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BackgroundWe assessed the prevalence of self-reported perceived discrimination in the workplace after the end of treatment among breast cancer (BC) survivors and studied its association with social, health-related and work-related factors.MethodsWe used data from a French prospective cohort (CANcer TOxicities) including women diagnosed with stage I–III BC. Our analysis included 2130 women who were employed, ResultsOverall, 26% of women reported perceived discrimination in the workplace after the end of treatment. Women working for a small company, in the public sector or with better overall health status were less likely to report perceived discrimination. Women who benefited from easing dispositions at their workplace, who did not feel supported by their colleagues and those who returned to work because of fear of job loss were more likely to report perceived discrimination.ConclusionsOne in four BC survivors perceives discrimination in the workplace. Health and work-related factors are associated with increased likelihood of reporting perceived discrimination.Trial registration numberNCT01993498.

Resume Introduction L’adjonction du palbociclib a l’hormonotherapie ameliore la survie sans progression chez les patients atteints d’un cancer du sein metastatique positif aux recepteurs hormonaux. Cette nouvelle therapie ciblee expose cependant les patients a une toxicite hematologique severe pouvant conduire a un report ou un arret du traitement et donc potentiellement a une baisse de son efficacite. L’objectif de cette etude etait d’identifier les facteurs predictifs d’hematotoxicite chez ces patients. Methodes Cette etude retrospective a inclus tous les patients ayant initie un traitement de palbociclib pour un cancer du sein metastatique positif aux recepteurs hormonaux entre le 1er decembre 2016 et le 1er janvier 2019. Toutes les donnees ont ete collectees via les dossiers electroniques ou papiers. Une hematotoxicite precoce et severe a ete definie comme l’apparition d’une toxicite hematologique grade 4 ou grade 3 ayant necessite une reduction de dose durant les trois premiers cycles. Resultats Cent quatre-vingt-un patients ont ete inclus. Quarante-six patients (25,4 %) ont developpe une hematotoxicite severe et precoce. Apres analyse multivariee, les facteurs predictifs de cette hematotoxicite sont le Performance Status de l’OMS superieur ou egal a 2 (p = 0,024) et des antecedents de radiotherapie osseuse dans l’annee (p = 0,003). Un taux de neutrophiles inferieur a 3,37 g/L avant la mise en place du palbociclib est egalement un facteur predictif de developper une hematotoxicite avec une sensibilite de 76 % et une specificite de 71 %. Conclusion Le Performance Status, les antecedents de radiotherapie osseuse dans l’annee et un taux bas de neutrophiles avant traitement sont associes a une augmentation du risque d’hematotoxicite chez les patients traites pour un cancer du sein metastatique.

Oncological at home-treatment improves patient quality of life and autonomy but requires close watchfulness of adverse events and compliance to treatment. For nearly ten years, pharmaceutical consultations for home-based anticancer oral therapies patients are proposed on medical request in Avignon-Provence Cancer Institute (ICAP). Organizational changes led us to modify this management by integrating dedicated nurses to create an Oral Therapy Unit (OTU).Needs and expectations assessment questionnaires were proposed to healthcare professionals and patients treated by oral therapies. The analysis of these questionnaires allows to set up an OTU, integrating a dedicated nurse, adapted to the expectations of patients and healthcare professionals. About 8 months later, a new evaluation was carried out to assess the impact of this new support for patient care and health professionals' organization.The results of the studies carried out before OTU implementation highlight the importance of multi-professional support for patients from the start of treatment and during the follow-up. With the new OTU pathway, professionals expect a patient course improvement (94%), a better compliance (88%), a therapeutic accidents reduction (81%) and an improvement in the patient-caregiver relationship (69%). Regarding the organization, 56% of them are expecting to save medical and pharmaceutical time.The OTU creation in our institution and these new multi-professionals' teams' management of patients has obtained a favourable opinion from healthcare professionals and patient satisfaction.

Background: Persistence of unhealthy behaviors may adversely affect breast cancer (BC) outcomes and quality of life. Cancer diagnosis can represent a teachable moment and a powerful catalyst to correct such behaviors. It has been suggested that some cancer patients (pts) may be motivated towards a healthier lifestyle, particularly in case of a worse cancer-related prognosis. In this study we aimed at understanding the evolution and barriers in adoption of health behaviors after BC. Methods: We analyzed 8580 pts enrolled from 2012-2015 in a nationwide, multicenter study of stage I-III BC (CANTO, NCT01993498). Pts were longitudinally assessed at diagnosis (baseline), year(y)1 and y2 post-diagnosis. Recreational physical activity (PA) was reported using the GPAQ-16. An unhealthy smoking behavior was defined as active smoker status and an unhealthy alcohol behavior as consumption of ≥1 drink/day at y1 and y2. First, we described the longitudinal evolution of health behaviors. Then, we examined factors associated with health behaviors, to define pts that fail to adopt healthy lifestyle changes. Random effect mixed models evaluated changes in PA over time. Logistic regression models estimated odds of unhealthy smoke and alcohol behavior at y1 and y2. All models were adjusted for tumor, including BC stage, clinico-behavioral and treatment characteristics. Results: Mean age at diagnosis was 55 y (SD 11), 9% pts had stage III BC, 49% were overweight/obese (body mass index [BMI] ≥25 Kg/m2), 41% did not meet PA recommendations (0.05 at both time points). Among pts who were active smokers at baseline, 37% at y1 and 30% at y2 reported reduced tobacco, and among those who used to have ≥1 drink/day at baseline, 11% at y1 and 8% at y2 reported reduced alcohol consumption. 11% pts at y1 and 12% pts at y2 had unhealthy smoke behavior whereas 13% pts at y1 and 14% pts at y2 had unhealthy alcohol behavior (Cochran-Armitage trend test: p=0.034 for smoke and p=0.193 for alcohol). Older age (adjusted odds ratio [aOR] for a 5-year increase in age, 0.69 [95%CI 0.66-0.73]) and being in a relationship (aOR vs not, 0.66 [95% CI 0.54-0.82]) were associated with reduced odds of unhealthy smoke behavior, although older pts (aOR for a 5-year increase in age, 1.34 [95%CI 1.22-1.40]) and those in a relationship (aOR vs not, 1.35 [95% CI 1.10-1.68]) were also more prone to unhealthy alcohol behavior. Lower BMI was consistently associated with higher odds of unhealthy smoke and alcohol behavior (aOR for each decreasing BMI unit: for smoke behavior, 1.05 [95%CI 1.03-1.07]; for alcohol behavior, 1.02 [95% CI 1.01-1.04]). BC stage was not associated with smoke and alcohol behavior. Conclusions: This large clinical study suggests that a substantial proportion of pts pursue a healthy lifestyle after BC. However, there are still survivors that fail to adopt positive and durable lifestyle changes. Uptake of increased levels of PA was not homogenous in this cohort, and we found an upward trend in unhealthy smoke behavior and steady rates of unhealthy alcohol behavior over time. We defined diverse behavioral profiles of pts, according, among others, to age, social status, BMI and BC characteristics. These data will help better inform targeted lifestyle interventions to improve health behaviors after BC. Citation Format: Antonio Di Meglio, Arnauld S Gbenou, Elise Martin, Laurence Vanlemmens, Charles Guenancia, Olivier Rigal, Marion Fournier, Patrick Soulie, Marie-Ange Mouret-Reynier, Carole Tarpin, Florence Boiffard, Sophie Guillermet, Sibille Everhard, Anne-Laure Martin, Sylvie Giacchetti, Thierry Petit, Florence Dalenc, Philippe Rouanet, Antoine Arnaud, Fabrice Andre, Ines Vaz-Luis. Lifestyle changes after breast cancer: A prospective study among 8580 women [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-03.

