Prospective, observational practice survey of applied skin care and management of cetuximab-related skin reactions: PROSKIN study.

PURPOSE The study aimed to investigate strategies to prevent and treat cetuximab-induced skin reactions and their perceived effectiveness in patients with metastatic colorectal cancer (mCRC) and recurrent/metastatic squamous cell cancer of the head and neck (SCCHN). METHODS This open-label, prospective observational study was conducted in Switzerland. RESULTS A total of 125 patients were included (n = 91 mCRC, n = 34 SCCHN; mean age 63.3 years; 73.6% males). The frequency of acneiform rash grade ≥ 2 increased from 12.6% at week 2 to 21.7% at week 16. The proportion of patients who reported no skin reaction decreased from 75.6% at week 2 to 43.3% at week 16. The most frequently used skin products at any time of observation were moisturizing (77.6%), lipid-regenerating (56.8%) or urea-containing products (52%), systemic antibiotics (49.6%), and vitamin K1 cream (43.2%). There was no clear effectiveness pattern for all product classes: in given patients, either the product showed no effect at all or a moderate/strong effect, consistently over time. CONCLUSIONS A great variety of low-cost general skin care products were commonly used. According to physician's preference, systemic antibiotics and vitamin K1 cream are an appropriate approach to prevent or treat cetuximab-related skin toxicity

Trajectoires oncologiques de personnes âgées en situation palliative ::« the long and winding road »

Cet article s’intéresse aux trajectoires des personnes âgées atteintes de cancer métastatique qui font l’expérience de plusieurs lignes de traitements oncologiques systémiques palliatifs. Sur la base d’un choix de photos évoquant des parcours, les représentations entre les patients et les soignants diffèrent. Là où ces derniers voient la pénibilité des traitements et des espaces de négociation, les patients veulent être appréhendés comme des battants, figure qu’il convient d’adopter pour faire face au cancer et aux traitements, jour après jour, et correspondre aux attentes médicales et sociales

Rising to the medication's requirements ::the experience of elderly cancer patients receiving palliative chemotherapy in the elective oncogeriatrics field

A new subfield of oncology has emerged in the last twenty years to raise awareness and address the specific needs of elderly cancer patients, a population that was long neglected in oncology. We sought to understand the individual experiences, as well as moral and social implications of considering elderly cancer patients as “treatable”. Following an anthropological critical interpretative approach focusing on practical and symbolic effects of chemotherapy in a rapidly evolving medical field, we conducted 20 semi-structured interviews and observations of medicine storage places at home among elderly cancer patients aged 70 and over in a clearly incurable situation receiving palliative chemotherapy. We used photographs representing paths as triggers in interviews, and compared the patients' views with those of 12 health professionals in oncology during a brief open-ended interview. Elderly cancer patients consider themselves to be survivors and fighters. Their long trajectory is a result of their successful struggle and tolerance of the treatments allowing them to carry on. They continually observe their physical ability and test their resistance, they resist complaining and are grateful to have cancer at a late stage of life. By highlighting their active life rather than the treatment inconveniences, they show they are “young elderly” persons, capable of keeping active physically. They are treated precisely because they demonstrated that they had the physical and moral capacity to take the hit of the chemotherapy to their bodies and had the will to fight. The development of oncogeriatrics has enabled the treatment of the fittest cancer patients over 70, but the ethical debate to treat some elderly patients and not others, and decisions of therapeutic abstention facing frail elderly cancer patients remains an issue rarely discussed. This aspect should not be eluded by the important progress achieved in medicine facing cancer

Chimiothérapie orale chez les 70 ans et plus: points de vue croisés entre usagers et médecins [Oral chemotherapy for patients aged 70 and over: crossed views between users and physicians]

Objectif de l'étude: L'étude analyse l'objet « rapport à la chimiothérapie orale » par le biais du discours des médecins et des patients âgés dans une perspective socio-anthropologique. Matériel et méthode: Nous avons croisé des entretiens semi-dirigés d'oncologues (10), de médecins généralistes dénommés ci-après médecins de premier recours (MPR) (10) et d'usagers de 70 ans et plus (20) sur la chimiothérapie orale. Les entretiens des usagers ont été complétés par des observations (20) à domicile. Résultats: Les oncologues considèrent ce traitement comme dangereux, posant la question de la compliance. Ils estiment cependant que cette modalité est plus simple pour les usagers et ne mesurent pas les impacts du traitement sur leur vie quotidienne. Les MPR connaissent mal ces produits. Comme les oncologues, ils les jugent plus simples d'usage sans évaluer leurs effets sur le quotidien des usagers. Ils estiment être écartés de la relation thérapeutique au profit des spécialistes. Cette modalité de traitement est également considérée comme plus simple par les malades. Ils gèrent concrètement une médication qui envahit leur espace domestique. La chimiothérapie orale introduit une hiérarchisation de toute la médication. La prise de médicaments usuels peut être différée, voire suspendue. L'âge des usagers est une variable qui se joue en toile de fond du traitement, entre argumentations médicales et représentations sociales. Conclusion: Le croisement des points de vue permet de comprendre comment un traitement tel que la chimiothérapie orale révèle les univers normatifs et symboliques de chacun sur le médicament, le cancer et l'âge

