Impact and management of chemotherapy/radiotherapy-induced nausea and vomiting and the perceptual gap between oncologists/oncology nurses and patients: a cross-sectional multinational survey

Purpose: chemotherapy/radiotherapy-induced nausea and vomiting (CINV/RINV) can affect half of oncology patients, significantly impacting daily life. Nausea without vomiting has only recently been thought of as a condition in its own right. As such, the incidence of nausea is often underestimated. This survey investigated the incidence and impact of CINV/RINV in patients compared with estimations of physicians/oncology nurses to determine if there is a perceptual gap between healthcare professionals and patients. Methods: an online research survey of physicians, oncology nurses and patients was conducted across five European countries. Participants had to have experience prescribing/recommending or have received anti-emetic medication for CINV/RINV treatment. Questionnaires assessed the incidence and impact of CINV/RINV, anti-emetic usage and compliance, and attribute importance of anti-emetic medication. Results: a total of 947 (375 physicians, 186 oncology nurses and 386 patients) participated in this survey. The incidence of nausea was greater than vomiting: 60 % of patients reported nausea alone, whereas 18 % reported vomiting. Physicians and oncology nurses overestimated the incidence of CINV/RINV but underestimated its impact on patients' daily lives. Only 38 % of patients reported full compliance with physicians'/oncology nurses' guidelines when self-administering anti-emetic medication. Leading factors for poor compliance included reluctance to add to a pill burden and fear that swallowing itself would induce nausea/vomiting. Conclusions: there is a perceptual gap between healthcare professionals and patients in terms of the incidence and impact of CINV/RINV. This may lead to sub-optimal prescription of anti-emetics and therefore management of CINV/RINV. Minimising the pill burden and eliminating the requirement to swallow medication could improve poor patient compliance with anti-emetic regimens

Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines.

n/

Multicenter randomized phase II study of two schedules of docetaxel, estramustine, and prednisone versus mitoxantrone plus prednisone in patients with metastatic hormone-refractory prostate cancer

A B S T R A C T Purpose Mitoxantrone-corticosteroid is currently the standard palliative treatment in hormone-refractory prostate cancer (HRPC) patients. Recent clinical trials documented the high activity of the docetaxel-estramustine combination. We conducted a randomized phase II study to evaluate prostate-specific antigen (PSA) response (primary end point) and safety of two docetaxelestramustine-prednisone (DEP) regimens and mitoxantrone-prednisone (MP). Patients and Methods One hundred thirty metastatic HRPC patients were randomly assigned to receive docetaxel (70 mg/m 2 on day 2 or 35 mg/m 2 on days 2 and 9 of each 21-day cycle) and estramustine (280 mg PO tid on days 1 through 5 and 8 through 12) or mitoxantrone 12 mg/m 2 every 3 weeks; all patients received prednisone (10 mg daily). Results One hundred twenty-seven patients were assessable for PSA response and safety. A Ն 50% PSA decline was found in a greater percentage of patients in the docetaxel arms (67% and 63%) compared with MP (18%; P ϭ .0001). Median time to PSA progression was five times longer with DEP than with MP (8.8 and 9.3 v 1.7 months, respectively; P ϭ .000001). Overall survival was better in the docetaxel arms (18.6 and 18.4 months) compared with the MP arm (13.4 months), but not significantly so (P ϭ .3). Crossover rates differed significantly among treatment arms (16%, 10%, and 48% in arms A, B, and C, respectively; P ϭ .00001). Treatment-related toxicities were mild and mainly hematologic. Conclusion The results of this randomized phase II study showed significantly higher PSA decline Յ 50% and longer times to progression in HRPC patients receiving DEP-based chemotherapy than MP, and that DEP could be proposed in this setting

Description and evolution of organisation between curative and palliative phase around care and iatrogenia : Supportive care in cancer

