The concept of geriatric oncology came from precursors in the USA and Italy in the late 80th. But it was developed in practice in France from the early 2000th. When the French National Cancer institute was settled, geriatric oncology was considered as a priority and then, financed on the base of the experience of different French physicians and institutions. Rapidly, geriatric oncology programs were implemented and became a national network including oversea regions. Their objectives were: patients' management, research, teaching, and professional and patients' information. An ambitious research trial allowed to validate the G8 screening tool of frailty. Then, France became a pioneer, participating in the international programs within the framework of the Société internationale d'oncologie gériatrique. Nevertheless, there are still important challenges to implement worldwide geriatric oncology activity and to define precisely decision-making processes.

OBJECTIVES:Cervical cancer is common in French Guiana. Previous studies of the cancer registry have shown that the only prognostic factor was FIGO stage, with a 5-year survival rate of 58%. This study aimed to describe the management and survival rates prior to the establishment of the University Hospital. METHODS:A multicenter retrospective study of 222 cases discussed in tumor board meetings between 2010 and 2021. Data collected included age, administrative status, comorbidities, place of residence, histology, FIGO stage, treatment modalities, and disease progression. RESULTS:Key findings were median age, 48 years; born abroad, 59%; residence on the Atlantic coast, 68%; FIGO stage III-IV, 54%; surgery, 47% of cases; radiotherapy, 46%; transfer outside French Guiana, 58%. Five-year overall survival was 65%, identical before and after 2016. In multivariate analysis, advanced FIGO stages (III, HR=3.22; IV, HR=3.65) and residence in remotes areas (HR=2.63) were independent prognostic factors for shorter survival. DISCUSSION:Difficulties in accessing care and mandatory transfers for radiotherapy impact patient outcomes. Recent decisions have been made within the framework of the new University Hospital (CHU), notably the establishment of a radiotherapy department and the strengthening of local healthcare infrastructure. These results provide a baseline for evaluating the impact of these decisions.

OBJECTIVE:Human T-lymphotropic virus 1 (HTLV-1) infection is endemic in western French Guiana and is associated with maternal morbidity and mortality. However, data on related obstetric and neonatal complications remain limited. This study evaluated temporal trends in the prevalence of HTLV-1 among pregnant women, and assessed associations with adverse obstetric and neonatal outcomes. METHODS:A retrospective, single-centre study was conducted at Western French Guiana Hospital Centre from 2013 to 2021, comparing HTLV-1-infected parturients with uninfected controls. Univariate and multivariate analyses were performed. RESULTS:Among 24,294 births, 402 were infected with HTLV-1 (prevalence 1.66%), with a decreasing trend over the study period. HTLV-1 infection was associated with higher rates of preterm birth (<37 weeks: 15% vs 11%; p = 0.04) and hypertensive disorders of pregnancy (12% vs 8%; p = 0.01). Multivariate analysis confirmed an independent association with preterm birth (odds ratio 1.55, 95% confidence interval 1.12-2.13; p = 0.007). Rates of fetal loss, postpartum complications, and low birth weight did not differ between HTLV-1-infected and uninfected women. Additionally, 4.1% of HTLV-1-infected women developed adult T-cell leukaemia/lymphoma or HTLV-1-associated myelopathy/tropical spastic paraparesis during pregnancy or the postpartum period. CONCLUSION:Although the prevalence of HTLV-1 among parturients in western French Guiana has declined progressively, it remains associated with substantial morbidity and independently increases the risk of preterm birth. Further studies are needed to confirm this association and elucidate the underlying mechanisms.

Background:Helicobacter pylori infection is a major etiological factor for gastric cancer, but its prognostic relevance once invasive gastric cancer has developed remains uncertain in French Guiana. Methods:We conducted a retrospective hospital-based study including all patients diagnosed with histologically confirmed invasive gastric carcinoma at Cayenne Hospital Center between 2018 and 2023. H. pylori status was assessed by routine histopathology. Sociodemographic, clinicopathological, and histological characteristics, including associated gastric lesions, were collected. Overall survival was estimated using the Kaplan-Meier method and compared using the log-rank test according to H. pylori status and initial management strategy. Exploratory multivariable Cox regression analyses were performed. Results:Eighty-two patients were included, of whom 43 (52.4%) were H. pylori-positive. H. pylori positivity was significantly associated with non-active chronic gastritis, whereas H. pylori detection was uncommon in active chronic gastritis. H. pylori status was not associated with tumor location, histological subtype, differentiation, or preneoplastic lesions. Median follow-up was 25.7 months. Overall survival did not differ between H. pylori-positive and H. pylori-negative patients. In multivariable analyses, H. pylori status was not associated with survival, whereas initial management was strongly associated with outcome, likely reflecting disease stage at diagnosis rather than a causal treatment effect. Conclusion:Routine histology detected H. pylori in about half of gastric tumors, with an association with non-active chronic gastritis. H. pylori status was not associated with survival; differences by initial management likely reflected disease severity, with interpretation limited by incomplete TNM staging.

