{"id":1840,"date":"2008-10-01T01:00:00","date_gmt":"2008-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/les-medecins-hospitaliers-face-au-depistage-du-cancer-colorectal\/"},"modified":"2018-10-20T18:39:44","modified_gmt":"2018-10-20T16:39:44","slug":"les-medecins-hospitaliers-face-au-depistage-du-cancer-colorectal","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/les-medecins-hospitaliers-face-au-depistage-du-cancer-colorectal\/","title":{"rendered":"Les m\u00e9decins hospitaliers face au d\u00e9pistage du cancer colorectal"},"content":{"rendered":"

2008<\/strong><\/p>\n

Paul Strock (1), Joel Mossong (2), Jos Weber (1), Jean-Marie Weydert (1), Andre Kerschen (1)
\n1 HepatoGastroent\u00e9rologie, Centre Hospitalier de Luxembourg, Luxembourg
\n2 Biostatistiques, Laboratoire National de Sant\u00e9, Luxembourg
\nCentre Hospitalier de Luxembourg, 4 rue Barbl\u00e9, L-1210 Luxembourg, T\u00e9l. 00 352 4411 2258
\nM\u00e9l: Strock.paul@chl.lu<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02008-05-30 –\u00a0 –<\/p>\n

________________________________<\/p>\n

Introduction: Au Luxembourg, le cancer colorectal (CCR) est la 2e cause de cancer. Les examens de d\u00e9pistage recommand\u00e9s chez les personnes asymptomatiques sont une coloscopie tous les 10 ans \u00e0 partir de 50 ans, ou, alternativement, un test h\u00e9moccult annuel. Cependant, il n\u2019y a pas de programme de d\u00e9pistage organis\u00e9. Une campagne d\u2019information nationale destin\u00e9e au grand public a eu lieu d\u00e9but 2005. Les donn\u00e9es de la s\u00e9curit\u00e9 sociale sugg\u00e8rent qu\u2019environ 22% de la population de plus de 50 ans a eu une coloscopie totale durant les 10 ann\u00e9es pr\u00e9c\u00e9dentes.
\nUne analyse des CCR diagnostiqu\u00e9s dans notre service durant le 1er semestre de 2006 a montr\u00e9 que 88% ont \u00e9t\u00e9 d\u00e9couverts \u00e0 un stade symptomatique. En outre, 73% de ces patients auraient pu b\u00e9n\u00e9ficier d\u2019un d\u00e9pistage du CCR auparavant et avaient consult\u00e9 au moins une fois dans notre h\u00f4pital durant les 5 ann\u00e9es pr\u00e9c\u00e9dentes.<\/p>\n

But et m\u00e9thodes: Nous avons \u00e9valu\u00e9 l\u2019attitude face au d\u00e9pistage du CCR des m\u00e9decins sp\u00e9cialistes hospitaliers (MSH), toutes sp\u00e9cialit\u00e9s confondues, par questionnaire avant et apr\u00e8s une campagne d\u2019information dans notre h\u00f4pital. Deux questionnaires papier (\u00ab avant \u00bb et \u00ab apr\u00e8s \u00bb) ont \u00e9t\u00e9 mis au point, puis valid\u00e9s sur un \u00e9chantillon d\u2019internes. Ces questionnaires ont \u00e9t\u00e9 envoy\u00e9s \u00e0 tous les m\u00e9decins seniors de l\u2019h\u00f4pital, suivis chacun de 2 rappels \u00e0 15 jours d\u2019intervalle. La 2e enqu\u00eate a eu lieu 12 mois apr\u00e8s la premi\u00e8re. La participation \u00e9tait de 55% (84\/154) et 51% (90\/176) aux 2 enqu\u00eates respectivement.<\/p>\n