Background The objective of the CHEOPS trial was to assess the benefit of adding aromatase inhibitor (AI) to metronomic chemotherapy, oral vinorelbine, 50 mg, three times a week for pre-treated, HR + /HER2- metastatic breast cancer patients. Methods In this multicentric phase II study, patients had to have progressed on AI and one or two lines of chemotherapy. They were randomized between oral vinorelbine (Arm A) and oral vinorelbine with non-steroidal AI (Arm B). Results 121 patients were included, 61 patients in Arm A and 60 patients in Arm B. The median age was 68 years. 109 patients had visceral metastases. They all had previously received an AI. The study had been prematurely stopped following the third death due to febrile neutropenia. Median PFS trend was found to be different with 2.3 months and 3.7 months in Arm A and Arm B, respectively (HR 0.73, 95%CI 0.50–1.06, p value = 0.0929). No statistical difference was shown in OS and better tumor response. 56 serious adverse events corresponding to 25 patients (21%) were reported (respectively, 12 (20%) versus 13 (22%) for arms A and B) (NS). Conclusion The addition of AI to oral vinorelbine over oral vinorelbine alone in aromatase inhibitor-resistant metastatic breast cancer was associated with a non-significant improvement of PFS. Several unexpected serious adverse events were reported. Metronomic oral vinorelbine schedule, at 50 mg three times a week, requires close biological monitoring. The question of hormonal treatment and chemotherapy combination remains open.

IMPORTANCE: Endometrial cancer is often hormone-dependent and treated with aromatase inhibitors. The PI3K-AKT-mTOR pathway deregulation observed in endometrial cancer drives hormonal resistance, thus supporting the rationale of combining mTOR inhibitor with endocrine therapy. OBJECTIVE: To evaluate the safety and efficacy of vistusertib in combination with anastrozole in the treatment of women with hormone receptor−positive recurrent or metastatic endometrial cancer. DESIGN, SETTINGS, AND PARTICIPANTS: The VICTORIA study was a multicenter, open-label, randomized clinical trial that accrued 75 patients with hormone receptor−positive recurrent or metastatic endometrial cancer from 12 cancer centers in France in April 2016 to October 2019. After a safety run-in period, a Simon 2-stage design was used. Data analyses were performed from December 11, 2020, to March 11, 2021. INTERVENTIONS: Patients were randomized in a 2:1 ratio to oral vistusertib (125 mg twice daily 2 days per week) and oral anastrozole (1 mg daily) in the combination vistusertib with anastrozole arm (V+A arm) or oral anastrozole alone (A arm). MAIN OUTCOMES AND MEASURES: The primary end point was serious adverse events for the safety run-in period and progression-free rate at 8 weeks (8wk-PFR)—assessed with a blinded independent central review in phase 2. The secondary end points were objective response rate, duration of response, progression-free survival (PFS), overall survival, and incidence of adverse events. RESULTS: Of the 75 patients who were randomized, 73 (median [range] age, 69.5 [37-88] y; all female) were treated: V+A arm, 49 patients; A arm, 24 patients. In the V+A arm, the 8wk-PFR was 67.3% (unilateral 95% CI, 54.7%) and in the A arm, 39.1% (unilateral 95% CI, 22.2%). No significant serious adverse events were reported during the safety run-in period (n = 6 in V+A arm). The overall response rate was 24.5% (95% CI, 13.3%-38.9%) in the V+A arm vs 17.4% (95% CI, 5.0%-38.8%) in the A arm. With a median follow-up of 27.7 months, median PFS was 5.2 (95% CI, 3.4-8.9) in the V+A arm and 1.9 (95% CI, 1.6-8.9) months in the A arm. Fatigue, lymphopenia, hyperglycemia, and diarrhea were the most common (grade ≥2) adverse events associated with vistusertib. CONCLUSIONS AND RELEVANCE: This multicenter, open-label, phase 1/2 randomized clinical trial demonstrated that adding vistusertib to anastrozole improved 8wk-PFR, overall response rate, and PFS for patients with endometrial cancer and had manageable adverse events. Identification of molecular subgroups would allow for more precise selection of patients who may be most likely to experience favorable outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02730923

Supervised exercise dietary programs are recommended to relieve cancer-related fatigue and weight increase induced by adjuvant treatment of early breast cancer (EBC). As this recommendation lacks a high level of evidence, we designed a multicenter randomized trial to evaluate the impact of an Adapted Physical Activity Diet (APAD) education program on fatigue. We randomized 360 women with EBC who were receiving adjuvant chemotherapy and radiotherapy to APAD or usual care at eight French cancer institutions. Data were collected at baseline, end of chemotherapy, end of radiotherapy, and 6 months post-treatment. The primary endpoint was the general cancer-related fatigue score using the MFI-20 questionnaire. Fatigue correlated with the level of precariousness, but we found no significant difference between the two groups in terms of general fatigue (p = 0.274). The APAD arm has a smaller proportion of patients with confirmed depression at the end of follow-up (p = 0.052). A transient modification in physical activity levels and dietary intake was reported in the experimental arm. However, a mixed hospital- and home-based APAD education program is not enough to improve fatigue caused by adjuvant treatment of EBC. Cancer care centers should consider integrating more proactive diet&ndash, exercise supportive care in this population, focusing on precarious patients.