Objectives. - The aim of the study was to analyze care providers perception of patients from a variety of multicultural backgrounds in palliative care. Methods. - We used a qualitative grounded theory methodology based on semi-structured interviews with palliative care professionals working in a regional hospital care team in West-Guiana, a remote area of French Guiana with a multicultural, poor and often foreign population. The study meets the consolidated criteria for qualitative research reports (COREQ). Results. - Data saturation was reached after 20 interviews of caregivers (43 years median age and 13 women/7 men). The data analysis found six themes: languages, beliefs about death and illness, rituals, family structures, traditional medicine, and eating habits. The difficulties encountered were language barrier, social context, clan-based family decisions, emotional expression, and interference between care and rituals. The proposals identified were teamworking, language and cultural learning and family meetings. It was also expressed that, despite cultural differences, each person had his or her singularity, i.e. the human being, independent of his or her culture, facing the end of life, with his or her loneliness and fear. Discussion. - Literature advocates a practice that respects cultural differences. It is important to value the cultural skills of caregivers to enable them to solve the difficulties they encounter while respecting cultural differences. (c) 2025 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Introduction > The aim was to analyze the implementation of the Onco-Geriatrics model in a remote ultramarine territory: West-French Guiana. The population is socially precarious in terms of income, social coverage and administrative status, and most often speaks a non-French language Methods > Narrative description of the implementation and retrospective study of anonymized data from the database of older patients managed for cancer between September 2014 and Results > A total of 574 new patients were managed. Of these, 107 were aged 70 and over; 78 (73 %) had a G8 test. Forty-two patients had a multidimensional geriatric assessment (MGA). More than half the patients had dependency criteria, malnutrition and a high number of severe comorbidities. Difficulties encountered were language, level of education, clinical context (in 18 patients), but also insufficient involvement of health professional and the consequences of health organization and gradual implementation. Discussion > Implementation was impacted by the fact that quality criteria for implementation were not sufficient. Studies in high-middle-income countries in South America suggest that initial implementation of the MGA may be preferable, that frailty screening tests and the MGA procedure can be adapted to non-Western populations, and that the use of new technologies can improve the management of older patients in this context.

Introduction > West Guiana is characterized by a precarious, poor, dispersed population, exposed to infectious and chemical factors. Prostate cancer is the leading cancer in terms of incidence in men. We examined its characteristics, management and main exposomes in this context. Methods > This is a retrospective, descriptive, observational, monocentric study. We considered general external expositions (medico-social status, precariousness, geographical remoteness, culture), specific external (viral serologies, occupation, hypothesizing chemical exposures), and risk factors (comorbidities, overweight), cross-referenced with two cancer characteristics (histopronostic grade and stage). Results > Over a 6-year period, 70 patients were managed: the majority at a metastatic stage (53%), with a high histopronostic grade. Possible exposures were precariousness 45%, scattered housing 39%, maroon culture 48%, exposure to chemical agents 53%, but no exposure to viruses or notable medical risk factors. None of the comparisons showed any significant difference, with the exception of a higher proportion of metastatic cancers in the case of precariousness (71% versus 39%; P = 0.015) and a trend for patients living in rural areas (67% versus 45%; P = 0.09). Conclusion > These results lead us to propose two strategies: 1-organization of care as close as possible to patients; 2-prospective translational research which, after an exhaustive review of the literature, concerns the study of candidate carcinogenic microorganisms, in particular HPV, and chemical pollution, which is very prevalent in French Guiana.

