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Claessens AKM, Ramaekers BLT, Lobbezoo DJA, van Kampen RJW, de Boer M, van de Wouw AJ, Dercksen MW, Geurts SME, Joore MA, Tjan-Heijnen VCG. Quality of life in a real-world cohort of advanced breast cancer patients: a study of the SONABRE Registry. Qual Life Res 2020; 29:3363-3374. [PMID: 32816222 PMCID: PMC7686224 DOI: 10.1007/s11136-020-02604-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE We aimed to evaluate quality of life (QoL) using the European Quality of Life Five-Dimensions questionnaire (EQ-5D-3L) in a real-world cohort of Dutch advanced breast cancer (ABC) patients. Secondary, we reported differences in QoL between subgroups of patients based on age, comorbidity, tumor-, and treatment characteristics, and assessed the association of duration of metastatic disease and time to death with QoL. METHODS ABC patients who attended the outpatient clinic between October 2010 and May 2011 were asked to fill out the EQ-5D-3L questionnaire. Patient-, disease-, and treatment characteristics were obtained from the medical files. Health-utility scores were calculated. Subgroups were described and compared for utility scores by parametric and non-parametric methods. RESULTS A total of 92 patients were included with a median utility score of 0.691 (Interquartile range [IQR] 0.244). Patients ≥ 65 years had significantly worse median utility scores than younger patients; 0.638 versus 0.743, respectively (p = 0.017). Moreover, scores were significantly worse for patients with versus those without comorbidity (medians 0.620 versus 0.725, p = 0.005). Utility scores did not significantly differ between subgroups of tumor type, type of systemic treatment, number of previous palliative treatment(s), or number or location of metastatic site(s). The remaining survival was correlated with utility scores (correlation coefficient (r) = 0.260, p = 0.0252), especially in the subgroup < 65 years (r = 0.340, p = 0.0169), whereas there was no significant correlation with time since metastatic diagnosis (r = - 0.106, p = 0.3136). CONCLUSION Within this real-world cross-sectional study, QoL was significantly associated with age, comorbidity, and remaining survival duration. The observation of a lower QoL in ABC patients, possibly indicating the last period of life, may assist clinical decision-making on timing of cessation of systemic antitumor therapy.
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Affiliation(s)
- Anouk K. M. Claessens
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
- Department of Medical Oncology, Zuyderland Medical Center, PO BOX 5500, 6130 MB Sittard-Geleen, The Netherlands
| | - Bram L. T. Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
| | - Dorien J. A. Lobbezoo
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
| | - Roel J. W. van Kampen
- Department of Medical Oncology, Zuyderland Medical Center, PO BOX 5500, 6130 MB Sittard-Geleen, The Netherlands
| | - Maaike de Boer
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
| | - Agnes J. van de Wouw
- Department of Internal Medicine, VieCuri Medical Center, PO BOX 1926, 5900 BX Venlo, The Netherlands
| | - M. Wouter Dercksen
- Department of Internal Medicine, Máxima Medical Center, PO BOX 90052, 5600 PD Eindhoven, The Netherlands
| | - Sandra M. E. Geurts
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
| | - Manuela A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
| | - Vivianne C. G. Tjan-Heijnen
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, The Netherlands
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Claessens AKM, Erdkamp FLG, Lopez-Yurda M, Bouma JM, Rademaker-Lakhai JM, Honkoop AH, de Graaf H, Tjan-Heijnen VCG, Bos MEMM. Secondary analyses of the randomized phase III Stop&Go study: efficacy of second-line intermittent versus continuous chemotherapy in HER2-negative advanced breast cancer. Acta Oncol 2020; 59:713-722. [PMID: 32141389 DOI: 10.1080/0284186x.2020.1731923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Previously, we showed that reintroduction of the same (first-line) chemotherapy at progression could only partially make up for the loss in efficacy as compared to continuously delivered first-line chemotherapy. Here, we report the probability of starting second-line study chemotherapy in the Stop&Go trial, and the progression-free survival (PFS) and overall survival (OS) of patients who received both the first- and second-line treatment in an intermittent versus continuous schedule.Methods: First-line chemotherapy comprised paclitaxel plus bevacizumab, second-line capecitabine or non-pegylated liposomal doxorubicin, given per treatment line as two times four cycles (intermittent) or as eight consecutive cycles (continuous).Results: Of the 420 patients who started first-line treatment within the Stop&Go trial (210:210), a total of 270 patients continued on second-line study treatment (64% of all), which consisted of capecitabine in 201 patients and of non-pegylated liposomal doxorubicin in 69 patients, evenly distributed between the treatment arms. Median PFS was 3.7 versus 5.0 months (HR 1.07; 95% CI: 0.82-1.38) and median OS 10.9 versus 12.4 months (HR 1.27; 95% CI: 0.98-1.66) for intermittent versus continuous second-line chemotherapy. Second-line PFS was positively influenced by prior hormonal therapy for metastatic disease and longer first-line PFS duration, while triple-negative tumor status had a negative influence. Patients with a shorter time to progression (TTP) in first-line (≤10 months) had a higher probability of starting second-line treatment if they received intermittent compared to continuous chemotherapy (OR 1.97; 95% CI: 1.02-3.80).Conclusion: We recommend continuous scheduling of both the first- and second-line chemotherapy for advanced breast cancer.
