su
rvie
de
s ca
s d
iag
no
stiq
ueacute
s d
e 1
98
9 agrave
20
04
amp s
uiv
is
jusq
ue
n 2
00
7
Bo
ssa
rd B
EH
20
13
Nombre de cas diagnostiqueacutes en 2012 INVS
Survie nette agrave 10 ans et nombre de cas en 2012
Cancer = de plus en plus une maladie chronique (ovaire 32 vulve vagin 35 col
uteacuterin 59 corps uteacuterin 68)
Pas un mais des cancers
Preacutevalence eacuteleveacutee Kcgeacutenitaux = 40
Concilier parcours de soins ET de vie +++
Qualiteacute vs quantiteacute de vie ni
contradictoire ni neacutegligeable
mais hellip
Axe majeur 3e
Plan Cancer ET obligation
meacutedicale eacutethique et deacuteontologique
Cancer et sexualiteacute
Cancer et sexualiteacute de quoi parle-t-on
La femme la plus sexy du monde en 2014 est une megravere de famille de 40 ans
Deacutefinitions OMS
bull laquo La santeacute est un eacutetat de complet bien-ecirctre physique mental etsocial et ne consiste pas seulement en une absence de maladie oudrsquoinfirmiteacute raquo OMS 1946
bull laquo La santeacute sexuelle est lrsquointeacutegration des aspects somatiquesaffectifs intellectuels et sociaux de lrsquoecirctre sexueacute de faccedilon agraveparvenir agrave un enrichissement et un eacutepanouissement de lapersonnaliteacute humaine de la communication et de lrsquoamour raquo OMS
1975
Organisation Mondiale de la Santeacute (OMS) Deacutefinition de la santeacute de lrsquoOMS [en ligne] Disponible sur http www whointaboutdefinitionfrprinthtml (consulteacute en 2014)bien
Cinq dimensions pour approche soignante moderne = personnaliseacutee
1 santeacute physique 2 santeacute mentale 3 santeacute sexuelle 4 mode de vie5 bien-ecirctre QdV
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal
and cervical cancer a comparison to national norms Gynecol Oncol 2007106413-8
Paramegravetre patient partenaire couple
La vie sexuelle quelle importance
- larges variations inter et intra-individuelle
- multifactorielle (fonction partenaire eacutetat de santeacute temporaliteacute)
29
39
3213
considegravere leur sexualiteacute comme essentielle outregraves importante
13assez important
13peu ou pas important
Les points cardinaux de la sexualiteacute enquecircte Lilly-IPSOS 2004 eacutechantillon 1000 Hgt 34 ans (acircge moyen 52) 8O ayant un(e)
partenaire sexuel
Reacutesultats identiques dans population adulte
atteintes de cancer et de maladies chroniques
+++
Morbiditeacute sexuelle (effets indeacutesirables) varie grade 0 agrave
3 selon individus couples meacutedecins ethellip
temps
Cancer et sexualiteacuteTrois dimensions essentielles
Biologique Identitaire
Relationnelle
Pathologies sexuelles = 1 2 ou 3 dysfonctionnement(s)ET souffrance mal-ecirctre lieacutes au(x) dysfonctionnement(s)
Couple = dimension essentielle de la vie sexuelle
bull Toutes les dimensions de la sexualiteacute = concerneacutees mais 3 principales
1 physique = dyspareunie modification vaginale et diminution activiteacute sexuelle
2 psychologique = baisse deacutesir alteacuterations image corporelle anxieacuteteacute lieacutee
performance sexuelle
3 sociale = difficulteacute conserver rocircle social anteacuterieur distanciation eacutemotionnelle
du partenaire sentiment modification de lrsquointeacuterecirct sexuel du partenaire
bull Majoriteacute de eacutetudes srsquointeacuteressent surtout agrave la dimension physique de la sexualiteacute tregraves
peu sur aspects psycho-eacuteducationnels
bull Les professionnels de santeacute doivent ecirctre plus attentifs aux besoins psychologiques
et sociaux
Quid des preacuteoccupations sexuelles des patientesatteintes de cancers gyneacutecologiques
Que dit la litteacuterature
Abbott-Anderson K Kwekkeboom KL A systematic review of sexual concerns reported by gynecological cancer survivorsGynecol Oncol2012124477-89
Vie sexuelle intime = multifactoriel
Cancers et sexualiteacuteQui est potentiellement concerneacute
bull Tous les patient(e)s = oui (directement ou non )
bull Peu de cancers laquo asexueacutes raquo et trop de cancers laquo orphelins raquo (ORL digestifs heacutemopathieshellip)
bull A tout acircge = souvent (y compris seniors +++)
bull Mais aussi tregraves souvent tous les proches
partenaire +++ parents enfants
bull Soit pregraves de 5 millions drsquoadultes en France
Eton et al Cancer 2005 Beck et al Urol Oncol 2009 Street et al Eur J Cancer Care 2O1O Bondil Habold La Lettre du canceacuterologue 2012 Colson MH et al Prog Urol 2012
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Pourquoi cancer et sexualiteacute (2)
bull Iatrogeacutenie sexuelle majeure +++
ndash tous traitements et toutes fonctions sexuelles
ndash tregraves deacutependante
bull cancer lui-mecircme (stade et pronostic)
bull patient (comorbiditeacutes souhaits partenaire environnement socioculturel)
ndash large variabiliteacute morbiditeacute sexuelle (immeacutediate ou diffeacutereacutee transitoire ou durable
leacutegegravere ou seacutevegravere)
bull Malades couples mal preacutepareacutes agrave faire face agrave perte de lrsquointimiteacute sexuelle (surtout laquo jeunes raquo)
bull Importance information communication + eacuteducation theacuterapeutique (preacutevention du risque deacutesinsertion intimiteacute sexuelle raquo)
Bondil P et al La Lettre canceacuterologie 201221 165-70 Chartier-Kastler E et al JSex Med 2008 5(3)693-704 Colson MH et al Prog urol 201222S72-
S92 Habold D et al La presse meacutedicale 2014431120-4 Harden H et alJ Cancer Surviv 2008284-94 Messaoudi R et al prog urol 201121 48-52
Mulhall et al J Sex Med 201310195-203 Tuppin P et al BMC Urology 2014 14 48-56 Wagner L et al Prog urol 200919 (suppl 4)S168-S172
Testicule
Thyroiumlde
Prostate
Meacutelanome
SeinHodgkin
Syndr Myeloprol Chron
Endomegravetre
ReinCol uteacuterus
LMNH
Cocirclon-rectum
VessieLarynx
Myeacutelodysplasie
Ovaire
Estomac
LAM
PoumonŒsophageFoie Pancreacuteas
0
25
50
75
100
0 10 000 20 000 30 000 40 000 50 000
Su
