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Pallaro S, Bigas M, Leobon S, Baffert KA, Peyramaure C, Dubest L, Venat L, Maillan G, Deluche É. [Administration of anti-HER2 and satisfaction of patients treated for breast cancer]. Bull Cancer 2024; 111:441-451. [PMID: 38480056 DOI: 10.1016/j.bulcan.2024.01.006] [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: 08/30/2023] [Revised: 11/15/2023] [Accepted: 01/01/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Quality of life (QoL) and patient satisfaction are major concerns in oncology. METHODS The aim of this prospective observational study was to evaluate these parameters according to the mode of administration of anti-HER2 (subcutaneous [SC] versus intravenous [IV]), the place of administration (Home Hospitalization or HOD versus hospital) for patients supervised by an advanced practice nurse (APN). RESULTS Between January 2022 and June 2023, 32 patients were included. They were statistically more satisfied with subcutaneous management (P=0.0004), a result explained by the speed of administration (43.5%), comfort during administration (26%) even though some expressed pain on injection and felt less anxiety (26%). Management by the APN seems more appropriate when anti-HER2 drugs were administered in HOD. In HOD, patients perceived an overall improvement in their quality of life, appetite and cognitive abilities, with a reduction in fatigue, pain and depression (P<0.05). However, the rate of outsourcing to HOD remained too low (30.4%), as 56.3% of patients would have liked to be cared for in HOD if they had had the opportunity. CONCLUSION SC administration of anti-HER2 under the supervision of an APN has advantages for the patient, resulting in greatest satisfaction and improved patient QOL, preferably in HOD.
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Affiliation(s)
- Solène Pallaro
- Unité de préparation des anticancéreux, CHU de Limoges, Limoges, France
| | - Marion Bigas
- Service d'oncologie médicale, CHU de Limoges, Limoges, France
| | - Sophie Leobon
- Service d'oncologie médicale, CHU de Limoges, Limoges, France
| | | | | | - Laurence Dubest
- Service d'oncologie médicale, CHU de Limoges, Limoges, France
| | - Laurence Venat
- Service d'oncologie médicale, CHU de Limoges, Limoges, France
| | - Gaëlle Maillan
- Unité de préparation des anticancéreux, CHU de Limoges, Limoges, France
| | - Élise Deluche
- Service d'oncologie médicale, CHU de Limoges, Limoges, France.
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2
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Deluche E, Salle H, Leobon S, Facchini-Joguet T, Fourcade L, Taibi A. ACACIAS 1: The physiological and subjective impacts of high fidelity simulation of the breaking of bad news. J Visc Surg 2023; 160:323-329. [PMID: 37005112 DOI: 10.1016/j.jviscsurg.2023.03.006] [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] [Indexed: 04/03/2023]
Abstract
STUDY OBJECTIVE Breaking bad news (BN) is difficult and necessitates targeted training. To be effective, training may call for High Fidelity Simulation (HFS). This prospective study was conducted to objectively assess the impact of HFS as a tool conducive to the development of clinical competence in situations involving the delivery of bad news. METHODS This feasibility study was conducted from January to May 2021 and included students in medical oncology and digestive surgery. The subjective and objective impacts of HFS were evaluated by means of a self-administered questionnaire and a wristband, Affect-tag, which recorded several indicators: emotional power (EP), emotional density (DE) and cognitive load (CL) in students undergoing training. RESULTS Forty-six (46) students with a median age of 25 years (21-34 years) were included. While the participants were effectively and emotionally involved in the HFS training, they were not completely overwhelmed by their emotions, a possible occurrence in this type of program. After two training programs, the students presented with lower EP (P<0.001) and higher DE (P=0.005), while their CL remained stable (P=0.751). The information given in the self-administered questionnaires and the evaluations by outside professionals (actor, nurse, psychologist…) highlighted improved skills. CONCLUSION Taking into account the emotional parameters observed and the questionnaires collected, HFS can be considered as a suitable and effective tool in the breaking of bad news.
