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Pérol O, Lepage N, Noelle H, Lebailly P, de Labrusse B, Clin B, Boulanger M, Praud D, Fournié F, Galvaing G, Dutheil F, Le Meur B, Serin D, Dansin E, Nisse C, Charbotel B, Fervers B. A Multicenter Study to Assess a Systematic Screening of Occupational Exposures in Lung Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5068. [PMID: 36981979 PMCID: PMC10049492 DOI: 10.3390/ijerph20065068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 06/18/2023]
Abstract
Occupational lung cancer cases remain largely under-reported and under-compensated worldwide. In order to improve the detection and compensation of work-related lung cancers, we implemented a systematic screening of occupational exposures, combining a validated self-administered questionnaire to assess occupational exposures and a specialized occupational cancer consultation. After a pilot study, the present prospective, open-label, scale-up study aimed to assess this systematic screening of occupational exposures in lung cancer patients in five sites in France by associating university hospitals with cancer centers. Patients with lung cancer were sent a self-administered questionnaire to collect their job history and potential exposure to lung carcinogens. The questionnaire was assessed by a physician to determine if a specialized occupational cancer consultation was required. During the consultation, a physician assessed if the lung cancer was occupation-related and, if it was, delivered a medical certificate to claim for compensation. Patients were offered help from a social worker for the administrative procedure. Over 15 months, 1251 patients received the questionnaire and 462 returned it (37%). Among them, 176 patients (38.1%) were convened to the occupational cancer consultation and 150 patients attended the consultation. An exposure to occupational lung carcinogen was identified in 133 patients and a claim for compensation was judged possible for 90 patients. A medical certificate was delivered to 88 patients and 38 patients received compensation. Our national study demonstrated that a systematic screening of occupational exposures is feasible and will bring a significant contribution to improve the detection of occupational exposures in lung cancer patients.
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Affiliation(s)
- Olivia Pérol
- Département Prévention Cancer Environnement, Centre Léon Bérard, 69373 Lyon, France
- INSERM U1296 Radiations: Défense, Santé, Environnement, Centre Léon Bérard, 69373 Lyon, France
| | - Nadège Lepage
- CHU Lille, Centre Régional de Pathologies Professionnelles et Environnementales, 59800 Lille, France
- CHU Lille, ULR 4483-IMPECS-IMPact de l’Environnement Chimique sur la Santé Humaine, University of Lille, 59000 Lille, France
| | - Hugo Noelle
- Département Prévention Cancer Environnement, Centre Léon Bérard, 69373 Lyon, France
- Faculté de Médecine, Université Claude Bernard Lyon 1, 69373 Lyon, France
- Service d’Evaluation Economique en Santé, Hospices Civils de Lyon, Pôle de Santé Publique, 69003 Lyon, France
| | - Pierre Lebailly
- INSERM U1086, Unité de Recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Université de Caen Normandie, UFR Santé, 14032 Caen, France
- Centre François Baclesse, 14076 Caen, France
| | | | - Bénédicte Clin
- INSERM U1086, Unité de Recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Université de Caen Normandie, UFR Santé, 14032 Caen, France
- Service de Santé au Travail et Pathologie Professionnelle, CHRU de Caen, 14033 Caen, France
| | | | - Delphine Praud
- Département Prévention Cancer Environnement, Centre Léon Bérard, 69373 Lyon, France
- INSERM U1296 Radiations: Défense, Santé, Environnement, Centre Léon Bérard, 69373 Lyon, France
| | - Françoise Fournié
- Département Interdisciplinaire des Soins de Support du Patient en Oncologie, Service Social, Centre Léon Bérard, 69373 Lyon, France
| | - Géraud Galvaing
- Chirurgie Thoracique, Centre Jean Perrin, 63011 Clermont-Ferrand, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Service Santé Travail Environnement, CHU Clermont Ferrand, 63011 Clermont-Ferrand, France
| | | | - Daniel Serin
- Institut du Cancer Sainte Catherine, 84918 Avignon, France
| | - Eric Dansin
- Département d’Oncologie Médicale, Centre Oscar Lambret, 59000 Lille, France
| | - Catherine Nisse
- CHU Lille, Centre Régional de Pathologies Professionnelles et Environnementales, 59800 Lille, France
- CHU Lille, ULR 4483-IMPECS-IMPact de l’Environnement Chimique sur la Santé Humaine, University of Lille, 59000 Lille, France
| | - Barbara Charbotel
- UMRESTTE (Unité Mixte IFSTTAR/UCBL), Université Lyon 1, 69373 Lyon, France
- Service des Maladies Professionnelles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - Beatrice Fervers
- Département Prévention Cancer Environnement, Centre Léon Bérard, 69373 Lyon, France
