References of "Coucke, Philippe"
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See detailEtude pilote auprès de patientes atteintes d'un cancer du sein: Apport des méthodes alternatives.
Bragard, Isabelle ULg; Etienne, Anne-Marie ULg; Faymonville, Marie-Elisabeth ULg et al

in Etienne, Anne-Marie; Bragard, Isabelle (Eds.) Evolutions Sociales, Innovations et Politiques: nouvelles questions et nouveaux enjeux pour la psychologie de la santé. (in press)

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See detailIs it possible to improve communication around radiotherapy delivery: A randomized study to assess the efficacy of team training?
Liénard, Aurore; Delevallez, France; Razavi, Darius et al

in Radiotherapy & Oncology (in press)

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See detailInfluence d'un programme de revalidation multidisciplinaire post-cancer du sein sur la fonction physique
Leclerc, Anne-France ULg; Foidart-Dessalle, Marguerite ULg; BURY, Thierry ULg et al

in 9ème Congrès commun SFMES - SFTS : Abstract book (2016, September 22)

Objectif : Le cancer du sein ainsi que ses traitements sont à l'origine de nombreux effets secondaires indésirables, notamment sur la fonction physique. Cette étude a pour objectif de déterminer les ... [more ▼]

Objectif : Le cancer du sein ainsi que ses traitements sont à l'origine de nombreux effets secondaires indésirables, notamment sur la fonction physique. Cette étude a pour objectif de déterminer les bénéfices éventuels d’un programme de revalidation multidisciplinaire sur la santé physique des femmes ayant été traitées pour un cancer du sein et d'évaluer l'influence de certaines caractéristiques individuelles initiales sur la réponse du groupe expérimental au programme de revalidation. Matériel et méthodes : L'étude constitue un essai clinique contrôlé non-randomisé évaluant une population totale de 209 patientes, recrutées sur base du volontariat et réparties en deux groupes, soit un groupe contrôle (n = 106) et un groupe expérimental (n = 103). Ce dernier a bénéficié d’une revalidation de trois mois comprenant un entraînement physique supervisé à raison de trois séances par semaine et diverses sessions psycho-éducatives. Pour l'ensemble des participantes, des évaluations constituées d'une part de mesures physiques et fonctionnelles et d'autre part de mesures de composition corporelle ont été programmées à 0 et 3 mois. Celles-ci ont inclus un test de souplesse ("Sit and Reach"), un test d'effort maximal sur bicyclette ergométrique avec suivi cardio-respiratoire, un test de marche de six minutes et la mesure de l'indice de masse corporelle et du pourcentage de graisse corporelle. Afin d'affiner l'analyse, trois groupes ont également été constitués au sein du groupe expérimental à partir des caractéristiques individuelles de thérapie adjuvante (présence de chimiothérapie ou non), de chirurgie (mastectomie ou tumorectomie) et de délai de fin de traitement (délai ≤ 4 mois ou ≥ 8 mois). Résultats : Initialement, toutes les patientes présentent un état de déconditionnement physique, non influencé par le délai de fin de traitement ou par le type de chirurgie, mais bien influencé par la présence d'une chimiothérapie puisque la VO2max apparaît significativement plus faible dans ce cas. Au terme des trois mois, la souplesse (p < 0,0001), la consommation maximale d'oxygène (p < 0,0001), la puissance maximale aérobie (p < 0,0001) et la distance de marche en six minutes (p < 0,0001) s’améliorent significativement au sein du groupe expérimental. Au sein du groupe contrôle, aucune amélioration n'est constatée, excepté pour la distance de marche (p = 0,0031). Par ailleurs, une augmentation significative de l'indice de masse corporelle (p = 0,034) et du pourcentage de graisse corporelle (p = 0,034) est observée au sein du groupe contrôle alors que ce paramètre diminue significativement au sein du groupe expérimental (p = 0,037). Enfin, toutes les patientes du groupe expérimental présentent un même profil de progression quelles que soient leurs caractéristiques individuelles initiales. Conclusion : Cette étude démontre ainsi les effets bénéfiques, tant sur le plan physique que de la composition corporelle, d’une prise en charge multidisciplinaire chez des femmes ayant été traitées pour le cancer du sein. [less ▲]

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See detailLa médecine du futur en question(s): les objets connectés
Coucke, Philippe ULg

in Healthcare Executive (2016)