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Affiliation(s)
- E Deluche
- Department of Medical Oncology, Limoges University Hospital, Limoges, France; Digital Health Education Department, Faculty of Medicine, University of Limoges, Limoges, France.
| | - H Salle
- Department of Neurosurgery, Limoges University Hospital, Limoges, France
| | - S Leobon
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | | | - L Fourcade
- Digital Health Education Department, Faculty of Medicine, University of Limoges, Limoges, France; Department of Pediatric Visceral Surgery, Limoges University Hospital, Children's Hospital, Limoges, France
| | - A Taibi
- Department of Digestive, General and Endocrinology Surgery, Limoges University Hospital, Limoges, France
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Pallier K, Prot O, Naldi S, Silva F, Denis T, Giry O, Leobon S, Deluche E, Tubiana-Mathieu N. Patient Identification and Tumor Identification Management: Quality Program in a Cancer Multicentric Clinical Data Warehouse. Cancer Inform 2023; 22:11769351231172609. [PMID: 37223319 PMCID: PMC10201142 DOI: 10.1177/11769351231172609] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/12/2023] [Indexed: 05/25/2023] Open
Abstract
Background The Regional Basis of Solid Tumor (RBST), a clinical data warehouse, centralizes information related to cancer patient care in 5 health establishments in 2 French departments. Purpose To develop algorithms matching heterogeneous data to "real" patients and "real" tumors with respect to patient identification (PI) and tumor identification (TI). Methods A graph database programed in java Neo4j was used to build the RBST with data from ~20 000 patients. The PI algorithm using the Levenshtein distance was based on the regulatory criteria identifying a patient. A TI algorithm was built on 6 characteristics: tumor location and laterality, date of diagnosis, histology, primary and metastatic status. Given the heterogeneous nature and semantics of the collected data, the creation of repositories (organ, synonym, and histology repositories) was required. The TI algorithm used the Dice coefficient to match tumors. Results Patients matched if there was complete agreement of the given name, surname, sex, and date/month/year of birth. These parameters were assigned weights of 28%, 28%, 21%, and 23% (with 18% for year, 2.5% for month, and 2.5% for day), respectively. The algorithm had a sensitivity of 99.69% (95% confidence interval [CI] [98.89%, 99.96%]) and a specificity of 100% (95% CI [99.72%, 100%]). The TI algorithm used repositories, weights were assigned to the diagnosis date and associated organ (37.5% and 37.5%, respectively), laterality (16%) histology (5%), and metastatic status (4%). This algorithm had a sensitivity of 71% (95% CI [62.68%, 78.25%]) and a specificity of 100% (95% CI [94.31%, 100%]). Conclusion The RBST encompasses 2 quality controls: PI and TI. It facilitates the implementation of transversal structuring and assessments of the performance of the provided care.
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Affiliation(s)
- Karine Pallier
- Centre de Coordination en Cancérologie
de la Haute-Vienne - 3C87, CHU de Limoges, Limoges, France
| | - Olivier Prot
- Univ. Limoges, CNRS, XLIM, UMR 7252,
Limoges, France
| | - Simone Naldi
- Univ. Limoges, CNRS, XLIM, UMR 7252,
Limoges, France
| | | | - Thierry Denis
- Département Exploitation Réseaux et
Infrastructures - DSI, CHU Limoges, Limoges, France
| | - Olivier Giry
- Département Exploitation Réseaux et
Infrastructures - DSI, CHU Limoges, Limoges, France
| | - Sophie Leobon
- Department of oncology, CHU de Limoges,
Limoges, France
| | - Elise Deluche
- Department of oncology, CHU de Limoges,
Limoges, France
| | - Nicole Tubiana-Mathieu
- Centre de Coordination en Cancérologie
de la Haute-Vienne - 3C87, CHU de Limoges, Limoges, France
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4
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Naessens C, Laloze J, Leobon S, Gauthier T, Lacorre A, Monteil J, Venat L, Deluche E. Physician compliance with multidisciplinary tumor board recommendations for managing gynecological cancers. Future Oncol 2023; 19:897-908. [PMID: 37232140 DOI: 10.2217/fon-2022-1183] [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] [Indexed: 05/27/2023] Open
Abstract
Aims: Evaluation of compliance with gynecological multidisciplinary tumor board (MTB) recommendations and its impact. Patients & methods: All patient records discussed in our MTB from 2018 to 2020 were analyzed. Results: We analyzed 437 MTB recommendations concerning 166 patients. Each patient was discussed an average of 2.6 (1.0-4.2) times. Of the 789 decisions, the decision was not followed 102 times (12.9%), corresponding to 85 MTB meetings (19.5%). Of these, 72 recommendations concerned therapeutic changes (70.5%), and 30 concerned non-therapeutic changes (29.5%). Of these 85 MTB decisions, 60 (71%) led to a new MTB submission. Noncompliance with MTB decisions decreased the overall survival (46 vs 138 months; p = 0.003). Conclusion: Improving compliance with MTB decisions is crucial to enhance patient outcomes.
