OBJECTIVE:To assess the association between parental occupational pesticide exposures at birth and adult testicular germ cell tumour (TGCT) by histological subtype and the agreement between two pesticide job-exposure matrices (JEM). METHODS:TGCT cases (n=454) and matched controls (n=670) aged 18-45 years were recruited from 20 French university hospitals into the TESTIS national case-control study. Paternal and maternal jobs at birth were obtained from interviews of participants and their mothers/relatives and coded into official nomenclatures (International Standard Classification of Occupations, French nomenclature of activity-1999). Two complementary JEMs, ALOHA+ and FRIJEM, assessed occupational exposure to all pesticides, herbicides, insecticides, fungicides with ALOHA+ for each parent by linking job titles to JEM-derived probability and intensity estimates (no/low/high). Cohen's Kappa coefficient (κ) assessed their agreement. ORs and 95% CIs comparing exposure and levels of exposure with no exposure were estimated using conditional logistic regression adjusted for literature-based covariates statistically associated with TGCT and stratified by histological subtypes. RESULTS:Agreement between ALOHA+and FRIJEM was moderate to substantial (κ 0.52-0.80). A statistically non-significant higher TGCT risk was observed for high paternal occupational pesticide exposure with ALOHA+ (OR 1.95, CI 0.98 to 3.84) and FRIJEM (OR 1.70, CI 0.88 to 3.28). With ALOHA+, statistically significant positive associations were seen for high paternal occupational exposure to herbicides (overall: OR 4.23, CI 1.75 to 10.22; seminomas: OR 4.78, CI 1.79 to 12.77; non-seminomas: OR 3.53, CI 1.21 to 10.3) and fungicides (overall: OR 2.09, CI 1.05 to 4.18; seminomas: OR 2.31, CI 1.02 to 5.23). No statistically significant associations were observed for other levels of paternal exposure or pesticide groups nor for maternal exposure. CONCLUSION:Only high paternal occupational exposure to pesticides at birth, especially herbicides and fungicides, was positively associated with TGCT.

Introduction Older adults with hematologic malignancies are at high risk of treatment-related functional decline. Although physical activity (PA) may mitigate these effects, evidence in older adults with acute myeloid leukemia (AML) and non-Hodgkin lymphoma (NHL) remains limited. We evaluated the feasibility and exploratory effects of a 6-month individualized PA program delivered during and after chemotherapy in this population. Material and methods The OncoGeriatric and Individualized Physical Activity (OCAPI) study is a single-arm, prospective feasibility study evaluating a 6-month individualized PA program in AML/NHL patients ≥65 years receiving chemotherapy ± immunotherapy. The PA program included supervised and unsupervised sessions, an activity tracker, and motivational phone calls. The primary outcome was progam adherence. Secondary outcomes were feasibility metrics (recruitment, retention, adherence, safety, and patient satisfaction) assessed throughout the study, and exploratory effectiveness measures (physical condition, PA behavior, and patient-reported and geriatric outcomes) evaluated at baseline, three, and six months. Results Forty-two participants were enrolled. Rates of recruitment and retention were 59% and 88%, respectively. Adherence was 66% for supervised sessions, and < 5% for unsupervised ones. Activity trackers were worn 63% of the prescribed time and 75% of scheduled calls were completed. No exercise-related adverse events occurred. Patient satisfaction was high (96%). Perceived usefulness was 91% for supervised sessions, 54% for unsupervised sessions, 84% for the activity tracker, and 86% for motivational calls. At three months, in the overall cohort, handgrip strength showed a decline and balance an improvement, but there were no changes in other performance, patient-reported, or geriatric outcomes. Changes in limb strength and walking endurance may varied by diagnosis, with NHL patients tending to improve, and AML ones tending to decline. At six months, among all participants, walking endurance improved significantly and clinically (+53 m in the 6-Minute Walk Test, p = 0.01), while left-hand grip strength declined. Nutritional status and quality of life also showed improvement, with no notable changes in other outcomes. Discussion The individualized PA program was feasible and safe for older patients with AML/NHL during chemotherapy. Exploratory effectivenness findings suggest that patients improved walking endurance and quality of life and diagnosis-specific functional trajectories. Larger multicenter trials are needed to confirm these preliminary observations.

