Influence de la consultation d'oncogériatrie sur la décision thérapeutique finale chez les patients âgés atteints de cancer

Contexte : Cette étude rétrospective avait pour objectif principal d évaluer l impact de l Evaluation Gériatrique Approfondie sur la prise en charge thérapeutique finale du cancer chez les patients âgés de 70 ans et plus. Patients et Méthode : Durant l année 2010, un avis thérapeutique a été sollicité pour 191 patients. La concordance entre les traitements proposés en Réunion de Concertation Pluridisciplinaire, après l Evaluation Gériatrique Approfondie et ceux finalement reçus a été évaluée à l aide du test de concordance de Kappa. Les facteurs prédictifs indépendants des différents traitements ont été précisés à l aide d analyses multivariées. Résultats : L âge moyen était de 81.5 +- 6.2 ans avec une prédominance féminine (60.7%). La plupart des patients étaient dépendants pour les activités instrumentales de la vie quotidienne (68%) et 36.1% d entre eux présentaient au moins une comorbidité très sévère selon la Cumulative Illness Rating Scale for Geriatrics. La concordance entre les traitements proposés en Réunion de Concertation Pluridisciplinaire et ceux suggérés après l Evaluation Gériatrique Approfondie était excellente sauf pour la chimiothérapie et la thérapie ciblée, moins suggérées par le gériatre (Kappa = 0.67), et les soins de support plus proposés après l Evaluation Gériatrique Approfondie (Kappa = 0.61). La concordance entre traitements proposés par le gériatre et traitements reçus était moins bonne pour la chimiothérapie (Kappa = 0.58) et la chirurgie (Kappa = 0.61), au profit le plus souvent d une prise en charge jugée moins agressive. En analyse multivariée, seuls l âge (p = 0.001) et l indice de Karnofsky (p = 0.02) restaient significativement associés à l absence de traitement par chimiothérapie, indépendamment des autres traitements. Conclusion : La concordance entre les propositions et les traitements reçus était correcte, néanmoins le choix du spécialiste restait primordial.DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Not COVID-19, Don’t Overlook Pneumocystis in Patients on Gefitinib!

An 82-year-old woman treated for advanced lung cancer with gefitinb was admitted to the emergency unit complaining of dyspnea. Chest computed tomography found abnormalities classified as possible diffuse COVID-19 pneumonia. RT-PCR for Sars-Cov-2 was twice negative. PCR for Pneumocystis jirovecii was positive on bronchoalveolar lavage. The final diagnosis was Pneumocystis jirovecii pneumonia. Therefore, physicians must be careful not to misdiagnose COVID-19, especially in cancer patients on small-molecule therapeutics like gefitinib and corticosteroids

Health-related quality of life is a prognostic factor for survival in older patients after colorectal cancer diagnosis: A population-based study

International audienceBackground: Studies carried out in the context of clinical trials have shown a relationship between survival and health-related quality of life in colorectal cancer patients.Aims: We assessed the prognostic value of health-related quality of life at diagnosis and of its longitudinal evolution on survival in older colorectal cancer patients. Methods: All patients aged >= 65 years, diagnosed with new colorectal cancer between 2003 and 2005 and registered in the Digestive Cancer Registry of Burgundy were eligible. Patients were asked to complete the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at inclusion, three, six and twelve months after. Multivariate regression models were used to evaluate the prognostic value of health-related quality of life scores at diagnosis and their deterioration on relative survival.Results: In multivariate analysis, a role functioning dimension lower than median was predictive of lower survival (hazard ratio = 3.1, p = 0.015). After three and six months of follow-up, patients with greater appetite loss were more likely to die, with hazard ratios of 4.7 (p = 0.013) and 3.7 (p = 0.002), respectively.Conclusions: Health-related quality of life assessments at diagnosis are independently associated with older colorectal cancer patients' survival. Its preservation should be a major management goal for older cancer patients. (C) 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved

Assessment of the interest of the geriatric oncology consultation among French general practitioners

International audienceOBJECTIVE: We assessed the interest of the geriatric oncology (GO) consultation (GOC) among general practitioners (GPs). MATERIALS AND METHODS: We conducted a survey among GPs whose patients had had a GOC in 2012. A questionnaire was sent to GPs. The 1st part collected GPs' characteristics including medical education in geriatrics and GO, and knowledge of GOC. The following parts concerned the GOC and included the cancer type, GOC report and care plan. RESULTS: One-hundred twenty-six questionnaires corresponding to 94 GPs were collected. Concerning the GPs' characteristics, age range 50-59 (44.7%), men (62.8%) and urban practice (79.8%) were the most represented, 80.8% had no expertise in geriatrics, 60.6% knew of the existence of GOCs, and 14.9% had received medical education in GO. The most frequent cancer location was gynecological (40.7%) (82.6% were breast cancers). Of the GPs, 69.8% had received a GOC report and 92% were (very) satisfied with the delivery time. A care plan was proposed after the GOC in 83% of cases. It was satisfactory in 96.4% of cases, and applied by 74.7% of GPs. Sixteen percent of GPs were called by the GO team. The less the GP was satisfied with the GOC, the more he or she wanted phone contact (p=0.02); 94% of GPs considered the GOC (very) satisfactory. Sixty-seven percent of GPs wanted to be trained in GO. CONCLUSION: Very few GPs had been trained in geriatrics and/or GO. They were mostly satisfied with GOC and expressed a wish to be trained in GO