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Affiliation(s)
- Clara Naessens
- Radiation Therapy Department, Limoges University Hospital, Limoges, 87000, France
| | - Jerome Laloze
- Reconstructive Surgery Department, Limoges University Hospital, Limoges, 87000, France
| | - Sophie Leobon
- Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France
| | - Tristan Gauthier
- Gynecological Department, Limoges University Hospital, Limoges, 87000, France
| | - Aymeline Lacorre
- Gynecological Department, Limoges University Hospital, Limoges, 87000, France
| | - Jacques Monteil
- Nuclear Medicine Department, Limoges University Hospital, Limoges, 87000, France
| | - Laurence Venat
- Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France
| | - Elise Deluche
- Medical Oncology Department, Limoges University Hospital, Limoges, 87000, France
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Zouhry Y, Taibi A, Durand-Fontanier S, Darbas T, Forestier G, Monteil J, Lebrun-Ly V, Fayemendy P, Leobon S, Jesus P, Deluche E. Degradation of skeletal mass in locally advanced oesophageal cancer between initial diagnosis and recurrence. BMC Cancer 2021; 21:1313. [PMID: 34876055 PMCID: PMC8653570 DOI: 10.1186/s12885-021-09037-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/29/2021] [Accepted: 11/19/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The prognostic value of a low skeletal mass index (SMI) has been investigated in locally advanced oesophageal (LAE) cancer at diagnosis. However, nothing is known about its evolution and clinical impact between initial diagnosis and recurrence. METHODS A total of 89 patients treated for LAE cancer between January 2009 and December 2019 were included in this study. Computed tomography (CT) scans before treatment and at recurrence were evaluated. SMI and other body composition parameters were analysed by the L3 scan method. RESULTS Participants were aged 66.0 (36.0-86) years. The incidence of low SMI increased by 12.3% between diagnosis and recurrence (70.7% vs. 83.0%, respectively) over a median follow-up of 16.9 (1.7-101.6) months. Patients with high SMI at diagnosis showed loss of muscle mass (58.0 vs. 55.2 cm2/m2, respectively; P < 0.001) and decreased body mass index (BMI) (27.9 vs. 26.3 kg/m2, respectively; P = 0.05), but fat mass was increased (68.9 vs. 72.0 cm2/m2, respectively; P = 0.01). Patients with low SMI at diagnosis showed no significant changes in body composition parameters and no improvement of SMI, even with nutritional support. Low SMI (hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.02-3.16) was an independent predictor (P = 0.041) of high nutritional risk index (HR: 1.79; 95% CI: 1.03-3.11; P = 0.039) at diagnosis. CONCLUSIONS The percentage of patients with a low SMI increased during follow-up. Our data suggest that an assessment of skeletal muscle parameters and nutrition support may be more useful in patients with a high SMI.
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Affiliation(s)
- Yacine Zouhry
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Abdelkader Taibi
- Digestive Surgery Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Sylvaine Durand-Fontanier
- Digestive Surgery Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Tiffany Darbas
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Geraud Forestier
- Neuroradiology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Jacques Monteil
- Nuclear Medicine Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Valérie Lebrun-Ly
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Philippe Fayemendy
- Nutrition Unit, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France.,Tropical Neuroepidemiology Institute GEIST, INSERM, U1094, 33 rue François Mitterrand, 87032, Limoges, France
| | - Sophie Leobon
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Pierre Jesus
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Elise Deluche
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France.
