Institut Jean Godinot

The aim of this study was to assess return to work (RTW) after breast cancer (BC) by baseline employment status. Using data from the CANTO cohort (NCT01993498), we examined RTW among women below age 57 at BC diagnosis 2 and 4 years after BC diagnosis. We also assessed continuous work between years 2 and 4 post-diagnosis. Poisson regression models investigated associations between baseline employment (self-employed vs. employees) and RTW outcomes, adjusting for clinical, sociodemographic, and work-related factors and quality of life. We used education (above high school; high school or lower) as a proxy to further distinguish between white collar self-employees vs. blue collar self-employees (vs. employees). About 8% of women were self-employed at diagnosis. RTW was slightly higher among the self-employed compared to employees 2 years (N = 3178; PR = 1.04, 95%CI 0.98–1.10) and 4 years after diagnosis (N = 2329; PR = 1.05, 0.99–1.12). This effect was limited to white collar self-employed women. Among those who returned to work 2 years after diagnosis (N = 1683), self-employed women showed a 1.15 (1.01–1.31) higher prevalence of continuous work until year 4 post-diagnosis than employees. Self-employed women do not strongly differ from employees when assessing RTW at specific time points, however once returned to work, they experience fewer work interruptions than employees. This was observed in adjusted models, showing the intrinsic importance of job status in the RTW process. These findings highlight the importance of viewing RTW as an ongoing process, in order to provide appropriate and sustained support.

BackgroundThe evolution of medical students’ population and their choices of medical residency is poorly documented in France. The objective of this study was to perform a retrospective analysis of medical student’s residency choices at their national ranking exam (NRE) once they have completed six years of theoretical and practical medical training.MethodsPublished choices after the French NRE were processed from 2011 to 2023. A longitudinal follow-up of the median rank of affected students for each medical speciality and each training university hospitals is presented. Demographics and gender statistics are also presented. Violin plots, heatmaps and bump charts were used for a better analysis. Mann–Kendall test was used for trend analysis.ResultsWe analyzed choices of more than 100,000 students and show that men were more likely to have a better ranking, though with a non homo-geneous distribution compared to women who were more homogeneously distributed. We also proved that younger students better performed at the exam. We observed an unprecedented increased attractiveness of medical gynecology (+ 14 places, p = 0.007) as well as anesthesiology and resucitation (+ 13 places, p = 0.008).Vascular medicine (+ 4 places, p = 0.014), otorhino-laryngology (+ 2 places, p = 0.041) and dermatology (+ 5 places, p = 0.019) also significantly gained attractivity over the study period contrary to neurosurgery (-23 places, p = 0.023) and infectious diseases (-8 places, p = 0.048). Medical schools of Rennes (+ 7 places, p = 0.005) and Caen (+ 3 places, p = 0.048) have been gaining interest over the whole period while Grenoble (-5 places, p = 0.013), Paris (-5 places, p = 0.0083) and Limoges (-4 places, p = 0.006) have been significantly loosing attractivity.ConclusionThis work provides an overview of choices trends at the French medical NRE and illustrates for the first time the evolution of medical students’ demography and residency choices over a thirteen-year period.

To evaluate the surgical management and oncologic outcomes of patients with FIGO stage IV ovarian cancer, using data from the French national ESME cohort. This retrospective multicenter study included patients diagnosed with FIGO stage IV ovarian cancer between January 2011 and December 2016, treated in 18 French Comprehensive Cancer Centers participating in the ESME-OVR program. Clinical characteristics, treatment strategies, metastatic site patterns, and survival outcomes (overall survival [OS], progression-free survival [PFS]) were analyzed and compared between FIGO IVA and IVB stages. A total of 159 patients were identified, of whom 107 (67.3 ​%) had FIGO stage IVB disease. Regardless of metastatic stage, surgical strategies and were comparable. Complete debulking surgery was achieved in 75 ​% of cases. Most of FIGO stage IVB patients (88.8 ​%) presented a single metastatic site including extra-abdominal lymph nodes (50.5 ​%), liver (20.6 ​%), and lungs (10.3 ​%); 15.9 ​% of patient with distant metastases underwent local treatment and predominantly targeted nodal disease. Complete debulking surgery was significantly associated with improved OS and PFS (p ​= ​0.002 and p ​< ​0.001, respectively), while local treatment of metastases did not provide survival benefit. The number of metastatic sites did not significantly influence prognosis. Complete debulking surgery is the critical factor from a progronostic point of view, whether in FIGO stage IVA or IVB. Feasibility of local treatment for distant metastases is observed, its impact on oncologic outcomes remains unclear and we need further prospective investigation. Surgical strategies should be integrated into a personalized approach to optimize management in advanced-stage disease.

Antiangiogenic therapy with bevacizumab improves outcomes in ovarian cancer but induces hypertension, leading to major adverse cardiovascular events (MACE). While calcium channel blockers (CCBs) and angiotensin‐converting enzyme inhibitors (ACEi) are recommended for managing bevacizumab‐associated hypertension, their impacts on cancer progression and cardiovascular outcomes are unclear. This study compared the effects of CCBs and ACEi on progression‐free survival (PFS) in ovarian cancer patients treated with adjuvant bevacizumab. The incidence of MACE and overall survival (OS) were also evaluated. We conducted an emulated clinical trial using data from January 1, 2011, to January 1, 2021, from the French National Health Data System (SNDS), covering 98.8% of the French population. Patients with FIGO stage III to IV ovarian cancer who underwent cytoreductive surgery and adjuvant chemotherapy with bevacizumab, treated with CCBs or ACEi monotherapy within 6 months after surgery, were included. Out of 4,165 patients treated with bevacizumab, 454 met inclusion criteria for the main analysis: 273 in the CCBs group and 181 in the ACEi group. CCBs use was associated with a longer median PFS compared to ACEi (21.8 vs. 18.2 months) and a higher 3‐year PFS rate (difference of 8.2 percentage points, 95% CI: 2.0%; 14.8%). No significant difference in OS was observed between groups. Cardiovascular complications were more frequent with CCBs compared to ACEi, particularly congestive heart failure (difference in 3‐year incidence of MACE: −4.5 percentage points; 95% CI: −8.2%; −1.1%). These findings emphasize the need for a balanced approach to managing hypertension in cancer patients, considering both oncologic and cardiologic outcomes.