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Précarité sociale, cancer et vulnérabilité psychique, lien direct ou indirect ?

Social precariousness, cancer and psychological vulnerability: directly or indirectly linked?

  • Article Original
  • Dossier : Cancers et cultures
  • Published:
Psycho-Oncologie

Résumé

La relation entre la vulnérabilité psychique et le cancer semble moins établie que celle entre la précarité sociale et certains facteurs liés au cancer. La fragilité psychique a été mise en cause dans certaines addictions facteurs de risque du cancer, comme le tabagisme. Les patients qui sont en précarité sociale risquent demoins bénéficier desméthodes de dépistage, d’avoir des traitements moins efficaces et finalement que le contrôle locorégional de leur pathologie et leur taux de survie soient plus faibles que ceux qui sont observés dans la population générale.

Les personnes en précarité ne sont cependant pas opposantes, il n’y a pas de rejet systématique du système de santé, et ces personnes sont souvent très au courant des méthodes de dépistage et de leur intérêt. Quelle que soit la classe de précarité dont l’analyse a été faite, la demande de soins de la part des patients est réelle.

Les problèmes principaux sont d’ordre organisationnel et de prise en charge. Le suivi des patients n’est pas toujours possible et la notion de « projet de vie » est souvent inexistante, ne permettant pas une organisation des soins. Dans le cadre des dépistages, celui-ci fait pour la population générale n’est pas adapté à une population en marge ou exclue.

Des solutions sont possibles, mais elles engagent les structures de politique sociale et de santé mais aussi la conduite de chaque personnel de santé.

Abstract

The link between psychological vulnerability and cancer is not clearly established. However, there does appear to be a link between cancer and social marginality. Psychological fragility has been shown to be associated with tobacco addiction. Socially vulnerable people are at risk of undergoing screening less frequently and being treated less efficiently. These data could explain the deficit in terms of both monitoring of their pathologies and observed survival rates, compared with those relating to the general population. Such people do not refuse treatment or screening and are often well aware of screening methods and their usefulness, and wish to be treated if they are ill.

The main problems relate to organisation and careprovision. Monitoring of such patients is not always possible and the notion of a “life-plan” is often nonexistent, thus preventing adequate management of the disease. Screening programs are not adapted for marginal and socially excluded populations. Solutions can be found but they depend on both social and health policies and the behaviour of every individual professional care-provider.

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Références

  1. Bouisson J, de Boucaud M (2003) Processus psychopathologique, sentiment et syndrome de vulnérabilité. Ann Med Psychol 161: 491–497

    Google Scholar 

  2. Berner P (1994) La transonographie dans la perspective du modèle de vulnérabilité. Ann Med Psychol 152: 50–51

    Google Scholar 

  3. Bruchon-Schweitzer M (2001) Stress et vulnérabilité: Un modèle transactionnel en psychologie de la santé, dans la vulnérabilité. In: Monographies de psychopathologie. PUF, Paris, pp. 97–123

    Google Scholar 

  4. Cambois E (2004) Les personnes en situation difficile et leur santé. In: les travaux de l’Observatoire national de la pauvreté et de l’exclusion sociale 2003–2004. La Documentation francaise, Paris, pp. 119–120

    Google Scholar 

  5. Sobin LH (2002) TNM classification of malignant tumors, sixth edition

  6. Lelerc A, Menvielle G, Luce D (2006) Social inequalities and cancer. Rev Francoph Psycho-Oncologie 5: 89–94

    Article  Google Scholar 

  7. Jang SN, Cho SI, Hwang SS, et al. (2007) Trend of socioeconomic inequality in participation in cervical cancer screening among korean women. J Prev Med Public Health 40: 505–511

    PubMed  Google Scholar 

  8. Mariani L, Morrone A, Preti M, et al. (2008) Migrant women and cervical cancer: Background of a prevention study. Eur J Gynaecol Oncol 29: 52–56

    PubMed  Google Scholar 

  9. Ramirez AJ, Westcombe AM, Burgess CC (1999) Factors predicting delayed presentation of symptomatic breast cancer: A systematic review. Lancet 353: 1127–1131