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6
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Darbas T, Forestier G, Leobon S, Pestre J, Jesus P, Lachatre D, Tubiana-Mathieu N, Descazeaud A, Deluche E. Impact of Body Composition in Overweight and Obese Patients With Localised Renal Cell Carcinoma. In Vivo 2021; 34:2873-2881. [PMID: 32871827 DOI: 10.21873/invivo.12115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND/AIM To investigate the impact of body composition on morbidity and mortality at the initial diagnosis of localised renal cell carcinoma (RCC) in patients with overweight or obesity. PATIENTS AND METHODS Sarcopenia was defined using sex-specific cut-off points and other body composition parameters by median values with computed tomography imaging. RESULTS Among the 96 patients, 40 had sarcopenia (43.0%) at diagnosis. Body composition had no effect on morbidity and 5-year disease-free survival contrary to the classic factors (p<0.05). In the subgroup of obese patients, those with sarcopenia had a poor prognosis (p=0.04) but not in the population with overweight (p=0.9). CONCLUSION Sarcopenia was frequently associated with localised RCC at the initial diagnosis. Body composition did not affect morbidity or outcomes. BMI was involved in morbidity and there was paradoxically longer survival in the obesity group.
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Affiliation(s)
- Tiffany Darbas
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Geraud Forestier
- Department of Radiology, Limoges University Hospital, Limoges, France
| | - Sophie Leobon
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Julia Pestre
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Pierre Jesus
- Nutrition Unit, Limoges University Hospital, Limoges, France
| | - Denis Lachatre
- Department of Radiology, Limoges University Hospital, Limoges, France
| | | | | | - Elise Deluche
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
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7
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Monteil J, Le Brun-Ly V, Cachin F, Zasadny X, Seitz JF, Mundler O, Selvy M, Smith D, Rullier E, Lavau-Denes S, Lades G, Labrunie A, Lecaille C, Valli N, Leobon S, Terrebonne E, Deluche E, Tubiana-Mathieu N. Comparison of 18FDG-PET/CT and conventional follow-up methods in colorectal cancer: A randomised prospective study. Dig Liver Dis 2021; 53:231-237. [PMID: 33153929 DOI: 10.1016/j.dld.2020.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND A surveillance program was performed in colorectal cancer (CRC) patients after surgery, to diagnose asymptomatic recurrence. AIMS To assess whether 18-FDG positron emission tomography/CT (PET/CT) improved the detection of recurrence during a 3-year follow-up. METHODS A multicentre, two-arm randomised prospective trial comparing different 36-month follow-up strategies. Complete colonoscopy was performed at baseline and after 3 years and clinical exams with imaging every 3 months. The conventional arm (A) received carcinoembryonic antigen, liver echography, and alternated between lung radiography and computed tomography (CT) scans. The experimental arm (B) received PET/CT. RESULTS A total of 365 patients with colon (79.4%) or rectal cancer (20.6%), stages II (48.2%) or III (50.8%), were enroled in this study. At 36 months, intention-to-treat analysis revealed recurrence in 31 (17.2%) patients in arm A and 47 (25.4%) in arm B (p = 0.063). At 3 years, 7 of 31 relapses (22.5%) in arm A were surgically treated with curative intent, compared to 17 of 47 (36.2%) in arm B (p = 0.25). The rates of recurrence and new cancers were higher in arm B than arm A (p = 0.038). CONCLUSIONS PET/CT follow-up every 6 months did not increase the rate of recurrence at 3 years or the rate of surgically treated recurrence compared with conventional follow-up.
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Affiliation(s)
- Jacques Monteil
- Department of Nuclear Medicine, University Hospital, Limoges, France
| | | | - Florent Cachin
- Department of Nuclear Medicine, Jean Perrin Cancer Institute, Clermont-Ferrand, France
| | - Xavier Zasadny
- Department of Radiotherapy, François Chénieux Clinic, Limoges, France
| | - Jean-François Seitz
- Department of Oncology and Hepato-Gastroenterology, University Hospital La Timone, Marseille, France
| | - Olivier Mundler
- Department of Nuclear Medicine, University Hospital La Timone, Marseille, France
| | - Marie Selvy
- Department of Digestive Surgery and Oncology, Estaing Hospital, Clermont-Ferrand, France
| | - Denis Smith
- Department of Digestive Oncology, University Hospital Saint André, Bordeaux, France
| | - Eric Rullier
- Department of Digestive Surgery, University Hospital Saint André, Bordeaux, France
| | | | - Guillaume Lades
- Department of Nuclear Medicine, University Hospital, Limoges, France
| | - Anais Labrunie
- Department of Biostatistics and Clinical Research, University Hospital, Limoges, France
| | - Cedric Lecaille
- Department of Gastroenterology and Digestive Oncology, Bordeaux Nord Polyclinic, Bordeaux, France
| | - Nathalie Valli
- Department of Nuclear Medicine, Bordeaux Nord Polyclinic, Bordeaux, France
| | - Sophie Leobon
- Department of Medical Oncology, University Hospital, Limoges, France
| | - Eric Terrebonne
- Department of Gastroenterology and Digestive Oncology, University Hospital Haut-Lévêque, Bordeaux, France
| | - Elise Deluche
- Department of Medical Oncology, University Hospital, Limoges, France.
