9 research outputs found
Evidence-based management of chemotherapy-induced nausea and vomiting: a position statement from a European cancer nursing forum
Chemotherapy-induced nausea and vomiting (CINV) is a common, but now often overlooked side effect of cancer treatment, and one that can be largely prevented through the implementation of international evidence-based guidelines. The European CINV Forum, comprising nurses from France, Germany, Portugal, Spain and the UK, discussed the use of CINV preventive strategies in routine practice, and the factors that affect optimal delivery of antiemetic therapies. Based on these discussions, they developed a series of recommendations for optimal, evidence-based management of CINV. These state that all patients receiving chemotherapy should undergo full assessment of their risk of CINV and receive appropriate prophylactic treatment based on guidelines from the Multinational Association of Supportive Care in Cancer (MASCC) and the National Comprehensive Cancer Network (NCCN), which were both updated in 2011. Other recommendations, aimed at raising awareness of CINV and its management, include timely updates of relevant local practice guidelines and protocols, translation of the MASCC and NCCN guidelines into all European languages and their dissemination through accessible articles in nursing journals and newsletters and via nursing conferences and study days, improved training for nurses on CINV, collaboration between the European Oncology Nursing Society and national nursing organisations to promote consistent practice, the development of a CINV toolkit, information provision for patients, local audits of CINV management, and a survey of CINV management between and within European countries
Evidence-based management of chemotherapy-induced nausea and vomiting: a position statement from a European cancer nursing forum
Chemotherapy-induced nausea and vomiting (CINV) is a common, but now often overlooked side effect of cancer treatment, and one that can be largely prevented through the implementation of international evidence-based guidelines. The European CINV Forum, comprising nurses from France, Germany, Portugal, Spain and the UK, discussed the use of CINV preventive strategies in routine practice, and the factors that affect optimal delivery of antiemetic therapies. Based on these discussions, they developed a series of recommendations for optimal, evidence-based management of CINV. These state that all patients receiving chemotherapy should undergo full assessment of their risk of CINV and receive appropriate prophylactic treatment based on guidelines from the Multinational Association of Supportive Care in Cancer (MASCC) and the National Comprehensive Cancer Network (NCCN), which were both updated in 2011. Other recommendations, aimed at raising awareness of CINV and its management, include timely updates of relevant local practice guidelines and protocols, translation of the MASCC and NCCN guidelines into all European languages and their dissemination through accessible articles in nursing journals and newsletters and via nursing conferences and study days, improved training for nurses on CINV, collaboration between the European Oncology Nursing Society and national nursing organisations to promote consistent practice, the development of a CINV toolkit, information provision for patients, local audits of CINV management, and a survey of CINV management between and within European countries
Pain related to repeated invasive procedures in oncology: Improvement of management between 1998 and 2004
âRegards croisĂ©s 2009â: survey on perception of fatigue and chemotherapy-induced anemia conducted in cancer patients and health professionals, typologies and insights
âȘRegards croisĂ©s 2009 â«: survey about perception and management of fatigue and chemotherapy-induced anemia conducted among cancer patients and health professionals
« Regards croisés 2009 »: perception of cancer patients and health professionals about consequences of fatigue and chemotherapy-induced anemia on daily life
