Participation of older newly-diagnosed cancer patients in an observational prospective pilot study: an example of recruitment and retention

<p>Abstract</p> <p>Background</p> <p>There have been few prospective observational studies which recruited older newly-diagnosed cancer patients, and of these only some have reported information on the number needed to screen to recruit their study sample, and the number and reasons for refusal and drop-out. This paper reports on strategies to recruit older newly-diagnosed cancer patients prior to treatment into an observational prospective pilot study and to retain them during a six-month period.</p> <p>Methods</p> <p>Medical charts of all patients in the Segal Cancer Centre aged 65 and over were screened and evaluated for inclusion. Several strategies to facilitate recruitment and retention were implemented. Reasons for exclusion, refusal and loss to follow-up were recorded. Descriptive statistics were used to report the reasons for refusal and loss to follow-up. A non-response analysis using chi-square tests and t-tests was conducted to compare respondents to those who refused to participate and to compare those who completed the study to those who were lost to follow-up. A feedback form with open-ended questions was administered following the last interview to obtain patient's opinions on the length of the interviews and conduct of this pilot study.</p> <p>Results</p> <p>3060 medical charts were screened and 156 eligible patients were identified. Of these 112 patients participated for a response rate of 72%. Reasons for refusal were: feeling too anxious (40%), not interested (25%), no time (12.5%), too sick (5%) or too healthy (5%) or other reasons (5%). Ninety-one patients participated in the six-month follow-up (retention 81.3%), seven patients refused follow-up (6.2%) and fourteen patients died (12.5%) during the course of the study. The median time to conduct the baseline interview was 45 minutes and 57% of baseline interviews were conducted at home. Most patients enjoyed participation and only five felt that the interviews were too long.</p> <p>Conclusion</p> <p>It was feasible to recruit newly-diagnosed cancer patients prior to treatment although it required considerable time and effort. Once patients were included, the retention rate was high despite the fact that most were undergoing active cancer treatment.</p

Assessment of glycemic control in nursing home residents with diabetes

International audienceObjective: To describe glycemic control in nursing home residents with diabetes and to evaluate the relevance of HbA1c in the detection of hypoglycemia risk.Design and methods: Diabetes treatment, geriatric assessment, blood capillary glucose (n= 24,682), and HbA1c were collected from medical charts of 236 southern France nursing home residents during a 4-month period. Glycemic control was divided into four categories: tight, fair, and moderate or severe chronic hyperglycemia using the High Blood Glucose Index or the analysis of blood glucose frequency distribution. Hypoglycemia episodes were identified by medical or biological records.Results: Glucose control was tight in 59.3 % and fair in 19.1 % of the residents. Chronic exposure to hyperglycemia was observed in 21.6 % of the residents (severe in 9.7 % and moderate in 11.9 %). Hypoglycemia was noticed in 42/236 (17.8%), in all categories of glycemic control. Relative hypoglycemia risk was significantly (P = 0.0095) higher in residents with moderate chronic hyperglycemia compared with those with tight control. The majority of residents with hypoglycemia (39/42) or chronic hyperglycemia (45/51) were insulin-treated. The relative risk of hypoglycemia was not significantly associated with HbA1c values.Conclusion: Hypoglycemia risk in nursing home residents is observed in all categories of glycemic control. In tight control, the potency of antidiabetic treatment should be reduced. In chronic hyperglycemia, diet and treatment should be reevaluated in order to reduce glucose variability. HbA1c is not sufficient for hypoglycemia risk detection; capillary blood glucose monitoring is warranted for nursing homes residents with diabetes

High-grade glioma in elderly patients: can the oncogeriatrician help?