Objectifs L’objectif de l’étude était d’analyser les perceptions des soignants à l’égard des patients d’origine multiculturelle diverse en matière de soins palliatifs. Méthodes Nous avons utilisé une méthodologie qualitative basée sur des entretiens semi-structurés avec des professionnels des soins palliatifs travaillant dans une équipe hospitalière dans l’ouest de la Guyane, région isolée de la Guyane française avec une population multiculturelle, pauvre et souvent étrangère. L’étude respecte les critères consolidés pour les rapports de recherche qualitative (COREQ). Résultats La saturation des données a été atteinte après 20 entretiens (âge médian des soignants, 43 ans ; 13 femmes, 7 hommes). L’analyse des données a permis de dégager six thèmes : les langues, les croyances sur la mort et la maladie, les rituels, les structures familiales, la médecine traditionnelle et les habitudes alimentaires. Les difficultés rencontrées sont : la barrière de la langue, le contexte social, les décisions familiales claniques, l’expression émotionnelle et l’interférence entre les soins et les rituels. Les propositions identifiées sont : le travail en équipe, l’apprentissage des langues et des cultures et les réunions avec les familles. Il a également été exprimé que, malgré les différences culturelles, chaque personne avait sa singularité, c’est-à-dire l’être humain, indépendant de sa culture, confronté à la fin de vie, avec sa solitude et sa peur. Discussion La littérature prône une pratique respectueuse des différences culturelles. Il est important de valoriser les compétences culturelles des soignants pour leur permettre de résoudre les difficultés rencontrées dans le respect des différences culturelles.

Adult T-cell leukemia/lymphoma (ATL) is a rare and aggressive malignancy caused by human T-cell leukemia virus type 1 (HTLV-1). French Guiana, located in northeastern South America, is a region of high HTLV-1 endemicity with a multiethnic population. We conducted a comprehensive 30-year study of ATL cases diagnosed between 1990 and 2019, capturing nearly all confirmed ATL cases in the territory (n = 137). The predominant subtypes were lymphoma (58%) and acute ATL (36%). Striking ethnic disparities emerged: 69% of patients were Maroons, and the median age at diagnosis was 43 years among Maroons versus 58 years among Creoles. Survival outcomes were uniformly poor, with median overall survival of 2.7 months for acute and 5.2 months for lymphoma ATL. In multivariate analysis, acute ATL subtype and hepatosplenomegaly at diagnosis were independently associated with worse survival. Complete HTLV-1 genome sequences were obtained for seven ATL cases, and phylogenetic analysis of complete genomes revealed strong ethnic clustering: all Creole strains belonged to the Transcontinental subtype, while all Maroon strains belonged to the West African subtype. Moreover, HTLV-1 seroprevalence in the general population was measured among 1078 Creoles tested in 1998, with a prevalence of 3.1%, markedly lower and occurring at older ages compared to previously published data for the Maroon population. Our findings highlight pronounced disparities in ATL epidemiology by ethnic group and emphasize the need for targeted prevention, early diagnosis, and improved care in high-risk populations.

Introduction L’Ouest-Guyane est caractérisé par une population précaire, pauvre, dispersée, exposée à des facteurs infectieux et chimiques. Le cancer de prostate y est le premier cancer en termes d’incidence chez l’homme. Nous avons examiné ses caractéristiques, sa prise en charge et les exposomes principaux dans ce contexte. Méthodes C’est une étude rétrospective descriptive observationnelle monocentrique. Nous avons considéré les expositions externes générales (statut médicosocial, précarité, éloignement géographique, culture), externes spécifiques (sérologies virales, métier, faisant l’hypothèse d’expositions chimiques), et internes (comorbidités, surpoids), croisés avec deux caractéristiques du cancer (grade histopronostique et stade). Résultats Pendant une période de six ans, 70 patients ont été pris en charge : la majorité à un stade métastatique (53 %), avec un grade histopronostique élevé. Les expositions éventuelles étaient : la précarité 45 %, l’habitat dispersé 39 %, la culture noire marron 48 %, l’exposition à des agents chimiques 53 %, mais sans exposition à des virus ni de facteurs de risque médicaux notables. Aucune des comparaisons ne montrait de différence significative à l’exception d’une proportion de cancers métastatiques plus élevée en cas de précarité (71 % versus 39 % ; p=0,015) et une tendance pour les patients vivant dans un habitat rural (67 % versus 45 % ; p=0,09). Conclusion Ces résultats conduisent à proposer deux stratégies : 1 – organisation de la prise en charge au plus près des patients ; 2 – recherche translationnelle prospective qui concerne, après une revue exhaustive de la littérature, l’étude des micro-organismes carcinogènes candidats, en particulier HPV, et la pollution chimique très prégnante en Guyane.