Traduction et republication de : « Maladie thromboembolique veineuse récidivante chez les patients cancéreux anticoagulés : diagnostic et traitement »
International audiencePatients with cancer are at significantly increased risk of venous thromboembolism (VTE), due both to the impact of malignant disease itself and to the impact of certain anticancer drugs on haemostasis. This is true both for first episode venous thromboembolism and recurrence. The diagnosis and management of VTE recurrence in patients with cancer poses particular challenges, and these are reviewed in the present article, based on a systematic review of the relevant scientific literature published over the last decade. Furthermore, it is uncertain whether diagnostic algorithms for venous thromboembolism, validated principally in untreated non-cancer patients, are also valid in anticoagulated cancer patients: the available data suggests that clinical decision rules and D-dimer testing perform less well in this clinical setting. In patients with cancer, computed tomography pulmonary angiography and venous ultrasound appear to be the most reliable diagnostic tools for diagnosis of pulmonary embolism and deep vein thrombosis respectively. Options for treatment of venous thromboembolism include low molecular weight heparins (at a therapeutic dose or an increased dose), fondaparinux or oral direct factor Xa inhibitors. The choice of treatment should take into account the nature (pulmonary embolism or VTE) and severity of the recurrent event, the associated bleeding risk, the current anticoagulant treatment (type, dose, adherence and possible drugâdrug interactions) and cancer progression.Les patients atteints de cancer prĂ©sentent un risque significativement accru de maladie thromboembolique veineuse (MTEV), en raison Ă la fois de lâimpact de la maladie maligne elle-mĂȘme et de lâimpact de certains mĂ©dicaments anticancĂ©reux sur lâhĂ©mostase. Cela est vrai Ă la fois pour le premier Ă©pisode de MTEV et pour sa rĂ©cidive. Le diagnostic et la prise en charge de la rĂ©cidive de la MTEV chez les patients atteints de cancer posent des problĂšmes particuliers, qui sont examinĂ©s dans le prĂ©sent article, sur la base dâune revue systĂ©matique de la littĂ©rature publiĂ©e au cours de la derniĂšre dĂ©cennie. Il nâest pas certain que les algorithmes de diagnostic de la MTEV, validĂ©s principalement chez les patients sans cancer et ne recevant pas dâanticoagulant, soient Ă©galement valables chez les patients cancĂ©reux sous traitement anticoagulant. Les donnĂ©es disponibles suggĂšrent que dans ce contexte clinique, les algorithmes diagnostiques utilisant la probabilitĂ© clinique et le dosage des D-dimĂšres seraient moins performants. Chez les patients atteints de cancer, lâangioscanner pulmonaire et lâĂ©chographie veineuse semblent ĂȘtre les outils les plus fiables pour le diagnostic de lâembolie pulmonaire et de la thrombose veineuse profonde, respectivement. Les options de traitement de la MTEV rĂ©cidivante sous anticoagulant comprennent les hĂ©parines de bas poids molĂ©culaire (Ă une dose thĂ©rapeutique ou Ă une dose plus Ă©levĂ©e), le fondaparinux ou les inhibiteurs directs du facteur Xa par voie orale. Le choix du traitement doit tenir compte de la nature (embolie pulmonaire ou thrombose veineuse profonde) et de la gravitĂ© de lâĂ©vĂ©nement rĂ©current, du risque hĂ©morragique associĂ©, du traitement anticoagulant en cours (type, dose, observance et interactions mĂ©dicamenteuses Ă©ventuelles) et de lâĂ©volution du cancer
Traduction et republication de : « Prise en charge de la maladie thromboembolique veineuse associée au cancer chez les populations vulnérables »