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Affiliation(s)
- Anouk K. M. Claessens
- Department of Medical Oncology, Zuyderland Medical Centre, Geleen, The Netherlands
- Department of Medical Oncology, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frans L. G. Erdkamp
- Department of Medical Oncology, Zuyderland Medical Centre, Geleen, The Netherlands
| | - Marta Lopez-Yurda
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeanette M. Bouma
- Department of Trial Registration, Comprehensive Cancer Centre the Netherlands, Rotterdam, The Netherlands
| | | | - Aafke H. Honkoop
- Department of Medical Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Hiltje de Graaf
- Department of Medical Oncology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Vivianne C. G. Tjan-Heijnen
- Department of Medical Oncology, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Monique E. M. M. Bos
- Department of Medical Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Claessens AKM, Ibragimova KIE, Geurts SME, Bos MEMM, Erdkamp FLG, Tjan-Heijnen VCG. The role of chemotherapy in treatment of advanced breast cancer: an overview for clinical practice. Crit Rev Oncol Hematol 2020; 153:102988. [PMID: 32599374 DOI: 10.1016/j.critrevonc.2020.102988] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/09/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022] Open
Abstract
This review aims to evaluate the role of chemotherapy-containing regimens in the treatment of advanced breast cancer (ABC), with the purpose to optimize selection, sequencing and duration of treatment with the currently available agents for clinical practice. Data from observational as well as randomized phase II and III studies were included. Chemotherapy yielded a median overall survival (OS) of 2 years in registration studies, with comparable efficacy of different agents. Combining chemotherapy agents did not yield OS improvement and caused greater toxicity compared with single-agent chemotherapy. Continuing chemotherapy till progression or unacceptable toxicity generated greater efficacy without detrimental impact on quality of life compared with a limited amount of cycles. In real-world studies, benefits after third-line chemotherapy were modest compared with first- and second-line. Furthermore, effects of previous chemotherapy predicted effects of next-line therapy in real-world. Physicians increasingly prescribed capecitabine or taxanes as first- or second-line chemotherapy over time.
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Affiliation(s)
- Anouk K M Claessens
- Department of Medical Oncology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, PO BOX 616, 6200 MD Maastricht, the Netherlands; Department of Medical Oncology, Zuyderland Medical Center, PO BOX 5500, 6130 MB Sittard-Geleen, the Netherlands.
| | - Khava I E Ibragimova
- Department of Medical Oncology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, PO BOX 616, 6200 MD Maastricht, the Netherlands.
| | - Sandra M E Geurts
- Department of Medical Oncology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, PO BOX 616, 6200 MD Maastricht, the Netherlands.
| | - Monique E M M Bos
- Department of Medical Oncology, Erasmus Medical Centre, PO BOX 2030, 3000 CA Rotterdam, the Netherlands.
| | - Frans L G Erdkamp
- Department of Medical Oncology, Zuyderland Medical Center, PO BOX 5500, 6130 MB Sittard-Geleen, the Netherlands.
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Center, PO BOX 5800, 6202 AZ Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, PO BOX 616, 6200 MD Maastricht, the Netherlands.