Introduction Les agents infectieux sont des facteurs exogènes importants de la carcinogénèse et tout particulièrement dans les zones tropicales. Ils viennent s'ajouter aux conditions endogènes (facteurs nutritionnels par exemple). Le but de cette étude est d'essayer d'analyser le rôle des « exposomes » exogènes (infectieux) et endogènes (ici le contexte métabolique) selon les pathologies malignes. Méthode Cohorte de 558 patients enregistrés prospectivement (informations administratives) en 2015-2020. Données médicales incluses rétrospectivement. Base de données anonymisée, déclaration RGPD. Dernière mise à jour 03/01/2022. Recueil des pathologies malignes (cancers solides et hémopathies), sérologies VIH, VHB, VHC et HTLV1 (il n'est pas tenu compte de la charge virale), pathologies infectieuses (Inf), hypertension (HTA), diabète (D), IMC (en kg/m2) en focalisant sur l'obésité (IMC ≥ 30) selon le genre et enfin le genre (% Féminin). Les données sur les infections HPV et Helicobacter pylori n'ont pas été recueillies, de même que des données sur une éventuelle prédisposition génétique. Gestion et analyse de la base sur EXCEL®. Nous avons regroupé les pathologies de la manière suivante : GEN- génitales (col, vagin, vulve, périnée, verge, anus – 56 pts), URO (Prostate, vessie, rein, testicule– 77 pts), AD- annexes digestives (Foie, voie biliaire, pancréas- 43 pts), Sein 63 pts, SAR- sarcomes (parties molles, os, utérus- 24 pts), RESP (poumon, ORL- 72 pts), Autre (CUP, CNS, endocrine, peau, conjonctive, placenta- 39 pts), GYN (Endomètre, ovaire- 38 pts), TD- tube digestif (Œsophage, estomac, grêle, colon-rectum- 69 pts), SMP- syndromes myéloprolifératifs (19 pts), SLP- syndromes lymphoprolifératifs (Lymphome, myélome, leucémie- 58 pts). Nous avons inclus des données sur la population générale guyanaise (POPg)2. Résultats La prévalence de VIH+ est plus élevée dans POPc que POPg : 8,6/1,2 % respectivement et surtout dans GEN et SLP (21,6 et 23,6 % respectivement). La prévalence de VHB+ plus élevée dans AD que POPc (20,6/5,5 % respectivement). la prévalence de HTLV1 est observée dans SLP (37,2 %). Les pathologies infectieuses principales : hépatites, 12 ; paludisme, 6 ; tuberculose, 5 ; infections du cadre SIDA, 5 pts dans GEN et SLP. La prévalence de HTA, D et obésité est plus élevée chez les femmes atteintes de cancer du sein et GYN que dans POPc : 38/22/32,6 %, 55,6/22.2/50,4 % versus 17,6/7,9/23 % respectivement. Discussion La prévalence du VIH est 7x celle de la population générale et se concentre dans les types GEN, AU et SLP. L'infection VHB est trouvée dans les types AD (hépatocarcinome) et AU et HTLV1 dans SLP (Lymphomes dont ATL). Les Inf sont concentrées dans les types GEN et SLP. Le syndrome métabolique (obésité, HTA, D) sont concentrés dans les types sein et GYN. Ces informations conduisant à proposer dans le cas de la lutte contre le cancer de focaliser la prévention sur les mesures concernant les infections virales et le syndrome métabolique et plus généralement l'obésité (surtout chez les femmes).

La Guyane française est un territoire d’outre-mer, équatorial, de population multiculturelle, situé en Amérique du Sud. Cette région est singulière : pays riche, système de santé universel, mais pauvreté importante, qui ressemble incomplètement à ses voisins, le Brésil et le Suriname. Le cancer est la deuxième cause de mortalité. L’incidence du cancer est plus faible qu’en France, les stades sont plus avancés et le pronostic est moins bon. Actuellement, l’oncologie est organisée par le biais d’une joint-venture entre les institutions et professionnels de santé locaux et un centre de cancérologie en France hexagonale, selon les recommandations de l’Institut national du cancer. La mise en place d’un projet médical et d’un cursus complet d’études médicales en Guyane est une formidable opportunité pour le développement de la cancérologie. Les principaux enjeux sont : la consolidation de la prise en charge médicale des patients, le contrôle qualité, l’oncologie génétique, la biologie moléculaire, l’implantation de la radiothérapie et de la médecine nucléaire, la recherche clinique et translationnelle, l’enseignement. Travailler en cancérologie en Guyane est enthousiasmant en raison de l’intérêt scientifique (caractéristiques particulières des cancers dans cette région, notamment le rôle de la cancérogenèse virale ou celle due aux micro-organismes ; les facteurs génétiques dans ces populations d’origine africaine et asiatique, et l’importance d’une politique de santé publique) et humain (patients issus de cultures différentes ; tous apportent des approches originales de la santé et de la maladie à prendre en compte). Cela nécessite l’appui de professionnels de santé enthousiastes pour cette aventure unique.