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See detailImpacts of Ionizing Radiation on the Different Compartments of the Tumor Microenvironment
Leroi, Natacha ULg; LALLEMAND, François ULg; COUCKE, Philippe ULg et al

in Frontiers in Pharmacology (2016), 7

During the last decade, the initial cancer cell-centered view of tumors has greatly evolved to an integrated vision of tumor biology taking into account the key contribution of the TME. Obviously, the ... [more ▼]

During the last decade, the initial cancer cell-centered view of tumors has greatly evolved to an integrated vision of tumor biology taking into account the key contribution of the TME. Obviously, the different compartments of TME are closely related and contribute not only to tumor progression, but also to its response to treatments. Importantly, the TME evolves over time during the different steps of cancer development and is also affected by different therapeutic modalities. Although, improvements have been achieved regarding RT delivery to the primary tumor, ionizing radiation also target nontumor cells that influence tumor growth and metastatic dissemination. Different approaches have been proposed to overcome the radioresistance of cancer cells. The TME-mediated radioresistance is now the object of researches, which has been elegantly reviewed recently by Barker et al. (2015) and severalarticles pointed out the importance of treatments that modify the TME and likely radiosensitize tumor (Ansiaux et al., 2005; Crokart et al., 2005b; Frérart et al., 2008). However, the impact of anti-cancer treatments on the TME and consequently on the tumor phenotype, response to treatment and metastases, is often neglected. Here we pointed out the impact of RT on the TME. Recent findings emphasize the interest to optimize RT (i.e., dose per fraction) and timing of surgery (Leroi et al., 2015; Surace et al., 2015) in order to prevent metastatic spreading. The future challenge in RT will be to define the most appropriate combinations between RT, and other therapeutic modalities with the optimal sequence and timing of treatments. In this context, investigation of the TME-related acquired resistance will be essential and will provide important innovative data. [less ▲]

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See detailFeasibility study of repetitive diffusion MRI after Neoadjuvant radiotherapy for following tumor microenvironment.
LALLEMAND, François ULg; Leroi, Natacha ULg; Bahri, Mohamed Ali ULg et al

Conference (2016, March 22)

Purpose/Objective. Neoadjuvant radiotherapy (NeoRT) improves tumor local control and tumor resection in many cancers. The timing between the end of the NeoRT and surgery is mostly driven by the occurrence ... [more ▼]

Purpose/Objective. Neoadjuvant radiotherapy (NeoRT) improves tumor local control and tumor resection in many cancers. The timing between the end of the NeoRT and surgery is mostly driven by the occurrence of side effects or the tumor downsizing. We previously demonstrated in an in vivo model that the timing of surgery and the schedule of NeoRT influenced the tumor dissemination. Here, our aim is to evaluate with functional MRI (fMRI) the impact of the radiation treatment on the tumor microenvironment and subsequently to identify non-invasive markers helping to determine the best timing to perform surgery for avoiding tumor spreading. First, we needed to demonstrate the feasibility of repetitive MRI imaging after NeoRT in mice. Material/methods. We used two models of NeoRT we previously developed in mice: MDA-MB 231 and 4T1 cells implanted in the flank of mice. When tumors reached the planned volume, they are irradiated with 2x5 Gy and then surgically removed at different time points after RT. In the mean time between the end of RT and the surgical procedure, mice were imaged in a 9,4T Agilent® MRI. Diffusion Weighted (DW) -MRI was performed every 2 days between RT and surgery. For each tumors we acquired 8 slices of 1 mm thickness and 0.5 mm gap with an “in plane voxel resolution” of 0.5 mm. For DW-MRI, we performed FSEMS (Fast Spin Echo MultiSlice) sequences, with 9 different B-values (from 40 to 1000) and B0, in the 3 main directions. We also performed IVIM (IntraVoxel Incoherent Motion) analysis, in the aim to obtain information on intravascular diffusion, related to perfusion (F: perfusion factor) and subsequently tumor vessels perfusion. Results. As preliminary results, with the MBA-MB 231 we observed a significant increase of F at day 6 after irradiation than a decrease and stabilization until surgery. No other modifications of the MRI signal, ADC, D or D* were observed. We observed similar results with 4T1 cells, F increased at day 3 than returned to initial signal. The difference in the timing of the peak of F can be related to the difference in tumor growth between MBA-MB 231 and 4T1 (four weeks vs one week). Conclusion. For the first time, we demonstrate the feasibility of repetitive fMRI imaging in mice models after NeoRT. With these models, we show a significant peak of the perfusion factor (F) at day 6 or day 3. This change occurs between the two previous time points of surgery demonstrating a difference in the metastatic spreading. Indeed, after a NeoRT of 2X5Gy we observed more metastases in the lung when MDA-MB 231 tumor bearing mice are operated 4 days after RT compared to 11 days. These preliminary results are very promising for identifying noninvasive markers for determining the best timing for surgery. [less ▲]