rvie
de
s ca
s d
iag
no
stiq
ueacute
s d
e 1
98
9 agrave
20
04
amp s
uiv
is
jusq
ue
n 2
00
7
Bo
ssa
rd B
EH
20
13
Nombre de cas diagnostiqueacutes en 2012 INVS
Survie nette agrave 10 ans et nombre de cas en 2012
Cancer = de plus en plus une maladie chronique (ovaire 32 vulve vagin 35 col
uteacuterin 59 corps uteacuterin 68)
Pas un mais des cancers
Preacutevalence eacuteleveacutee Kcgeacutenitaux = 40
Concilier parcours de soins ET de vie +++
Qualiteacute vs quantiteacute de vie ni
contradictoire ni neacutegligeable
mais hellip
Axe majeur 3e
Plan Cancer ET obligation
meacutedicale eacutethique et deacuteontologique
Cancer et sexualiteacute
Cancer et sexualiteacute de quoi parle-t-on
La femme la plus sexy du monde en 2014 est une megravere de famille de 40 ans
Deacutefinitions OMS
bull laquo La santeacute est un eacutetat de complet bien-ecirctre physique mental etsocial et ne consiste pas seulement en une absence de maladie oudrsquoinfirmiteacute raquo OMS 1946
bull laquo La santeacute sexuelle est lrsquointeacutegration des aspects somatiquesaffectifs intellectuels et sociaux de lrsquoecirctre sexueacute de faccedilon agraveparvenir agrave un enrichissement et un eacutepanouissement de lapersonnaliteacute humaine de la communication et de lrsquoamour raquo OMS
1975
Organisation Mondiale de la Santeacute (OMS) Deacutefinition de la santeacute de lrsquoOMS [en ligne] Disponible sur http www whointaboutdefinitionfrprinthtml (consulteacute en 2014)bien
Cinq dimensions pour approche soignante moderne = personnaliseacutee
1 santeacute physique 2 santeacute mentale 3 santeacute sexuelle 4 mode de vie5 bien-ecirctre QdV
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal
and cervical cancer a comparison to national norms Gynecol Oncol 2007106413-8
Paramegravetre patient partenaire couple
La vie sexuelle quelle importance
- larges variations inter et intra-individuelle
- multifactorielle (fonction partenaire eacutetat de santeacute temporaliteacute)
29
39
3213
considegravere leur sexualiteacute comme essentielle outregraves importante
13assez important
13peu ou pas important
Les points cardinaux de la sexualiteacute enquecircte Lilly-IPSOS 2004 eacutechantillon 1000 Hgt 34 ans (acircge moyen 52) 8O ayant un(e)
partenaire sexuel
Reacutesultats identiques dans population adulte
atteintes de cancer et de maladies chroniques
+++
Morbiditeacute sexuelle (effets indeacutesirables) varie grade 0 agrave
3 selon individus couples meacutedecins ethellip
temps
Cancer et sexualiteacuteTrois dimensions essentielles
Biologique Identitaire
Relationnelle
Pathologies sexuelles = 1 2 ou 3 dysfonctionnement(s)ET souffrance mal-ecirctre lieacutes au(x) dysfonctionnement(s)
Couple = dimension essentielle de la vie sexuelle
bull Toutes les dimensions de la sexualiteacute = concerneacutees mais 3 principales
1 physique = dyspareunie modification vaginale et diminution activiteacute sexuelle
2 psychologique = baisse deacutesir alteacuterations image corporelle anxieacuteteacute lieacutee
performance sexuelle
3 sociale = difficulteacute conserver rocircle social anteacuterieur distanciation eacutemotionnelle
du partenaire sentiment modification de lrsquointeacuterecirct sexuel du partenaire
bull Majoriteacute de eacutetudes srsquointeacuteressent surtout agrave la dimension physique de la sexualiteacute tregraves
peu sur aspects psycho-eacuteducationnels
bull Les professionnels de santeacute doivent ecirctre plus attentifs aux besoins psychologiques
et sociaux
Quid des preacuteoccupations sexuelles des patientesatteintes de cancers gyneacutecologiques
Que dit la litteacuterature
Abbott-Anderson K Kwekkeboom KL A systematic review of sexual concerns reported by gynecological cancer survivorsGynecol Oncol2012124477-89
Vie sexuelle intime = multifactoriel
Cancers et sexualiteacuteQui est potentiellement concerneacute
bull Tous les patient(e)s = oui (directement ou non )
bull Peu de cancers laquo asexueacutes raquo et trop de cancers laquo orphelins raquo (ORL digestifs heacutemopathieshellip)
bull A tout acircge = souvent (y compris seniors +++)
bull Mais aussi tregraves souvent tous les proches
partenaire +++ parents enfants
bull Soit pregraves de 5 millions drsquoadultes en France
Eton et al Cancer 2005 Beck et al Urol Oncol 2009 Street et al Eur J Cancer Care 2O1O Bondil Habold La Lettre du canceacuterologue 2012 Colson MH et al Prog Urol 2012
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Testicule
Thyroiumlde
Prostate
Meacutelanome
SeinHodgkin
Syndr Myeloprol Chron
Endomegravetre
ReinCol uteacuterus
LMNH
Cocirclon-rectum
VessieLarynx
Myeacutelodysplasie
Ovaire
Estomac
LAM
PoumonŒsophageFoie Pancreacuteas
0
25
50
75
100
0 10 000 20 000 30 000 40 000 50 000
Su
rvie
de
s ca
s d
iag
no
stiq
ueacute
s d
e 1
98
9 agrave
20
04
amp s
uiv
is
jusq
ue
n 2
00
7
Bo
ssa
rd B
EH
20
13
Nombre de cas diagnostiqueacutes en 2012 INVS
Survie nette agrave 10 ans et nombre de cas en 2012
Cancer = de plus en plus une maladie chronique (ovaire 32 vulve vagin 35 col
uteacuterin 59 corps uteacuterin 68)
Pas un mais des cancers
Preacutevalence eacuteleveacutee Kcgeacutenitaux = 40
Concilier parcours de soins ET de vie +++
Qualiteacute vs quantiteacute de vie ni
contradictoire ni neacutegligeable
mais hellip
Axe majeur 3e
Plan Cancer ET obligation
meacutedicale eacutethique et deacuteontologique
Cancer et sexualiteacute
Cancer et sexualiteacute de quoi parle-t-on
La femme la plus sexy du monde en 2014 est une megravere de famille de 40 ans
Deacutefinitions OMS
bull laquo La santeacute est un eacutetat de complet bien-ecirctre physique mental etsocial et ne consiste pas seulement en une absence de maladie oudrsquoinfirmiteacute raquo OMS 1946
bull laquo La santeacute sexuelle est lrsquointeacutegration des aspects somatiquesaffectifs intellectuels et sociaux de lrsquoecirctre sexueacute de faccedilon agraveparvenir agrave un enrichissement et un eacutepanouissement de lapersonnaliteacute humaine de la communication et de lrsquoamour raquo OMS