Management and Outcomes of Pancreatic Cancer in French Real-World Clinical Practice

Background: Our objective was to describe real-world patterns of care and outcomes in pancreatic cancer. Methods: 912 patients diagnosed with pancreatic cancer from 2014 to 2017 were registered by the population-based cancer registry of Burgundy (France). Progression-free and net survival were estimated. Results: at diagnosis, 52% of tumors were associated with metastases. Among the 20% of patients fulfilling resectability criteria, half of those aged 75–84 years and none of those ≥85 years actually underwent resection. Age was not associated with 3-year observed survival in patients who underwent resection. Overall, 77% of patients aged <75 years, 55% of those aged 75–84 years and 8% of those ≥85 years received chemotherapy. Among patients who were offered chemotherapy, 73% of those aged ≥85 years refused. Chemotherapy toxicity was higher with Gemcitabine_Oxaliplatin/Gemcitabine_Abraxane and FOLFIRINOX than with Gemcitabine alone. Patients resected after induction FOLFIRINOX and those treated with adjuvant Gemcitabine presented the lowest risk of progression. Three-year net survival was 35% in patients with non-metastatic resectable tumors and under 10% for other patients. Conclusions: Only half of patients aged 75–84 years with a resectable tumor actually underwent resection. Two thirds of patients aged ≥85 years refused chemotherapy, thus underlining the need to expand geriatric assessments

Folfirinox in elderly patients with pancreatic or colorectal cancer-tolerance and efficacy

International audienceAIMTo study the tolerance and the efficiency of FOLFIRINOX in elderly patients diagnosed with colorectal or pancreatic cancer.METHODSThis retrospective study included elderly patients aged over 70 years of age treated at Georges-Francois Leclerc Center by FOLFIRINOX for histological proved colorectal or pancreatic cancer between January 2009 and January 2015. Chemotheapy regimen consisted of oxaliplatin (85 mg/m(2) in over 120 min) followed by leucovorin (400 mg/m(2) in over 120 min), with the addition, after 30 min of irinotecan (180 mg/m(2) in over 90 min) then 5 fluorouracil (5FU) (400 mg/m(2) administred intravenous bolus), followed by 5FU (2400 mg/m2 intraveinous infusion over 46 h) repeated every 2 wk. Geriatric parameters were recorded at the beginning. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events 4.03. Tumor response was evaluated by CT scan. Treatment continued until disease progression, unacceptable toxicities or patient refusal.RESULTSFifty-two patients aged from 70 to 87 years were treated by FOLFIRINOX, 34 had colorectal cancer and 18 had pancreatic cancer. Most of them were in good general condition, 82.7% had a 0-1 performance status and 61.5% had a Charlson Comorbidity Index < 10. The most frequent severe toxicities were neutropenia (17 patients, n = 32.7%) and diarrhea (35 patients n = 67.3%); 10 of the case of neutropenia and 5 of diarrhea registered a grade 4 toxicity. Thirty-nine patients (75%) initially received an adapted dose of chemotherapy. The dosage was adjusted for 26% of patients during the course of treatment. Tumor response evaluated by RECIST criteria showed a controlled disease for 25 patients (48.1%), a stable disease for 13 and a partial response for 12 patients. Time under treatment was higher for colorectal cancer with a median time of 2.44 mo (95% CI: 1.61-3.25). Overall survival was 43.88 mo for colorectal cancer and 12.51 mo for pancreatic cancer. In univariate or multivariate analysis, none of geriatric parameters were linked to overall survival. Only the type of tumor (pancreatic/colorectal) was linked in both analysis.CONCLUSIONFor people over 70 years old, FOLFIRINOX regimen seems to induce manageable toxicities but similar, even higher, median survival rates compared to younger people

Management of elderly patients suffering from cancer: Assessment of perceived burden and of quality of life of primary caregivers