Purpose Genomic tests can identify ER-positive HER2-negative localized breast cancer patients who may not benefit from adjuvant chemotherapy. Such tests seem especially interesting in “intermediate” clinico-pathological risk categories. The psychological impact of the decision uncertainty in these women remains largely unexplored. We assessed the clinical and psychological impact of EndoPredict® (EpClin), a clinico-genomic test, in these patients. Methods This multicenter, single arm prospective study (NCT02773004) enrolled patients for which adjuvant chemotherapy was uncertain, based on predefined criteria. The primary endpoint was the proportion of change between initial adjuvant decision and final administration of chemotherapy. Secondary endpoints included post-test (Day 17) and 1-year patient reported outcomes. Results One third of 200 evaluable patients had a high EpClin score (≥3.32867; 10 years cumulative risk of distance failure ≥10%). The overall change rate of chemotherapy decision was 72/200 (35.8%, 95% CI 29.2–42.4). Chemotherapy was withdrawn in 57 cases (28.4% [22.2–34.8]) and added in 15 (7.5% [3.8–11.2]. 6 changes (8%) were based on patients’ decisions. Anxiety and distress levels increased at Day 17 when adding chemotherapy after the test result (p, Highlights • EndoPredict ® (EpClin) allowed a chemotherapy decision modification in 35% of the patients included in the Adendom trial. • Patient-physician concertation is important: 8% of treatment changes are based on patients’ will. • A single-step decision including the test appears preferable to limit anxiety and distress.

Metastatic breast cancer (MBC) patients experience long survival and report poorer quality of life than localized breast cancer patients. Comprehensive supportive care (CSC) has been shown to improve the quality of life (QoL) of MBC. The respective part of each support care has not been fully examined, and little is known about whether meeting patients’ needs is accompanied by decreased unscheduled hospital care (UHC). This prospective monocentric study included women who started a new treatment line for MBC between January 2018 and December 2018. The endpoints were factors associated with UHC and QoL (SF36) at month 12. 100 patients were offered CSC, 78 were included (21 refusals, 1 no MBC). CSC was provided to 60 patients: pain (43%), psychological (37%), kinesitherapy (30%), social assistance (22%), esthetic (18%), nutrition (18%), massage (13%), and none (10%). CSC rate was not statistically different among patients with (58%) and without UHD (49%). Factors associated with a decrease of UHC were age > 65 years (p = 0.01), no previous treatment for MBC (p = 0.0001) with a trend for the lack of CSC (p = 0.054). Among the 8 domains of the SF36 scale, only health change perception was improved (p = 0.01) and its predictive factors were treatment carried out as planned (p = 0.0004), pain care (p = 0.003), and lack of MBC progression (p = 0.0035). CSC can improve QoL in MBC. Painful patients might benefit more from CSC. UHC did not decrease for patients receiving CSC as expected possibly because of their important needs for clinical care.

Background There is no large prospective trial assessing mid-term adverse effects of adjuvant chemotherapy. In order to address this question, we developed CANTO (CANcer TOxicities - NCT01993498 - http://etudecanto.org/), a prospective trial dedicated to the quantification of side effects after treatment for patients with early breast cancer and to develop predictors of such toxicities. The aim of this presentation is to assess chemotherapy (CT) practice and to report toxicities that persist 3-6 months after CT. Methods CANTO is a prospective study enrolling newly diagnosed invasive cT0-cT3, cN0-3, M0 breast cancer patients (pts) of 26 French comprehensive cancer centers. The study has included 10 500 patients at the time of submission. Pts are assessed at diagnosis, 3-6, 12, 36, 48 and 60 months after treatment completion. CANTO collects >100 items related to toxicities. In the current study, we focus on the first set of data available from the trial (1st database lock, n=6090). We here assess CT practice and toxicities at 3 months. Results Information about (neo)adjuvant CT (NACT/ACT) is available in 5805 pts (96%). Median age at diagnosis was 57y (22-93). Pts had HR+/HER2-, HER2+ or triple negative (TN) tumors in 74%, 15% and 11% of cases. Ki67 was assessed in 70%, and genomic tests in 1% of pts, respectively. Overall, 3074 pts (53%) received CT, either adjuvant (ACT: 76%) or neoadjuvant (NACT: 24%). ACT/NACT pts (84%) received a sequential anthracyclines–taxanes based 6 courses CT schedule. CT was administered in 44.7%, 87.2% and 92.3% of HR+/HER2+/TN tumors, respectively. ACT was administered in 73.2% of pT2+ pts (vs 36.0% in pT0-1 – p We focus here on clinically most relevant patient reported symptoms at 3 m (any grade). side effects at 3m no CT (%)CT (%)p valuePain76.682.1 Pain complaint was recorded in 3596 pts (97.2% of pts with available data), with a median value of 4 on the VAS (range 1-10). In ACT/NACT pts, muscle and joint pain were predominant. Neurological symptoms were seen in 3024 pts (59%), the most frequent pertaining to cognitive disorder (attention trouble, CT: 61.2% vs noCT: 56% - p=.06) and peripheral neuropathy (overall 31%). Paresthesias and sensory neuropathy were much more frequent in CT vs noCT pts: respectively 37.3% vs 20.3% and 25.7% vs 12.8% (both p Conclusions In this real life, prospective cohort, CT is frequently prescribed and appears in good compliance with current guidelines. Overall, symptoms burden at treatment completion is strikingly high, and much higher in pts receiving CT. A special attention should be given to pain and neurological symptoms. Dedicated questionnaires and sub-studies will explore in depth these side effects. Extended analyses of CT practice and toxicities will be presented. Citation Format: Cottu PH, Amar Y, Pistilli B, Bonsang-Kitzis H, Lesur A, Lerebours F, Vanlemmens L, Tredan O, Levy C, Jouannaud C, Fournier M, Soulie P, Rigal O, Giacchetti S, Arnaud A, Arsene O, Savignoni A, Mesleard C, Andre F, Arveux P. CANTOCHEM: Analysis of chemotherapy practice and early side effects in the 6090 first patients from the prospective CANTO cohort [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-18.