Emeline Tabouret,1 Louis Tassy,2 Olivier Chinot,1 ElodieCr&eacute;tel,3 Frederique Retornaz,4 Frederique Rousseau5 1Department of Neuro-oncology, Timone Hospital, Marseille, France; 2Department of Medical Oncology, Centre L&eacute;on B&eacute;rard, Lyon, France; 3Transveral Oncogeriatric Unit, University Hospital Timone, Marseille, France; 4Departmental Gerontologic Center, Marseille, France; 5Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France Abstract: Gliomas are the most frequent primary brain tumors in adults. As the population ages in Western countries, the number of people being diagnosed with glioblastoma is expected to increase. Clinical management of elderly patients with primary brain tumors is difficult, owing to multiple comorbidities, polypharmacy, decreased tolerance to chemotherapy, and an increased risk of radiation-induced neurotoxicity. A few specific randomized studies have shown a benefit for radiotherapy in elderly patients with good performance status. For patients with poor performance status, chemotherapy (temozolomide) has been shown to be associated with prolonged duration of response. Patients with methylated O6-alkylguanine deoxyribonucleic acid alkyltransferase promoter seem to have better outcomes. Oncogeriatrics proposes the geriatric evaluation of elderly patients to improve therapeutic choices and optimize the management of treatment toxicities and comorbidities. Keywords: brain tumor, older cancer patient, chemotherapy toxicity, oncogeriatric charte

: Non adherence to substitutive treatment by L-Thyroxine : a case report

International audienceIntroduction. - La non observance du traitement substitutif de l'hypothyroïdie est la cause la plus fréquente de la discordance entre une TSH élevée et la posologie de L-thyroxine.Observation. - La TSH varie de 100 à 400 mUI/L chez un patient de 36 ans traité par L-thyroxine et L-triiodothyronine (respectivement 300 et 75 μ g/jour) pour hypothyroïdie post-chirurgicale. L'absorption de L-thyroxine est normale après charge orale. La TSH est par la suite normalisée par une prise orale hebdomadaire de 1000 μ g de L-thyroxine. Conclusion. - Le test de charge orale en L-thyroxine est indispensable au diagnostic. La prise en charge est à discuter au cas par cas: prise quotidienne du traitement sous surveillance, prise hebdomadaire d'une forte dose (1000 μ g) de L-thyroxine ou injection sous-cutanée ou intra-musculaire de la même posologie (sous réserve de l'accord de l'assurance maladie)

Characteristics and information searched for by French patients with ă systemic lupus erythematosus: A web-community data-driven online survey

International audienceIntroduction: To provide information about the needs of patients with ă systemic lupus erythematosus (SLE) using Carenity, the first European ă online platform for patients with chronic diseases. Methods: At one year ă after its creation, all posts from the Carenity SLE community were ă collected and analysed. A focused cross-sectional online survey was ă performed. Results: The SLE community included 521 people (93% females; ă mean age: 39.8 years). Among a total of 6702 posts, 2232 were classified ă according to disease-related topics. The 10 most common topics were ă `lupus and...' either `treatment', `fatigue', `entourage', `sun ă exposure', `diagnosis', `autoimmune diseases', `pregnancy', ă `contraception', `symptoms' or `sexuality'. 112 SLE patients ă participated in the online survey. At the time of diagnosis, only 17 ă (15%) patients had heard of SLE and 84 (75%) expressed a need for more ă information on outcomes (27%), treatments (27%), daily life (14%), ă patients' associations (11%), symptoms (8%), the disease (8%) and ă psychosocial aspects (7%). When treatment was initiated, 48 patients ă (43%) would have liked more information about side effects (46%), ă long-term effects (21%), treatment duration/cessation (12.5%) and type ă (10%) and mechanism of action (8%) of treatments. All participants ă except one had used the internet to find information about SLE. Sources ă of information included healthcare providers (51%/61%/67%), ă journals/magazines (7%/12%/6%), lupus Websites (51%/77%/40%), web ă forums/blogs (34%/53%/19%), patients' associations (11%/23%/9%) ă accessed at `just before diagnosis', `just after diagnosis' and `before ă treatment initiation'. Conclusions: Online patient communities provide ă original unbiased information that can help improve provision of ă information to SLE patients

Statin and cardiovascular diseases after 75 years

International audienceStatin prescription in persons older than 75 years or with frailty signs ă raises questions on the role of cholesterol in the genesis of ă atherosclerosis in this population, on the benefit of this treatment in ă primary or secondary prevention, and on their side effects in a context ă of multiple pathology and multiple medications. These questions are ă approached with the available literature data for this population. In ă secondary prevention, statin prescription is recommended whatever the ă age although intensive treatment should be avoided. In primary ă prevention, in the absence of consensus, their prescription depends on ă both geriatric and cardiovascular risk assessment. (C) 2016 Societe ă Nationale Francaise de Medecine Interne (SNFMI). Published by Elsevier ă Masson SAS. All rights reserved

Statine et pathologies cardiovasculaires après 75 ans

International audienc