Early life exposure to pesticides, in particular through pesticides drift in residents nearby agricultural crops, is suspected to increase testicular germ cell tumors (TGCT) risk. We conducted a hospital-based case-control study of 472 TGCT cases and 683 matched controls aged 18-45 years in France and estimated adult TGCT risk associated with agricultural surfaces around residence as a surrogate for environmental exposure to agricultural pesticides at time of birth. Surface of arable lands, orchards and vineyards in 500 m buffer around the participants' residential address at birth was assessed using geographic information system (GIS) methods and software semi-automatic processing of historical aerial images. Odds ratios (OR) for TGCT (overall and by histological subtype) and 95% confidence intervals (CI) were estimated using conditional logistic regression. No increased risk of TGCT was observed for presence of arable lands (OR = 1.14, CI = 0.86-1.52), vineyards (OR = 0.88, CI = 0.56-1.36) and agricultural surfaces overall (OR = 1.13, CI = 0.84-1.51) in 500 m buffer around residence at birth. Presence of orchards (prevalence: 8.7%) was associated with a modest increase in TGCT risk (OR = 1.51, 95% CI = 0.99-2.32), slightly stronger for seminoma (OR = 1.78, 1.07-2.97) and in participants conceived or in their first trimester after conception during spring-summer (OR = 1.70, 1.03-2.82). In conclusion, the study found no overall association between adult TGCT risk and agricultural crops around residence at birth, except for the presence of orchards, with a possible increase in seminoma risks, as well as TGCT risk in participants for whom the first trimester after conception fell into spring-summer.

Abstract Background Despite the proven benefits of physical activity during breast cancer treatment, many women reduce their practice after diagnosis. A better understanding of how the neighborhood environment influences physical activity behavior could help optimize strategies for physical activity in breast cancer patients undergoing cancer treatment. This study examined associations between perceived neighborhood environment and physical activity among breast cancer patients undergoing treatment and engaged in a physical activity program. Methods Participants were 313 breast cancer patients enrolled in the DISCO physical activity intervention trial (NCT03529383). In the present observational analysis (DiscoSpace), cross-sectional (at baseline) and longitudinal (during intervention) associations between perceived neighborhood environment and physical activity were investigated. The perceived neighborhood environment was assessed using the ALPHA questionnaire, physical activity and physical functioning were evaluated through the Recent Physical Activity Questionnaire (self-reported physical activity) and the 6-Minute Walk Test (to measure the 6-Minute Walk Distance (6MWD)). Associations were estimated through mixed linear regression models. Results Better perceived cycling and walking infrastructures and network were associated with higher self-reported physical activity at baseline (total infrastructures: β = 0.226, 95% CI (0.063;0.388); network: β = 0.161, 95% CI (0.008;0.314)). Perceived distance to local facilities was inversely associated with 6MWD at baseline (β=-11.363, 95% CI (-20.607;-2.118)). The perception of densely populated neighborhoods (β=-0.306, 95% CI (-0.494;-0.117)) was associated with a smaller increase in self-reported physical activity during the intervention, after adjustment for trial arm. These associations varied according to women’s socioeconomic status and municipality class. Conclusions The perceived neighborhood environment and socioeconomic characteristics of women with breast cancer should be given greater consideration for developing effective programs to promote physical activity in this population.