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Baudouin A, Armoiry X, Dussart C. L’évaluation médico-économique des stratégies thérapeutiques en milieu hospitalier : une revue systématique des travaux français. ANNALES PHARMACEUTIQUES FRANÇAISES 2017; 75:227-235. [DOI: 10.1016/j.pharma.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/29/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022]
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Hurtaud A, Donnadieu A, Escalup L, Cottu PH, Baffert S. Costs associated with Eribulin treatment for patients with metastatic breast cancer in a comprehensive cancer center in France. Breast 2016; 30:73-79. [DOI: 10.1016/j.breast.2016.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/27/2016] [Accepted: 08/30/2016] [Indexed: 11/26/2022] Open
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Cortesi L, Toss A, Cirilli C, Marcheselli L, Braghiroli B, Sebastiani F, Federico M. Twenty-years experience with de novo metastatic breast cancer. Int J Cancer 2015; 137:1417-26. [PMID: 25736070 DOI: 10.1002/ijc.29503] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/26/2015] [Indexed: 02/04/2023]
Abstract
Although new treatments have been widely studied to improve the survival of patients with metastatic breast cancer (BC), prognosis continues to be poor with an average survival time no longer than 3 years. We carried on a population-based study with the purpose of evaluating the outcome of metastatic breast cancer in the province of Modena from 1990 to 2009. We examined the Modena Cancer Registry and evaluated the 5-year overall survival (OS) of women diagnosed with a de novo metastatic breast cancer between 1990 and 2009, defining 5 periods of 4 years each. After a median follow-up time of 29 months, the 5-year OS was 11% for years 1990-1993, 15% for years 1994-1997, 12% for years 1998-2001, 20% for years 2002-2005 and 29% for years 2006-2009 (p = 0.012). Overall, although no OS differences were noted in the first decade analyzed, a real advantage has been shown in the last two cohorts. In a multivariate analysis, the 5-year OS was significantly increased only for hormone receptor positive and HER2+ tumors, whereas chemotherapy treatments were not significant independent predictors of survival in "de novo" metastatic BC (p = 0.08). Our analysis confirms that the prognosis of de novo metastatic breast cancer has improved overtime, particularly in the last decade. Trastuzumab, LH-RH analogues and aromatase inhibitors have determined a significant clinical benefit and cost-effectiveness in metastatic breast cancer treatment.
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Affiliation(s)
- Laura Cortesi
- Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Angela Toss
- Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Cirilli
- Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Marcheselli
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Braghiroli
- Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Sebastiani
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Federico
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
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Liu XH, Man YN, Cao R, Liu C, Wu XZ. Individualized chemotherapy based on organ selectivity: a retrospective study of vinorelbine and capecitabine for patients with metastatic breast cancer. Curr Med Res Opin 2014; 30:1017-24. [PMID: 24528110 DOI: 10.1185/03007995.2014.895310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study proposed a conception of individualized chemotherapy based on organ selectivity of drug distribution by retrospectively comparing the effect of vinorelbine and capecitabine in patients with metastatic breast cancer. METHODS Between January 2002 and December 2009, 133 patients with lung metastasis and 87 patients with liver metastasis were analyzed and followed up until December 2012. The survival analysis was performed by Kaplan-Meier. Multivariate analysis was conducted to identify independent prognostic factors. RESULTS The median time to progression of the vinorelbine, capecitabine and anthracycline/taxane groups of patients with lung metastasis was 5.7, 2.9 and 2.1 months, respectively. Median overall survival of the vinorelbine group (27.4 months) was longer than the capecitabine (12.2 months, P = 0.027) and anthracycline/taxane groups (9.1 months, P < 0.001) in patients with lung metastasis. The median time to progression of the vinorelbine, capecitabine and anthracycline/taxane groups of patients with liver metastasis was 2.3, 7.3 and 2.6 months, respectively. Median overall survival of the capecitabine group (15.2 months) was longer than the vinorelbine (9.0 months, P = 0.029) and anthracycline/taxane groups (6.4 months, P = 0.004) in patients with liver metastasis. CONCLUSIONS Our results indicate that vinorelbine and capecitabine have different advantageous effects in breast cancer patients with lung/liver metastasis. Thus, we propose individualized chemotherapy based on organ specificity and pharmacokinetics.
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Affiliation(s)
- Xiao-Hui Liu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Center for Cancer, Key Laboratory of Cancer Prevention and Therapy , Tianjin , China
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Nerich V, Chelly J, Montcuquet P, Chaigneau L, Villanueva C, Fiteni F, Meneveau N, Perrin S, Voidey A, Monnot T, Pivot X, Limat S. First-line trastuzumab plus taxane-based chemotherapy for metastatic breast cancer: cost-minimization analysis. J Oncol Pharm Pract 2013; 20:362-8. [PMID: 24158979 DOI: 10.1177/1078155213508440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To carry out a cost-minimization analysis including a comparison of the costs arising from first-line treatment by trastuzumab plus docetaxel versus trastuzumab plus paclitaxel in patients with metastatic breast cancer. METHODS All consecutive patients with human epidermal growth receptor 2-postive metastatic breast cancer who were treated at Besançon University Hospital and Saint Vincent private hospital between 2001 and 2010 by first-line therapy containing trastuzumab plus taxane were retrospectively studied. Economic analysis took into account costs related to drugs, hospitalization, and healthcare travel. RESULTS Progression-free survival difference between the two treatments was not significant (p = 0.65). First-line treatment by trastuzumab plus taxane was estimated at approximately €68,000 (p = 0.74). The drug costs represented around 70-75% of the total cost, mainly related to the use of trastuzumab. CONCLUSION Our economic analysis shows that although the costs of the two trastuzumab plus taxane regimens are similar, they may contribute to the on-going debate about the availability and use of innovative chemotherapy drugs, in particular in human epidermal growth factor receptor 2-positive metastatic breast cancer with new therapies such as trastuzumab-DM1 and pertuzumab.