1975
Organisation Mondiale de la Santeacute (OMS) Deacutefinition de la santeacute de lrsquoOMS [en ligne] Disponible sur http www whointaboutdefinitionfrprinthtml (consulteacute en 2014)bien
Cinq dimensions pour approche soignante moderne = personnaliseacutee
1 santeacute physique 2 santeacute mentale 3 santeacute sexuelle 4 mode de vie5 bien-ecirctre QdV
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal
and cervical cancer a comparison to national norms Gynecol Oncol 2007106413-8
Paramegravetre patient partenaire couple
La vie sexuelle quelle importance
- larges variations inter et intra-individuelle
- multifactorielle (fonction partenaire eacutetat de santeacute temporaliteacute)
29
39
3213
considegravere leur sexualiteacute comme essentielle outregraves importante
13assez important
13peu ou pas important
Les points cardinaux de la sexualiteacute enquecircte Lilly-IPSOS 2004 eacutechantillon 1000 Hgt 34 ans (acircge moyen 52) 8O ayant un(e)
partenaire sexuel
Reacutesultats identiques dans population adulte
atteintes de cancer et de maladies chroniques
+++
Morbiditeacute sexuelle (effets indeacutesirables) varie grade 0 agrave
3 selon individus couples meacutedecins ethellip
temps
Cancer et sexualiteacuteTrois dimensions essentielles
Biologique Identitaire
Relationnelle
Pathologies sexuelles = 1 2 ou 3 dysfonctionnement(s)ET souffrance mal-ecirctre lieacutes au(x) dysfonctionnement(s)
Couple = dimension essentielle de la vie sexuelle
bull Toutes les dimensions de la sexualiteacute = concerneacutees mais 3 principales
1 physique = dyspareunie modification vaginale et diminution activiteacute sexuelle
2 psychologique = baisse deacutesir alteacuterations image corporelle anxieacuteteacute lieacutee
performance sexuelle
3 sociale = difficulteacute conserver rocircle social anteacuterieur distanciation eacutemotionnelle
du partenaire sentiment modification de lrsquointeacuterecirct sexuel du partenaire
bull Majoriteacute de eacutetudes srsquointeacuteressent surtout agrave la dimension physique de la sexualiteacute tregraves
peu sur aspects psycho-eacuteducationnels
bull Les professionnels de santeacute doivent ecirctre plus attentifs aux besoins psychologiques
et sociaux
Quid des preacuteoccupations sexuelles des patientesatteintes de cancers gyneacutecologiques
Que dit la litteacuterature
Abbott-Anderson K Kwekkeboom KL A systematic review of sexual concerns reported by gynecological cancer survivorsGynecol Oncol2012124477-89
Vie sexuelle intime = multifactoriel
Cancers et sexualiteacuteQui est potentiellement concerneacute
bull Tous les patient(e)s = oui (directement ou non )
bull Peu de cancers laquo asexueacutes raquo et trop de cancers laquo orphelins raquo (ORL digestifs heacutemopathieshellip)
bull A tout acircge = souvent (y compris seniors +++)
bull Mais aussi tregraves souvent tous les proches
partenaire +++ parents enfants
bull Soit pregraves de 5 millions drsquoadultes en France
Eton et al Cancer 2005 Beck et al Urol Oncol 2009 Street et al Eur J Cancer Care 2O1O Bondil Habold La Lettre du canceacuterologue 2012 Colson MH et al Prog Urol 2012
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Cancer et sexualiteacute
Cancer et sexualiteacute de quoi parle-t-on
La femme la plus sexy du monde en 2014 est une megravere de famille de 40 ans
Deacutefinitions OMS
bull laquo La santeacute est un eacutetat de complet bien-ecirctre physique mental etsocial et ne consiste pas seulement en une absence de maladie oudrsquoinfirmiteacute raquo OMS 1946
bull laquo La santeacute sexuelle est lrsquointeacutegration des aspects somatiquesaffectifs intellectuels et sociaux de lrsquoecirctre sexueacute de faccedilon agraveparvenir agrave un enrichissement et un eacutepanouissement de lapersonnaliteacute humaine de la communication et de lrsquoamour raquo OMS
1975
Organisation Mondiale de la Santeacute (OMS) Deacutefinition de la santeacute de lrsquoOMS [en ligne] Disponible sur http www whointaboutdefinitionfrprinthtml (consulteacute en 2014)bien
Cinq dimensions pour approche soignante moderne = personnaliseacutee
1 santeacute physique 2 santeacute mentale 3 santeacute sexuelle 4 mode de vie5 bien-ecirctre QdV
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal
and cervical cancer a comparison to national norms Gynecol Oncol 2007106413-8
Paramegravetre patient partenaire couple
La vie sexuelle quelle importance
- larges variations inter et intra-individuelle
- multifactorielle (fonction partenaire eacutetat de santeacute temporaliteacute)
29
39
3213
considegravere leur sexualiteacute comme essentielle outregraves importante
13assez important
13peu ou pas important
Les points cardinaux de la sexualiteacute enquecircte Lilly-IPSOS 2004 eacutechantillon 1000 Hgt 34 ans (acircge moyen 52) 8O ayant un(e)
partenaire sexuel
Reacutesultats identiques dans population adulte
atteintes de cancer et de maladies chroniques
+++
Morbiditeacute sexuelle (effets indeacutesirables) varie grade 0 agrave
3 selon individus couples meacutedecins ethellip
temps
Cancer et sexualiteacuteTrois dimensions essentielles
Biologique Identitaire
Relationnelle
Pathologies sexuelles = 1 2 ou 3 dysfonctionnement(s)ET souffrance mal-ecirctre lieacutes au(x) dysfonctionnement(s)
Couple = dimension essentielle de la vie sexuelle
bull Toutes les dimensions de la sexualiteacute = concerneacutees mais 3 principales
1 physique = dyspareunie modification vaginale et diminution activiteacute sexuelle
2 psychologique = baisse deacutesir alteacuterations image corporelle anxieacuteteacute lieacutee
performance sexuelle
3 sociale = difficulteacute conserver rocircle social anteacuterieur distanciation eacutemotionnelle
du partenaire sentiment modification de lrsquointeacuterecirct sexuel du partenaire