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See detailLa médecine dans l’œil du cyclone
COUCKE, Philippe ULg

in Le spécialiste (2016)

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See detail[18F]FPRGD2 PET/CT imaging of integrin αvβ3 levels in patients with locally advanced rectal carcinoma
WITHOFS, Nadia ULg; Martinive, Philippe ULg; VANDERICK, Jean ULg et al

in European journal of nuclear medicine and molecular imaging (2016)

PURPOSE: Our primary objective was to determine if [18F]FPRGD2 PET/CT performed at baseline and/or after chemoradiotherapy (CRT) could predict tumour regression grade (TRG) in locally advanced rectal ... [more ▼]

PURPOSE: Our primary objective was to determine if [18F]FPRGD2 PET/CT performed at baseline and/or after chemoradiotherapy (CRT) could predict tumour regression grade (TRG) in locally advanced rectal cancer (LARC). Secondary objectives were to compare baseline [18F]FPRGD2 and [18F]FDG uptake, to evaluate the correlation between posttreatment [18F]FPRGD2 uptake and tumour microvessel density (MVD) and to determine if [18F]FPRGD2 and FDG PET/CT could predict disease-free survival. METHODS: Baseline [18F]FPRGD2 and FDG PET/CT were performed in 32 consecutive patients (23 men, 9 women; mean age 63 +/- 8 years) with LARC before starting any therapy. A posttreatment [18F]FPRGD2 PET/CT scan was performed in 24 patients after the end of CRT (median interval 7 weeks, range 3 - 15 weeks) and before surgery (median interval 4 days, range 1 - 15 days). RESULTS: All LARC showed uptake of both [18F]FPRGD2 (SUVmax 5.4 +/- 1.5, range 2.7 - 9) and FDG (SUVmax 16.5 +/- 8, range 7.1 - 36.5). There was a moderate positive correlation between [18F]FPRGD2 and FDG SUVmax (Pearson's r = 0.49, p = 0.0026). There was a moderate negative correlation between baseline [18F]FPRGD2 SUVmax and the TRG (Spearman's r = -0.37, p = 0.037), and a [18F]FPRGD2 SUVmax of >5.6 identified all patients with a complete response (TRG 0; AUC 0.84, 95 % CI 0.68 - 1, p = 0.029). In the 24 patients who underwent a posttreatment [18F]FPRGD2 PET/CT scan the response index, calculated as [(SUVmax1 - SUVmax2)/SUVmax1] x 100 %, was not associated with TRG. Post-treatment [18F]FPRGD2 uptake was not correlated with tumour MVD. Neither [18F]FPRGD2 nor FDG uptake predicted disease-free survival. CONCLUSION: Baseline [18F]FPRGD2 uptake was correlated with the pathological response in patients with LARC treated with CRT. However, the specificity was too low to consider its clinical routine use. [less ▲]

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See detailFDG PET/CT texture analysis for predicting the outcome of lung cancer treated by stereotactic body radiation therapy.
LOVINFOSSE, Pierre ULg; Janvary, Zsolt Levente; COUCKE, Philippe ULg et al

in European journal of nuclear medicine and molecular imaging (2016)

INTRODUCTION: With 18F-FDG PET/CT, tumor uptake intensity and heterogeneity have been associated with outcome in several cancers. This study aimed at investigating whether 18F-FDG uptake intensity, volume ... [more ▼]

