Séquelles incapacitantes après chimio- et radiothérapie
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Résumé
Le nombre de survivants à un cancer ne cesse d’augmenter. La chimiothérapie et la radiothérapie restent les bases incontournables du traitement, lorsque les chances de guérison par la chirurgie seule sont jugées insuffisantes. Mis à part la toxicité aiguë engendrée par ces deux modalités, de nombreux effets secondaires à long terme ont été identifiés, dont certains sont incapacitants. L’expérience accumulée avec le temps, l’avènement de nouveaux traitements plus spécifiques et de techniques d’irradiation plus précises, les programmes de détection précoce de certaines tumeurs suggèrent cependant que les effets secondaires sévères, du moins physiques, sont appelés à décroître. Le spectre des séquelles invalidantes tend donc à se déplacer vers des troubles moins aisément quantifiables, pourtant bien réels, que sont une fatigue persistante, invalidante, un état dépressif, des troubles cognitifs avec diminution des performances. La crainte d’une récidive et les risques d’un deuxième cancer s’ajoutent à ce tableau. Un environnement psychosocial aidant, une reconnaissance empathique de la réalité de ces troubles, associés à d’autres mesures de soutien sont des facteurs importants pour en diminuer les conséquences.
Mots clés
Cancer Chimiothérapie Radiothérapie Survie à long terme Séquelles invalidantesIncapacitating late effects after chemo- and radiotherapy
Abstract
An increasing number of patients with cancer become long-term survivors. Currently, chemotherapy and radiotherapy remain the mainstay of cancer treatment when surgery alone is considered insufficient. Both approaches, whether used alone or in combination, produce transient acute toxicities but may also result in long-term incapacitating late effects. Regarding exclusively late physical disabilities, accumulated experience, early detection programs, the advent of newer, more specific and tumor-targeted agents as well as sophisticated irradiation techniques suggest that the incidence of such late effects will decrease. In contrast, chronic incapacitating fatigue, cognitive impairment and psychosocial distress are likely to become critical issues and are more difficult to assess. Fear of relapse and risk of second malignancy all add to this sometimes distressing situation. A supportive psychosocial environment, empathic acknowledgement of a genuine suffering and other therapeutic approaches are important goals towards rehabilitation.
Keywords
Cancer Chemotherapy Radiotherapy Longterm survival Late effectsRéférences
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