Background In early breast cancer (BC), there has been a trend to escalate endocrine therapy (ET) and to de-escalate chemotherapy (CT). However, the impact of ET versus CT on the quality of life (QoL) of early BC patients is unknown. Here, we characterize the independent contribution of ET and CT on patient-reported outcomes (PROs) at 2 years after diagnosis. Patients and methods We prospectively collected PROs in 4262 eligible patients using the European Organization for Research and Treatment of Cancer QLQ-C30/BR23 questionnaires inside CANTO trial (NCT01993498). The primary outcome was the C30 summary score (C30-SumSc) at 2 years after diagnosis. Results From eligible patients, 37.2% were premenopausal and 62.8% postmenopausal; 81.9% received ET and 52.8% CT. In the overall cohort, QoL worsened by 2 years after diagnosis in multiple functions and symptoms; exceptions included emotional function and future perspective, which improved over time. ET (Pint = 0.004), but not CT (Pint = 0.924), had a persistent negative impact on the C30-SumSc. In addition, ET negatively impacted role and social function, pain, insomnia, systemic therapy side-effects, breast symptoms and further limited emotional function and future perspective recovery. Although CT had no impact on the C30-SumSc at 2-years it was associated with deteriorated physical and cognitive function, dyspnea, financial difficulties, body image and breast symptoms. We found a differential effect of treatment by menopausal status; in premenopausal patients, CT, despite only a non-significant trend for deteriorated C30-SumSc (Pint = 0.100), was more frequently associated with QoL domains deterioration than ET, whereas in postmenopausal patients, ET was more frequently associated with QoL deterioration, namely using the C30-SumSc (Pint = 0.004). Conclusion(s) QoL deterioration persisted at 2 years after diagnosis with different trajectories by treatment received. ET, but not CT, had a major detrimental impact on C30-SumSc, especially in postmenopausal women. These findings highlight the need to properly select patients for adjuvant ET escalation.

International audience; Ameloblastomas are uncommon locally aggressive tumors of odontogenic epithelium that rarely metastasize. Currently, there is no standard of care for the metastatic forms. Several studies have shown that ameloblastomas frequently have a BRAF mutation.Case presentation: We report a case of a 33-year-old Caucasian woman with ameloblastoma diagnosed 30 years ago who developed lung metastasis 19 years ago. Systemic oral treatment with vemurafenib, a BRAF inhibitor, was initiated 28 months ago within the AcSé French basket clinical trial of vemurafenib.Conclusions: The patient has shown a durable clinical, functional, and radiographic partial response with vemurafenib. These observations suggest the possibility of introducing neoadjuvant and/or adjuvant targeted therapy in locally advanced ameloblastoma to improve outcome. BRAF inhibition has proved to be an efficient strategy in patients with a BRAF-mutated ameloblastoma.

5507 Background: Endometrial carcinoma is generally hormone dependent and aromatase inhibitors are used in routine practice before or after 1st line chemotherapy (CT) for HR positive patients. Deregulation of the Pi3K-Akt-mTOR signaling pathway is observed in many tumor types including endometroid carcinoma driven oncogenesis and hormonal resistance. Vistusertib (V) is a small-molecule ATP competitive inhibitor of both mTORC1 and mTORC2 complexes. Methods: Adult patients (pts) with recurrent oestrogen or progesterone (ER and/or PR) positive advanced/metastatic endometrial carcinoma, one previous line of chemotherapy (CT) allowed, with ECOG PS 0/1, were randomised (2:1, stratification according to prior CT line: 0 vs 1) to receive V (125 mg bid/2 days/week, orally) + Anastrozole (A, 1 mg/d, orally) or A alone. Treatments were given until progression, intolerable toxicity or patient willingness. Following a safety run in phase, a Simon’s 2-stage design was employed to explore the 8-week progression free rate (PFR-8W) according to central review (p1: 60%, p0: 40%, type I error rate of 5%, power of 80%). At the end of Stage II, if ≥24/46 evaluable pts are progression free at 8w in Arm A+V, the combination will be considered of interest for further investigation. Overall response rate (ORR) by RECIST v1.1, safety and progression-free survival (PFS) were key secondary endpoints. Results: Out of 75 patients (pts) enrolled, 73 were randomised and treated (Arm V+A: 49; Arm A: 24; median age: 69.5 y [36.8; 87.8]), BMI ≥30 kg/m²: 45%). PS ECOG was 0 (48%) and 44% of randomised pts were chemotherapy naïve; 12% previously received hormonal therapy. At the end of the safety run-in, no major safety concerns were reported. At the end of Simon’ Stage II, centrally assessed PFR-8W was 67.3% (33/49 [95% CI unilateral: 54.7; -]) for A + V arm and 39.1% (9/23 [[95% CI unilateral: 22.2; -[) for arm A. Median PFS was 5.2 months (95% CI: 3.4-8.9) and 1.9 months (95% CI: 1.6-8.9) for A+V and A arms, respectively. One complete response and 11 partial responses (PR) were observed (ORR: 24.5 % (CI 95% [13.3 – 38/9%]) in the combination arm and 4 PR in arm A (ORR: 17.4% [CI 95%: 5-38.8%]). Fatigue, lymphopenia, hyperglycaemia and diarrhoea were the main (≥10%) Grade ≥2 adverse events related to V. Overall survival and translational research are ongoing. Conclusions: The A+V combination demonstrated clinically and meaningful improvement in 8w-PFR and median PFS with manageable toxicity. PI3K pathway remains a key target for new therapies in endometrial cancer and translational research must help to better select pts benefiting from these targeted therapies. Clinical trial information: NCT02730923.

Resume Objectif Depuis les dernieres recommandations nationales elaborees par l’Institut national du cancer (INCa) et la Societe francaise de senologie et de pathologie mammaire (SFSPM) sur l’ensemble de la prise en charge diagnostique et therapeutique des carcinomes canalaires in situ (CCIS), de nouvelles publications ont fait emerger des interrogations en termes de bonnes pratiques et sur les possibilites de desescalade therapeutique dans la prise en charge des CCIS. L’actualisation de ces recommandations intervient dans un contexte de questionnement sur le surdiagnostic et son corollaire le surtraitement. Elle met a la disposition des professionnels des informations sur les bonnes pratiques correspondant a l’etat le plus recent des connaissances scientifiques et etudie notamment les possibilites de desescalade therapeutique. Methode Le processus d’elaboration est base sur une revue systematique de la litterature et sur le jugement argumente d’experts cliniciens au sein d’un groupe de travail multidisciplinaire. Avant publication, les recommandations sont revues par plus de cent experts cliniciens independants du groupe de travail. Resultats Cet article presente les recommandations nationales relatives a l’indication de l’IRM, la place de la macrobiopsie en cas de microcalcifications et la conduite a tenir en cas de CCIS de bas grade identifie par biopsie, dans le diagnostic des CCIS.