bull Majoriteacute de eacutetudes srsquointeacuteressent surtout agrave la dimension physique de la sexualiteacute tregraves
peu sur aspects psycho-eacuteducationnels
bull Les professionnels de santeacute doivent ecirctre plus attentifs aux besoins psychologiques
et sociaux
Quid des preacuteoccupations sexuelles des patientesatteintes de cancers gyneacutecologiques
Que dit la litteacuterature
Abbott-Anderson K Kwekkeboom KL A systematic review of sexual concerns reported by gynecological cancer survivorsGynecol Oncol2012124477-89
Vie sexuelle intime = multifactoriel
Cancers et sexualiteacuteQui est potentiellement concerneacute
bull Tous les patient(e)s = oui (directement ou non )
bull Peu de cancers laquo asexueacutes raquo et trop de cancers laquo orphelins raquo (ORL digestifs heacutemopathieshellip)
bull A tout acircge = souvent (y compris seniors +++)
bull Mais aussi tregraves souvent tous les proches
partenaire +++ parents enfants
bull Soit pregraves de 5 millions drsquoadultes en France
Eton et al Cancer 2005 Beck et al Urol Oncol 2009 Street et al Eur J Cancer Care 2O1O Bondil Habold La Lettre du canceacuterologue 2012 Colson MH et al Prog Urol 2012
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Deacutefinitions OMS
bull laquo La santeacute est un eacutetat de complet bien-ecirctre physique mental etsocial et ne consiste pas seulement en une absence de maladie oudrsquoinfirmiteacute raquo OMS 1946
bull laquo La santeacute sexuelle est lrsquointeacutegration des aspects somatiquesaffectifs intellectuels et sociaux de lrsquoecirctre sexueacute de faccedilon agraveparvenir agrave un enrichissement et un eacutepanouissement de lapersonnaliteacute humaine de la communication et de lrsquoamour raquo OMS
1975
Organisation Mondiale de la Santeacute (OMS) Deacutefinition de la santeacute de lrsquoOMS [en ligne] Disponible sur http www whointaboutdefinitionfrprinthtml (consulteacute en 2014)bien
Cinq dimensions pour approche soignante moderne = personnaliseacutee
1 santeacute physique 2 santeacute mentale 3 santeacute sexuelle 4 mode de vie5 bien-ecirctre QdV
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal
and cervical cancer a comparison to national norms Gynecol Oncol 2007106413-8
Paramegravetre patient partenaire couple
La vie sexuelle quelle importance
- larges variations inter et intra-individuelle
- multifactorielle (fonction partenaire eacutetat de santeacute temporaliteacute)
29
39
3213
considegravere leur sexualiteacute comme essentielle outregraves importante
13assez important
13peu ou pas important
Les points cardinaux de la sexualiteacute enquecircte Lilly-IPSOS 2004 eacutechantillon 1000 Hgt 34 ans (acircge moyen 52) 8O ayant un(e)
partenaire sexuel
Reacutesultats identiques dans population adulte
atteintes de cancer et de maladies chroniques
+++
Morbiditeacute sexuelle (effets indeacutesirables) varie grade 0 agrave
3 selon individus couples meacutedecins ethellip
temps
Cancer et sexualiteacuteTrois dimensions essentielles
Biologique Identitaire
Relationnelle
Pathologies sexuelles = 1 2 ou 3 dysfonctionnement(s)ET souffrance mal-ecirctre lieacutes au(x) dysfonctionnement(s)
Couple = dimension essentielle de la vie sexuelle
bull Toutes les dimensions de la sexualiteacute = concerneacutees mais 3 principales
1 physique = dyspareunie modification vaginale et diminution activiteacute sexuelle
2 psychologique = baisse deacutesir alteacuterations image corporelle anxieacuteteacute lieacutee
performance sexuelle
3 sociale = difficulteacute conserver rocircle social anteacuterieur distanciation eacutemotionnelle
du partenaire sentiment modification de lrsquointeacuterecirct sexuel du partenaire
bull Majoriteacute de eacutetudes srsquointeacuteressent surtout agrave la dimension physique de la sexualiteacute tregraves
peu sur aspects psycho-eacuteducationnels
bull Les professionnels de santeacute doivent ecirctre plus attentifs aux besoins psychologiques
et sociaux
Quid des preacuteoccupations sexuelles des patientesatteintes de cancers gyneacutecologiques
Que dit la litteacuterature
Abbott-Anderson K Kwekkeboom KL A systematic review of sexual concerns reported by gynecological cancer survivorsGynecol Oncol2012124477-89
Vie sexuelle intime = multifactoriel
Cancers et sexualiteacuteQui est potentiellement concerneacute
bull Tous les patient(e)s = oui (directement ou non )
bull Peu de cancers laquo asexueacutes raquo et trop de cancers laquo orphelins raquo (ORL digestifs heacutemopathieshellip)
bull A tout acircge = souvent (y compris seniors +++)
bull Mais aussi tregraves souvent tous les proches
partenaire +++ parents enfants
bull Soit pregraves de 5 millions drsquoadultes en France
Eton et al Cancer 2005 Beck et al Urol Oncol 2009 Street et al Eur J Cancer Care 2O1O Bondil Habold La Lettre du canceacuterologue 2012 Colson MH et al Prog Urol 2012
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal
and cervical cancer a comparison to national norms Gynecol Oncol 2007106413-8
Paramegravetre patient partenaire couple
La vie sexuelle quelle importance
- larges variations inter et intra-individuelle
- multifactorielle (fonction partenaire eacutetat de santeacute temporaliteacute)
29
39
3213
considegravere leur sexualiteacute comme essentielle outregraves importante
13assez important
13peu ou pas important
Les points cardinaux de la sexualiteacute enquecircte Lilly-IPSOS 2004 eacutechantillon 1000 Hgt 34 ans (acircge moyen 52) 8O ayant un(e)
partenaire sexuel
Reacutesultats identiques dans population adulte
atteintes de cancer et de maladies chroniques
+++
Morbiditeacute sexuelle (effets indeacutesirables) varie grade 0 agrave
3 selon individus couples meacutedecins ethellip
temps
Cancer et sexualiteacuteTrois dimensions essentielles
Biologique Identitaire
Relationnelle
Pathologies sexuelles = 1 2 ou 3 dysfonctionnement(s)ET souffrance mal-ecirctre lieacutes au(x) dysfonctionnement(s)