Background/Objectives: Recent preclinical studies suggest that acute exercise induces immune modulation, enhances tumor blood perfusion, and is associated with reduced tumor growth. Adding exercise to immunochemotherapy treatment (ICT) has been proposed as a strategy to increase treatment effectiveness. The ERICA trial (NCT04676009) aimed to assess the feasibility of acute aerobic exercise performed immediately before the administration of ICT in patients with metastatic non-small cell lung cancer (mNSCLC) and to explore hypothesis-generating outcomes related to physical fitness and patient-reported outcomes. Methods: Newly diagnosed mNSCLC patients were randomly assigned (2:1) to the exercise or control group. The exercise intervention included supervised acute exercise before each of four ICT cycles plus a 3-month home-based walking program with an activity tracker and step goals. The feasibility of the exercise protocol was assessed through adherence, acceptability, tolerability, and safety. Clinical, physical, and patient-reported outcomes were assessed at baseline and after 3 months. Results: Twenty-six patients (mean age 60.6 years; SD 10.65) participated, with an 87.5% acceptance rate. In the exercise group (n = 17), 80.9% of participants completed the acute exercise sessions, with a median interval of 38 min [IQR, 20-60] between exercise and ICT. No exercise-related adverse effects were reported. After 3 months, 60% of participants in the exercise group were classified as active and maintained their step goals. Self-reported measures suggest that maintaining physical fitness is favorable for reducing fatigue and insomnia, and therefore improving quality of life. Conclusions: Acute exercise performed immediately before each ICT administration in patients with mNSCLC appears feasible and safe.

BACKGROUND:Most physical activity research focuses on general populations, and its cancer-preventive benefits in adults with cardiometabolic diseases remain poorly understood. This study investigated associations between non-occupational physical activity and cancer risk in adults with and without cardiometabolic diseases (cardiovascular disease and/or type 2 diabetes). METHODS:We conducted a meta-analysis of individual participant data of 598,890 men and women, aged 35-70 years at recruitment, across six European countries from the European Prospective Investigation into Cancer and Nutrition (EPIC) and UK Biobank. Participants with cancer at baseline were excluded. Physical activity was assessed at baseline using self-reported validated questionnaires. We used multivariable-adjusted Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between non-occupational physical activity and the risk of physical activity-related cancers (a composite of 15 cancers), with a multiplicative interaction between non-occupational physical activity and time-varying cardiometabolic disease status. RESULTS:We show that after a median follow-up of 11 years, 37,182 participants developed a first primary physical activity-related cancer (EPIC and UK Biobank combined). In the meta-analysis of both cohorts, a 1 standard deviation increment of non-occupational physical activity is associated with a lower risk of physical activity-related cancer, with HRs of 0.96 (95% CI: 0.93, 0.98) and 0.93 (95% CI: 0.91, 0.96) in adults without and in those with a cardiometabolic disease, respectively (all p-interaction ≥ 0.17). CONCLUSIONS:The findings of this study suggest that higher non-occupational physical activity is equally beneficial for cancer prevention in adults with and without cardiometabolic diseases.

Purpose Whether physical activity is associated with the risk of cancer among adults with a cardiometabolic disease is not well understood. This study investigated associations between physical activity and cancer risk in adults with and without a history of cardiometabolic diseases (cardiovascular disease and/or type 2 diabetes). Methods We conducted a meta-analysis of individual participant data of 564,622 men and women, aged 35–70 years at recruitment, across six European countries from the European Prospective Investigation into Cancer and Nutrition (EPIC) and UK Biobank. We excluded participants from these cohorts who had cancer, cardiovascular disease, or type 2 diabetes at baseline. Data on physical activity were assessed at baseline with self-reported validated questionnaires and modelled as metabolic equivalent task hours per week (MET-h/week). We used multivariable-adjusted Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between physical activity and the risk of physical activity-related cancers, with a multiplicative interaction between physical activity and time-varying cardiometabolic disease status. Results After a median of 11 years of follow-up, 28,345 participants developed a first primary physical activity-related cancer (EPIC and UK Biobank combined). In the meta-analysis of both cohorts, a 1 standard deviation (SD) increment of physical activity was associated with a lower risk of physical activity-related cancer, with HRs of 0.96 (95% CI: 0.95, 0.97) and 0.94 (95% CI: 0.90, 0.99) in adults without and in those with a cardiometabolic disease, respectively (p-interaction > 0.3). Conclusions The findings of this study among European adults suggest that higher physical activity is equally beneficial for cancer prevention in adults with and without underlying cardiometabolic diseases.

