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Faut-il être fou pour refuser sa chimiothérapie ?

Le refus de soin, rançon de l’autonomisme chez les patients occidentaux ou difficulté de la relation médecin-malade ?

Is it insane to refuse chemotherapy?

The refusal of treatment: a price to pay for the autonomy of Western patients, or an issue of doctor-patient communication?

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Oncologie

Abstract

Aim

The international literature rarely concerns itself with the refusal of treatment. We have studied the adaptation and subconscious defence mechanisms triggered in patients at the time of proposing adjuvant chemotherapy after cancer surgery.

Materials and methods

This longitudinal clinical study based on 50 breast cancer patients compares the psychological factors involved in the making of decisions following oncological consultation.

Results

Eighty-two percent of patients accepted chemotherapy while 18% refused it. The Accepting group usually exhibits depression in its reaction whereas the Refusing group generally has more hostile traits. Anxiety, significantly higher in the Accepting group than in the Refusing group, seems to be linked to feelings that are repressed by the patient that submits to the medical advice. Conversely, patients refusing the treatment tend to exhibit their hostility towards doctors and medicine verbally.

Conclusion

Changes in doctor- patient communication, coupled with a greater knowledge of the personality of patients, may help encourage patients to accept the treatment offered to them.

Résumé

Objectifs

La littérature internationale s’intéresse rarement au refus du traitement. Nous avons exploré l’adaptation et les défenses inconscientes de patientes lors de la proposition d’une chimiothérapie adjuvante après chirurgie curative de leur cancer.

Matériel et méthodes

Cette étude clinique longitudinale compare les facteurs psychologiques dans la prise de décision, en consultation avec l’oncologue, de 50 patientes suivies pour un cancer du sein.

Résultats

Quatre-vingt-deux pour cent des patientes ont accepté la chimiothérapie adjuvante et 18 % l’ont refusée. Le groupe Adhésion manifeste surtout une réaction dépressive, alors que dans le groupe Refus, prédominent les traits de personnalité hostiles. L’anxiété, significativement plus élevée dans le groupe Adhésion que dans le groupe Refus, semble liée à la répression des émotions des malades qui se soumettent à la proposition médicale. Les patientes qui refusent le traitement expriment, au contraire, verbalement leurs émotions hostiles à l’égard des médecins et de la médecine.

Conclusion

L’adaptation des modes de communication du médecin, et la connaissance plus approfondie des traits de personnalité des patients pourraient faciliter le niveau de participation des patients à leur protocole thérapeutique.

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Références

  1. Altschuler A, Somkin C (2005) Women’s decision-making about whether or not to use breast cancer chemoprevention. Women Health 41(2): 81–95

    Article  PubMed  Google Scholar 

  2. Bacqué MF (2011) Médecines parallèles: un révélateur de la relation médecin-malade. Psycho-Oncologie 5: 149–151

    Article  Google Scholar 

  3. Bastian LA, Lipkus IM, Kuchibhatla MN, et al. (2001) Women’s interest in chemoprevention for breast cancer. Arch Intern Rimer Med 161(13): 1639–1644

    Article  CAS  Google Scholar 

  4. Bion WR (1983) Une théorie de l’activité de pensée. Réflexion faite, PUF, Paris

    Google Scholar 

  5. Blanchard CG, Labrecque MS, Ruckdeschel JC, Blanchard EB (1990) Physician behaviors, patient perceptions, and patient charasteristics as predictors of satisfaction of hospitalized adult cancer patients. Cancer 65: 186–192

    Article  PubMed  CAS  Google Scholar 

  6. Bober SL, Hoke LA, Duda RB, et al. (2004) Decision-making about tamoxifen in women at high risk for breast cancer: clinical and psychological factors. J Clin Oncol 22(24): 4951–4957

    Article  PubMed  Google Scholar 

  7. Bonneterre J (2007) Cancéroguide. Margaux orange, Paris

    Google Scholar 

  8. Brown RF, Butow PN, Juraskava I, et al. (2010) Sharing decisions in breast cancer care: Development of the decision analysis system for oncology to identify shared decision making during treatment consultations. Health expect

  9. Bruchon-Schweitzer M, Quintard B (2001) Personnalités et maladies. Stress, coping et ajustement. Dunod, Paris

    Google Scholar 

  10. Casagrande T (2004) Le respect du rapport benefice/risque versus la volonté du patient: que dit la loi ? Rev Francoph Psycho-Oncol 4: 180–181