INTRODUCTION: With 18F-FDG PET/CT, tumor uptake intensity and heterogeneity have been associated with outcome in several cancers. This study aimed at investigating whether 18F-FDG uptake intensity, volume or heterogeneity could predict the outcome in patients with non-small cell lung cancers (NSCLC) treated by stereotactic body radiation therapy (SBRT). METHODS: Sixty-three patients with NSCLC treated by SBRT underwent a 18F-FDG PET/CT before treatment. Maximum and mean standard uptake value (SUVmax and SUVmean), metabolic tumoral volume (MTV), total lesion glycolysis (TLG), as well as 13 global, local and regional textural features were analysed. The predictive value of these parameters, along with clinical features, was assessed using univariate and multivariate analysis for overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS). Cutoff values were obtained using logistic regression analysis, and survivals were compared using Kaplan-Meier analysis. RESULTS: The median follow-up period was 27.1 months for the entire cohort and 32.1 months for the surviving patients. At the end of the study, 25 patients had local and/or distant recurrence including 12 who died because of the cancer progression. None of the clinical variables was predictive of the outcome, except age, which was associated with DFS (HR 1.1, P = 0.002). None of the 18F-FDG PET/CT or clinical parameters, except gender, were associated with OS. The univariate analysis showed that only dissimilarity (D) was associated with DSS (HR = 0.822, P = 0.037), and that several metabolic measurements were associated with DFS. In multivariate analysis, only dissimilarity was significantly associated with DSS (HR = 0.822, P = 0.037) and with DFS (HR = 0.834, P < 0.01). CONCLUSION: The textural feature dissimilarity measured on the baseline 18F-FDG PET/CT appears to be a strong independent predictor of the outcome in patients with NSCLC treated by SBRT. This may help selecting patients who may benefit from closer monitoring and therapeutic optimization. [less ▲]

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See detailLa médecine de demain: science-fiction ou science-réalité ?
COUCKE, Philippe ULg

in Onco : Revue Multidisciplinaire d'Oncologie (2015), 9(6), 3-4

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See detailPsychological benefits of a multidisciplinary rehabilitation program after breast cancer
Leclerc, Anne-France ULg; FOIDART-DESSALLE, Marguerite ULg; Bury, Thierry ULg et al

in European Cancer Congress : Abstract book (2015, September 27)

Background : Breast cancer is the most frequent cancer in women, affecting 8 women out of 100. With early detection and improved treatments, the number of deaths linked to this disease has declined ... [more ▼]

Background : Breast cancer is the most frequent cancer in women, affecting 8 women out of 100. With early detection and improved treatments, the number of deaths linked to this disease has declined. However, the disease and its treatments are at the origin of many undesirable side effects such as fatigue, anxiety, weight gain and sleep disorders. The objective of this study is to determine the psychological benefits of a multidisciplinary rehabilitation program among women treated for breast cancer (on average six months after the end of the adjuvant radiotherapy or chimiotherapy). Material and methods : 122 patients were included into a control group (n = 61) and a treated group (n = 61). All participants were submitted to evaluations before the beginning of the trial and after three months. These evaluations included different questionnaires exploring the quality of life, anxiety, depression and various functions and other symptoms related to cancer (EORTC QLQ-C30, EQ-5D, STAI, HADS) and functional assessments. The control group has received no intervention unlike the treated group that received a three-month rehabilitation including supervised physical training (90 min) with three times a week and various psycho-educational sessions (120 min) once a week. Results : After three months, the health status (quality of life) (p < 0,0001), the functional role (p = 0,031), emotional state (p < 0,0001) and physical (p = 0,0045), cognitive (p = 0,0027) and social functions (p = 0,0018) improve significantly in the treated group. This observation also applies to symptoms of fatigue (p < 0,0001), insomnia (p < 0,0001), pain (p = 0,002), dyspnea (p = 0,009), loss of appetite (p = 0,04), anxiety (p < 0,0001) and depression (p < 0,0001) as well as physical parameters obtained through functional assessments. In the control group, these improvements do not appear. Conclusions : This study shows the feasibility and psychological benefits of such a multidisciplinary oncological rehabilitation program in women after their treatments for breast cancer. Additional studies are needed to know the optimal time of beginning (during treatments or after them) and the optimal management time for this support. [less ▲]

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See detailPhysical benefits of a multidisciplinary rehabilitation program after breast cancer
Leclerc, Anne-France ULg; FOIDART-DESSALLE, Marguerite ULg; Bury, Thierry ULg et al

Poster (2015, September 26)

