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Theses

La détresse des patients atteints de cancer : prévalence, facteurs prédictifs, modalités de repérage et de prise en charge.

Abstract : Cancer is commonly associated with psychological distress, leading to a major need for psychological support or psychotherapy in this patient population faced with numerous stressful events. Clinical assessment is made difficult by the broad continuum of the clinical manifestations of distress. Distress is often underestimated, not recognized and not appropriately treated, but these disorders can have a direct impact on the patient's quality of life and capacity to share in medical decisions, comply with treatment and consequently benefit from the best available treatment for their somatic disease. Screening procedures are necessar y to detect patients requiring psycho-oncological assessment and/or inter vention. The first part of this work consisted of adapting a screening instrument, the PDS (Psychological Distress Scale), to identify patients presenting distress. This approach, combined with quality of life assessment, can also identify factors associated with distress in a French population and allow comparison of these results with data from the international literature. Combined with assessment of the patient's needs and resources, this structured screening should allow better detection of distressed patients and patients at risk of decompensation, in order to propose specific support. Identification of distress should be a prerequisite for all health care professionals in the field of oncology. Although it is only the first step for the psycho-oncologist, it facilitates access to patients experiencing significant distress and requiring their specialized care. The second part of our work, emphasizing the need to evaluate psycho-oncology practices to adapt interventions to the French population based on experiences described in other countries, describes a randomized trial evaluating the effects of a psycho-educational group, based on a cognitive-behavioral approach, in early stage breast cancer women following treatment. This study demonstrated a significant reduction in anxiety and certain dimensions of the mood states and quality of life profile. Global satisfaction levels with the intervention were very high. In the field of psychotherapeutic interventions, this study also demonstrated the feasibility of this type of structured approach in a population of French cancer women, not familiar with this type of approach. Future research will need to address the efficacy of these interventions, specifically focusing on cancer patients with significant psychopathological disorders. Psycho-oncology specialists, an integral part of the cancer team, deal specifically with cancer patients experiencing psychopathological disorders. This comorbidity may have a major impact on quality of life and the conditions and outcomes of somatic treatment. Future lines of research will be to deter- mine the optimal modalities of care for these patients, in order to provide them with the same treatment outcome chances as other patients. These endeavors to prioritize patients' needs and to evaluate professional practices in the field of psycho-oncology can serve as a model in the field of supportive care, as this new health care framework is subtended by the need to identify patients with complex personal situations and to estimate the efficacy of new specialized modes of management taking into account their expectations and needs, the specialists' response capacities, as well as institutional and community priorities.
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https://tel.archives-ouvertes.fr/tel-00432252
Contributor : Sylvie Dolbeault <>
Submitted on : Sunday, November 15, 2009 - 7:22:56 PM
Last modification on : Monday, December 14, 2020 - 9:42:41 AM
Long-term archiving on: : Thursday, June 17, 2010 - 8:24:49 PM

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  • HAL Id : tel-00432252, version 1

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Sylvie Dolbeault. La détresse des patients atteints de cancer : prévalence, facteurs prédictifs, modalités de repérage et de prise en charge.. Neurosciences [q-bio.NC]. Université Pierre et Marie Curie - Paris VI, 2009. Français. ⟨tel-00432252⟩

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