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Lucchi E, Berger F, Milder M, Commer JM, Morin S, Capodano G, Thomaso M, Fogliarini A, Bremaud N, Henry A, Mastroianni B, Chvetzoff G, Bouleuc C. Palliative Care Interventions and End-of-Life Care for Patients with Metastatic Breast Cancer: A Multicentre Analysis. Oncologist 2024; 29:e708-e715. [PMID: 38387031 PMCID: PMC11067792 DOI: 10.1093/oncolo/oyae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The aim of this study was to describe the implementation of integrated palliative care (PC) and the intensity of care in the last 3 months before death for patients with metastatic breast cancer. MATERIALS AND METHODS We conducted a multicentric study of all adult patients with metastatic breast cancer who died over a 4-month period. Complete data were collected and checked from clinical records, including PC interventions and criteria regarding EOL care aggressiveness. RESULTS A total of 340 decedent patients from 12 comprehensive cancer centres in France were included in the study. Sixty-five percent met the PC team with a median time of 39 days between the first intervention and death. In the last month before death, 11.5% received chemotherapy, the frequency of admission to intensive care unit was 2.4%, and 83% experienced acute hospitalization. The place of death was home for 16.7%, hospitalization for 63.3%, PC unit for 20%. Univariate and multivariate analyses showed factors independently associated with a higher frequency of chemotherapy in the last month before death: having a dependent person at home, meeting for the first time with a PC team < 30 days before death, and time between the first metastasis and death below the median. CONCLUSION PC team integration was frequent and late for patients with metastatic breast cancer. However, PC intervention > 30 days is associated with less chemotherapy in the last month before death. Further studies are needed to better understand how to implement a more effective mode of PC integration for patients with metastatic breast cancer.
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Affiliation(s)
- Elisabeth Lucchi
- Supportive and Palliative Care Department, Institut Curie, Paris, France
| | | | - Maude Milder
- Biostatistics Department, Institut Curie, Paris, France
| | - Jean-Marie Commer
- Supportive and Palliative Care Department, Institut de Cancerologie de Loire, Anger, France
| | - Sophie Morin
- Supportive and Palliative Care Department, Institut Bergonie, Paris, France
| | - Geraldine Capodano
- Supportive and Palliative Care Department, Institut Paoli-Calmette, Marseille, France
| | - Muriel Thomaso
- Supportive and Palliative Care Department, Institut de Cancerologie de Montpellier, Montpellier, France
| | - Anne Fogliarini
- Supportive and Palliative Care Department, Centre Lacassagne, Nice, France
| | - Nathalie Bremaud
- Supportive and Palliative Care Department, Centre Georges François Leclerc, Dijon, France
| | - Aline Henry
- Supportive and Palliative Care Department, Centre Alexis Vautrin, Nancy, France
| | | | - Gisele Chvetzoff
- Supportive and Palliative Care Department, Centre Léon Berard, Lyon, France
| | - Carole Bouleuc
- Supportive and Palliative Care Department, Institut Curie, Paris, France
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Chvetzoff G, Girodet M, Despax J, Baudry V, Duranti J, Mastroianni B, Vanacker H, Vinceneux A, Brahmi M, Renard O, Gautier J, Britel M, Ducimetière F, Anota A, Cassier P, Christophe V. Reasons for acceptance and refusal of early palliative care in patients included in early-phase clinical trials in a regional comprehensive cancer centre in France: protocol for a qualitative study. BMJ Open 2022; 12:e060317. [PMID: 35459679 PMCID: PMC9036432 DOI: 10.1136/bmjopen-2021-060317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A few studies have highlighted the potential synergy between early palliative care and inclusion in an early-phase clinical trial that may improve quality of life, reduce symptoms of exhaustion related to the side effects of treatment and allow patients to complete their treatment protocol. The primary objective of this qualitative study is to evaluate the reasons for acceptance or refusal of early palliative care in patients included in early-phase clinical trials. METHOD AND ANALYSIS All patients from the Centre Léon Bérard (Comprehensive Cancer Centre in Lyon, France) who consent to one of the early-phase clinical trials proposed at the centre will be invited to participate in this study. The cohort will consist of a subgroup (n=20) of patients who accept palliative care together with their clinical trial, and a second subgroup (n=20) of patients who decline it. Patients will be interviewed in exploratory interviews conducted by a psychology researcher before the start of their clinical trial. The interviews will be audio-recorded. Patients will also be asked to complete quality of life and anxiety/depression questionnaires both before the beginning of the treatment and at the end of their clinical trial. The content of the interviews will be analysed thematically. Descriptive and comparative statistical analysis of both cohorts will also be conducted. ETHICS AND DISSEMINATION Personal data will be collected and processed in accordance with the laws and regulations in force. All patients will give informed consent to participate. This study complies with reference methodology MR004 of the Commission Nationale de l'Informatique et des Libertés. The protocol has received the validation of an ethics committee (Groupe de Réflexion Ethique du CLB, number: 2020-006). The results will be disseminated through conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT04717440.