Background : Breast cancer is the most frequent cancer in women, affecting 8 women out of 100. With early detection and improved treatments, the number of deaths linked to this disease has declined ... [more ▼]

Background : Breast cancer is the most frequent cancer in women, affecting 8 women out of 100. With early detection and improved treatments, the number of deaths linked to this disease has declined. However, the disease and its treatments are at the origin of many undesirable side effects such as fatigue, anxiety, weight gain and decreased physical fitness. The objective of this study is to determine the physical benefits of a multidisciplinary rehabilitation program among women treated for breast cancer (on average six months after the end of the adjuvant radiotherapy or chimiotherapy). Material and methods : 122 patients were included into a control group (n = 61) and a treated group (n = 61). All participants were submitted to evaluations before the beginning of the trial and after three months. These evaluations included functional assessments (a maximal incremental exercise protocol on a cycle ergometer, flexibility by Sit and Reach Test and walking distance by Six-Minute Walk Test), anthropometric and body composition measurements (Body Mass Index and body fat percentage) and different questionnaires on quality of life, anxiety and other symptoms related to cancer. The control group has received no intervention unlike the treated group that received a three-month rehabilitation including supervised physical training (90 min) with three times a week and various psycho-educational sessions (120 min) once a week. Results : After three months, maximal oxygen consumption (p < 0,0001), maximal aerobic power (p < 0,0001), peak of ventilation (p < 0,0001) and time to exhaustion (p = 0,0055) during the maximal incremental exercise protocol improve significantly in the treated group. This observation also applies to flexibility (p < 0,0001), walking distance in six minutes (p < 0,0001) and different physical and psychological parameters obtained through questionnaires. In the control group, these improvements do not appear and a significant increase in body mass index (p = 0,032) and body fat percentage (p = 0,034) is observed while these data remain constant in the treated group. Conclusions : This study shows the feasibility and physical benefits of such a multidisciplinary oncological rehabilitation program in women after their treatments for breast cancer. Additional studies are needed to know the optimal time of beginning (during treatments or after them) and the optimal management time for this support. [less ▲]

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See detailFunctional MRI for predicting metastatic spreading at the time of surgery after neoadjuvant radiotherapy
LALLEMAND, François ULg; Leroi, Natacha ULg; Bahri, Mohamed Ali ULg et al

Poster (2015, April)

Neoadjuvant radiotherapy (NeoRT) improves tumor local control and tumor resection in many cancers. The timing between the end of the NeoRT and surgery is driven by the occurrence of side effects or the ... [more ▼]

Neoadjuvant radiotherapy (NeoRT) improves tumor local control and tumor resection in many cancers. The timing between the end of the NeoRT and surgery is driven by the occurrence of side effects or the tumor downsizing. Some studies demonstrated that the timing of surgery and the RT schedule could influence tumor dissemination and subsequently patient overall survival. Our aim is to evaluate with functional MRI the impact of the radiation treatment on the tumor microenvironment and subsequently to determine the best timing to perform surgery for avoiding tumor spreading. [less ▲]

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See detailL'Eau se retire: le Tsunami arrive
COUCKE, Philippe ULg

in Healthcare Executive (2015), 81

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See detailIdentification of predictive markers based on functional imaging of metastatic spreading at the time of surgery after neoadjuvant radiotherapy
LALLEMAND, François ULg; Leroi, Natacha ULg; Bahri, Mohamed Ali ULg et al

Poster (2015, January 27)

Neoadjuvant radiotherapy (NeoRT) improves tumor local control and tumor resection in many cancers. The timing between the end of the NeoRT and surgery are driven by the occurrence of side effects or the ... [more ▼]