La prise en charge d’un patient atteint d’un cancer impose, au soignant, la recherche du meilleur traitement antinéoplastique possible en association avec un engagement d’accompagnement depuis l’annonce du diagnostic jusqu’à la phase après cancer ou le décès. Au cours de son parcours de soin, le malade et ses proches vont être confrontés à différentes équipes, différentes visions du traitement et différentes approches du soin. Le travail présenté consiste en une analyse nationale française sur l’organisation des soins d’accompagement ainsi que la gestion de la iatrogénie liée à trois grandes familles de thérapeutiques symptomatiques : les érythropoïétines, les biphosphonates et les morphiniques. Basé sur cette photographie du soin d’accompagnement en cancérologie, le développement de ces soins sur un établissement sera alors présenté depuis la gestion ambulatoire en hospitalisation de jour, jusqu’à l’hospitalisation complète dans une unité pilote. Le lien, les différences et les complémentarités entre les équipes aux phases curatives et palliatives seront alors discutés, permettant de définir la place et l’importance du regard global et réunificateur par le biais des soins de support en cancérologieThe management of a cancer patient requires, to the caregivers, finding the best antineoplastic therapy in combination with support involvement from the diagnosis to the stage after cancer or death. During the course of care, patient and family will be confronted with different teams, different visions and different treatment approaches of their care. The work presented starts threw an analysis of French organizations of supportive care and management of iatrogenic effects due to three main types of symptomatic therapeutics: erythropoietins, bisphosphonates and opioids. Based on this photograph of accompanying cancer care, the development in an institution of an health care will be presented for ambulatory management of day hospital for chemotherapy administration, until full hospitalization in a pilot unit. The link, the differences and complementaries between the teams in curative and palliative phases will be discussed to define the role and importance of the overall look and unifying supportive care in oncolog

Motivation of patients with chronic cancer during COVID-19: a qualitative analysis

International audiencePurpose: Motivation to treat cancer and prevent its negative impact has been largely explored in a non-pandemic context. However, little is known about the motivation to comply with the treatment, especially during a pandemic. To fill this gap, we have explored the individual and contextual factors impacting patients' motivation during the COVID-19 period using the integrated model.Methods: We have conducted two qualitative studies before (study 1) and during the COVID-19 (study 2) period in a cancer centre. We respectively interviewed 30 and 22 patients with various chronic cancers in study 1 and also with COVID-19 in study 2. Data analysis was based on content analysis and grounded theory approach identifying the factors affecting patient motivations during both periods, and then comparing them.Results: Our results show the mechanisms that allow patients to maintain their motivation despite the threats related to COVID-19. They underline the importance of respecting the rules and laws for patients' motivation.Conclusion: Compliance with legislation fuels the psychological need of protection in patients, which is a key determinant of motivation in the context of the pandemic. Considering patients' self-regulatory activities to assess motivational factors, going beyond clinical aspects, to include organisational and quality-of-life-related aspects throughout their care pathway is crucial

Essential digital health

International audienc

Treatment and Prevention of Cancer-Associated Thrombosis in Frail Patients: Tailored Management

Advanced age is one of the major determinants of frailty in patients with cancer-associated thrombosis. However, multiple other factors contribute to frailty in these patients. The identification of frailty in patients with cancer-associated thrombosis is critical as it influences the complexity of the anticoagulant treatment in this population at high risk of venous thromboembolism and bleeding. Factors that contribute to frailty in patients with cancer-associated thrombosis include age, type of cancer, comorbidities such as chronic kidney disease, poly-pharmacotherapy, treatment compliance, cognitive impairment, anemia, thrombocytopenia, mobility, nutritional status, Eastern Cooperative Oncology Group grade, risk of falls, and reduced life expectancy. In the absence of specific clinical studies current anticoagulant treatment guidelines for the management are not fully applicable to frail patients with cancer. The anticoagulant treatment should therefore benefit from a tailored approach based on an algorithm that takes into account the specificities of the malignant disease

A patient reported outcome platform, a useful tool to improve monitoring and effective management of Covid-19–positive patients with cancer