Couple = dimension essentielle de la vie sexuelle
bull Toutes les dimensions de la sexualiteacute = concerneacutees mais 3 principales
1 physique = dyspareunie modification vaginale et diminution activiteacute sexuelle
2 psychologique = baisse deacutesir alteacuterations image corporelle anxieacuteteacute lieacutee
performance sexuelle
3 sociale = difficulteacute conserver rocircle social anteacuterieur distanciation eacutemotionnelle
du partenaire sentiment modification de lrsquointeacuterecirct sexuel du partenaire
bull Majoriteacute de eacutetudes srsquointeacuteressent surtout agrave la dimension physique de la sexualiteacute tregraves
peu sur aspects psycho-eacuteducationnels
bull Les professionnels de santeacute doivent ecirctre plus attentifs aux besoins psychologiques
et sociaux
Quid des preacuteoccupations sexuelles des patientesatteintes de cancers gyneacutecologiques
Que dit la litteacuterature
Abbott-Anderson K Kwekkeboom KL A systematic review of sexual concerns reported by gynecological cancer survivorsGynecol Oncol2012124477-89
Vie sexuelle intime = multifactoriel
Cancers et sexualiteacuteQui est potentiellement concerneacute
bull Tous les patient(e)s = oui (directement ou non )
bull Peu de cancers laquo asexueacutes raquo et trop de cancers laquo orphelins raquo (ORL digestifs heacutemopathieshellip)
bull A tout acircge = souvent (y compris seniors +++)
bull Mais aussi tregraves souvent tous les proches
partenaire +++ parents enfants
bull Soit pregraves de 5 millions drsquoadultes en France
Eton et al Cancer 2005 Beck et al Urol Oncol 2009 Street et al Eur J Cancer Care 2O1O Bondil Habold La Lettre du canceacuterologue 2012 Colson MH et al Prog Urol 2012
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Paramegravetre patient partenaire couple
La vie sexuelle quelle importance
- larges variations inter et intra-individuelle
- multifactorielle (fonction partenaire eacutetat de santeacute temporaliteacute)
29
39
3213
considegravere leur sexualiteacute comme essentielle outregraves importante
13assez important
13peu ou pas important
Les points cardinaux de la sexualiteacute enquecircte Lilly-IPSOS 2004 eacutechantillon 1000 Hgt 34 ans (acircge moyen 52) 8O ayant un(e)
partenaire sexuel
Reacutesultats identiques dans population adulte
atteintes de cancer et de maladies chroniques
+++
Morbiditeacute sexuelle (effets indeacutesirables) varie grade 0 agrave
3 selon individus couples meacutedecins ethellip
temps
Cancer et sexualiteacuteTrois dimensions essentielles
Biologique Identitaire
Relationnelle
Pathologies sexuelles = 1 2 ou 3 dysfonctionnement(s)ET souffrance mal-ecirctre lieacutes au(x) dysfonctionnement(s)
Couple = dimension essentielle de la vie sexuelle
bull Toutes les dimensions de la sexualiteacute = concerneacutees mais 3 principales
1 physique = dyspareunie modification vaginale et diminution activiteacute sexuelle
2 psychologique = baisse deacutesir alteacuterations image corporelle anxieacuteteacute lieacutee
performance sexuelle
3 sociale = difficulteacute conserver rocircle social anteacuterieur distanciation eacutemotionnelle
du partenaire sentiment modification de lrsquointeacuterecirct sexuel du partenaire
bull Majoriteacute de eacutetudes srsquointeacuteressent surtout agrave la dimension physique de la sexualiteacute tregraves
peu sur aspects psycho-eacuteducationnels
bull Les professionnels de santeacute doivent ecirctre plus attentifs aux besoins psychologiques
et sociaux
Quid des preacuteoccupations sexuelles des patientesatteintes de cancers gyneacutecologiques
Que dit la litteacuterature
Abbott-Anderson K Kwekkeboom KL A systematic review of sexual concerns reported by gynecological cancer survivorsGynecol Oncol2012124477-89
Vie sexuelle intime = multifactoriel
Cancers et sexualiteacuteQui est potentiellement concerneacute
bull Tous les patient(e)s = oui (directement ou non )
bull Peu de cancers laquo asexueacutes raquo et trop de cancers laquo orphelins raquo (ORL digestifs heacutemopathieshellip)
bull A tout acircge = souvent (y compris seniors +++)
bull Mais aussi tregraves souvent tous les proches
partenaire +++ parents enfants
bull Soit pregraves de 5 millions drsquoadultes en France
Eton et al Cancer 2005 Beck et al Urol Oncol 2009 Street et al Eur J Cancer Care 2O1O Bondil Habold La Lettre du canceacuterologue 2012 Colson MH et al Prog Urol 2012
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Cancer et sexualiteacuteTrois dimensions essentielles
Biologique Identitaire
Relationnelle
Pathologies sexuelles = 1 2 ou 3 dysfonctionnement(s)ET souffrance mal-ecirctre lieacutes au(x) dysfonctionnement(s)
Couple = dimension essentielle de la vie sexuelle
bull Toutes les dimensions de la sexualiteacute = concerneacutees mais 3 principales
1 physique = dyspareunie modification vaginale et diminution activiteacute sexuelle
2 psychologique = baisse deacutesir alteacuterations image corporelle anxieacuteteacute lieacutee
performance sexuelle
3 sociale = difficulteacute conserver rocircle social anteacuterieur distanciation eacutemotionnelle
du partenaire sentiment modification de lrsquointeacuterecirct sexuel du partenaire
bull Majoriteacute de eacutetudes srsquointeacuteressent surtout agrave la dimension physique de la sexualiteacute tregraves
peu sur aspects psycho-eacuteducationnels
bull Les professionnels de santeacute doivent ecirctre plus attentifs aux besoins psychologiques
et sociaux
Quid des preacuteoccupations sexuelles des patientesatteintes de cancers gyneacutecologiques
Que dit la litteacuterature
Abbott-Anderson K Kwekkeboom KL A systematic review of sexual concerns reported by gynecological cancer survivorsGynecol Oncol2012124477-89
Vie sexuelle intime = multifactoriel
Cancers et sexualiteacuteQui est potentiellement concerneacute