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Affiliation(s)
- Gisele Chvetzoff
- Department of Oncology Patient Support Care, Centre Léon Bérard, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Universite Claude Bernard Lyon 1, Lyon, France
| | - Magali Girodet
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Universite Claude Bernard Lyon 1, Lyon, France
- Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
| | - Johanna Despax
- Sciences Humaines et Sociales, Centre Léon Bérard, Lyon, France
| | - Valentine Baudry
- Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
| | - Julie Duranti
- Department of Oncology Patient Support Care, Centre Léon Bérard, Lyon, France
| | | | - Hélène Vanacker
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Olivier Renard
- Department of Oncology Patient Support Care, Centre Léon Bérard, Lyon, France
| | - Julien Gautier
- Clinical Research and Innovation Department, Centre Léon Bérard, Lyon, France
| | - Manon Britel
- Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
| | | | - Amélie Anota
- Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
- Clinical Research and Innovation Department, Centre Léon Bérard, Lyon, France
| | - Philippe Cassier
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Véronique Christophe
- Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
- CNRS, UMR 9193, SCALab Cognitives and Affectives Sciences, University of Lille, Lille, France
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Couillet A, Mastroianni B, Hailloud J, Le Bris MP, Chvetzoff G. Méditation de pleine conscience pour les patients en oncologie : adapter la pratique en temps de pandémie. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Des ateliers de méditation ont été proposés aux patients, nous en avons étudié la faisabilité pendant les soins oncologiques. Ils ont été adaptés du fait de la Covid-19 : une session a eu lieu en présentiel, la suivante en distanciel. Les données ont été analysées de manière rétrospective. Une analyse mixte a été menée : le volet quantitatif a évalué la participation aux ateliers, les caractéristiques des patients et l’impact des ateliers, le volet qualitatif s’est concentré sur l’appropriation de cet outil par les patients. Concernant la faisabilité, 66,7 % des patients ont terminé le programme, il n’y avait pas de différence dans la participation en présentiel et en distanciel. Nous retrouvons une amélioration des compétences de pleine conscience, une diminution de l’anxiété et des douleurs physiques, une aggravation des nausées. La méditation semble être un outil intéressant pour les patients pendant leurs soins en oncologie, en présentiel et en distanciel.
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Bouleuc C, Savignoni A, Chevrier M, Renault-Tessier E, Burnod A, Chvetzoff G, Poulain P, Copel L, Cottu P, Pierga JY, Brédart A, Dolbeault S. A Question Prompt List for Advanced Cancer Patients Promoting Advance Care Planning: A French Randomized Trial. J Pain Symptom Manage 2021; 61:331-341.e8. [PMID: 32739563 DOI: 10.1016/j.jpainsymman.2020.07.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 12/18/2022]
Abstract
CONTEXT 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.
