Thesis (M.Tech.: Radiography) - Dept. of Radiography, Durban Institute of Technology, 2003 1 v. (various pagings) / Cancer is an inexorably progressive disease and a favourable outcome in its management often depends on early intervention (Mackillop, Zhou and Quirt, 1995: 532). Early detection of the disease is therefore important for a favourable outcome to be achieved. When the disease is diagnosed at a late stage, the treatment that is offered is only palliative. Palliative treatment is only offered with the aim to relieve the local symptoms of advanced disease. The treatment intent is therefore not curative but only to give the patient a better quality of life, which sometimes is not possible especially for very advanced disease. In KwaZulu-Natal the incidence of Zulu speaking patients presenting with a late stage disease to the major cancer treatment centres is very high with the result that the majority of these patients can only be offered palliative treatment (Pervan, Cohen and Jaftha, 1995 : 162). Aim of the study is to investigate the factors that contribute to the late presentation of rural Zulu patients with cancer to the two major provincial cancer treatment centers in KwaZulu-Natal (prior to December 2002).

Thesis (M.Tech.: Radiography) - Dept. of Radiography, Durban Institute of Technology, 2003 1 v. (various pagings) / Cancer is an inexorably progressive disease and a favourable outcome in its management often depends on early intervention (Mackillop, Zhou and Quirt, 1995: 532). Early detection of the disease is therefore important for a favourable outcome to be achieved. When the disease is diagnosed at a late stage, the treatment that is offered is only palliative. Palliative treatment is only offered with the aim to relieve the local symptoms of advanced disease. The treatment intent is therefore not curative but only to give the patient a better quality of life, which sometimes is not possible especially for very advanced disease. In KwaZulu-Natal the incidence of Zulu speaking patients presenting with a late stage disease to the major cancer treatment centres is very high with the result that the majority of these patients can only be offered palliative treatment (Pervan, Cohen and Jaftha, 1995 : 162). Aim of the study is to investigate the factors that contribute to the late presentation of rural Zulu patients with cancer to the two major provincial cancer treatment centers in KwaZulu-Natal (prior to December 2002).

Les maladies les plus fréquentes prédisposant au cancer colorectal sont le Syndrome de Lynch et la Polypose Adénomateuse Familiale. Les gènes du système MMR, le gène APC et le gène MUTYH sont respectivement responsables. Le conseil génétique est primordial pour une prise en charge optimale des patients et des familles. Les Comités d'Oncogénétique aident les professionnels de santé à décider d'une indication d'analyse génétique et au suivi des familles. Nous souhaitons évaluer et améliorer a qualité décision prise pour une famille à risque. Des décisions très disparates d'un cas familial à un autre équivalent ont été suspectées. A Lyon, nous avons créé une base de données pour analyser et contribuer cela. Résultat : 100% (33/33) des centres français de consultations principales d'oncogénétique ont décrit l'organisation de leurs COG: 76% développent un COG spécifique, 24% utilisent une concertation standard. Environ 3.75 spécialités médicales sont rassemblées par COG, dont des oncogénéticiens (100%), gastro-entérologues (76%), conseillers en génétiques (84%), chirurgiens (32%), et biologistes/anatomopathologistes (36%). Vingt pourcent des centres ayant une COG spécifique discutent tous leurs cas familiaux, 80% sélectionnent leurs dossiers. Dans notre région, un outil informatique a été élaboré et sera largement diffusé. Notre but étant de standardiser nos décisions et, catégoriser des groupes de patients/familles, pour standardiser la surveillance proposée chez les familles équivalentes. Une meilleure rationalisation de la prise en charge, du suivi des familles, et de la prévention est ici ciblée. / The most common diseases that predispose for colorectal cancers are Lynch Syndrome and Familial Adenomatous Polyposis. The genes of MMR system, the APC gene and the MUTYH gene are respectively responsible. Genetic counselling is imperative for an optimal care making for patients and at-risk families. Multidisciplinary committees (MDC) are organized so as to help healthcare professionals for gene analysis decision and families' follow-up. Our aim is evaluation and improvement of quality decision-making for at-risk families. A disparate distribution of decisions from one familial case to another equivalent one has been suspected and observed. In Lyon region we created a database to analyse that and contribute to harmonize the different participants' work in MDC. Results: the 33 French oncogenetic main consultation centers described the organization of their MDC. Answering rate reached 100%. Among these centers, 76% developed a specific MDC, whereas 24% used standard consultation. About 3.75 different medical specialities are gathered by MDC. Among them, there are oncogeneticists (100%), gastroenterologists (76%), genetic counsellors (84%), surgeons (32%), and biologists (36%). Twenty percent of centers having a specific MDC evaluate all their patient cases, whereas 80% select them. In Lyon region, a computerized tool has been elaborated and will be widely disseminated to every collaborating partners of our MDC. It will enable us to standardize our decision-making and, by comparing decisions through quality criteria, to differentiate and categorize some patients/families groups. A better rationalization of care management, families' follow-up and prevention is targeted.