Contexte Cette analyse de pratique visait à évaluer l’évolution pondérale pendant et après une intervention nutritionnelle chez des patients atteints de cancer. Méthode Cette étude rétrospective a été menée entre janvier 2014 et octobre 2020 chez des patients majeurs atteints de tous types de cancers, pris en charge au Centre Léon-Bérard, en cours de traitement ou en suivi post-thérapeutique, ayant un indice de masse corporelle (IMC)≥25kg/m2 et ayant bénéficié d’au moins trois consultations avec un médecin nutritionniste. La prise en charge était axée sur les dimensions comportementales, métaboliques et nutritionnelles, et comportait un suivi de l’évolution anthropométrique des patients, tels que tour de taille, poids et IMC. L’objectif était d’évaluer l’impact de cette intervention nutritionnelle sur l’évolution des paramètres anthropométriques chez ces patients. Résultats Au total, 247 patients ont été inclus dans l’analyse. La durée médiane de suivi nutritionnel était de 7,2 mois. Entre la première et la dernière consultation de nutrition, le tour de taille a diminué pour 97,2 % des patients, avec une médiane de dix centimètres. Le poids et l’IMC ont diminué chez 85,0 % et 83,8 % des patients, respectivement. Six mois après la fin du suivi, 53,7 % des patients avaient un poids stable ou en baisse. Conclusion Cette analyse de pratique montre l’intérêt d’une consultation nutritionnelle pendant les traitements du cancer pour l’amélioration des paramètres anthropométriques au cours de la prise en charge ainsi qu’une stabilisation ou un maintien de la perte à distance de la prise en charge pour la moitié des patients.

Paraganglioma and pheochromocytoma (PPGL) are rare neuroendocrine tumors with a strong genetic component. SDHx genes are well-known PPGL susceptibility genes. A role of environmental factors, such as succinate dehydrogenase inhibitor (SDHi) fungicides, is suspected in PPGL tumorigenesis. We evaluated the feasibility of a case-control study investigating the association between pesticides, focusing on SDHi fungicides, and the risk of SDHx-related PPGL. The study was conducted in a single referral center between March and June 2022. Cases were patients with PPGL and an SDHx germline mutation diagnosed between 2000 and 2021. Controls, were selected among relatives of cases, diagnosed as SDHx mutation carriers by a presymptomatic genetic test and without PPGL after tumor screening tests. A matching process was formulated to prioritize cases and controls that could be matched according to date of birth, type of gene mutated and distinct family. Phone interviews were used to collect data on general characteristics, PPGL risk factors, the domestic use of pesticides, residential history, occupational history. Addresses were geocoded. The presence of crops within a buffer of 1,500 m was estimated for residential addresses at diagnosis. The probability of occupational exposures to SDHi fungicides was assessed based on the French crop-exposure matrix PESTIMAT. An information letter was sent to 138 subjects out of the 193 followed-up by the center. The prioritization of recruitment was defined by the matching potential of each subject. Overall, 110 subjects were reached by phone, 101 accepted to be included, and 42 cases and 40 controls were interviewed (response rate: 81%). Missing data on domestic exposure to pesticides were more frequent for the households most back-in-time. Even for the oldest residential addresses, at least 81% of the addresses had a precise geocoding. In a buffer with a radius of 1500 m, arable land was present for 55% of subjects' addresses, vineyards and orchards for 5% and 3.8% respectively. Two subjects might have been exposed to SDHi fungicides in the occupational context. Our study showed high participation and response rates. Exposure to pesticides could be assessed with moderate to good precision, even for exposures far back in time.