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Affiliation(s)
- Carole Bouleuc
- Supportive Care Department, Institut Curie, Palliative Care Unit, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France.
| | - Alexia Savignoni
- Clinical Research Department, Institut Curie, Biometric Unit, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France
| | - Marion Chevrier
- Clinical Research Department, Institut Curie, Biometric Unit, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France
| | - Evelyne Renault-Tessier
- Supportive Care Department, Institut Curie, Palliative Care Unit, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France
| | - Alexis Burnod
- Supportive Care Department, Institut Curie, Palliative Care Unit, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France
| | | | - Phillipe Poulain
- Palliative Care Department, Polyclinique de l'Ormeau, Tarbes, France
| | - Laure Copel
- Palliative Care Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Paul Cottu
- Medical Oncology Department, Institut Curie, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France
| | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France
| | - Anne Brédart
- Institut Curie, Psycho-Oncology Unit, Paris, France; Institute of Psychology, Paris Descartes University, Boulogne-Billancourt, France
| | - Sylvie Dolbeault
- Institut Curie, Psycho-Oncology Unit, Paris, France; CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif, France
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Heudel P, Chabaud S, Perol D, Flechon A, Fayette J, Combemale P, Tredan O, Desseigne F, de la Fouchardiere C, Boyle H, Perol M, Bachelot T, Cassier P, Avrillon V, Terret C, Michallet AS, Neidhardt-Berard EM, Nicolas-Virelizier E, Dufresne A, Belhabri A, Brahmi M, Lebras L, Nicolini F, Sarabi M, Rey P, Bonneville-Levard A, Rochefort P, Provensal AM, Eberst L, Assaad S, Swalduz A, Saintigny P, Toussaint P, Guillermin Y, Castets M, Coutzac C, Meeus P, Dupré A, Durand T, Crochet H, Fervers B, Gomez F, Rivoire M, Gregoire V, Claude L, Chassagne-Clement C, Pilleul F, Mognetti T, Russias B, Soubirou JL, Lasset C, Chvetzoff G, Mehlen P, Beaupère S, Zrounba P, Ray-Coquard I, Blay JY. Immune checkpoint inhibitor treatment of a first cancer is associated with a decreased incidence of second primary cancer. ESMO Open 2021; 6:100044. [PMID: 33516148 PMCID: PMC7844579 DOI: 10.1016/j.esmoop.2020.100044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background Second primary cancers (SPCs) are diagnosed in over 5% of patients after a first primary cancer (FPC). We explore here the impact of immune checkpoint inhibitors (ICIs) given for an FPC on the risk of SPC in different age groups, cancer types and treatments. Patients and methods The files of the 46 829 patients diagnosed with an FPC in the Centre Léon Bérard from 2013 to 2018 were analyzed. Structured data were extracted and electronic patient records were screened using a natural language processing tool, with validation using manual screening of 2818 files of patients. Univariate and multivariate analyses of the incidence of SPC according to patient characteristics and treatment were conducted. Results Among the 46 829 patients, 1830 (3.9%) had a diagnosis of SPC with a median interval of 11.1 months (range 0-78 months); 18 128 (38.7%) received cytotoxic chemotherapy (CC) and 1163 (2.5%) received ICIs for the treatment of the FPC in this period. SPCs were observed in 7/1163 (0.6%) patients who had received ICIs for their FPC versus 437/16 997 (2.6%) patients receiving CC and no ICIs for the FPC versus 1386/28 669 (4.8%) for patients receiving neither CC nor ICIs for the FPC. This reduction was observed at all ages and for all histotypes analyzed. Treatment with ICIs and/or CC for the FPC are associated with a reduced risk of SPC in multivariate analysis. Conclusion Immunotherapy with ICIs alone and in combination with CC was found to be associated with a reduced incidence of SPC for all ages and cancer types. From 2013 to 2018, 3.9% of the 46 829 patients diagnosed with a first cancer presented with an SPC. Treatment of the first cancer with ICIs was associated with a major reduction of SPC. CC given for an FPC was also associated with a lower magnitude of reduction of SPC. There were no SPC in cancer patients treated with ICIs in the localized phase of their first cancer.