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8
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Baffert KA, Darbas T, Lebrun-Ly V, Pestre-Munier J, Peyramaure C, Descours C, Mondoly M, Latrouite S, Bignon E, Nicouleau S, Geyl S, Leobon S, Deluche E. Quality of Life of Patients With Cancer During the COVID-19 Pandemic. In Vivo 2021; 35:663-670. [PMID: 33402524 DOI: 10.21873/invivo.12306] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The COVID-19 pandemic has changed the organisation of medical care. PATIENTS AND METHODS This is the first prospective observational study on patient-reported outcomes, quality of life (HRQOL) and satisfaction in patients with cancer with their care management in a day hospital during the period of May-June 2020. The Generalised Anxiety Disorder Screener and 12-Item Short-Form Health Survey were used. RESULTS The survey was completed by 189 of 267 patients. They were generally aged 61 to 70 years and women and presented with lung, breast, or colorectal cancer. Patients had low anxiety scores (mean: 3.2±4.5), with only 11.1% showing anxiety. Risk factors of anxiety included female gender (p=0.03) and lifestyle (residence, family environment) (p=0.01). The patient's physical health was stable, whereas mental health had deteriorated (p<0.0001). Risk factors of altered HRQOL included age and lifestyle. Patients greatly appreciated all the facilities of the day hospital and its organisation. CONCLUSION This study shows a preserved HRQOL and low anxiety of patients with cancer during the COVID-19 pandemic.
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Affiliation(s)
| | - Tiffany Darbas
- Department of Medical Oncology, University Hospital, Limoges, France
| | - Valerie Lebrun-Ly
- Department of Medical Oncology, University Hospital, Limoges, France
| | | | | | | | - Melanie Mondoly
- Department of Medical Oncology, University Hospital, Limoges, France
| | - Simon Latrouite
- Department of Medical Oncology, University Hospital, Limoges, France
| | - Elisa Bignon
- Department of Medical Oncology, University Hospital, Limoges, France
| | | | - Sophie Geyl
- Department of Medical Oncology, University Hospital, Limoges, France
| | - Sophie Leobon
- Department of Medical Oncology, University Hospital, Limoges, France
| | - Elise Deluche
- Department of Medical Oncology, University Hospital, Limoges, France
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9
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Vincent F, Deluche E, Bonis J, Leobon S, Antonini MT, Laval C, Favard F, Dobbels E, Lavau-Denes S, Labrunie A, Thuillier F, Venat L, Tubiana-Mathieu N. Home-Based Physical Activity in Patients With Breast Cancer: During and/or After Chemotherapy? Impact on Cardiorespiratory Fitness. A 3-Arm Randomized Controlled Trial (APAC). Integr Cancer Ther 2020; 19:1534735420969818. [PMID: 33228382 PMCID: PMC7691904 DOI: 10.1177/1534735420969818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 11/26/2022] Open
Abstract
Objectives: Physical activity (PA) programs are recommended for breast cancer care.