    Article  PubMed  Google Scholar 

  10. Zeigler-Johnson CM, Rennert H, Mittal RD, et al. (2008) Evaluation of prostate cancer characteristics in four populations worldwide. Can J Urol 15: 4056–4064

    PubMed  Google Scholar 

  11. Zagars GK, Pollack A, Pettaway CA (1998) Prostate cancer in African-American men: Outcome following radiation therapy with or without adjuvant androgen ablation. Int J Radiat Oncol Biol Phys 42: 517–523

    PubMed  Google Scholar 

  12. Datta GD, Colditz GA, Kawachi I, et al. (2006) Individual-, neighborhood-, and state-level socioeconomic predictors of cervical carcinoma screening among U.S. Black women: A multilevel analysis. Cancer 106: 664–669

    Article  PubMed  Google Scholar 

  13. Ueda K, Kawachi I, Tsukuma H (2006) Cervical and corpus cancer survival disparities by socioeconomic status in a metropolitan area of Japan. Cancer Sci 97: 283–291

    Article  PubMed  Google Scholar 

  14. Westin SN, Bustillos D, Gano JB, et al. (2008) Social factors affecting treatment of cervical cancer: Ethical issues and policy implications. Obstet Gynecol 111: 747–751

    PubMed  Google Scholar 

  15. Dalton SO, Schuz J, Engholm G, et al. (2008) Social inequality in incidence of and survival from cancer in a population-based study in Denmark, 1994–2003: Summary of findings. Eur J Cancer 44: 2074–2085

    Article  PubMed  Google Scholar 

  16. McKenna MC, Zevon MA, Corn B, Rounds J (1999) Psychosocial factors and the development of breast cancer: A meta-analysis. Health Psychol 18: 520–531

    Article  PubMed  Google Scholar 

  17. Nielsen NR, Gronbaek M (2006) Stress and breast cancer: A systematic update on the current knowledge. Nat Clin Pract Oncol 3: 612–620

    Article  PubMed  Google Scholar 

  18. Hatsukami DK, Stead LF, Gupta PC (2008) Tobacco addiction. Lancet 371: 2027–2038

    Article  PubMed  Google Scholar 

  19. Gidron Y, Ronson A (2008) Psychosocial factors, biological mediators, and cancer prognosis: A new look at an old story. Curr Opin Oncol 20: 386–392

    Article  PubMed  Google Scholar 

  20. Sephton SE, Sapolsky RM, Kraemer HC, Spiegel D (2000) Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst 92: 994–1000

    Article  PubMed  Google Scholar 

  21. Cassoni P, Marrocco T, Deaglio S, et al. (2001) Biological relevance of oxytocin and oxytocin receptors in cancer cells and primary tumors. Ann Oncol 12 (Suppl. 2): S37–S39

    Article  PubMed  Google Scholar 

  22. Agelink MW, Boz C, Ullrich H, Andrich J (2002) Relationship between major depression and heart rate variability. Clinical consequences and implications for antidepressive treatment. Psychiatry Res 113: 139–149

    Article  PubMed  Google Scholar 

  23. Coyne JC, Marcus SC (2006) Health disparities in care for depression possibly obscured by the clinical significance criterion. Am J Psychiatry 163: 1577–1579

    Article  PubMed  Google Scholar 

  24. Widlöcher D, Jouvert R (1995) 17: 25–41

  25. Freud S (1971) Malaise dans la civilisation. Coll. Bibliothèque de psychanalyse, PUF, Paris, p. 108

    Google Scholar 

  26. Lebrun JP (2008) Lebrun JP: Les désarrois nouveaux du sujet: prolongements théorico-cliniques au monde sans limite. ERES 2001: 348 pages

  27. Louwman WJ, Vulto JC, Verhoeven RH, et al. (2007) Clinical epidemiology of breast cancer in the elderly. Eur J Cancer 43: 2242–2252

    Article  PubMed  Google Scholar 

  28. Anaes (2006) Recommandations pour la pratique clinique. Éléments d’information des hommes envisageant la réalisation d’un dépistage individuel du cancer de la prostate — document à l’usage des professionnels de santé. http://wwwhas-santefr/portail/upload/docs/application/pdf/information_kp_recommandations-2006pdf