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Affiliation(s)
- P Heudel
- Centre Léon Bérard, Lyon, France
| | | | - D Perol
- Centre Léon Bérard, Lyon, France
| | | | | | | | - O Tredan
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | | | - H Boyle
- Centre Léon Bérard, Lyon, France
| | - M Perol
- Centre Léon Bérard, Lyon, France
| | - T Bachelot
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | | | - C Terret
- Centre Léon Bérard, Lyon, France
| | | | | | | | - A Dufresne
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | - M Brahmi
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - L Lebras
- Centre Léon Bérard, Lyon, France
| | - F Nicolini
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - M Sarabi
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - P Rey
- Centre Léon Bérard, Lyon, France
| | | | | | | | - L Eberst
- Centre Léon Bérard, Lyon, France
| | - S Assaad
- Centre Léon Bérard, Lyon, France
| | | | - P Saintigny
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | | | - M Castets
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - C Coutzac
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - P Meeus
- Centre Léon Bérard, Lyon, France
| | - A Dupré
- Centre Léon Bérard, Lyon, France
| | - T Durand
- Centre Léon Bérard, Lyon, France
| | | | | | - F Gomez
- Centre Léon Bérard, Lyon, France
| | - M Rivoire
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | - L Claude
- Centre Léon Bérard, Lyon, France
| | | | - F Pilleul
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | | | | | - C Lasset
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | - P Mehlen
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - S Beaupère
- Centre Léon Bérard, Lyon, France; Unicancer, Paris, France
| | | | - I Ray-Coquard
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - J-Y Blay
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France; Unicancer, Paris, France.
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Daubié S, Pilleul F, Thivolet A, Kalenderian AC, Cuinet M, Ricoeur A, Schiffler C, Bouhamama A, Chvetzoff G, Mastier C. Cryoneurolysis in Patients with Dorsal Neuropathic Pain Secondary to Tumor Invasion. J Vasc Interv Radiol 2020; 31:917-924. [PMID: 32376175 DOI: 10.1016/j.jvir.2020.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 12/26/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of cryoneurolysis (CNL) in patients with refractory thoracic neuropathic pain related to tumor invasion. MATERIALS AND METHODS Between January 2013 and May 2017, this single-center and retrospective study reviewed 27 computed tomography-guided CNLs performed on 26 patients for refractory thoracic neuropathic pain related to tumor invasion. Patients with cognitive impairment were excluded. Pain levels were recorded on a visual analog scale (VAS) before the procedure, on days 1, 7, 14, 28 and at each subsequent follow-up appointment. CNL was clinically successful if the postprocedural VAS decreased by 3 points or more. To determine the duration of clinical success, the end of pain relief was defined as either an increased VAS of 2 or more points, the introduction of a new analgesic treatment, a death with controlled pain, or for lost to follow-up patients, the latest follow-up appointment date with controlled pain. RESULTS Technical success rate was 96.7% and clinical success rate was 100%. Mean preprocedural pain score was 6.4 ± 1.7 and decreased to 2.4 ± 2.4 at day 1; 1.8 ± 1.7 at day 7 (P < .001); 3.3 ± 2.5 at day 14; 3.4 ± 2.6 at day 28 (P < .05). The median duration of pain relief was 45 days (range 14-70). Two minor complications occurred. CONCLUSIONS Cryoneurolysis is a safe procedure that significantly decreased pain scores in patients with thoracic neuropathic pain related to tumor invasion, with a median duration of clinical success of 45 days.