However, their modalities remain to be discussed. This study determined the
best time to begin a personalized or adapted program based on
cardiopulmonary exercise test function. This randomized controlled trial
evaluated the effect of home-based adapted PA (APA) performed during or
after treatment on cardiorespiratory fitness (CRF) at 12 months. Method: The primary endpoint was the peak oxygen consumption (VO2peak) at
12 months (group A vs C and B vs C). Secondary endpoints included the
6-minute walking test, assessment of muscle strength, fatigue, quality of
life, anxiety, and depression, and a questionnaire on PA levels. All tests
were evaluated at baseline and at 6 and 12 months. A total of 94 patients
with breast cancer were randomized to 3 different groups: group A,
performing 6 months of APA during adjuvant care; group B, 6 months of APA
after adjuvant care; and group C, 12 months of APA during and after specific
care. The program combined 1 resistance session and 2 aerobic sessions per
week. Analysis of variance was used for repeated measures, Student’s
t-test or the Mann–Whitney U-test for
continuous variables, and χ2 test for binary or categorical
variables. Results: The study assessed 81 participants at 6 months and 73 at 12 months. The
majority of patients completed more than 85% of the exercise sessions. The
baseline for VO2peak and secondary outcomes did not differ among
the groups. VO2peak increased during the exercise period and
decreased during the chemotherapy period without APA, but at 12 months no
significant difference was observed. The same variation was observed in the
6-minute walking test, with significance at 6 months between A+C versus B
(P = .04), but no difference among the groups at
12 months. In the 3 groups, no decreases in other studied parameters were
noted, except at 6 months in group B without APA. Conclusion: Home-based APA in breast cancer patients has a positive effect on CRF and
physical functions, with no differences based on the timing of this program
based on specific cancer treatment. Trial Registration: ClinicalTrials.gouv.fr (NCT01795612). Registered 20 February
2013.
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Affiliation(s)
- François Vincent
- Department of Physiology, University Hospital, Limoges, France.,Faculty of Medicine, University of Limoges, Limoges, France
| | - Elise Deluche
- Faculty of Medicine, University of Limoges, Limoges, France.,Department of Medical Oncology, University Hospital, Limoges, France
| | - Joëlle Bonis
- Faculty of Medicine, University of Limoges, Limoges, France
| | - Sophie Leobon
- Department of Biostatistics and Clinical Research, University Hospital, Limoges, France
| | | | - Caroline Laval
- Department of Physiology, University Hospital, Limoges, France.,Faculty of Medicine, University of Limoges, Limoges, France
| | - Florent Favard
- Department of Physiology, University Hospital, Limoges, France
| | - Eloïse Dobbels
- Department of Biostatistics and Clinical Research, University Hospital, Limoges, France
| | - Sandrine Lavau-Denes
- Department of Biostatistics and Clinical Research, University Hospital, Limoges, France
| | - Anaïs Labrunie
- Department of Biostatistics and Clinical Research, University Hospital, Limoges, France
| | - Frédéric Thuillier
- Department of Biostatistics and Clinical Research, University Hospital, Limoges, France
| | - Laurence Venat
- Department of Biostatistics and Clinical Research, University Hospital, Limoges, France
| | - Nicole Tubiana-Mathieu
- Faculty of Medicine, University of Limoges, Limoges, France.,Department of Medical Oncology, University Hospital, Limoges, France.,Department of Biostatistics and Clinical Research, University Hospital, Limoges, France
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10
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Deluche E, Salle H, Facchini-Joguet T, Leobon S, Troussel A, Tubiana-Mathieu N, Caire F, Fourcade L. [High fidelity simulation training for medical oncology announcement consultation]. Bull Cancer 2020; 107:417-427. [PMID: 32245605 DOI: 10.1016/j.bulcan.2020.02.007] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/11/2020] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Medical oncology bad news consultation is a particularly stressful situation for both the patient and the physician. High-fidelity simulation is a learning option that has never been evaluated in France in this field. MATERIALS AND METHODS This is a feedback from simulated announcement consultations carried out from January 2018 to May 2019. Residents from the medical oncology and radiotherapy departments performed high-fidelity simulations at the announcement consultation with an announcement nurse, a psychologist, a certified coach and an oncologist. A competency assessment was completed in pre-test, immediate post-test and after 5 months. RESULTS Fourteen of the 16 eligible interns participated. The pre-test competency assessment showed that interns over 5 semesters reported being more comfortable at the consultation (P=0.04) and thought they were clearly explaining the disease (P=0.03). However, all residents, regardless of the semester, felt stressed before a consultation. The evolution of parameters skills after the simulation was positive for all criteria, particularly for adaptation to patient reactions, use of appropriate vocabulary and reduction of stress (P<0.05). This evolution was independent of the gender, curriculum, semester, or previous completion of a medical oncology internship. More than 80% of the students were ready to repeat this type of training. CONCLUSION This training demonstrates the value of simulation training for medical oncology advertising consultation.