8 pages; International audience; Lateralization refers to the preferential use of one side of the body to perform certain tasks, often as a consequence of the specialization of cerebral hemispheres. Individuals may benefit from lateralization if it allows them to perform complex tasks simultaneously. Studies on laterality further suggest that sex and age can influence the extent of lateralization. However, most studies on lateralization have been performed on captive individuals, exposed to simplified environments and expressing limited behavioural repertoire. Here, we evaluated behavioural lateralization in the greater flamingo, Phoenicopterus roseus, through observations of wild individuals 5–37 years old. We examined the lateralization of simple behaviours (resting postures) and of several demanding behaviours requiring enhanced motor control and coordination (stamping for food and five courtship postures). Resting postures were not lateralized. In contrast, nearly all flamingos were completely lateralized for stamping, with a significant predominance of right-footed individuals. During courtship displays, twist-preens were significantly lateralized, yet with no dominant laterality at the population level. Finally, we detected a slight positive effect of age on the intensity of twist-preen lateralization, which may be related to the increased complexity of courtship displays with age in this species. Our results support the hypothesis that lateralization manifests in complex behaviours, even in wild animals.

The Greater Flamingo Phoenicopterus roseus is a waterbird commonly found in saline and brackish lagoons throughout the Mediterranean Region. We have gathered existing data on Greater Flamingos in Turkey and carried out field surveys to present the most up to date information on wintering (1999–2014) and breeding (1969– 2014). The wintering population of flamingos shows an increasing trend with 54,947±20,794 individuals mainly concentrated in the Gediz, Buyuk Menderes and Cukurova deltas, respectively. Breeding attempts were recorded in at least seven wetlands in Turkey in the past, yet after 1999 most of the colonies were abandoned due to basin scale intensive water management practices in Central Anatolia. Currently, only Tuz Lake and Gediz Delta are used as regular breeding sites, while breeding has been recorded sporadically in Acigol and Aksehir Lakes. The breeding colony of Tuz Lake is of prime importance at the Mediterranean scale, with the number of young chicks in 2011, 2012 and 2013 accounting fo...

a b s t r a c t This study tracks temporal variations in the habitat use of breeding adult greater flamingos (Phoeni copterus roseus) in the Camargue (southern France) using simultaneous sampling of d 15 N, d 13 C and d 34 S from feather and blood of chicks at fledging. Camargue flamingos forage in a heterogeneous complex of saltpans, permanent and temporary brackish lagoons, freshwater and euryhaline marshes to provision their chicks over a two month period. Using Bayesian mixing models with diet and tissue speci fic discrimination factors and invertebrates collected from 23 locations, we investigated whether blood and feather isotopes indicated temporal variations in habitat use relative to salinity and hydroperiod. We also tested whether fledgling body condition could be explained by the isotopic signatures of their tis sues. While d 13 C and d 15 N values did not differ signi ficantly between blood and feather, marked differ ences were apparent in the d 34 S values obtained from these tissues. Saltpans (38%) and freshwater marshes (33%) appeared to be the main habitats visited by adult birds in the early phase of parental care with use of saline wetlands increasing later in the season (54%). This habitat shift may be related to the peak of resources in saltpans and the drying up of freshwater and brackish marshes by mid summer. Habitat shift (as expressed in individual shifts in isotope values between feather and blood) was not correlated with offspring age, and differed between individuals. A negative relationship was observed between offspring body condition and feather d 15 N, indicating that chicks fed from temporary flooded marshes fare better than those provisioned from permanent marshes. Foraging strategies of greater flamingos during parental care were heterogeneous, possibly tracking changes in resource availability as the season progressed and re flecting differences in the competitive ability of parent birds. Given that the Camargue saltpans face closure and the region ’s temporary wetlands remain threatened, our results emphasize the critical importance of conserving these two key habitats for greater flamingos. Dual tissue, triple stable isotope analysis provides a useful and sensitive means of tracking localized environmental change in this threatened system.

Background In patients treated with cardiotoxic chemotherapies, the presence of cardiovascular risk factors and previous cardiac disease have been strongly correlated to the onset of cardiotoxicity. The influence of overweight and obesity as risk factors in the development of treatment-related cardiotoxicity in breast cancer (BC) was recently suggested. However, due to meta-analysis design, it was not possible to take into account associated cardiac risk factors or other classic risk factors for anthracycline (antineoplastic antibiotic) and trastuzumab (monoclonal antibody) cardiotoxicity. Methods and findings Using prospective data collected from 2012–2014 in the French national multicenter prospective CANTO (CANcer TOxicities) study of 26 French cancer centers, we aimed to examine the association of body mass index (BMI) and cardiotoxicity (defined as a reduction in left ventricular ejection fraction [LVEF] > 10 percentage points from baseline to LVEF < 50%). In total, 929 patients with stage I–III BC (mean age 52 ± 11 years, mean BMI 25.6 ± 5.1 kg/m2, 42% with 1 or more cardiovascular risk factors) treated with anthracycline (86% epirubicin, 7% doxorubicin) and/or trastuzumab (36%), with LVEF measurement at baseline and at least 1 assessment post-chemotherapy were eligible in this interim analysis. We analyzed associations between BMI and cardiotoxicity using multivariate logistic regression. At baseline, nearly 50% of the study population was overweight or obese. During a mean follow-up of 22 ± 2 months following treatment completion, cardiotoxicity occurred in 29 patients (3.2%). The obese group was more prone to cardiotoxicity than the normal-weight group (9/171 versus 8/466; p = 0.01). In multivariate analysis, obesity (odds ratio [OR] 3.02; 95% CI 1.10–8.25; p = 0.03) and administration of trastuzumab (OR 12.12; 95% CI 3.6–40.4; p < 0.001) were independently associated with cardiotoxicity. Selection bias and relatively short follow-up are potential limitations of this national multicenter observational cohort. Conclusions In BC patients, obesity appears to be associated with an important increase in risk-related cardiotoxicity (CANTO, ClinicalTrials.gov registry ID: NCT01993498). Trial registration ClinicalTrials.gov NCT01993498., Charles Guenancia and colleagues investigate the association of obesity to breast cancer treatment related cardiotoxicity., Author summary Why was this study done? Anthracyclines remain a cornerstone of breast cancer therapy, in combination with new-generation targeted drugs such as trastuzumab, and represent the major culprit in chemotherapy-induced heart disease. In a recent meta-analysis, we showed that overweight and obesity increased cardiotoxicity, but it was not possible to take into account associated cardiac risk factors or other classic risk factors for anthracycline and trastuzumab cardiotoxicity. We examined the association of body mass index (BMI) and cardiotoxicity using prospective data collected in the CANTO study, a French national cohort. What did the researchers do and find? In patients treated for stage I–III breast cancer with anthracyclines and/or trastuzumab, being obese was associated with increased risk of developing cardiotoxicity, regardless of other predictors of cardiotoxicity. Among all the classic risk factors for cardiotoxicity, overweight and obesity were by far the most common risk factors in this breast cancer population. What do these findings mean? Obesity appears to be a risk factor for cardiotoxicity in breast cancer patients. Overweight and obese patients may benefit from careful cardiac screening and follow-up during and after chemotherapy.