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Affiliation(s)
- Sophie Daubié
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France.
| | - Frank Pilleul
- CREATIS, UMR CNRS (Unités Mixtes de Recherche Centre National de Recherche Scientifique) 5220 - INSERM 1206, Lyon, France
| | - Arnaud Thivolet
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | | | - Marie Cuinet
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Alexis Ricoeur
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Camille Schiffler
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Amine Bouhamama
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Gisele Chvetzoff
- DISSPO (Département des Soins de Support du Patient en Oncologie), Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Charles Mastier
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
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7
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Heudel P, Durand T, Fervers B, Gomez F, Rivoire M, Bachelot T, Claude L, Chassagne-Clement C, Pilleul F, Mognetti T, Devaux Y, Soubirou JL, Lasset C, Perol D, Chvetzoff G, Pezet C, Beaupere S, Zrounba P, Blay JY. Data-mining of 110 172 electronic patient records with the ConSoRe tool: An analysis of second primary cancer in a comprehensive cancer center. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy294.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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Poulain P, Berleur MP, Lefki S, Lefebvre Kunt D, Serra E, Chvetzoff G, Derniaux A, Tremellat F, Filbet M, Simon A, Dang Vu B, Guillaume C. Efficacy and safety of methadone in the treatment of pain in palliative care patients with cancer: The EQUIMETH2 national, randomized, open, phase III study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.26_suppl.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
212 Background: Methadone is used more and more as a second-line treatment for refractory cancer pain in palliative care patients. Methods: The study aimed to compare the effect of two methadone titration methods (Stop and Go vs progressive titration) in 146 palliative care cancer patients with pain inadequately relieved or intolerant to level 3 opioids. The primary endpoint was the rate of success/failure at Day 4 defined by pain relief (reduction of at least two points of the numerical scale (0 - 10) AND a pain score < 5 for 2 consecutive days) AND no overdose (Rudkin scale ≥ 3 AND respiratory rate < 8/min). Results: Pain was nociceptive in 16% and mixed in 84%. 85% of the patients had breakthrough pain. Half received oxycodone, 1/5 fentanyl, 1/5 morphine and < 10% hydromorphone. Reasons for switching were lack of efficacy isolated (56%), or with intolerance to previous opioid (38%). More than 2/3 of the patients reached a pain score < 5 for two days at D4, adequate pain relief was obtained in 80% of the patients (median of 3 days in both groups (p = 0.12)) and lasted until D56. The rate of success/failure was about 40% at D4 with no difference between the two methods. Overdoses defined as respiratory rate < 8/min were observed in 13.2% patients throughout the study with no difference between groups. 9 required naloxone. The two methods were equally considered easy by about 60% of the clinicians. Conclusions: Methadone is an effective and sustainable second-line alternative opioid in the treatment of cancer pain in palliative care patients inadequately relieved or intolerant to level 3 opioids. The two methods of titration of methadone are comparable in terms of efficacy, safety and ease of use.
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Affiliation(s)
| | | | - Shimsi Lefki
- Laboratoires Bouchara Recordati, Puteaux, France
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Richioud B, Beji H, Pechard M, Sindou M, Chvetzoff G. A Spinal Cord Radiofrequency Destruction. J Vasc Interv Radiol 2015. [PMID: 26210241 DOI: 10.1016/j.jvir.2015.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bertrand Richioud
- Department of Radiology, Centre Leon Berard, 28 rue Laennec, Lyon 69008, France.