R\u00e9sultats:
\nEnqu\u00eate 2006 \u201cavant\u201d: La connaissance de leurs ant\u00e9c\u00e9dents familiaux par les MSH \u00e9tait meilleure en ce qui concerne le CCR que les ad\u00e9nomes colorectaux (positif : 26 % et 18%, n\u00e9gatif : 71% et 57%, ne sait pas : 2 et 23%). 32% des MSH avaient plus de 50 ans. La grande majorit\u00e9 des MSH adh\u00e9rait personnellement au d\u00e9pistage du CCR : 21% en avaient d\u00e9j\u00e0 fait un, et 69% pr\u00e9voyaient de le faire dans l\u2019avenir. Seuls 10% ne souhaitaient pas de d\u00e9pistage du CCR pour eux-m\u00eames. Les tests que les MSH choisissaient pour eux-m\u00eames sont r\u00e9sum\u00e9s dans le tableau 1. Il n\u2019y avait pas de diff\u00e9rence avec les tests qu\u2019ils proposaient \u00e0 leurs patients. La connaissance des recommandations en mati\u00e8re de d\u00e9pistage du CCR \u00e9tait correcte. Le d\u00e9but du d\u00e9pistage devait se situer entre 45 et 55 ans pour 85% des MSH et 86% affirmaient que les tests, m\u00eames n\u00e9gatifs, devaient \u00eatre r\u00e9p\u00e9t\u00e9s p\u00e9riodiquement. Cependant 12% des MSH citaient les marqueurs tumoraux biologiques comme test de d\u00e9pistage du CCR. Seulement 43% des MSH conseillaient le d\u00e9pistage du CCR souvent ou r\u00e9guli\u00e8rement \u00e0 leur famille et amis. Ces chiffres n\u2019\u00e9taient pas diff\u00e9rents en ce qui concerne les recommandations \u00e0 leurs patients.
\nEnqu\u00eate 2007 \u201capr\u00e8s\u201c: 44% des MSH qui r\u00e9pondaient au questionnaire avaient plus de 50 ans, et 21% \u00e9taient des femmes. L\u2019attitude personnelle envers le d\u00e9pistage \u00e9tait inchang\u00e9e: 88% des MSH avaient d\u00e9j\u00e0 subi un test de d\u00e9pistage ou pensaient en faire un dans l\u2019avenir. Parmi les MSH n\u2019envisageant pas de faire un test de d\u00e9pistage, il y avait une pr\u00e9dominance parmi ceux \u00e2g\u00e9s de moins de 50 ans (22% vs. 3%, p=0.038). Les m\u00e9thodes de d\u00e9pistage pr\u00e9f\u00e9r\u00e9es avaient \u00e9volu\u00e9 (tableau 1, p<0.05). 50% des MSH recommandaient maintenant le d\u00e9pistage du CCR \u00e0 leurs patients, contre 40 % auparavant, mais cette diff\u00e9rence n\u2019\u00e9tait pas significative. Les facteurs limitants cit\u00e9s \u00e9taient manque de temps (19%), manque d\u2019informations (8%), exercice d\u2019une sp\u00e9cialit\u00e9 sans rapport avec l\u2019appareil digestif (20%), manque d\u2019int\u00e9r\u00eat des patients (18%), peur de la part des patients (18%).Tous les MSH consid\u00e9raient que le d\u00e9pistage \u00e9tait efficace pour diminuer la mortalit\u00e9 par CCR.
\nDurant les 6 mois apr\u00e8s la campagne nationale de sensibilisation de 2005, le nombre de coloscopies totales r\u00e9alis\u00e9es dans notre service augmentait de 15%. En 2006, leur nombre redescendait au niveau de 2004. Durant les 6 mois apr\u00e8s notre campagne d\u2019information interne, le nombre de coloscopies augmentait \u00e0 nouveau de 11%. M\u00eame si les indications et la pertinence de ces coloscopies en ce qui concerne le d\u00e9pistage du CCR ne sont pas connues, l\u2019effet de ces campagnes d\u2019informations ne parait gu\u00e8re soutenu.<\/p>\n

Tableau 1 :
\nExamens de d\u00e9pistage pr\u00e9f\u00e9r\u00e9s\t2006\t2007
\nColoscopie\t67%\t82%
\nH\u00e9moccult\t23%\t38%
\nColoscopie virtuelle et radiologie\t15%\t4%
\nMarqueurs tumoraux s\u00e9riques\t12%\t4%<\/p>\n

Conclusion:
\n1. Une large majorit\u00e9 des MSH adh\u00e8re personnellement au d\u00e9pistage du CCR, cependant ils ne sensibilisent que peu souvent leurs patients, familles et amis \u00e0 ce d\u00e9pistage.
\n2. Des campagnes d\u2019informations isol\u00e9es destin\u00e9es au grand public ou aux MSH n\u2019ont qu\u2019un impact limit\u00e9 sur le d\u00e9pistage du cancer colorectal par coloscopie. Seul un d\u00e9pistage organis\u00e9 syst\u00e9matique pourrait augmenter de fa\u00e7on durable la participation au d\u00e9pistage, mais l\u2019impact de cette attitude doit \u00eatre \u00e9valu\u00e9.<\/p>\n","protected":false},"excerpt":{"rendered":"

2008 Paul Strock (1), Joel Mossong (2), Jos Weber (1), Jean-Marie Weydert (1), Andre Kerschen (1) 1 HepatoGastroent\u00e9rologie, Centre Hospitalier de Luxembourg, Luxembourg 2 Biostatistiques, Laboratoire National de Sant\u00e9, Luxembourg Centre Hospitalier de Luxembourg, 4 rue Barbl\u00e9, L-1210 Luxembourg, T\u00e9l. 00 352 4411 2258 M\u00e9l: Strock.paul@chl.lu Gastroent\u00e9rologie – \u00a02008-05-30 –\u00a0 – ________________________________ Introduction: Au Luxembourg, […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[19],"class_list":["post-1840","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-19"],"yoast_head":"\nLes m\u00e9decins hospitaliers face au d\u00e9pistage du cancer colorectal - 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