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Affiliation(s)
- Elise Deluche
- Service d'oncologie médicale, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France; Faculté de médecine de Limoges, département universitaire d'enseignement numérique en santé, 2, rue du Docteur-Marcland, 87025 Limoges cedex, France.
| | - Henri Salle
- Hôpital Dupuytren, service de neurochirurgie, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France; Faculté de médecine de Limoges, département universitaire d'enseignement numérique en santé, 2, rue du Docteur-Marcland, 87025 Limoges cedex, France
| | | | - Sophie Leobon
- Service d'oncologie médicale, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Alexandre Troussel
- Service d'oncologie médicale, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | | | - François Caire
- Hôpital Dupuytren, service de neurochirurgie, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France; Faculté de médecine de Limoges, département universitaire d'enseignement numérique en santé, 2, rue du Docteur-Marcland, 87025 Limoges cedex, France
| | - Laurent Fourcade
- Hôpital des Enfants, service de chirurgie viscérale pédiatrique, 8, avenue Dominique-Larrey, 87042 Limoges cedex, France; Faculté de médecine de Limoges, département universitaire d'enseignement numérique en santé, 2, rue du Docteur-Marcland, 87025 Limoges cedex, France
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Fayemendy C, Jésus P, Fayemendy P, Mollard J, Leobon S, Tubiana-Mathieu N, Deluche E, Aubard Y. PT11.05: Body Mass Index and Invasive Breast Cancer Prognosis: Study of 1,638 Locally Breast Cancers. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32604-4] [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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Bourcier K, Fermeaux V, Leobon S, Deluche E. Lobular Breast Carcinoma Metastasis to the Thyroid Gland: Case Report and Literature Review. J Breast Cancer 2018; 21:463-467. [PMID: 30607169 PMCID: PMC6310724 DOI: 10.4048/jbc.2018.21.e55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 07/06/2018] [Accepted: 09/16/2018] [Indexed: 12/20/2022] Open
Abstract
Metastasis from primary cancer to the thyroid is uncommon in breast cancer. Here we present a case of lobular breast carcinoma that metastasized to the thyroid. A 54-year-old woman without symptoms was admitted to our institution for staging of the lymph node above the left clavicle. An 18F-fluoro-deoxy-D-glucose positron emission tomography scan was performed for staging, and low uptakes were observed in the left supraclavicular and cervical lymph nodes. High uptake was seen in the posterior and lower left lobe of the thyroid. Histologic findings indicated lobular breast carcinoma (positive GATA3, loss of E-cadherin expression) metastatic to the thyroid with a luminal profile. Immunohistochemical analysis was negative for primary thyroid or parathyroid carcinoma. To our knowledge, this is the first report of a patient presenting a metastatic invasive lobular carcinoma in the thyroid and lymph nodes without a prior diagnosis of breast cancer.
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Affiliation(s)
- Kevin Bourcier
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | | | - Sophie Leobon
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Elise Deluche
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
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Deluche E, Leobon S, Lamarche F, Tubiana-Mathieu N. First validation of the G-8 geriatric screening tool in older patients with glioblastoma. J Geriatr Oncol 2018; 10:159-163. [PMID: 30037767 DOI: 10.1016/j.jgo.2018.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 04/24/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Management of glioblastoma, with a very poor prognosis, remains a challenge in older patients because of coexisting comorbidities and the increased risk of toxic treatment effects. The use of screening tools to identify vulnerable patients is essential. This study was performed to establish whether the G8 scale can be used for screening older patients with glioblastoma. METHODS We retrospectively reviewed the files of patients assessed by the G8 scale and diagnosed with glioblastoma at a single center from January 2010 to July 2017. Patients aged 65 years or older were classified into three groups (more efficiently than two groups) according to their G8 score to identify those with a poor prognosis: high score group, G8 score 14.5-17; intermediate score group, G8 score 10.5-14; and low score group, G8 score < 10.5. RESULTS Of 89 patients, 19% were classified into the high score group, 43% into the intermediate score group, and 38% into the low score group. Median overall survival was four months in the low score group, 15 months in the intermediate score group, and 42 months in the high score group (p < .0001). On multivariate analysis, G8 score was a significant independent predictor of overall survival (hazard ratio: 55.46; 99.5% confidence interval: 13.42-229.13; p < .0001). CONCLUSIONS Here, we highlighted the possibility of using the G8 score, with possibly three cut-offs, in the management of older patients with glioblastoma and determined the prognostic role of this quick and easy screening tool.