| | - Hedi Beji
- Department of Radiology, Centre Leon Berard, 28 rue Laennec, Lyon 69008, France
| | - Marie Pechard
- Department of Palliative Care, Centre Leon Berard, 28 rue Laennec, Lyon 69008, France
| | - Marc Sindou
- Department of Neurosurgery, Centre Hospitalo-Universitaire, Lyon, France
| | - Gisele Chvetzoff
- Department of Palliative Care, Centre Leon Berard, 28 rue Laennec, Lyon 69008, France
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10
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Krakowski I, Baylot D, Collin E, Chvetzoff G, Coulouma R, Dixmerias F, Feuvret L, Freyssinet-Durand C, Lauwers-Allot E. 3057 KalinoxTM: an effective and well-tolerated method for pain management during invasive procedures in oncology – results of a randomized study. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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11
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Valette L, Kante V, Arbiol E, Lancry L, Chvetzoff G. 682 PATIENT CONTROLLED ANALGESIA (PCA) FOR AMBULATORY CANCER PATIENTS (PTS): A PROSPECTIVE DESCRIPTIVE STUDY OF 40 PTS. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- L. Valette
- Centre Léon Bérard, Lyon Cedex 8, France
| | - V. Kante
- Centre Léon Bérard, Lyon Cedex 8, France
| | - E. Arbiol
- Centre Léon Bérard, Lyon Cedex 8, France
| | - L. Lancry
- Centre Léon Bérard, Lyon Cedex 8, France
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Tredan O, Chvetzoff G, Bajard A, Pérol D, Rebattu P, Ray-Coquard IL, Bachelot T. Prognostic factors for survival in adult patients (pts) with metastatic cancer (MC) after the first-line chemotherapy. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Chvetzoff G, Pérol D, Rebattu P, Devaux Y, Saltel P. Prospective cohort study of quality of care (QC) and quality of life (QL) of palliative cancer patients in three different situations: In-patient hospitalization (IN), palliative care unit (PA) and home care (HO). Final analysis. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Chvetzoff G, Krakowski I, Rodríguez-Arias D, Hervé C. Directives anticipées, testament de vie, personne de confiance: définitions et revue de la littérature. ONCOLOGIE 2006. [DOI: 10.1007/s10269-006-0571-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Krakowski I, Chvetzoff G. Les soins oncologiques de support: l’essentiel de la cancérologie à domicile... ONCOLOGIE 2006. [DOI: 10.1007/s10269-006-0434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Krakowski I, Theobald S, Balp L, Bonnefoi MP, Chvetzoff G, Collard O, Collin E, Couturier M, Delorme T, Duclos R, Eschalier A, Fergane B, Larue F, Magnet M, Minello C, Navez ML, Richard A, Richard B, Rostaing-Rigattieri S, Rousselot H, Santolaria N, Torloting G, Toussaint S, Vuillemin N, Wagner JP, Fabre N. Summary version of the Standards, Options and Recommendations for the use of analgesia for the treatment of nociceptive pain in adults with cancer (update 2002). Br J Cancer 2003; 89 Suppl 1:S67-72. [PMID: 12915905 PMCID: PMC2753010 DOI: 10.1038/sj.bjc.6601086] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- I Krakowski
- Centre Alexis Vautrin, Vandoeuvre les Nancy, France
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17
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Chvetzoff G, Ray-Coquard I, Dumortier A, Engel C, Mevelec MF, Latour JF, Philip T, Chauvin F. [Huriet law: application in a regional cancer centre (Centre Léon-Bérard, Lyon)]. Bull Cancer 2000; 87:671-9. [PMID: 11038417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Clinical research is one of the main activities in cancer centres and is submitted in France to a specific law (named "loi Huriet") which includes good clinical practices. We are now conducting a general program of quality evaluation and improvement in the regional cancer centre of Lyon (centre Léon-Bérard). Part of this program is an audit of the application of the Huriet law. Since no instrument exist for measuring this application, we have created a specific one, that attribute notation according to the different aspects of the law. Results show a good level of conformity but sometime non sufficient. There is no difference between the two studied years. Quality changes according to promoters (private or academic) and monitoring. Written procedures and specific training for the different actors are required to improve quality of clinical research with focus on the patient interest.
