Les besoins d information médicale évalués sur une cohorte de 100 patients traités pour un cancer métastatique à l Institut Curie

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Pratique de l'alimentation paretérale en situation palliative dans un centre anti-cancéreux

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Définir les Soins de Support : une contribution philosophique

International audienceTwenty years after the arrival of supportive care in France, this work, which is the result of a thesis in philosophy on supportive care, proposes to take stock of its definition and its position in the healthcare system. The aim is to describe and understand the conceptual vagueness and the wide variety of care offered in France and abroad. Based on an analysis of the literature and on fieldwork, the place given to patients as partners in care is proposed as a common and structuring foundation within the diversity of practices. We will question the links between the place of patients receiving supportive care and the “patient partner” model. Where the “Montreal model” refers to a concept of patient autonomy, supportive care proposes attention and adaptation to the individual and to the fluctuation of his or her needs over time.Vingt ans après l’arrivée en France des soins de support, ce travail issu d’une thèse en philosophie sur les soins de support propose de faire le point sur leur définition et leur positionnement dans le système de soins. Il s’agit de décrire et de comprendre le flou conceptuel et la grande variété des offres de soins sur le territoire français et à l’international. En s’appuyant sur une analyse de la littérature et sur un travail de terrain, la place accordée aux patients en tant que partenaire des soins est proposée comme un fondement commun et structurant au sein de la diversité des pratiques. Nous interrogerons les liens entre la place des patients bénéficiant de soins de support et le modèle de « patient partenaire ». Là où le modèle dit « de Montréal » se réfère à un concept d’autonomie du patient, les soins de support proposent une attention et une adaptation à l’individu et à la fluctuation de ses besoins au cours du temps

Association between Nutritional Status and Treatment Response and Survival in Patients Treated with Immunotherapy for Lung Cancer: A Retrospective French Study

Malnutrition is associated with a greater risk of morbidity and mortality and lower tolerance to chemotherapy. Our purpose was to study the association between nutritional status and the efficiency and tolerance of immunotherapy in non-small cell lung cancer (NSCLC). Nutritional and oncological data were reported at 2 months (M2) and 4 months (M4) after the initiation of immunotherapy (M0). The influence of nutritional status at M0 was estimated with the efficacy and toxicity of immunotherapy at M2 to M4. In total, 127 patients were included in the study, and nutritional status was estimated at M0 for 120 patients: 67% were not malnourished, 20% presented with moderate malnutrition, and 13% presented with severe malnutrition. There was no significant link between the nutritional status at M0 and the toxicity of immunotherapy at M2 and M4. However, severe malnutrition was significantly associated with treatment efficacy at M2 (p = 0.04) and with a lower survival rate with an HR (Hazard Ratio) = 2.32–95% C.I: 1.13–4.75 (p = 0.02). Furthermore, a monthly decrease of 1% of the weight had an HR = 1.17–95% C.I: 1.13–1.21 (p = 0.0001). Severe malnutrition and weight loss are independent factors associated with lower survival. Studies integrating the systemic detection of sarcopenia with a closer nutritional follow-up could highlight an improvement in survival

L’HDJ de soins palliatifs dans le travail de trajectoire du cancer intraitable. Une recherche qualitative originale

International audienc

Florilège des actualités oncologiques internationales en 2019

International audienceComme chacune de ces dernières années, le monde de l’oncologie bouge et avance. Les résultats de grands essais changent nos pratiques, voire les révolutionnent ! Dans ce manuscrit, humblement, le comité éditorial du Bulletin du Cancer fait le focus sur certains d’entre eux qui lui ont semblé importants de connaître peut-être même au-delà de nos spécialités

Multicentre analysis of intensity of care at the end-of-life in patients with advanced cancer, combining health administrative data with hospital records: variations in practice call for routine quality evaluation

Abstract Background Accessible indicators of aggressiveness of care at the end-of-life are useful to monitor implementation of early integrated palliative care practice. To determine the intensity of end-of-life care from exhaustive data combining administrative databases and hospital clinical records, to evaluate its variability across hospital facilities and associations with timely introduction of palliative care (PC). Methods For this study designed as a decedent series nested in multicentre cohort of advanced cancer patients, we selected 997 decedents from a cohort of patients hospitalised in 2009–2010, with a diagnosis of metastatic cancer in 3 academic medical centres and 2 comprehensive cancer centres in the Paris area. Hospital data was combined with nationwide mortality databases. Complete data were collected and checked from clinical records, including first referral to PC, chemotherapy within 14 days of death, ≥1 intensive care unit (ICU) admission, ≥2 emergency department visits (ED), and ≥ 2 hospitalizations, all within 30 days of death. Results Overall (min-max) indicator values as reported by facility providing care rather than the place of death, were: 16% (8–25%) patients received chemotherapy within 14 days of death, 16% (6–32%) had ≥2 admissions to acute care, 6% (0–15%) had ≥2 emergency visits and 18% (4–35%) had ≥1 intensive care unit admission(s). Only 53% of these patients met the PC team, and the median (min-max) time between the first intervention of the PC team and death was 41 (17–112) days. The introduction of PC > 30 days before death was independently associated with lower intensity of care. Conclusions Aggressiveness of end-of-life cancer care is highly variable across centres. This validates the use of indicators to monitor integrated PC in oncology. Disseminating a quality audit-feedback cycle should contribute to a shared view of appropriate end-of-life care objectives, and foster action for improvement among care providers

A Question Prompt List for Advanced Cancer Patients Promoting Advance Care Planning: A French Randomized Trial

International audienceContext: Advance care planning is essential to enable informed medical decisions to be made and to reduce aggressiveness in end-of-life (EOL) care.Objectives: This study aimed to explore whether a question prompt list (QPL) adapted to French language and culture could promote discussions, particularly on prognosis and EOL issues, among advanced cancer patients attending outpatient palliative care (PC) consultations.Methods: In this multicenter randomized study, patients assigned to the intervention arm received a QPL to help them prepare for the next consultation one month later. The main inclusion criteria were advanced cancer patients referred to the PC team with an estimated life expectancy of less than one year. The primary endpoint was the number of questions raised, globally and by topic. The secondary objectives were the impact of the QPL on psychological symptoms, quality of life, satisfaction with care, and coping styles at two months.Results: Patients (n = 71) in the QPL arm asked more questions (mean 21.8 vs. 18.2, P = 0.03) than patients in the control arm (n = 71), particularly on PC (5.6 vs. 3.7, P = 0.012) and EOL issues (2.2 vs. 1, P = 0.018) but not on prognosis (4.3 vs. 3.6, not specified). At two months, there was no change in anxiety, depression, or quality of life in either arm; patient satisfaction with doctors' technical skills was scored higher (P = 0.024), and avoidance coping responses were less frequent (self-distraction, P = 0.015; behavioral disengagement, P = 0.025) in the QPL arm.Conclusion: Questions on PC and EOL issues in outpatient PC consultations were more frequent, and patient satisfaction was better when a QPL was made available before the consultation