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Affiliation(s)
- Virginie Nerich
- Department of Pharmacy, University Teaching Hospital of Besançon, France INSERM U645 EA-2284 IFR-133, University of Franche-Comté, Besançon, France
| | - Jennifer Chelly
- Department of Pharmacy, University Teaching Hospital of Besançon, France
| | - Philippe Montcuquet
- Department of Medical Oncology, University Teaching Hospital of Besançon, France
| | - Loïc Chaigneau
- Department of Medical Oncology, University Teaching Hospital of Besançon, France
| | - Cristian Villanueva
- Department of Medical Oncology, University Teaching Hospital of Besançon, France
| | - Frédéric Fiteni
- Department of Medical Oncology, University Teaching Hospital of Besançon, France
| | - Nathalie Meneveau
- Department of Medical Oncology, University Teaching Hospital of Besançon, France
| | - Sophie Perrin
- Department of Pharmacy, University Teaching Hospital of Besançon, France
| | - Aline Voidey
- Department of Pharmacy, University Teaching Hospital of Besançon, France
| | - Tess Monnot
- Department of Pharmacy, University Teaching Hospital of Besançon, France
| | - Xavier Pivot
- INSERM U645 EA-2284 IFR-133, University of Franche-Comté, Besançon, France Department of Medical Oncology, University Teaching Hospital of Besançon, France
| | - Samuel Limat
- Department of Pharmacy, University Teaching Hospital of Besançon, France INSERM U645 EA-2284 IFR-133, University of Franche-Comté, Besançon, France
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Benjamin L, Cotté FE, Mercier F, Vainchtock A, Vidal-Trécan G, Durand-Zaleski I. Burden of breast cancer with brain metastasis: a French national hospital database analysis. J Med Econ 2012; 15:493-9. [PMID: 22304337 DOI: 10.3111/13696998.2012.662924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Incidence of breast cancer with brain metastases (BCBM) is increasing, especially among patients over-expressing HER2. Epidemiology on this sub-type of cancer is scarce, since cancer registries carry no information on the HER2 status. A retrospective database analysis was conducted to estimate the burden of BCBM, especially among HER2-positive patients in a secondary objective. METHODS Patients with a new diagnosis of BCBM carried out between January and December 2008 were identified from the national hospital database using the International Disease Classification. Patients receiving a targeted anti-HER2 therapy were identified from the national pharmacy database. Hospital and pharmacy claims were linked to estimate the burden of HER2-positive patients. Data on hospitalizations were extracted to describe treatment patterns and healthcare costs during a 1-year follow-up. Predictors of treatment cost were analyzed through multi-linear regression analysis. RESULTS Two thousand and ninety-nine BCBM patients were identified (mean age (SD) = 57.8 (13.6)), of whom 12.2% received a targeted anti-HER2 therapy; 79% of patients had brain metastases associated with extracranial metastases, and the attrition rate reached 82%. Patients received mostly palliative care (47.4%), general medical care (40.6%), and chemotherapy (35.0%). The total annual hospital cost of treatment was 8,426,392€, representing a mean cost of 22,591€ (±14,726) per patient, mainly influenced by extracranial metastases, surgical acts, and HER2-overexpression (p < 0.0001). CONCLUSIONS The database linkage of hospital and pharmacy claims is a relevant approach to identify sub-type of cancer. Chemotherapy was widely used as a systemic treatment for breast cancer rather than for local treatment of brain metastases whose morbi-mortality remains high. The variability of treatment costs suggests clinical heterogeneity and, thus, extensive individualization of protocols.
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Affiliation(s)
- L Benjamin
- Epidémiologie, Evaluation et Politiques de santé (EA 4069), Université Paris Descartes, Sorbonne Paris Cité, France.
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