Background In this study we aimed to examine the independent effect of baseline QoL and persistent CRT among pts with early BC. Methods We included data stage I-III BC pts treated with chemotherapy who were included in the CANTO prospective cohort study (NCT-01993498) from 03/2012 to 12/2014. The primary outcome was CRT defined as the presence at 3-6 months after the end of treatment, of any of the following toxicities (NCI-CTC-AE): infection, venous or arterial thrombosis, neurological G2-4, digestive G3-4 or pulmonary toxicities G3-4). Treatment deliver including chemotherapy dose reductions were also examined. The independent variable of this study was baseline Qol defined by the EORTC QLQ-C30 subscales of general global health status (GHS) ( Results Among 3079 BC pts included in this analysis, 33% received neoadjuvant and 77% adjuvant treatment. Median age at diagnosis was 53 years, median BMI= 25 kg/m2, 94% of patients had a PS = 0 and 83% stage I-II disease. Pts reported on average a good GHS = 68 (±19) and PF = 90 (±14). GHS and PF were higher in women with better performance status PS = 0 vs 1+, (68 vs 60 p Conclusions Global and physical QoL before BC treatments are independently associated with CRT. QoL should be assessed before any treatment to identify patients at risk CRT. Clinical trial identification NCT01993498. Legal entity responsible for the study UNICANCER/Villejuif, France, 94805 Principal Investigator: Fabrice Andre Gustave Roussy – Villejuif. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

512 Background: We recently witnessed a trend to de-escalate CT and escalate ET in adjuvant BC treatment (tx). However, there has been limited prior research investigating the differential impact on QoL of tx classes. We aimed to test the impact of CT and ET on QoL PROs 2 yrs after diagnosis (dx). Methods: CANTO (NCT01993498) is a multicenter prospective longitudinal study of stage I-III BC pts that characterizes long-term toxicities of BC tx. For this analysis we included 4262 pts recruited from 2012-14. QoL was extensively evaluated using the EORTC QLQ C30 and BR23. Linear regression modeling was performed, adjusting for demographic and clinical factors, with use of CT and/or ET as independent variables. Analyses were stratified by menopausal status due to different tx patterns and sequelae of CT. Results: Median age at dx was 56 yrs, 63% of pts were post (PostM) and 37% premenopausal (PreM), 80% had Charlson score 0, 91% stage I-II. 26% received mastectomy, 52% CT (preM 68%, postM 44%; 86% anthracycline+taxane) and 82% ET (preM 89% tamoxifen; postM 88% aromatase inhibitor). 32% preM pts had menses 1 year after ET initiation. Overall, QoL deteriorates 2 yrs after dx. ET negatively impacts more QoL domains than CT at 2 yrs. Also, young age, smoking, income, aggressive local tx and physiological distress are often associated with low QoL. In the stratified analyses, in postM pts, mostly ET (not CT) is associated with deteriorated QoL. In contrast, in preM pts, mostly CT (not ET) is associated with deteriorated QoL. Table shows eg of associations. Conclusions: In a large prospective cohort of BC survivors, detrimental QoL 2 yrs after dx is mostly associated with ET; however, negative effects of CT persist on preM. This differential effect on QOL should be considered when choosing optimal adjuvant therapy and appropriate selection of pts for ET escalation should be a research priority. [Table: see text]

1043 Background: For ER+/HER2- metastatic breast cancer (mBC), efficacy of endocrine therapy + chemotherapy combination remain an open question. We hypothesized that continuing ER targeted therapy after progression in combination with chemotherapy may improve disease control. The objective of the CHEOPS trial was to assess the benefit of adding aromatase inhibitor (AI) to metronomic chemotherapy,oral vinorelbine, 50mg/3 time a week (OV) for AI pre-treated, ER+/HER2- mBC patients. Methods: Eligible patients had to have progressed on endocrine therapy and one or two lines of chemotherapy. They were randomized between vinorelbine (OV) and vinorelbine + AI (OV+AI). Primary end point was progression-free survival (PFS). To show an increase of median PFS (from 3.5 to 5.5 month, HR 0.636), with alpha = 5% and power = 80%, 130 evaluable patients were needed. Results: 121 patients were Included (OV = 61; OV+AI = 60). Median age was 68 (range: 49-87), Median time from metastatic diagnosis was 3.2 years (range 0 - 16.9). 109 patients (90%) had visceral metastases. They all had previously received an AI and had been treated with one line (N = 66, 54.5%), or 2 lines (N = 55, 45.5%) of chemotherapy. Median PFS was increased from 2.3 months with OV to 3.7 months with OV+AI, but this difference was not significant (HR 0.73 [95 % CI 0.50-1.06], log-rank test: P = 0.09) 81 patients (67%) had at least one adverse event (AE) of grade ≥ 3 (40 (66%) for OV vs 41 (68%) for OV+AI). The most common grade ≥ 3 AE were: GT gammas (23%), neutropenia (18%), arterial hypertension and lymphopenia (17%). The occurrence of 3 toxic deaths (OV = 1; OV+AI = 2) secondary to febrile aplasia motivated the early cessation of this clinical trial. 9 patients (5 OV (10%) and 4 OV+AI (8%) presented an objective complete or partial response. Conclusions: The addition of AI to OV over OV alone in AI resistant mBC was associated with a non-significant improvement of PFS, but both PFS are lower than expected. Metronomic OV schedule, at 50 mg three times a week, requires close biological monitoring. The question of hormonal treatment and chemotherapy combination remains open. Clinical trial information: EudraCT Number: 2015-000401-39.

Since the last guidelines published by the French National Cancer Institute (INCa) and the learning society "Société française de sénologie et de pathologie mammaire (SFSPM)" in 2009 about diagnosis and management of ductal carcinoma in situ, new data raised issues about overdiagnosis and its consequences, overtreatment. Therefore, an update was necessary, to provide healthcare professionals up-to-date guidelines and study therapeutic desescalation in particular.The clinical practice guidelines development process is based on systematic literature review and critical appraisal by a multidisciplinary experts workgroup. The recommendations are thus based on the best available evidence and experts agreement. Prior to publication, the guidelines are also reviewed by more than 100 independent practitioners in cancer care delivery.This article presents French guidelines about MRI and vacuum assisted breast biopsy indications for DCIS diagnosis and the management of low-grade DCIS.