- INSERM U1296 Radiations: Défense, Santé, Environnement, Centre Léon Bérard, 69373 Lyon, France
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Deneuve S, Charbotel B, Massardier-Pilonchéry A, Fort E, Milliet-Baude C, Pérol O, Fayette J, Zrounba P, Fervers B. Systematic screening for occupations and occupational exposures in head and neck squamous cell carcinoma patients. Eur Arch Otorhinolaryngol 2019; 276:857-864. [PMID: 30607561 DOI: 10.1007/s00405-018-05275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/27/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE The importance of occupational exposures in patients with head and neck squamous cell carcinomas (HNSCC) has received little attention. METHODS In a single-center study, we prospectively characterized occupational exposures in 154 HNSCC cancer patients in a systematic occupational consultation and examined the association between most frequent exposures, HNSCC stage and localization. RESULTS Patients occupied a mean of 3.3 different positions during their working life. The prevalence of asbestos, the most frequent exposure (46 patients; 29.9%) was higher than in the French population > 50 years. Other frequent exposures were solvents (n = 26; 16.9%) and silica (n = 19; 12.3%). For 37 patients (24%) a possible link was identified between occupational exposures and HNSCC. Duration of asbestos exposure was significantly higher (p = 0.04) in patients with hypopharyngeal and laryngeal cancer compared to other localizations. CONCLUSIONS Occupational exposures are frequent in patients with HNSCC and should receive increased attention by physicians.
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Affiliation(s)
- Sophie Deneuve
- Oncologic Surgery Department, Léon Bérard Center, 28 Rue Laennec, 69008, Lyon, France. .,Centre de Recherche en Cancérologie de Lyon, UMR INSERM 1052-CNRS 5286, 69008, Lyon, France.
| | - Barbara Charbotel
- Université Lyon 1, UMRESTTE (Unité Mixte IFSTTAR/UCBL), 69373, Lyon, France.,Service des Maladies Professionnelles, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495, Pierre Bénite, France
| | - Amélie Massardier-Pilonchéry
- Université Lyon 1, UMRESTTE (Unité Mixte IFSTTAR/UCBL), 69373, Lyon, France.,Service des Maladies Professionnelles, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495, Pierre Bénite, France
| | - Emmanuel Fort
- Université Lyon 1, UMRESTTE (Unité Mixte IFSTTAR/UCBL), 69373, Lyon, France
| | | | - Olivia Pérol
- Département d'Oncologie Médicale, Centre Léon Bérard, 69373, Lyon, France
| | - Jérome Fayette
- Département Cancer et Environnement, Centre Léon Bérard, 69373, Lyon, France
| | - Philippe Zrounba
- Oncologic Surgery Department, Léon Bérard Center, 28 Rue Laennec, 69008, Lyon, France
| | - Béatrice Fervers
- Département d'Oncologie Médicale, Centre Léon Bérard, 69373, Lyon, France.,Centre de Recherche en Cancérologie de Lyon, UMR INSERM 1052-CNRS 5286, 69008, Lyon, France.,Université Lyon 1, Faculté Lyon Est, Université de Lyon, 69008, Lyon, France
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Pérol O, Charbotel B, Perrier L, Bonnand S, Belladame E, Avrillon V, Rebattu P, Gomez F, Lauridant G, Pérol M, Fervers B. Systematic Screening for Occupational Exposures in Lung Cancer Patients: A Prospective French Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E65. [PMID: 29300325 PMCID: PMC5800164 DOI: 10.3390/ijerph15010065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/22/2017] [Accepted: 12/27/2017] [Indexed: 11/18/2022]
Abstract
Occupational lung cancers are under-reported and under-compensated worldwide. We assessed systematic screening for occupational exposure to carcinogens combining a self-administered questionnaire and an occupational consultation to improve the detection of occupational lung cancers and their compensation. Social deprivation and the costs of this investigation were estimated. Patients with lung cancer received a self-administered questionnaire to collect their job history, potential exposure to carcinogens and deprivation. A physician assessed the questionnaire and recommended an occupational consultation if necessary. During the consultation, a physician assessed if the lung cancer was work-related and, if it was, delivered a medical certificate to claim for compensation. Over 18 months, 440 patients received the self-administered questionnaire: 234 returned a completed questionnaire and a consultation was required for 120 patients. Compensation was judged possible for 41 patients. Among the 35 medical certificates delivered, 19 patients received compensation. Nearly half the patients (46%) were assessed as socially deprived and these patients took significantly longer to return the questionnaire compared with those who were not deprived. The mean cost of the process was €62.65 per patient. Our results showed a systematic self-administered questionnaire can be used to identify patients potentially exposed to carcinogens and to improve compensation.