  29. Ancelle-Park R, Sancho-Garnier H, Faivre J (1999) Recommandation pour le dépistage du cancer dans l’Union européenne préparé par le groupe des experts pour la prévention des cancers de l’Union européenne — novembre 1999. http://wwwinvssantefr/publications/depistage_cancer/depistage_cancerhtm

  30. Screening for prostate cancer (2008) U.S. Preventive services task force recommendation statement. Ann Intern Med 149: 185–191

    Google Scholar 

  31. Wildiers H, Kunkler I, Biganzoli L, et al. (2007) Management of breast cancer in elderly individuals: Recommendations of the international society of geriatric oncology. Lancet Oncol 8: 1101–1115

    Article  PubMed  Google Scholar 

  32. Bickell NA, Vermund SH, Holmes M, et al. (1991) Human papillomavirus, gonorrhea, syphilis, and cervical dysplasia in jailed women. Am J Public Health 81: 1318–1320

    Article  PubMed  Google Scholar 

  33. Keime-Guibert F, Chinot O, Taillandier L, et al. (2007) Radiotherapy for glioblastoma in the elderly. N Engl J Med 356: 1527–1535

    Article  PubMed  Google Scholar 

  34. Roa W, Brasher PM, Bauman G, et al. (2004) Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: A prospective randomized clinical trial. J Clin Oncol 22: 1583–1588

    Article  PubMed  Google Scholar 

  35. Langer CJ (2008) Resectable non-small cell lung cancer in the elderly: Is there a role for adjuvant treatment? Drugs Aging 25: 209–218

    PubMed  Google Scholar 

  36. Misono S, Weiss NS, Fann JR, et al. (2008) Incidence of suicide in persons with cancer. J Clin Oncol (in press)

  37. Lonardi S, Bortolami A, Stefani M, Monfardini S (2007) Oral anticancer drugs in the elderly: An overview. Drugs Aging 24: 395–410

    Article  PubMed  Google Scholar 

  38. Chin MH, Walters AE, Cook SC, Huang ES (2007) Interventions to reduce racial and ethnic disparities in health care. Med Care Res Rev 64: 7S–28

    Article  PubMed  Google Scholar 

  39. Maskarinec G, Noh JJ (2004) The effect of migration on cancer incidence among Japanese in Hawaii. Ethn Dis 14: 431–439

    PubMed  Google Scholar 

  40. Spano JP, Busson P, Atlan D, et al. (2003) Nasopharyngeal carcinomas: An update. Eur J Cancer 39: 2121–2135

    Article  PubMed  Google Scholar 

  41. Visser O, Van Leeuwen FE (2007) Cancer risk in first generation migrants in north-Holland/flevoland, the Netherlands, 1995–2004. Eur J Cancer 43: 901–908

    Article  PubMed  Google Scholar 

  42. Norredam M, Krasnik A, Pipper C, Keiding N (2007) Cancer incidence among 1st generation migrants compared to native danesa retrospective cohort study. Eur J Cancer 43: 2717–2721

    PubMed  Google Scholar 

  43. Akers AY, Newmann SJ, Smith JS (2007) Factors underlying disparities in cervical cancer incidence, screening, and treatment in the united states. Curr Probl Cancer 31: 157–181

    Article  PubMed  Google Scholar 

  44. Downs LS, Smith JS, Scarinci I, et al. (2008) The disparity of cervical cancer in diverse populations. Gynecol Oncol 109: S22–S30

    Article  PubMed  Google Scholar 

  45. Stirbu I, Kunst AE, Vlems FA, et al. (2006) Cancer mortality rates among first and second generation migrants in the netherlands: Convergence toward the rates of the native dutch population. Int J Cancer 119: 2665–2672

    Article  PubMed  Google Scholar 

  46. Stirbu I, Kunst AE, Bos V, Mackenbach JP (2006) Differences in avoidable mortality between migrants and the native Dutch in the Netherlands. BMC Public Health 6: 78