The long-lived greater flamingo (Phoenicopterus roseus) is famous for performing conspicuous group displays during which adults try to acquire a new mate each year with varying success. We examined variation in the sexual display complexity (SDC) of wild flamingos aged between 4 and 37 yrs. SDC was defined as the product of richness (the number of different display movements) and versatility (the number of transitions between movements) within a 5 min behavioral sequence. In both sexes, date in the pairing season had a linear and positive effect on SDC, whereas age had a quadratic effect, with SDC increasing until about age 20yrs, and declining afterwards. SDC better explained pairing patterns than age, and positively influenced the probability of becoming a breeder. Our results thus support the idea that SDC is an honest signal of individual quality and further suggest that senescence in display could be an overlooked aspect of reproductive decline in species with no or weak pair bonding.

In case of a new breast symptom or an abnormal result of breast imaging, some women have a problem finding a quick answer to allay their anxiety. The Institut Sainte-Catherine in Avignon has set up a new form of accelerated disease management through the opening of a new dedicated consultation called SOS SEIN 84. We present the result of a prospective quality study of our first new patients.

Mate guarding by males is common in species with long-lasting pair bonds. We tested if the need to guard females affected foraging depth in male teal (Anas crecca), and if they were more vigilant than females when foraging with submerged eyes (preventing monitoring of competing males and predators). These predictions were not supported, suggesting that foraging depth selection is primarily driven by other factors, presumably food related. A likely reason why deeply foraging males did not increase vigilance is that 37.5% of the foraging time was already dedicated to it. The apparent lack of guarding costs in foraging male teal may explain why such small ducks can maintain pair bonds for up to 7 months.

A 35-year-old man had prolonged occupational exposure to lead carboxylate, triethylbenzene, xylene, and dichloromethane, when he developed a subacute predominantly sensory neuropathy. Ultrastructural examination of a peripheral nerve biopsy showed axonal degeneration and unusual lesions of the myelin, with Schwann cell sequestration of vesicular and lamellar debris. Biochemical analysis of lead in a frozen peripheral nerve specimen revealed no significant difference between the propositus and a control. The authors were unable to find any similar peripheral nerve lesions in the literature dealing with neurotoxic chemicals. Any of the several organic solvents could have equally caused the neuropathy and may have been potentialized by the other chemicals.

Prognostic signification of micrometastases ou isolated tumor cells (ITC) has not yet been clearly precised. Management of the axilla in case of micrometastases or ITC depends on the local pratices: no surgical completion or axillary lymph node dissection (ALND). Axillary lymph node status is the most important prognostic factor in patients with breast cancer; morbidity of ALND is now well known whereas its therapeutic benefit has not been demonstrated. This study is based on a retrospective database of 1375 patients who underwent sentinel node (SN) biopsy for breast cancer. In case of micrometastase or ITC in SN with completion axillary dissection, we examined if non-sentinel lymph node status has changed the indications of adjuvant treatments (chimiotherapy or radiotherapy). The results of our study show that non-sentinel lymph node status modify systemic therapy for a very few patients (less than 4% concerning chimiotherapy and less than 15% concerning radiotherapy).

International audience; The trade-off foragers make between predation risk and feeding efficiency is readily studied in dabbling ducks, which have stereotyped feeding methods, some of which prevent predator detection while others do not. Teals forage mostly with only the bill submerged (eyes above the water surface) in winter, but use a broader foraging repertoire in summer. Given the different environments used by teals over the year, it is likely that such a shift is due to changes in diet, but it may also be caused by differences in predation risk between habitats. However, neither predation risk nor teal behaviour has been studied with consistent methods around the year or throughout any of its flyways. Covering wintering, spring-staging, breeding and moulting sites, we combined focal observations of teals and predator flyover data from seven regions ranging from southern France to northern Sweden. Although not apparent at the scale of days within sites, teals indeed relied more on shallow foraging where predation risk was higher, i.e. at wintering sites. Average foraging depth increased gradually from September to August, i.e. from wintering to breeding sites. Foraging bout length of deeply foraging teals did not decrease over the year, suggesting that it is through selection of foraging technique, rather than by the balance between foraging and interruptions, that birds adjust to predation risk. This study highlights behavioural plasticity in response to contrasting selection regimes within a flyway, in dabbling ducks as well as long-distance migrants in general.

Many dabbling ducks Anas spp. are largely granivorous, consuming a variety of seeds chiefly from aquatic plants. To assess the relative value and carrying capacity of wetlands for dabbling ducks, species-specific information about seed mass is needed, but it is still largely missing or scattered in the literature. By combining weights of seeds collected in the field with a literature review, we provide a reference table for seed mass of 200 western European plant taxa frequently encountered by foraging dabbling ducks. Seeds collected in the field were sampled in microhabitats and at depths at which ducks were observed to forage, and study sites represent wintering, staging as well as breeding areas within a flyway in western Europe. When combined with calorimetric data, the present reference table will aid managers and scientists in assessing the importance of seed food resources at different sites and during different parts of the annual cycle.

La répartition pharmaceutique fait partie intégrante du paysage urbain et rural actuel. Aux pharmacies et à leurs croix vertes, il convient d'ajouter les camionnettes de livraison portant la mention « Urgent médicaments » qui desservent, plusieurs fois par jour , l'ensemble des pharmacies d'officine du territoire. Chaque pharmacien connait les différents grossistes répartiteurs qui existent en France. Il existe cependant deux types de sociétés qui exercent le métier de répartiteur pharmaceutique: les sociétés classiques que nous qualifierons de « capitalistes» et les coopératives. Il semblerait pourtant que très peu de pharmaciens connaissent les différences entre ces deux systèmes à l'heure actuelle. Nous avons donc décidé de présenter le systèmecoopératif et son application à la répartition pharmaceutique.L'objectif principal de cette thèse n'est pas d'établir un comparatif des différentsrépartiteurs pharmaceutiques et d'en désigner un vainqueur, mais plutôt de montrer l'originalité du système coopératif et en quoi les coopératives de répartition pharmaceutique peuvent être une alternative intéressante au système classique. Nous aurons également l'occasion d'observer les principales différences entre les deux types de répartiteurs, tant au niveau de la place du pharmacien qu'à celui de l'aspect financier, mais aussi du point de vuedes stratégies mises en place et celles à venir.