bull Tous les patient(e)s = oui (directement ou non )
bull Peu de cancers laquo asexueacutes raquo et trop de cancers laquo orphelins raquo (ORL digestifs heacutemopathieshellip)
bull A tout acircge = souvent (y compris seniors +++)
bull Mais aussi tregraves souvent tous les proches
partenaire +++ parents enfants
bull Soit pregraves de 5 millions drsquoadultes en France
Eton et al Cancer 2005 Beck et al Urol Oncol 2009 Street et al Eur J Cancer Care 2O1O Bondil Habold La Lettre du canceacuterologue 2012 Colson MH et al Prog Urol 2012
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
bull Toutes les dimensions de la sexualiteacute = concerneacutees mais 3 principales
1 physique = dyspareunie modification vaginale et diminution activiteacute sexuelle
2 psychologique = baisse deacutesir alteacuterations image corporelle anxieacuteteacute lieacutee
performance sexuelle
3 sociale = difficulteacute conserver rocircle social anteacuterieur distanciation eacutemotionnelle
du partenaire sentiment modification de lrsquointeacuterecirct sexuel du partenaire
bull Majoriteacute de eacutetudes srsquointeacuteressent surtout agrave la dimension physique de la sexualiteacute tregraves
peu sur aspects psycho-eacuteducationnels
bull Les professionnels de santeacute doivent ecirctre plus attentifs aux besoins psychologiques
et sociaux
Quid des preacuteoccupations sexuelles des patientesatteintes de cancers gyneacutecologiques
Que dit la litteacuterature
Abbott-Anderson K Kwekkeboom KL A systematic review of sexual concerns reported by gynecological cancer survivorsGynecol Oncol2012124477-89
Vie sexuelle intime = multifactoriel
Cancers et sexualiteacuteQui est potentiellement concerneacute
bull Tous les patient(e)s = oui (directement ou non )
bull Peu de cancers laquo asexueacutes raquo et trop de cancers laquo orphelins raquo (ORL digestifs heacutemopathieshellip)
bull A tout acircge = souvent (y compris seniors +++)
bull Mais aussi tregraves souvent tous les proches
partenaire +++ parents enfants
bull Soit pregraves de 5 millions drsquoadultes en France
Eton et al Cancer 2005 Beck et al Urol Oncol 2009 Street et al Eur J Cancer Care 2O1O Bondil Habold La Lettre du canceacuterologue 2012 Colson MH et al Prog Urol 2012
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Vie sexuelle intime = multifactoriel
Cancers et sexualiteacuteQui est potentiellement concerneacute
bull Tous les patient(e)s = oui (directement ou non )
bull Peu de cancers laquo asexueacutes raquo et trop de cancers laquo orphelins raquo (ORL digestifs heacutemopathieshellip)
bull A tout acircge = souvent (y compris seniors +++)
bull Mais aussi tregraves souvent tous les proches
partenaire +++ parents enfants
bull Soit pregraves de 5 millions drsquoadultes en France
Eton et al Cancer 2005 Beck et al Urol Oncol 2009 Street et al Eur J Cancer Care 2O1O Bondil Habold La Lettre du canceacuterologue 2012 Colson MH et al Prog Urol 2012
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Cancers et sexualiteacuteQui est potentiellement concerneacute
bull Tous les patient(e)s = oui (directement ou non )
bull Peu de cancers laquo asexueacutes raquo et trop de cancers laquo orphelins raquo (ORL digestifs heacutemopathieshellip)
bull A tout acircge = souvent (y compris seniors +++)
bull Mais aussi tregraves souvent tous les proches
partenaire +++ parents enfants
bull Soit pregraves de 5 millions drsquoadultes en France
Eton et al Cancer 2005 Beck et al Urol Oncol 2009 Street et al Eur J Cancer Care 2O1O Bondil Habold La Lettre du canceacuterologue 2012 Colson MH et al Prog Urol 2012
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Ougrave situer cancer et sexualiteacute
Oncopeacutediatrie
Oncogeacuteriatrie
Oncofertiliteacute
Oncoplastie
Oncogeacuteneacutetique
Monde de lrsquooncologie
Cancer et sexualiteacuteOncosexologie
Soins de support
Bondil et al Bull Cancer 201299 499
Nouvelles offres de soins de support dans le PPS
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Hui D et al Support Care Cancer Mar 2013 21(3) 659ndash685 A conceptual framework toward understanding ldquosupportive carerdquo ldquopalliative carerdquo and ldquohospice carerdquo Under this model ldquohospice carerdquo is part of ldquopalliative carerdquo which in turn is part of ldquosupportive carerdquo Importantly the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service A increasing number of articles suggest that ldquopalliative carerdquo should start from the time of diagnosis Other distinguishing features among the three terms are listed on the right hand side
Oncosexologie oncofertiliteacute
Soins oncologiques de support = recommandationactuelle de mise en place preacutecoce dans PPS
Parcours de soins et dehellip vie
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Conseacutequences des cancers H-Fsur la vie intime priveacutee = 1egravere reacutealiteacute
bull Sexualiteacute encore souvent perturbeacutee = 65
bull Kc caviteacute pelvienne = 89 H et 75 F
bull Fertiliteacute souvent compromise = 37 F en acircge de procreacuteer et 30 H
bull Relations de couple = le plus souvent preacuteserveacutees (55) ou renforceacutees (37)
Particulariteacutes
difficulteacutes seacutequelles sexuelles ou intimes souvent brutales et durent longtemps
Irruption du cancer dans parcours de vie couple modifie tregraves souvent les prioriteacutes de vie
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Quels troubles sexuels
De multiples perturbations attendues agrave diffeacuterents niveaux de la reacuteponse physiologique
Dysorgasmies
Aneacutejaculation
Modifications des perceptions
orgastiques
Douleurs
Incontinences
Perturbation des rapports
Dyspareunies
Douleurs
Dyspneacutees
Positions
Incontinences
Troubles du deacutesir
Psychogegravenes
- Blocages sensoriels vue
odeurs bruits touchers
-Alteacuteration de la motivation
-Communication insuffisante
Iatrogegravenes