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Affiliation(s)
- G Chvetzoff
- Département de cancérologie médicale, Centre Léon-Bérard, 28, rue Laennec, 69373 Lyon Cedex 08
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Abstract
The management of mucositis is the subject of many controversies, and the optimal treatment is still not known. Several evaluation scoring systems have been described, but no one of these is appropriate to all clinical situations: a simple scale such as that devised by the WHO can be used routinely, and more sophisticated ones can be implemented by trained experimenters working in research. We have considered the impact of each of the treatments currently available on each stage of mucositis. In attempts at prevention, self-care, in the sense of oral hygiene, must remain atraumatic. It is probably advisable to differentiate patients with good previous oral care, in whom tooth brushing is beneficial, from others, in whom the risk of hemorrhage and infection excludes any brushing. Before the dosage of chemotherapy is reduced, the curative or palliative intent of the strategy must be carefully evaluated. In the vascular phase protection of the proliferating cells is attempted by means of vasoconstriction (cryotherapy), cytoprotection (prostaglandin E2 and other antioxidants) or epithelial cell-inhibiting factors such as TGF-B3. Treatments applied in the epithelial phase are directed at increasing the cell proliferation to accelerate epithelial restoration by sucralfate and several growth factors: hematopoietic GF, which has demonstrated a direct effect on the mucosa (GM-CSF), or epithelial growth factors such as keratinocyte GF. In the ulcerative and bacteriological phase attempts are made to attenuate sepsis by means of antiseptics (chlorhexidine), amphotericin B and antiviral agents or antibiotic lozenges. In the healing phase application of the low-energy helium-neon laser has demonstrably been followed by a later time of onset, less pronounced peak severity and shorter duration of oral mucositis. After cancer treatment, oral hygiene, inhibition of oral flora, and pain relief are the main goals. Physiopathogen-specific treatment is the next step, with the emphasis on the inhibition of epithelial cell proliferation during drug exposure and facilitation of epithelial maturation and healing.
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Affiliation(s)
- P Biron
- Centre Léon Bérard, Lyon, France
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Bonnotte B, Gresset AC, Chvetzoff G, Martin F, Lorcerie B, Chauffert B. Efficacy of colchicine alone or in combination with vinca alkaloids in severe corticoid-resistant thrombocytopenic purpura: six cases. Am J Med 1999; 107:645-6. [PMID: 10625040 DOI: 10.1016/s0002-9343(99)00251-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chvetzoff G, Bonnotte B, Chauffert B. [Anticancer chemotherapy. Prevention of toxicity]. Presse Med 1998; 27:2106-12. [PMID: 9893704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
UNLABELLED A MAJOR CHALLENGE: Prevention of short and long term toxicity of chemotherapy is an important challenge in oncology in order to maintain the dose/intensity of protocols and to increase patient comfort. AVAILABLE CHEMOPROTECTORS Amifostine protects against the blood, kidney and nerve toxicity of cisplatin. Protection is less evident for carboplatin and should be further evaluated for alkylating agents, anthracyclines and taxans. Dexrazoxane protects against the cumulative cardiotoxicity of anthracyclines without reduction of antitumor efficacy. It must be used beyond a cumulative dose of 300 mg/m2 doxorubicin (or equivalent) in responsive patients. Its use in the curative treatment of lymphoma should be assessed by further clinical trials. Mesna must be widely used to prevent the urotoxicity of cyclophosphamide and ifosfamide. An oral preparation is now available for outpatients. Protection of the gonadic function could be achieved by LH-FH analogs in young women. PERSPECTIVES Due to their high cost and the risk of diminishing the antitumor efficacy in curable diseases, a precise evaluation of present and future chemoprotectors is necessary before wider use.
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Affiliation(s)
- G Chvetzoff
- Service de Médecine interne, Hôpital du Bocage, CHU de Dijon
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Chauffert B, Bonnotte B, Chvetzoff G, Flesch M. [The major response of metastatic kidney cancer to the combination of oxaliplatin, 5-fluorouracil and folinic acid (FOX-FOL)]. Presse Med 1998; 27:859. [PMID: 9767871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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Bonnotte B, Mercier E, Chvetzoff G, Martin F, Chauffert B, Lorcerie B. Purpura thrombopénique auto-immun réfractaire : ne pas oublier la colchicine ! Rev Med Interne 1998. [DOI: 10.1016/s0248-8663(98)90210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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