    Article  Google Scholar 

  11. Charavel M (2004) Participation au choix thérapeutique en oncologie. Rev Francoph Psycho-Oncol 3(4): 201–205

    Article  Google Scholar 

  12. Colleoni M, Mandala M, Peruzzotti G, et al. (2000) Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet 356: 1326–1327

    Article  PubMed  CAS  Google Scholar 

  13. Cotton T, Locker AP, Jackson L, et al. (1991) A prospective study of patient choice in treatment for primary breast cancer. Eur J Surg Oncol 17: 115–117

    PubMed  CAS  Google Scholar 

  14. Dalton SO, Laursen TM, Ross L, et al. (2009) Risk for hospitalization with depression after a cancer diagnosis: a nationwide, population-based study of cancer patients in Denmark from 1973 to 2003. J Clin Oncol 27: 1440–1445

    Article  PubMed  Google Scholar 

  15. Daly MB, Lerman CL, Ross E, et al. (1996) Gail model breast cancer risk components are poor predictors of risk perception and screening behavior. Breast Cancer Res Treat 41: 59–70

    Article  PubMed  CAS  Google Scholar 

  16. Dash KB, Lerman CL, Cohen H, et al. (2010) Affective differenciation in breast cancer patients. J Behav Med 33(6): 441–453

    Article  Google Scholar 

  17. Despres C (2012) Le renoncement aux soins pour raisons financières, analyse socio-anthropologique. DREES, 119

  18. Dodwell DJ (1998) Adjuvant cytotoxic chemotherapy for early breast cancer: doubts and decisions. Lancet 351(9114): 1506–1507

    Article  PubMed  CAS  Google Scholar 

  19. Duric VM, Stocker M (2001) Patient’s preferences for adjuvant chemotherapy in early breast cancer: a review makes it worthwile? Lancet Oncol 2: 691–697

    Article  PubMed  CAS  Google Scholar 

  20. Edery L, Bacqué MF (2010) Adjuvant chemotherapy in breast cancer. Do you agree or not? Patients decision making factors. Psycho-Oncology 19(Suppl 2): 1–313, 31

    Google Scholar 

  21. Edery L, Bacqué MF (2009) The multidisciplinary therapeutic decision and the mentalization of the choice of the treatment of cancer patients. Psycho-Oncology 18(Suppl 2): S1–S330, S13

    Google Scholar 

  22. Fischer GN (2002) Traité de psychologie de la santé. Dunod, Paris

    Google Scholar 

  23. Gattelari M, Voigt KJ, Butow PN, Tattersall MH (2002) When the treatment is not cure: are cancer patients equipped to make informed decisions? J Clin Oncol 20: 503–513

    Article  Google Scholar 

  24. Harter M, Baumeister H, Reuter K, et al. (2007) Increased 12 month prevalence rates of mental disorders in patients with chronic somatic diseases. Psychother Psychosom 76: 354–360

    Article  PubMed  Google Scholar 

  25. Honda K, Goodwin RD (2004) Cancer and mental disorders in a national community sample: findings from the comorbidity survey. Psychother Psychosom 73: 235–242

    Article  PubMed  Google Scholar 

  26. Jansen SJT, Otten W, Stiggelbout AM (2006) Factors affecting patient’s perception of choice regarding adjuvant chemotherapy for breast cancer. Breast Cancer Res Treat 99: 35–45

    Article  PubMed  Google Scholar 

  27. Keating NL, Guadagnoli E, Landrum MB, et al. (2002) Treatment decision making in early-stage breast cancer: should surgeons match patients’ desired level of involvement? J Clin Oncol 20: 1473–1479

    Article  PubMed  Google Scholar 

  28. Königsberg RD (2011) Time Magazine, pp. 7–10

  29. Lambrichs LL (2011) Le livre de Pierre. Psychisme et cancer. Seuil, Paris

  30. Llewellyn-Thomas HA (1997) Investigating patients’ preferences for different treatment options. Can J Nurs Res 29: 45–64

    PubMed  CAS  Google Scholar 

  31. Lindley C, Vasa S, Sawyer WT, Winer EP (1996) Quality of life and preferences for treatment following systemic adjuvant therapy for early breast cancer. J Clin Oncol 16: 1380–1387