    Article  PubMed  Google Scholar 

  47. Bouchardy C, Parkin DM, Wanner P, Khlat M (1996) Cancer mortality among North African migrants in France. Int J Epidemiol 25: 5–13

    Article  PubMed  Google Scholar 

  48. Bouchardy C, Wanner P, Parkin DM (1995) Cancer mortality among sub-saharan african migrants in france. Cancer Causes Control 6: 539–544

    Article  PubMed  Google Scholar 

  49. Bouchardy C, Parkin DM, Khlat M (1994) Cancer mortality among Chinese and South-East Asian migrants in France. Int J Cancer 58: 638–643

    Article  PubMed  Google Scholar 

  50. Coleman MP, Quaresma M, Berrino F, et al. (2008) Cancer survival in five continents: A worldwide population-based study (concord). Lancet Oncol 9: 730–756

    Article  PubMed  Google Scholar 

  51. Chen MS, Jr. (2005) Cancer health disparities among Asian Americans: What we do and what we need to do. Cancer 104: 2895–2902

    Article  PubMed  Google Scholar 

  52. Patel DA, Barnholtz-Sloan JS, Patel MK, et al. (2005) A population-based study of racial and ethnic differences in survival among women with invasive cervical cancer: Analysis of surveillance, epidemiology, and end results data. Gynecol Oncol 97: 550–558

    Article  PubMed  Google Scholar 

  53. Goel MS, Wee CC, McCarthy EP, et al. (2003) Racial and ethnic disparities in cancer screening: The importance of foreign birth as a barrier to care. J Gen Intern Med 18: 1028–1035

    Article  PubMed  Google Scholar 

  54. Benard VB, Lawson HW, Eheman CR, et al. (2005) Adherence to guidelines for follow-up of low-grade cytologic abnormalities among medically underserved women. Obstet Gynecol 105: 1323–1328

    PubMed  Google Scholar 

  55. Spallek J, Spix C, Zeeb H, et al. (2008) Cancer patterns among children of Turkish descent in Germany: A study at the German childhood cancer registry. BMC Public Health 8: 152

    Article  PubMed  Google Scholar 

  56. Norredam M, Krasnik A, Pipper C, Keiding N (2008) Differences in stage of disease between migrant women and native Danish women diagnosed with cancer: Results from a population-based cohort study. Eur J Cancer Prev 17: 185–190

    Article  PubMed  Google Scholar 

  57. Smith-Bindman R, Miglioretti DL, Lurie N, et al. (2006) Does utilization of screening mammography explain racial and ethnic differences in breast cancer? Ann Intern Med 144: 541–553

    PubMed  Google Scholar 

  58. Schwartz KL, Crossley-May H, Vigneau FD, et al. (2003) Race, socioeconomic status and stage at diagnosis for five common malignancies. Cancer Causes Control 14: 761–766

    Article  PubMed  Google Scholar 

  59. Farley JH, Hines JF, Taylor RR, et al. (2001) Equal care ensures equal survival for African-American women with cervical carcinoma. Cancer 91: 869–873

    Article  PubMed  Google Scholar 

  60. Mignotte H, Perol D, Fontaniere B, et al. (1998) The role of the medical corps in a mass screening program for cervical cancer. The program “Female health action in 3 urban districts of lyons”. J Gynecol Obstet Biol Reprod (Paris) 27: 501–507

    Google Scholar 

  61. Weinreb L, Goldberg R, Perloff J (1998) Health characteristics and medical service use patterns of sheltered homeless and low-income housed mothers. J Gen Intern Med 13: 389–397

    Article  PubMed  Google Scholar 

  62. Collectif (2006) Le rapport de l’Observatoire national de la pauvreté et de l’exclusion sociale 2005–2006. La Documentation française, Paris

    Google Scholar 

  63. La Roch-re B (de) (2003) La santé des sans-domicile usagers des services d’aide. Insee première 893

  64. Kushel MB, Vittinghoff E, Haas JS (2001) Factors associated with the health care utilization of homeless persons. JAMA 285: 200–206