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Affiliation(s)
- Olivia Pérol
- Département Cancer et Environnement, Centre Léon Bérard, 69373 Lyon CEDEX 08, France.
| | - Barbara Charbotel
- Université Lyon 1, UMRESTTE (Unité Mixte IFSTTAR/UCBL), 69373 Lyon CEDEX 03, France.
- Hospices Civils de Lyon, Service des Maladies Professionnelles, Centre Hospitalier Lyon Sud, 69495 Pierre Bénite, France.
| | - Lionel Perrier
- Université Lyon, Centre Léon Bérard, GATE L-SE UMR 5824, F-69008 Lyon, France.
| | - Sandrine Bonnand
- Département Interdisciplinaire de soins de Support du Patient en Oncologie, Service Social, Centre Léon Bérard, 69373 Lyon CEDEX 08, France.
| | - Elodie Belladame
- Département Cancer et Environnement, Centre Léon Bérard, 69373 Lyon CEDEX 08, France.
| | - Virginie Avrillon
- Département d'Oncologie Médicale, Centre Léon Bérard, 69373 Lyon CEDEX 08, France.
| | - Paul Rebattu
- Département d'Oncologie Médicale, Centre Léon Bérard, 69373 Lyon CEDEX 08, France.
| | - Frédéric Gomez
- Département d'Information Médicale, Centre Léon Bérard, 69373 Lyon CEDEX 08, France.
| | - Géraldine Lauridant
- Département d'Oncologie Médicale, Centre Oscar Lambret, 59000 Lille, France.
| | - Maurice Pérol
- Département d'Oncologie Médicale, Centre Léon Bérard, 69373 Lyon CEDEX 08, France.
| | - Beatrice Fervers
- Département Cancer et Environnement, Centre Léon Bérard, 69373 Lyon CEDEX 08, France.
- Centre de Recherche en Cancérologie de Lyon, UMR INSERM 1052-CNRS 5286, F-69008 Lyon, France.
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Characteristics of Laws Requiring Physicians to Report Patient Information for Public Health Surveillance: Notable Patterns from a Nevada Case Study. J Community Health 2017; 43:328-337. [PMID: 28929402 DOI: 10.1007/s10900-017-0426-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Laws across the globe require healthcare providers to disclose patient health information to public health entities for surveillance and intervention purposes. Physicians play a unique role in such mandatory reporting regimes. However, research reveals consistent under-reporting and points to limited knowledge of mandates, perceived burdens of reporting, misaligned incentives and penalties, and a lack of streamlined processes as significant reporting barriers. These barriers suggest that how legal mandates are structured may impact compliance; yet little research systematically examines their characteristics. Law-based reporting requirements differ across jurisdictions. Thus, we conducted a case study in the U.S. State of Nevada to characterize its physician mandatory reporting laws using legal mapping methodology. Nevada is a useful case study because it has few local jurisdictions and its legislature meets biennially. First, we searched key terms to find relevant state mandates and screened them using inclusion criteria. We then scanned near included provisions for additional requirements and incorporated requirements known a priori. We also searched relevant local regulations. Next, we analyzed all included provisions. Our findings indicate wide, intra-jurisdictional variation in reporting requirements across conditions. Variability extends to physician discretion, information reported, timing, recipient agencies, reporting processes, and implications of non-compliance. Local-level variation adds further complexity. Some relevant state requirements apply only to physicians and nearly one-third were absent from our searches. Our findings support exploring the hypothesis that reporting requirements' characteristics may impact compliance and call for empirically testing such relationships to enhance compliance and public health surveillance and intervention efforts.