International audienceAlthough all patients with cancer-associated thrombosis (CAT) have a high morbidity and mortality risk, certain groups of patients are particularly vulnerable. This may expose the patient to an increased risk of thrombotic recurrence or bleeding (or both), as the benefit-risk ratio of anticoagulant treatment may be modified. Treatment thus needs to be chosen with care. Such vulnerable groups include older patients, patients with renal impairment or thrombocytopenia, and underweight and obese patients. However, these patient groups are poorly represented in clinical trials, limiting the available data on which treatment decisions can be based. Meta-analysis of data from randomised clinical trials suggests that the relative treatment effect of direct oral factor Xa inhibitors (DXIs) and low molecular weight heparin (LMWH) with respect to major bleeding could be affected by advanced age. No evidence was obtained for a change in the relative risk-benefit profile of DXIs compared to LMWH in patients with renal impairment or of low body weight. The available, albeit limited, data do not support restricting the use of DXIs in patients with TAC on the basis of renal impairment or low body weight. In older patients, age is not itself a critical factor for choice of treatment, but frailty is such a factor. Patients over 70 years of age with CAT should undergo a systematic frailty evaluation before choosing treatment and modifiable bleeding risk factors should be addressed. In patients with renal impairment, creatine clearance should be assessed and monitored regularly thereafter. In patients with an eGFR less than 30mL/min/1.72m2, the anticoagulant treatment may need to be adapted. Similarly, platelet count should be assessed prior to treatment and monitored regularly. In patients with grade 3-4, thrombocytopenia (less than 50,000platelets/ÎŒL) treatment with a LMWH at a reduced dose should be considered. For patients with CAT and low body weight, standard anticoagulant treatment recommendations are appropriate, whereas in obese patients, apixaban may be preferred.Bien que tous les patients atteints de thrombose associĂ©e au cancer (TAC) prĂ©sentent un risque Ă©levĂ© de morbiditĂ© et de mortalitĂ©, certains groupes de patients sont particuliĂšrement vulnĂ©rables. Cela peut exposer le patient Ă un risque accru de rĂ©cidive thrombotique ou dâhĂ©morragie (ou les deux), car le rapport bĂ©nĂ©fice/risque du traitement anticoagulant peut ĂȘtre modifiĂ©. Le traitement doit donc ĂȘtre choisi avec soin. Ces groupes vulnĂ©rables comprennent les patients ĂągĂ©s, les patients souffrant dâinsuffisance rĂ©nale ou de thrombopĂ©nie, ainsi que les patients obĂšses ou en sous-poids. Cependant, ces groupes de patients sont peu reprĂ©sentĂ©s dans les essais cliniques, ce qui limite les donnĂ©es disponibles sur lesquelles les dĂ©cisions thĂ©rapeutiques peuvent ĂȘtre basĂ©es. Une mĂ©ta-analyse des donnĂ©es issues dâessais cliniques randomisĂ©s suggĂšre que lâimpact relatif des inhibiteurs directs du facteur Xa par voie orale (DXI) et des hĂ©parines de bas poids molĂ©culaire (HBPM) en ce qui concerne les hĂ©morragies majeures pourrait ĂȘtre influencĂ© par lâĂąge avancĂ©. Aucune preuve nâa Ă©tĂ© obtenue quant Ă une modification du balance bĂ©nĂ©ficie risque relatif des DXI par rapport aux HBPM, chez les patients souffrant dâinsuffisance rĂ©nale ou de faible poids corporel. Les donnĂ©es disponibles, bien que limitĂ©es, ne permettent pas de restreindre lâutilisation des DXI chez les patients de faible poids corporel ou souffrant dâinsuffisance rĂ©nale. Chez les patients plus ĂągĂ©s, lâĂąge nâest pas en soi un facteur dĂ©terminant pour le choix du traitement, contrairement Ă la fragilitĂ©. La fragilitĂ© des patients ĂągĂ©s de plus de 70 ans ayant une TAC mĂ©rite dâĂȘtre Ă©valuĂ©e avant de choisir un traitement. Les facteurs de risque hĂ©morragique modifiables devraient Ă©galement ĂȘtre pris en compte. Chez les patients souffrant dâinsuffisance rĂ©nale, la clairance de la crĂ©atine doit ĂȘtre Ă©valuĂ©e et surveillĂ©e rĂ©guliĂšrement par la suite. Chez les patients dont le DFGe est infĂ©rieur Ă 30 mL/min/1,72 m2, il peut ĂȘtre nĂ©cessaire dâadapter le traitement anticoagulant. De mĂȘme, la numĂ©ration plaquettaire doit ĂȘtre Ă©valuĂ©e avant le traitement et surveillĂ©e rĂ©guliĂšrement. Chez les patients ayant une thrombopĂ©nie de grade 3â4 (moins de 50 000 plaquettes/L), un traitement par HBPM Ă dose rĂ©duite doit ĂȘtre envisagĂ©. Pour les patients de faible poids corporel, les recommandations de traitement anticoagulant standard sont appropriĂ©es, tandis que pour les patients obĂšses, lâapixaban peut ĂȘtre prĂ©fĂ©rĂ©