- direct chirurgie
radiotheacuterapie meacutedicamenteux
hormonotheacuterapie
- indirect effets secondaires
type fatigue nauseacuteeshellip
Troubles de lrsquoexcitation
Dysfonction Eacuterectile
Seacutecheresse vaginale
Modification des
scriptshabitudes
E
P
O
R
EP
O
R
E = Excitation
P = Plateau
O = Orgasme
R = Reacutesolution
HOMME
FEMME
Phases physiologiques(drsquoapregraves le scheacutema de Masters et Johnson)
E
Reacutefeacuterentiel AFSOS laquo Cancer santeacute sexuelle vie intime raquo disponible sur afosorg
orgasmurieFibrose (localiseacutee
ou eacutetendue)
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Lindau ST Gavrilova N Anderson D Sexual morbidity in very long term survivors of vaginal and cervical cancer a comparison to
national norms Gynecol Oncol 2007106413-8
Cancers gyneacutecologiques et morbiditeacute sexuelle chez laquo survivantes raquo = une reacutealiteacute
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Hill EK Assessing Gynecologic and Breast Cancer Survivorsrsquo Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors) Cancer 2011 117 2643ndash2651
bull 7 ont beacuteneacuteficieacute drsquoune aide
bull 416 inteacuteresseacutees par prise en charge
bull gt 30 souhaiteraient consulter un meacutedecin pour ce problegraveme
bull 35 souhaiteraient ecirctre contacteacutees si programme formaliseacute mis en place
bull femmes plus jeunes et apregraves un an de traitement = les plus demandeuses population n = 261 acircge moyen 55 dont 23 avec partenaire
cancers gyneacutecologiques 912 (ovaire trompe peacuteritoneacuteal 36
endomegravetre 322 col 188 vulve vagin 42) et sein 88
Cancers gyneacutecologiques et sexualiteacuteDemande reacuteelle mais ni satisfaisante ni satisfaite
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Lever le silence pour autoriser agrave en parler et leacutegitimer la demande =
enjeu majeur
2e reacutealiteacute dialogue difficile + deacuteficit drsquoinformation = reacuteelle ineacutegaliteacute drsquoaccegraves aux soins
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Variables drsquoajustement mental agrave la maladie canceacutereuse(cognitives comportementales et eacutemotionnelles)
bull Information (PP)
bull Soutien affectif et moral
des amis et de la famille (PP)
bull Activiteacute sexuelle (PP)
bull Qualiteacute de vie physique (PP)
bull Qualiteacute de vie mentale (PP)
Esprit combatif Deacutetresse
bull Information
bull Deacutesir soutien psy
bull Non satisfaits de leur suivi
bull Soutien affectif et moral
bull Deacuteteacuterioration du couple
bull Activiteacute sexuelle
Seacutequelles (preacutesence gecircne et
prise en compte)
PsychotropesAdaptation positive
Adaptation neacutegativeAnne-Gaeumllle Le Corroller Soriano 2008
Rocircle reacuteellement neacutegligeable de santeacute sexuelle vie couple
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Purpose To examine the impact of marital status on stage at diagnosis use of definitive therapy andcancer-specific mortality among each of the 10 leading causes of cancer-related death in the US
Methods We used the Surveillance Epidemiology and End Results program to identify 1260898 patients diagnosed in2004 through 2008 with lung colorectal breast pancreatic prostate liverintrahepatic bile duct non-Hodgkinlymphoma headneck ovarian or esophageal cancer We used multivariable logistic and Cox regression to analyze the734889 patients who had clinical and follow-up information available
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR] 083 95 CI082 to 084 P 001) more likely to receive definitive therapy (adjusted OR 153 95 CI 151 to 156 P 001) and lesslikely to die as a result of their cancer after adjusting for demographics stage and treatment (adjusted hazard ratio080 95 CI 079 to 081 P 001) than unmarried patients These associations remained significant when eachindividual cancer was analyzed (P 05 for all end points for each malignancy) The benefit associated with marriage wasgreater in males than females for all outcome measures analyzed (P 001 in all cases) For prostate breast colorectalesophageal and headneck cancers the survival benefit associated with marriage was larger than the publishedsurvival benefit of chemotherapy
Conclusion Even after adjusting for known confounders unmarried patients are atsignificantly higher risk of presentation with metastatic cancer undertreatment and deathresulting from their cancer This study highlights the potentially significant impact that socialsupport can have on cancer detection treatment and survival
Marital Status and Survival in Patients With Cancer
Aiser AA et al J Clin Oncol 2013 Nov 131(31)3869-76
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
CancerType of
ChemotherapyStudy
Population Evaluated in Chemotherapy Study
Chemotherapy ReferenceHR for
Chemotherapy
HR for Marriage in
Present Study
Prostate Randomized trial25
Metastatic hormone-resistant prostate
cancer
Docetaxel every 3 weeks
Mitoxantrone 079 074
Breast Meta-analysis26 Early breast cancerAnthracycline-
basedNo
chemotherapy084 078
Lung Systematic review27 Stage I-III nonndashsmall-cell lung cancer
AnyNo
chemotherapy071 085
Colorectal Randomized trial28 T3-T4 resectable rectal cancer
Adjuvant fluorouracil
and leucovorin
No adjuvant chemotherapy
085 072
Pancreatic Randomized trial29 Resectable pancreatic cancer
FluorouracilNo
chemotherapy071 087
Liver IHBD Randomized trial30
Advanced hepatocellular
carcinomaSorafenib
No chemotherapy
069 088
Esophageal Meta-analysis31 Resectable esophageal cancer
AnyNo
chemotherapy087 077
Ovarian Systematic review32 Early-stage epithelial ovarian cancer
AnyNo
chemotherapy074 087
Headneck Meta-analysis33 Nonmetastatic head and neck cancer
AnyNo
chemotherapy087 067
Comparison of HRs for overall survival associated with chemotherapy (based on
prior literature) with cancer-specific survival associated with marriage (in the