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Chauhan BF, Jeyaraman MM, Mann AS, Lys J, Skidmore B, Sibley KM, Abou-Setta AM, Zarychanski R. Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews. Implement Sci 2017; 12:3. [PMID: 28057024 PMCID: PMC5216570 DOI: 10.1186/s13012-016-0538-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/13/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers. METHODS Study design: overview of reviews. DATA SOURCE MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015). STUDY SELECTION two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language. DATA EXTRACTION AND SYNTHESIS two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors' conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.). RESULTS Of 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change. CONCLUSIONS Behavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.
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Affiliation(s)
- Bhupendrasinh F Chauhan
- College of Pharmacy, University of Manitoba, Winnipeg, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
| | - Maya M Jeyaraman
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Justin Lys
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Kathryn M Sibley
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ryan Zarychanski
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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Porru S, Carta A, Toninelli E, Bozzola G, Arici C. Reducing the underreporting of lung cancer attributable to occupation: outcomes from a hospital-based systematic search in Northern Italy. Int Arch Occup Environ Health 2016; 89:981-9. [PMID: 27137812 DOI: 10.1007/s00420-016-1135-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/21/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Occupational exposure to lung carcinogens is and was common in workplaces. 5-25 % of lung cancers (LCs) could be causally attributable to occupation; however, LC underreporting and undercompensation are widespread, with remarkable tolls paid by individuals and society. This work aims to: describe an ongoing hospital-based systematic search (SS) of occupational LC; improve aetiological diagnosis; increase number and quality of LC notifications. METHODS Through a short form, physicians at a public hospital referred incident LC to the Occupational Health Unit (OHU). Only patients selected through the form were interviewed; a personal, occupational and clinical history was collected; reports were sent to the ward and Local Health Authority, with aetiological diagnosis criteria and probability of causation. RESULTS From 1998 to 2013, 3274 cases of LC were notified to the OHU; prior to the system, just couple of dozens were assessed. A total of 1522 patients were fully interviewed; in 395 cases, causation was attributed to occupation (26 % of interviewed patients); all were notified to authorities, as compared to the handful reported before the system was adopted. Main aetiological agents were silica, asbestos, polycyclic aromatic hydrocarbons, truck driving, painting, multiple exposures. Compensation rate was remarkable (39 %). CONCLUSIONS Through SS, many occupational LCs were found that otherwise would have been lost. Aetiological diagnosis proved to be rich of scientific advantages and practical implications, with attention to equity and social aspects. SS was easy, accountable and fostered multidisciplinary collaboration among medical specialties, significantly reducing underreporting and undercompensation of occupational LC.
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Affiliation(s)
- Stefano Porru
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Angela Carta
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Elena Toninelli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Giordano Bozzola
- Division of Pneumology, Spedali Civili of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Cecilia Arici
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
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Curti S, Sauni R, Spreeuwers D, De Schryver A, Valenty M, Rivière S, Mattioli S. Interventions to increase the reporting of occupational diseases by physicians: a Cochrane systematic review. Occup Environ Med 2016; 73:353-4. [PMID: 26936362 PMCID: PMC4853596 DOI: 10.1136/oemed-2015-103209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 02/09/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Riitta Sauni
- Finnish Institute of Occupational Health, Tampere, Finland
| | | | - Antoon De Schryver
- Epidemiology and Social Medicine, University of Antwerp, Antwerpen, Belgium
| | - Madeleine Valenty
- Département Santé Travail, Institut de Veille Sanitaire, Saint Maurice, France
| | - Stéphanie Rivière
- Département Santé Travail, Institut de Veille Sanitaire, Saint Maurice, France
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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