Anemie hemolytique dans le contexte de cancer

Hemolysis (from the Greek word: hemolysis: hema = blood + lysis = liberation) is a medical term that describes red blood cell's destruction by mechanisms of lysis of the membrane. An hemolytic anemia occurs when excessive destruction of red blood cells overwhelms bone marrow's capacity of regeneration. Although anemia is frequently associated with an oncologic disease, hemolytic anemia is rarely diagnosed in oncologic patients. Consequently, a massive hemolysis can be quickly deleterious and often fatal. An early diagnosis can improve survival and can be made with inexpensive tests. In this article, we present the different types of hemolytic anemia associated with oncologic diseases, their mechanism and the treatment propositions depending on the etiology

Are cancer patients willing to travel more or further away for a slightly more efficient therapy?

Centralisation of cancer services is ongoing in many countries due to the rapid increase of knowledge in oncology, the interdisciplinary of many cancer treatments and economic pressure. This study investigated whether cancer patients are willing to accept this additional burden. All patients who came in February 2012 for a consultation or an ambulant treatment were asked to answer to a survey. The questionnaire covered among other six questions whether the patients would be willing to travel more frequently or further away. These questions were split in two groups: one for a slightly more efficacious therapy and the other for a therapy with slightly fewer side effects. To travel more frequently is well accepted as a clear majority of patients say yes or rather yes to travel more frequently for a more efficacious therapy (67%) as for a therapy with fewer side effects (62%). To travel further away doesn't have a clear majority as 51% of the patients say yes or rather yes for a more efficacious therapy and 49% for a therapy with fewer side effects. General acceptance of travelling further away as a consequence of centralisation of oncology services cannot be assumed. Particularly elderly patients are reluctant to it and will require specific solutions

How do gender, age and travel time impact on the need for social support of patients to have access to cancer treatment?

Purpose: Disparities in cancer treatment for geographical and socioeconomic reasons have been demonstrated in several countries. In Valais, a canton in Switzerland, to travel to one of the oncology wards can be time consuming, cost intensive and make support by relatives or external persons and institutions necessary. Method: We investigated which kind of support cancer patients in Valais need today to make a treatment possible, quantified it and identified subgroups with particular needs. All patients who came in February 2012 for a consultation or an ambulant therapy to one of the four centres of the “Département Valaisan d’Oncologie” or the unique private practice in the region were asked to answer to a questionnaire. Results were summarised and analysed. Results: 84% of the patients need support. 40% of the patients need two or more kinds of support. Kind and quantity of support depend on gender, age and distance. Cancer patients in Valais need support to make their treatments possible. Some subgroups have a complex pattern of support and need specific assistance as younger women or elderly patients. Conclusions: We demonstrate that cancer patients in Valais need social support to handle their treatment days and that their out of the pocket travel expenses increase rapidly with distance. The pattern of support needed varies according to patient characteristics as gender, age and distance to treatment centre

Etat de santé de la population valaisanne 2010

Sur mandat du Service de la santé publique, l'Observatoire valaisan de la santé (OVS) publie le 4e Rapport sur l'état de santé de la population valaisanne. Selon ce rapport, la population du canton bénéficie d'un très bon état de santé général. L'espérance de vie y est une des meilleures au monde. Les maladies cardiovasculaires et les cancers continuent d'être responsables de près de 2/3 des décès. Pour diminuer l'impact de ces maladies, il est nécessaire de poursuivre sur la voie d'une politique de promotion de la santé et de prévention active et ciblée. Le Conseil d'Etat a adopté un programme-cadre allant dans ce sens. Réalisé par l'OVS en collaboration avec l'Institut universitaire de médecine sociale et préventive de Lausanne (IUMSP), le rapport sur l'état de santé livre une photographie sanitaire de la population valaisanne. Il sert de document de référence au gouvernement pour définir les axes de la politique de promotion de la santé et de prévention pour les années 2011-2014