present study) in patients with solid malignancies
Aizer AA et al Marital Status and Survival in Patients With Cancer J Clin Oncol 2013 Nov 131(31)3869-76
Pour les cancers de prostate du sein
colorectal oesophage et ORL le
beacuteneacutefice en terme de survie lieacute au
mariage est supeacuterieur agrave ceux publieacutes
pour la chimiotheacuterapie
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Santeacute sexuelle et vie intime = marqueurs cliniques pertinents (HF) pour deacutetecter deacutetresse deacutepression
et QdV bien-ecirctre)
Interrogatoire +++ questionnaire type eacutechelle visuelle deacutetresse
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Cancers = morbiditeacute sexuelle importante avec iatrogeacutenie majeure
Souvent laquo brutaleraquo = information preacutevention reacutehabilitation
origine multifactorielle
Enjeux prioriteacutes et impacts
sexuels = tregraves inhomogegravenes en
fonction du cancer (stade pronostic
traitement) et du patient (acircge comorbiditeacutes
projets de vie et proximologie)
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Traitement souvent multimodal = iatrogeacutenie et morbiditeacute santeacute sexuelle vie intime croissantes
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Chaque eacutetape prioriteacutes propres au cancer et agrave son traitement au patient etaux soignantsPas une annonce mais une succession drsquoannoncePour optimiser systeacutematiser un espace temps et des supports facilitateurs (associations patients)
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Patient couple Professionnels de santeacute
Demande information = 100 informer = tous soignants
Si dysfonction sexuelle distinguer si simple ou complexe
13 non demandeurs ++ informer traitement possible
13 demandeur si simple accessible majoriteacute soignants
13 tregraves demandeurs si complexe = orienter fonction
nature eacutetiologie DS
Reacutealiteacute du terrain ouhellip il faut deacutemystifierla pathologie sexuelle
Notion capitaleprobleacutematiques oncosexuelles
=responsabiliteacute et compeacutetence de la
grande majoriteacute = soins primaires +++ (preacutevention prise en charge hors fertiliteacute)
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Prise en charge personnaliseacutee= multiforme et adapteacutee DS + attentes demandes besoins du patient et couple
= information eacuteducation theacuterapeutique traitement
Regravegles de bonnes pratiques cliniques Diagnostic situationnel et eacuteducatif
Reacutefeacuterences guidelines EAU ISSM JSM AFSOS
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Nouvelle approche = renforcer la deacutefense lutte contre le laquo preacutedateur raquo (cancer) en ciblant aussi la laquo proie raquo (malade)
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Early palliative care integrated into standard oncological therapy can prolong survival compared with standard oncologic therapy for second-line metastatic non-small cell lung cancer Adapted from Temel JS Greer JA Muzikansky A et al Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med 2010363733ndash742 with permission
Avanceacutee majeure reacutecente
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Association between physical activity (PA) and mortality in colorectal cancer A meta‐analysis of prospective cohort studies
International Journal of Cancer Je Y et al 20131331905-1913httponlinelibrarywileycomdoi101002ijc28208fullijc28208-fig-0002
In conclusions both prediagnosis and postdiagnosis PA were associated with reduced colorectal cancer-specific
mortality and all-cause mortality
prediagnosis postdiagnosis
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Comment ameacuteliorer le mode de vie drsquoun malade canceacutereux
1 Donrsquot smoke2 Avoid secondhand smoke3 Exercise regularly4 Avoid weight gain5 Eat a healthy diet6 Drink alcohol in moderation if at all7 Stay connected with friends family and
other survivors8 Get screening tests and go to your regular
check-ups
9 Enjoy your sexual intimate life
Available at httpwwwcancernewsincontextorg
Eight ways to stay healthy after cancer an evidence-based message Kathleen Y Wolin Hank Dart and Graham A ColditzCancer Causes Control 2013 May 24(5) 827ndash837
Apregraves lrsquoAPAhellip lrsquoAIA (activiteacute intime adapteacutee ) ++++
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Pourquoi prendre en charge la sexualiteacute en cas de cancers gyneacutecologiques en 2015
bull Exigences meacutedicales
ndash maladie souvent chronique = probleacutematique QdV et bien-ecirctre
ndash demande besoin forts et leacutegitimes de preacuteservation retour agrave une laquo normaliteacute raquo y comprishellip sexuelle (malades proches)
ndash preacutevalence trop eacuteleveacutee de soins de support non satisfaits ++
ndash ameacuteliore ajustement au cancer ++
ndash relativiser car un sujet sur deux nrsquoest pas ou peu concerneacute
ndash prise en charge scientifique et humaniste (meacutedecine personnaliseacutee)
bull Demandes socieacutetales
ndash Plans cancer = inteacutegrer parcours de vie dans parcours de soins
ndash reacuteduire ineacutegaliteacutes accegraves qualiteacute des soins car reacuteponses soignantes insuffisantes (eacutechelon individuel et institutionnel)
fait partie inteacutegrante du soin oncologique
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
2010
4 Toulouse6-7 Octobre 2015
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
Structuration de lrsquooffre de formations en oncosexologie
Niveau 3 expertise
DIU drsquooncosexologie
Formations de niveau 2 formations courtes non diplomantes (mooc seacuteminaires preacutesentiels)
Formations de niveau 1
seacuteminaires courts drsquoinitiation et sensibilisation des soignants Identifier les pb
Informer orienter
Informer conseiller eacuteduquer eacutevaluer prendre en charge