The benefits of physical activity are widely recognized in primary and tertiary breast cancer prevention. Most women do not meet the international physical activity recommendations for breast cancer prevention despite public health policies. The aim of this study is to better understand barriers, facilitators, and preferences for physical activity among adult women in France. A web-based observational study was conducted between February and March 2021 through a Seintinelles French collaborative research platform. Women with and without a history of breast cancer were asked to complete an online questionnaire measuring sociodemographic and health characteristics, physical activity behaviors, physical activity barriers and facilitators, and physical activity preferences. A total of 2,306 women participated in this study, including women without breast cancer (n = 1,245), women with localized breast cancer undergoing treatment (n = 530), or post-treatment (n = 396), and women with metastatic breast cancer (n = 135). The mean age was 48.7 years (SD = 13.2) and 63.8

BACKGROUND:Despite an incidence increase in recent decades, the etiology of testicular germ cell tumors (TGCT) remains poorly understood. The hypothesis of a two-stage development, combining initial alteration in utero followed by malignant transformation later in life, has been suggested. This study examined the association between cumulative lifetime occupational and para-occupational solvent exposure and TGCT risk. METHODS:The French multicenter case-control study TESTIS included 454 cases and 670 controls. Participants provided information on their occupational history; participants' mothers (N = 547) provided information on their own and the father's occupational history. Solvent exposure was assessed by using the Matgéné job-exposure matrices. The influence of the parental and subject's occupational exposures over the lifetime and at different periods (i.e. fetal life/infancy; childhood; adolescence; subject's exposure) on TGCT was examined. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by using conditional logistic regression models. RESULTS:An OR for TGCT of 1.03 (95% CI 0.59-1.79) was found for the lifetime solvent exposure. When each period was examined individually, the results showed an increased TGCT risk in adult males who were occupationally exposed to trichloroethylene (OR = 3.09; 95% CI 1.25-7.65); fuels and petroleum-based solvents (OR = 1.91; 95% CI 1.21-3.02); diesel, kerosene, and fuel oil (OR = 2.26; 95% CI 1.16-4.41); and ketones and esters (OR = 1.66; 95% CI 1.02-2.71), and suggested a positive association with solvent exposure during adolescence (OR = 1.77; 95% CI 0.95-3.31). CONCLUSION:Overall, this study did not suggest a substantial role of cumulative lifetime solvent exposure and TGCT risk. The results showed an increased TGCT risk associated with solvent exposure during adulthood. Indirect exposure to certain solvents during adolescence might also promote TGCT development.

Background: Several studies have highlighted the role of environmental exposures in malignant hemopathies etiology. Some patients with malignant hemopathies can be compensated as occupational diseases. The Prolymphome research aimed to assess a systematic screening of occupational exposures in patients with lymphoma or myeloma treated in three hospitals in the Rhône-Alpes region. Methods: Patients received a self-administered questionnaire to fill in at home to collect their job history and potential occupational exposures to carcinogens. A physician assessed the questionnaire to determine if a dedicated consultation was required and the possibility of claiming compensation. Patients were systematically assisted by a social worker for administrative procedures. Results: In 12 months, 754 patients were enrolled in the study, and 361 (48%) returned the questionnaire. A specialized consultation was proposed for 123 patients, and 98 patients attended the consultation. Overall, a compensation claim was proposed to 18 patients: 11 have been occupationally exposed to pesticides and seven to trichloroethylene. Conclusions: Our results confirmed the feasibility of the systematic screening procedure. Barriers were observed at every step of the process, and it underlined that patients are rarely nformed about occupational exposures. As the prevalence of occupational exposures in malignant hemopathies remains scarce, a systematic targeted screening could be relevant in this population.

PurposeDespite its demonstrated benefits, prehabilitation before lung cancer surgery remains poorly implemented. This study investigated the preferences, interests, and barriers to exercise-based prehabilitation among patients eligible for thoracic surgery.MethodThis cross-sectional study conducted from January 2022 to July 2023 used self-administered questionnaires to collect data on preferences and barriers to exercise-based prehabilitation in cancer patients scheduled for lung resection at a French comprehensive cancer center.ResultsMost of the 23 participants (n = 20, 90.9%) were unaware of prehabilitation but expressed a strong interest in participating in an exercise program prior to lung surgery (n = 16, 72.7%). Walking (n = 16, 80.0%) and home-based exercise (n = 14, 70.0%) were the most preferred activities. Programs of short to moderate duration (1-4 weeks) and located within 30 min travel from home were preferred. Participants preferred exercising alone or with family members and showed limited interest in the group or facility-based sessions. While 81.8% (n = 18) felt capable of engaging in an exercise-based prehabilitation program, common barriers included distance from the care center, breathlessness, and fatigue. Physical and medical limitations were more frequently reported than psychological ones.ConclusionDespite limited awareness, lung cancer patients show a strong interest in exercise-based prehabilitation. Home-based and flexible programs aligned with patient preferences may help overcome participation barriers. These findings support the development of personalized, accessible prehabilitation strategies to enhance engagement before lung surgery.