    Google Scholar 

  32. Mitchell AJ, Chan M, Bhatti H, et al. (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interviewbased studies. Lancet Oncol 12(2): 160–174

    Article  PubMed  Google Scholar 

  33. Moumjid N, Carrère MO, Charavel M (2003) Clinical issues in shared decisionmaking applied to breast cancer. Health Expect 6: 222–227

    Article  PubMed  Google Scholar 

  34. Phipps LL, Cuthill JD (2002) Breaking bad news: a clinician’s view of literature. Ann R Coll Physicians Sup Can 35(5):287–293

    Google Scholar 

  35. Pedersen AE, Sawatzy JA, Hack TF (2010) The sequelae of anxiety in breast cancer: a human response to illness model. Oncol Nurs Forum 37(4): 469–475

    Article  PubMed  Google Scholar 

  36. Protière C, Moatti JP, Maraninchi D, Viens P (1998) Choix et révélation des préférences, vers le partage de la décision thérapeutique en cancérologie: de la théorie économique à la pratique. Bull Cancer 85: 173–179

    PubMed  Google Scholar 

  37. Protière C, Viens P, Genre D, et al. (2000) Patient participation in medical decisionmaking: a French study in adjuvant radiochemotherapy for early breast cancer. Ann Oncol 11: 39–45

    Article  PubMed  Google Scholar 

  38. Pucheu S, Consoli SM, Landi B, Lecomte T (2005) Personnalité, représentations et adaptation à la maladie cancéreuse: étude comparative. Rev Francoph Psycho-Oncol 4: 268–277

    Article  Google Scholar 

  39. Prieto JM, Blanch J, Atala J, et al. (2002) Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation. J Clin Oncol 20: 1907–1917

    Article  PubMed  Google Scholar 

  40. Radvin PM (1998) Survey of breast cancer patients concerning their knowledge and expectations of adjuvant therapy. J Clin Oncol 16: 515–521

    Google Scholar 

  41. Razavi D, Delvaux N (2002) Interventions psycho-oncologiques: la prise en charge du patient cancéreux. Masson, Paris

    Google Scholar 

  42. Schaeffer J (1997) Le refus du féminin. PUF, Paris

    Google Scholar 

  43. Slevin ML, Stubbs L, Plant HJ, et al. (1990) Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. Br Ed J 300: 1458–1460

    CAS  Google Scholar 

  44. Simes RJ, Coates AS (2001) Patient preferences for adjuvant chemotherapy of early breast cancer: how much benefit is needed? J Nat Cancer Inst Monogr 30:146–152

    Article  Google Scholar 

  45. Stark DP, Kieley M, Smith A, et al. (2002) Anxiety disorders in cancer patients: Their nature, associations and relation to quality of life. J Clin Oncol 20: 3137–3148

    Article  PubMed  CAS  Google Scholar 

  46. Surbon A (2001) Ethical implications of genetic testing for breast cancer susceptibility. Crit Rev Oncol Hematol 40(2): 149–157

    Article  Google Scholar 

  47. Vennin P, Hecquet B, Marcuzzi I, Demaille MC (1995) Cancer du sein: l’information en question(s). Enquête auprès des patients et des médecins d’un centre de lutte contre le cancer. Bull Cancer, Paris

    Google Scholar 

  48. Zimmerman C, Baldoc C, Molino A (2000) Framing of outcome and probability of recurrence: breast cancer patient’s choice of adjuvant chemotherapy (ACT) in hypothetical patient scenarios. Breast Cancer Res Treat 60: 9–14

    Article  Google Scholar 

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Authors and Affiliations

  1. Service de neuro-oncologie et neurochirurgie, hôpital la Timone, F-13005, Marseille, France

    L. Edery

  2. Psychopathologie clinique, université de Strasbourg, EA 3071, F-67000, Strasbourg, France

    M. -F. Bacqué

Authors
  1. L. Edery
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  2. M. -F. Bacqué
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Correspondence to L. Edery.

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Edery, L., Bacqué, M.F. Faut-il être fou pour refuser sa chimiothérapie ?. Oncologie 15, 20–30 (2013). https://doi.org/10.1007/s10269-013-2246-6

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  • DOI: https://doi.org/10.1007/s10269-013-2246-6

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