Neoadjuvant radiotherapy (NeoRT) improves tumor local control and tumor resection in many cancers. The timing between the end of the NeoRT and surgery are driven by the occurrence of side effects or the tumor downsizing. Some studies demonstrated that the timing of surgery and the RT schedule could influence tumor dissemination. Our aim is to evaluate with functional MRI the impact of the radiation treatment on the tumor microenvironment and subsequently to determine the best timing to perform surgery. We used a model of NeoRT, 4T1 cells were implanted in the flank of BalbC mice. Seven days after, tumors were irradiated with 2x5Gy than we surgically removed this lesion 11 days after RT. Diffusion Weighted (DW) and Dynamic Contrast Enhancement (DCE) -MRI was performed every 2 days during 11 days between RT and surgery. We developed a homemade “portacath” specifically dedicated for mice and for repetitive I.V. contrast agent injection. For DW-MRI, we performed sequences with 10 different B-value to achieve IntraVoxel Incoherent Motion analysis. For DCE-MRI, we used FSEMS sequence for keeping the same slices as with DW-MRI. For both images, we performed analysis on the entire tumor volume. We obtained very promising preliminary results showing good uniformity in the ADC (Attenuation Diffusion Coefficient). We succeeded to follow mice with imaging during the 11 days without major troubles. We observed less variability of the ADC signal during the 11 days in the irradiated tumors compared to the control. The signal to noise ratio was relatively poor for the diffusion sequence and need to be improved. For the first time, we demonstrate the feasibility of repetitive MRI functional imaging in a mice model of NeoRT. These results open perspectives for studying modifications of the tumor microenvironment induced by neoadjuvant RT. The techniques need to be improved and correlated to the tumor dissemination in function of the RT schedule and timing of surgery. [less ▲]

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See detailTransfer of communication skills to the workplace: Impact of a 38-hour communication skills training program designed for radiotherapy teams
Merckaert, Isabelle; Delevallez, France; Gibon, Anne-Sophie et al

in Journal of Clinical Oncology (2015), 33(8), 901-909

Purpose This study assessed the efficacy of a 38-hour communication skills training program designed to train a multidisciplinary radiotherapy team. Methods Four radiotherapy teams were randomly assigned ... [more ▼]

Purpose This study assessed the efficacy of a 38-hour communication skills training program designed to train a multidisciplinary radiotherapy team. Methods Four radiotherapy teams were randomly assigned to a training program or a waiting list. Assessments were scheduled at baseline and after training for the training group and at baseline and 4 months later for the waiting list group. Assessments included an audio recording of a radiotherapy planning session to assess team members’ communication skills and expression of concerns of patients with breast cancer (analyzed with content analysis software) and an adapted European Organisation for Research and Treatment of Cancer satisfaction with care questionnaire completed by patients at the end of radiotherapy. Results Two hundred thirty-seven radiotherapy planning sessions were recorded. Compared with members of the untrained teams, members of the trained teams acquired, over time, more assessment skills (P = .003) and more supportive skills (P = .050) and provided more setting information (P = .010). Over time, patients interacting with members of the trained teams asked more open questions (P = .022), expressed more emotional words (P = .025), and exhibited a higher satisfaction level regarding nurses’ interventions (P = .028). Conclusion The 38-hour training program facilitated transfer of team member learned communication skills to the clinical practice and improved patients’ satisfaction with care. [less ▲]

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See detailOncologie et revalidation physique
Leclerc, Anne-France ULg; Foidart-Dessalle, Marguerite ULg; COUCKE, Philippe ULg et al

in Abstract Book du Colloque "Femmes et Santé" (Université d'Hiver) (2015, January 26)

Le cancer constitue une maladie fréquente en Belgique puisqu'un homme sur trois et une femme sur quatre sont confrontés à la maladie avant l'âge de septante-cinq ans (Fondation Registre du Cancer, 2008 ... [more ▼]

Le cancer constitue une maladie fréquente en Belgique puisqu'un homme sur trois et une femme sur quatre sont confrontés à la maladie avant l'âge de septante-cinq ans (Fondation Registre du Cancer, 2008). La détection précoce et l'amélioration des traitements du cancer, généralement une combinaison de chirurgie, radiothérapie, chimiothérapie, hormonothérapie et thérapie ciblée, ont permis une augmentation du taux de survie. Cependant, ces traitements peuvent être à l'origine de nombreux effets secondaires, non seulement précoces, mais également tardifs, réduisant la qualité de vie. De nombreux programmes de réhabilitation après cancer sont basés sur la psychothérapie et le support social uniquement, or ceux-ci n'agissent généralement pas sur les problèmes physiques encourus par les patients tels que la fatigue, la prise de poids et la diminution des capacités fonctionnelles. C'est pourquoi nous émettons l'hypothèse qu'une revalidation physique, associée à des séances psycho-éducatives et constituant ainsi une prise en charge multidisciplinaire, permettrait d'améliorer d'autant plus la qualité de vie et le bien-être tant physique que psychologique des patients ayant été traités pour un cancer. [less ▲]

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