Complications are often poorly identified and managed in cancer survivors after treatment and restoring their initial quality of life remains a challenge, particularly in a context of unequal access to care nationwide. The PASCA “Parcours de Santé au cours du Cancer [in English: healthcare pathways with cancer]” feasibility study was conducted in the Léon Bérard Comprehensive Cancer Center (Lyon, France) to assess the feasibility of a complications detection program, in cancer survivors who have received intensive chemotherapy. An initial network of physicians and healthcare professionals was also set up to facilitate medical referrals after detection. The study had a high recruitment rate (83.8%) and an adherence rate of 43%. In our analysis population (n = 98), 8% presented de novo dermatological, cardiological, and pneumological complications. Of these, 42 completed all program visits. Among them, the number of patients who developed a ≥ grade 2 complication increased between the first and last visits in: nephrology (+13.9%), overweight/obesity (+12.5%), endocrinology (+8.3%) and cardiology (+5.6%). Patient satisfaction was high (68%). The results supported the feasibility of a complication detection program and highlighted the presence of de novo complications at the first visit, as well as an increase in the number of patients developing complication in four areas between the first and last visit. In the future, after-treatment programs could be improved by increasing the motivation of the referring oncologists and patients, improving communication and by adapting the follow-up visits to take into consideration the constraints and profiles of the cancer survivors.

Weight gain during chemotherapy is frequently reported in breast cancer patients and adversely impacts survival and quality of life. However, weight change over the long term and its determinants in breast cancer patients who received chemotherapy remain unclear. This study aimed to characterize weight change over 13 years among French breast cancer patients diagnosed with early-stage breast cancer who received adjuvant chemotherapy. We examined weight change over 13 years in a cohort of 267 early breast cancer patients diagnosed between 2004 and 2006 and treated with adjuvant chemotherapy. Yearly weight measures were obtained from medical records, or from questionnaires when not available from medical records. We compared weight at each time using analysis of variance for repeated data based on mixed-effect models, and examined clinical and individual factors as potential determinants of weight change over the study period. More than one third of women experienced weight gain > 5

CONTEXT:The aim of this practice evaluation was to assess weight trends during and after a nutritional intervention in cancer patients and survivors. METHODS:This retrospective study was conducted between January 2014 and October 2020 in adults with different cancer types managed at the Léon-Bérard Cancer Center, undergoing treatment or during post-treatment follow-up, with a BMI≥25kg/m2 and who had at least 3 consultations with a nutrition physician. Nutritional management focused on behavioral, metabolic and nutritional aspects. Anthropometrics measurements, i.e., waist circumference, weight and BMI, were monitored prospectively during the nutritional consultation. The aim of this study was to evaluate the impact of the nutritional intervention on the anthropometrics measurements. RESULTS:Overall, 247 patients were included in the analysis. The median duration of the nutritional intervention was 7.2months. Between the first and the last nutrition consultation, waist circumference was reduced in 97.2% of the patients, with a median loss of 10cm; weight and BMI were reduced in 85.0% and 83.8% of the patients respectively. Six months after the end of the nutritional intervention, 53.7% of patients had stable or continued reduced weight. CONCLUSION:This analysis of practice shows the positive impact of a nutritional intervention during cancer treatments on anthropometric parameters, and maintenance or continued weight loss at distance from the intervention in half of the patients.