International audienc

Constipation et cancer : stratégies actuelles

International audienceDigestive disorders, in particular constipation, are symptoms very often reported by cancer patients as having a major impact on their quality of life. An accurate diagnosis of bowel delayed transit and defecation disorders is required to best adapt therapeutic management. Constipation associated with cancer may be related to several causes, which can be placed in three nosological categories that sometimes overlap: chronic constipation prior to cancer and having its own evolution; constipation related to the cancer condition, in particular the occlusive syndrome, and constipation induced by cancer therapies. The stricter application of diet and lifestyle measures is often necessary and sometimes sufficient. Laxative drug treatments come under various galenic forms and administration routes and must be selected according to the clinical features of constipation. Surgical management can be indicated in case of ileus or pelvic static disorders. In the case of refractory constipation induced by opioids and within the framework of palliative care to treat an advanced pathology, a peripheral morphinic antagonist can offer fast symptom relief. A way forward to improve the patients' quality of life could be to identify the contributing factors (in particular, genetic factors) to determine which patients are the more at risk and anticipate their management.Les troubles digestifs, et notamment la constipation, constituent des symptômes très fréquemment décrits par les patients atteints de cancer, avec un retentissement important sur leur qualité de vie. Le diagnostic précis du ralentissement du transit et des troubles de la défécation est nécessaire afin d’adapter au mieux la prise en charge thérapeutique. Les étiologies de constipation associées au cancer sont nombreuses et peuvent être séparées en trois cadres nosologiques, s’intriquant parfois entre eux : la constipation chronique antérieure au cancer et évoluant pour son propre compte, la constipation liée à la maladie cancéreuse avec notamment le syndrome occlusif et la constipation liée aux traitements du cancer. Le renforcement des mesures hygiéno-diététiques est souvent nécessaire et parfois suffisant. Les traitements médicamenteux laxatifs présentent des formes galéniques et voies d’administration différentes et seront choisis en fonction des caractéristiques de la constipation. Une prise en charge chirurgicale peut être indiquée en cas d’occlusion intestinale ou de troubles de la statique pelvienne. En cas de constipation rebelle liée aux opioïdes et dans le cadre d’une prise en charge palliative d’une pathologie avancée, un antagoniste morphinique périphérique peut permettre de soulager rapidement les symptômes. Afin d’améliorer la qualité de vie des patients, l’identification de facteurs favorisants notamment génétiques permettrait de déterminer les patients les plus à risque et ainsi anticiper leur prise en charge

Impact and management of chemotherapy/radiotherapy-induced nausea and vomiting and the perceptual gap between oncologists/oncology nurses and patients: a cross-sectional multinational survey

Purpose: chemotherapy/radiotherapy-induced nausea and vomiting (CINV/RINV) can affect half of oncology patients, significantly impacting daily life. Nausea without vomiting has only recently been thought of as a condition in its own right. As such, the incidence of nausea is often underestimated. This survey investigated the incidence and impact of CINV/RINV in patients compared with estimations of physicians/oncology nurses to determine if there is a perceptual gap between healthcare professionals and patients. Methods: an online research survey of physicians, oncology nurses and patients was conducted across five European countries. Participants had to have experience prescribing/recommending or have received anti-emetic medication for CINV/RINV treatment. Questionnaires assessed the incidence and impact of CINV/RINV, anti-emetic usage and compliance, and attribute importance of anti-emetic medication. Results: a total of 947 (375 physicians, 186 oncology nurses and 386 patients) participated in this survey. The incidence of nausea was greater than vomiting: 60 % of patients reported nausea alone, whereas 18 % reported vomiting. Physicians and oncology nurses overestimated the incidence of CINV/RINV but underestimated its impact on patients' daily lives. Only 38 % of patients reported full compliance with physicians'/oncology nurses' guidelines when self-administering anti-emetic medication. Leading factors for poor compliance included reluctance to add to a pill burden and fear that swallowing itself would induce nausea/vomiting. Conclusions: there is a perceptual gap between healthcare professionals and patients in terms of the incidence and impact of CINV/RINV. This may lead to sub-optimal prescription of anti-emetics and therefore management of CINV/RINV. Minimising the pill burden and eliminating the requirement to swallow medication could improve poor patient compliance with anti-emetic regimens