International audienceObjective: To evaluate the perceived burden and the quality of life (QoL) at 3 and 6 months of the primary caregiver (PC) of patients aged 70 and over suffering from cancer and the predictors of QoL in this population.Methods: In this prospective observational study, 98 patients aged 70 and older with cancer and 96 PCs were included between 01/06/2014 and 18/03/2015. The Medical Outcomes Study 12-item Short Form Health Survey (SF-12) was used to assess the QoL of PCs and the Zarit Burden Interview (ZBI) was used to measure the perceived burden at 3 and 6 months. The major determinants of QoL were identified using mixed linear models for the dimensions of the SF-12 that showed an average difference of at least 5 points between baseline and follow-up at 6 months.Results: The QoL scores of PCs showed a decrease in the dimensions "role emotional" and "bodily pain" over 6 months. In multivariate analysis, the main determinants of QoL for "role emotional" were the PC's age (p = 0.005), a low perceived burden (p < 0.0001) and a functionally independent patient (p = 0.01), and for "bodily pain" was a low perceived burden (p < 0.0001) and the non-use of hormone therapy during the treatment (p < 0.0001).Conclusion: The main determinants of the QoL of PCs concerned factors inherent to the PC (age and perceived burden) and patient (functional independence)

Identification of resources and skills developed by partners of patients with advanced colon cancer: a qualitative study

National audienceLes aidants familiaux jouent un rôle central auprès des patients présentant un cancer de stade avancé. Parmi les proches susceptibles d’apporter une aide aux personnes malades, les conjoints, en raison des liens qui les unissent et parce qu’ils partagent leur vie quotidienne, sont sans doute les plus confrontés à la maladie. Ils sont également majoritairement désignés comme étant l’aidant principal. L’irruption de la maladie et le besoin d’accompagnement qu’elle nécessite, viennent bouleverser en profondeur les différents équilibres structurant leur quotidien et leur organisation. Ils viennent aussi questionner la nature des relations qu’ils entretiennent, dans une diversité d’espace-temps soumise à une régulation précise et rigoureuse permettant la stabilité des activités sociales de ses membres. L’aide à apporter n’étant jamais entièrement prévisible ni planifiable, les conjoints doivent constamment adapter leurs comportements, modifier leur(s) rôle(s) et leur aide en fonction des évolutions de la maladie, de l’état de santé et du vécu du proche malade. Ils doivent donc apprendre à devenir « compétents » et tenter de tirer parti de combinaisons appropriées de ressources, qu’elles soient internes ou externe au couple. S’interroger, à partir d’une enquête qualitative, sur ces aspects organisationnels et structurels de l’aide apportée par les conjoints nous a semblé important dans cette étude car la nature de ces choix et leurs conséquences peuvent considérablement venir renforcer, ou au contraire affaiblir, le degré d’implication des aidants, leur potentielle reconnaissance vis-à-vis de leur rôle d’accompagnement ainsi que leur propre état de santé et leur qualité de vie. L’objectif de notre analyse était donc d'identifier les compétences mobilisées, développées ou réactualisés par les conjoints de patients présentant un cancer du côlon, ainsi que les ressources associées dans lesquelles ils choisissent ou non de puiser

Long-term quality of life and sexual function of elderly people with endometrial or ovarian cancer

International audienceBackground: With the growing number of older endometrial cancer (EC) and ovarian cancer (OC) survivors, data on long-term health-related quality of life (HRQoL) became an important issue in the management of older patients. So, the aim of this study was to describe and compare according to age long-term HRQoL, sexual function, and social deprivation of adults with either EC or OC. Methods: A cross-sectional study was set up using data from the Côte d’Or gynecological cancer registry. A series of questionnaires assessing HRQoL (SF-12), sexual function (FSFI), anxiety/depression (HADS), social support (SSQ6) and deprivation (EPICES) were offered to women with EC or OC diagnosed between 2006 and 2013. HRQoL, sexual function, anxiety/depression, social support and deprivation scores were generated and compared according to age (< 70 years and ≥ 70 years). Results: A total of 145 women with EC (N = 103) and OC (N = 42) participated in this study. Fifty-six percent and 38% of EC and OC survivors respectively were aged 70 and over. Treatment did not differ according to age either in OC or EC. The deprivation level did not differ between older and younger survivors with OC while older survivors with EC were more precarious. The physical HRQoL was more altered in older EC survivors. This deterioration concerned only physical functioning (MD = 24, p = 0.012) for OC survivors while it concerned physical functioning (MD = 30, p < 0.0001), role physical (MD = 22, p = 0.001) and bodily pain (MD = 21, p = 0.001) for EC survivors. Global health (MD = 11, p = 0.011) and role emotional (MD = 12, p = 0.018) were also deteriorated in elderly EC survivors. Sexual function was deteriorated regardless of age and cancer location with a more pronounced deterioration in elderly EC survivors for desire (p = 0.005), arousal (p = 0.015) and orgasm (p = 0.007). Social support, anxiety and depression were not affected by age regardless of location. Conclusion: An average 6 years after diagnosis, the impact of cancer on HRQoL is greatest in elderly survivors with either EC or OC