    Article  PubMed  Google Scholar 

  65. Hwang SW (2000) Mortality among men using homeless shelters in Toronto, Ontario. JAMA 283: 2152–2157

    Article  PubMed  Google Scholar 

  66. Chau S, Chin M, Chang J, et al. (2002) Cancer risk behaviors and screening rates among homeless adults in los angeles county. Cancer Epidemiol Biomarkers Prev 11: 431–438

    PubMed  Google Scholar 

  67. Ben-Arie A, Perlman S, Hazan Y, et al. (2004) High-risk endometrial cancer in young indigent women. Int J Gynecol Cancer 14: 927–930

    Article  PubMed  Google Scholar 

  68. Penson RT, Fergus LA, Haston RJ, et al. (2003) The kenneth b. Schwartz center at massachusetts general hospital hematology-oncology department: Hope for the homeless. Oncologist 8: 488–495

    Article  PubMed  Google Scholar 

  69. Binswanger IA, White MC, Perez-Stable EJ, et al. (2005) Cancer screening among jail inmates: Frequency, knowledge, and willingness. Am J Public Health 95: 1781–1787

    Article  PubMed  Google Scholar 

  70. Mathew P, Elting L, Cooksley C, et al. (2005) Cancer in an incarcerated population. Cancer 104: 2197–2204

    Article  PubMed  Google Scholar 

  71. Revet S (2003) La santé en prison. Résumé du séminaire Paris 9 octobre 2003: santé, inégalités, ruptures sociales en Ile-de-France INSERM — U 444 — http://www.b3e.jussieu.fr/sirs/SEMINAIRE091003.pdf

  72. Magee CG, Hult JR, Turalba R, McMillan S (2005) Preventive care for women in prison: A qualitative community health assessment of the Papanicolaou test and follow-up treatment at a California state women’s prison. Am J Public Health 95: 1712–1717

    Article  PubMed  Google Scholar 

  73. Lin JT, Mathew P (2005) Cancer pain management in prisons: A survey of primary care practitioners and inmates. J Pain Symptom Manage 29: 466–473

    Article  PubMed  Google Scholar 

  74. Glaser JB, Greifinger RB (1993) Correctional health care: A public health opportunity. Ann Intern Med 118: 139–145

    PubMed  Google Scholar 

  75. Binswanger IA, Stern MF, Deyo RA, et al. (2007) Release from prison-a high risk of death for former inmates. N Engl J Med 356: 157–165

    Article  PubMed  Google Scholar 

  76. Martin RE (2000) Would female inmates accept Papanicolaou smear screening if it was offered to them during their incarceration? CMAJ 162: 657–658

    PubMed  Google Scholar 

  77. Linder JF, Meyers FJ (2007) Palliative care for prison inmates: “Don’t let me die in prison”. JAMA 298: 894–901

    Article  PubMed  Google Scholar 

  78. Schiltz L, Houbre B, Martiny C (2007) Précarité sociale, marginalisation et pathologie limite: Étude comparative de plusieurs groupes de sujets en rupture de projet de vie. Evol Psychiatr 72: 453–468

    Google Scholar 

  79. Ferreri M (2001) Événements de vie. Neuro-Psy 12: 18–22

    Google Scholar 

  80. Ey H (1968) La conscience. PUF, Paris

    Google Scholar 

  81. Mellier D (2006) Précarité psychique et dispositifs d’intervention clinique. Pratiques psychologiques 12: 145–155

    Article  Google Scholar 

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  1. CMCO, 19, rue Louis-Pasteur, F-67300, Schiltigheim, France

    A. Fernandez

  2. Centre de lutte contre le cancer Paul-Strauss, 3, rue de la Porte-de-l’Hôpital, BP42, F-67065, Strasbourg Cedex, France

    G. Noël

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  1. A. Fernandez
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Fernandez, A., Noël, G. Précarité sociale, cancer et vulnérabilité psychique, lien direct ou indirect ?. Psycho Oncologie 2, 250–265 (2008). https://doi.org/10.1007/s11839-008-0098-5

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  • DOI: https://doi.org/10.1007/s11839-008-0098-5

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