The functional response, i.e. the change in per capita food intake rate per time unit with changed food availability, is a widely used tool for understanding the ecology and behaviour of animals. However, waterfowl remain poorly explored in this context. In an aviary experiment we derived a functional response curve for teal (Anas crecca) foraging on rice (Oryza sativa) seeds. We found a linear relationship between intake rate and seed density, as expected for a filter-feeder. At high seed densities we found a threshold, above which intake rate still increased linearly but with a lower slope, possibly reflecting a switch from filter-feeding to a scooping foraging mode. The present study shows that food intake rate in teal is linearly related to food availability within the range of naturally occurring seed densities, a finding with major implications for management and conservation of wetland habitats.

Introduction: The admission time for stroke patients remains too long. This delay could be reduced by a promptly recognizing of stroke symptoms. Information campaigns have been developed specifically for this purpose. Objectives: To evaluate the knowledge of stroke and the reflex to call an emergency medical service (15) for hospitalized patients in the neurovascular unit (UNV) of Périgueux, but also their level of awareness and their mode. Material and method: This retrospective study was realized through a patient’s questionnaire submitted to any patient over 18 years old, living at home in Dordogne, without any communication disorder and hospitalized in the UNV of Périgueux for a first episode of stroke from December 2018 to February 2019. Results: 62 questionnaires were analysed. 84% of patients had at least one risk factor for stroke (excluding age), but only 3% thought they were a risk for stroke. 55% of patients did not know any warning signs compared to 45% who reported to know at least one warning sign. 71% of the patients were sensitized on stroke but only 41% felt that this information was sufficient. The attending physician was alerted first-line in 35% of cases and only 27% to call emergency services (15). Conclusion: the population’s knowledge of the warning signs of stroke and the reflex to call the 15 remain insufficient. Improvements can only be achieved through a large communication and information campaign adapted for each stratum of the population., Introduction : le délai d’admission des patients victimes d’accident vasculaire cérébral (AVC) demeure trop long. La reconnaissance des symptômes peut raccourcir ce délai. Les campagnes d’information ont été élaborées dans ce but. Objectifs : évaluer les connaissances sur l’AVC et le réflexe d’appel du 15 des patients hospitalisés dans l’unité neurovasculaire (UNV) de Périgueux, ainsi que leur niveau de sensibilisation et leur mode. Matériel et méthode : il s’agit d’une étude rétrospective réalisée à l’aide d’un questionnaire soumis aux patients de plus de 18 ans, domiciliés en Dordogne, vivant à domicile, sans trouble de la communication, ayant été hospitalisés au sein de l’UNV de Périgueux, pour un premier épisode d’AVC de décembre 2018 à février 2019. Résultats : 62 questionnaires ont été analysés. 84 % des patients étaient porteurs d’au moins un facteur de risque d’AVC (hormis l’âge), mais seulement 3 % s’estimaient à risque de faire un AVC. 55 % des patients ne connaissaient aucun signe d’AVC contre 45 % qui se déclaraient en connaître au moins un. 71 % des patients ont été sensibilisés sur l’AVC mais seulement 41 % estimaient que ces informations ont été suffisantes. Le médecin traitant a été alerté en première intention dans 35 % des cas tandis que le Centre 15 dans seulement 27 % des cas. Conclusion : les connaissances des signes d’alerte et l’appel du 15 restent encore insuffisantes. Les améliorations ne peuvent résulter que de l’utilisation d’un large éventail de supports de diffusion, adapté à l’environnement de la population.

Introduction: patient education has evolved a lot these last ten years both legally and theoretically. This approach permits us to have overall patient care management by allowing the patient to take part in his health care. At the Périgueux hospital an educational program has been put in place and has been taking place for 3 years for patients suffering from remitting multiple sclerosis (MS). Objective: the main objective was to describe the benefits obtained on patients’ knowledge of their disease via the educational group activities. We then assessed the impact of this program on their anxiety, their feeling of depression and how tired they felt. Methods: between April 2014 and November 2017 we studied 30 patients suffering from remitting MS who agreed to take part in the educational program offered by the Périgueux hospital neurology department. Were not included patients suffering from secondarily progressive remitting MS and progressive MS as well as patients not capable or not willing to participate in the program. Were excluded the patients suffering from secondarily progressive remitting MS. Results: we demonstrated an improvement in patients’ knowledge of their disease and better management of their daily tiredness in the patients who participated in the educational program compared to those who didn’t. These results are statistically significant. However, we didn’t find significantly different results concerning anxiety and depression. Conclusion: our study found there was a positive effect of group educational programs on patients’ quality of life and allows us to consider setting up educational programs for other conditions (self-medication, childhood fever)., Introduction : l'éducation thérapeutique a beaucoup évolué durant les dix dernières années tant sur le plan juridique que théorique. Cette approche permet une prise en charge globale du patient en le faisant participer de façon active à ses soins. À l'Hôpital de Périgueux, un programme d'éducation thérapeutique a été mis en place depuis 3 ans pour les patients atteints de sclérose en plaque de forme rémittente. Objectif : l'objectif principal été de décrire les bénéfices apportés par les ateliers d'éducation thérapeutique aux patients atteints de sclérose en plaque sur leurs connaissances. Et dans un second temps, nous avons évalué l'impact du programme sur leurs angoisses, leurs sentiments de dépression ainsi que sur leur ressenti de la fatigue. Matériel et méthode : entre avril 2014 et novembre 2017, nous avons étudié 30 patients ayant une sclérose en plaques de forme rémittente et ayant accepté de participer aux ateliers du programme d'éducation thérapeutique proposé par le service de neurologie du CHP. Ont été non inclus les patients ayant une SEP de forme rémittente secondairement progressive et de forme progressive ainsi que les patients ne pouvant et ne voulant pas participer au programme. Ont été exclus les patients ayant une SEP rémittente secondairement progressive. Résultats : nous avons montré une amélioration des connaissances ainsi qu'une meilleure gestion de la fatigue au quotidien chez les patients ayant bénéficié des 5 ateliers d'ETP ses résultats sont statistiquement significatifs. Cependant nous n'avons pas obtenu de résultats significatifs en ce qui concerne l'anxiété et la dépression. Conclusion : notre étude a montré l'amélioration de la qualité de vie des patients suite à la réalisation des ateliers d'ETP ce qui nous permet d'envisager un jour d'élargir l'ETP à d'autres niveaux d'apprentissage (automédication, fièvre enfants).