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Affiliation(s)
- Elise Deluche
- Department of Medical Oncology, University Hospital, Limoges 87042, France.
| | - Sophie Leobon
- Department of Medical Oncology, University Hospital, Limoges 87042, France
| | - Francois Lamarche
- Department of Medical Oncology, University Hospital, Limoges 87042, France
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Deluche E, Leobon S, Desport JC, Venat-Bouvet L, Usseglio J, Tubiana-Mathieu N. Impact of body composition on outcome in patients with early breast cancer. Support Care Cancer 2018; 26:861-868. [PMID: 28948392 PMCID: PMC5785600 DOI: 10.1007/s00520-017-3902-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/13/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE We investigated the impact of body composition on outcomes of patients with early breast cancer. Skeletal muscle mass, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and muscle fat infiltration or inter-muscular adipose tissue areas (IMAT), obtained by computed tomography (CT), were assessed. METHODS A total of 119 female patients who had breast cancer were included in this retrospective study. The total skeletal muscle and fat tissue areas were evaluated in two adjacent axial slices obtained at the third lumbar vertebra by CT used for disease staging. The women were assigned to either a sarcopenia or non-sarcopenia group based on their skeletal muscle index (cut-off 41.0 cm2/m2). They also were classified into high and low VAT/SAT ratio groups and assigned to either the high or low IMAT index group. The association of the body composition parameters and prognosis was statistically analyzed. RESULTS Among the 119 evaluable patients, 58 were sarcopenic (48.8%), 55 (46.2%) had a high VAT/SAT ratio, and 62 (52.1%) had a high IMAT index. Median follow-up was 52.4 months. Multivariate analysis revealed sarcopenia and IMAT index as independent prognostic factors for disease-free survival (p = 0.02 and p = 0.04, respectively) and overall survival (p = 0.05 and p = 0.02, respectively). BMI was not significantly associated with disease-free survival, but a trend was observed (p = 0.09). CONCLUSIONS Sarcopenia and IMAT index are independent prognostic factors in early breast cancer; therefore, assessing body composition could be a simple and useful approach to integrate into patient management.
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Affiliation(s)
- Elise Deluche
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France.
| | - Sophie Leobon
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | | | - Laurence Venat-Bouvet
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - Julie Usseglio
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - Nicole Tubiana-Mathieu
- Department of Medical Oncology, University Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
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Deluche E, Venat-Bouvet L, Leobon S, Fermeaux V, Mollard J, Saidi N, Jammet I, Aubard Y, Tubiana-Mathieu N. Assessment of Ki67 and uPA/PAI-1 expression in intermediate-risk early stage breast cancers. BMC Cancer 2017; 17:662. [PMID: 28954632 PMCID: PMC5618730 DOI: 10.1186/s12885-017-3648-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/06/2017] [Accepted: 09/13/2017] [Indexed: 12/17/2022] Open
Abstract
Background The objective of this study was to compare the efficacy of biomarkers in assessing the risk of breast cancer recurrence in patients with node-negative or micrometastatic grade II breast cancer. Specifically, we compared risk assessments based on the St. Gallen clinicopathological criteria, Ki67 expression and urokinase plasminogen activator (uPA)/plasminogen activator inhibitor-1 (PAI-1) expression. Methods This retrospective study included 347 patients with breast cancer followed at Limoges University Hospital. The optimal cut-off for high Ki67 expression (Ki67hi) was established as 20%. The threshold for uPA and PAI-1 positivity was 3 ng/mg and 14 ng/mg, respectively. Results Ki67 expression was lower in uPA/PAI-1-negative than in uPA/PAI-1-positive tumours (227 tumours; P = 0.04). The addition of Ki67 status to the St. Gallen criteria resulted in a 28% increase in the rate of identification of high-risk tumours with a potential indication for chemotherapy (P < 0.001). When considering uPA/PAI-1 levels together with the St Gallen criteria (including Ki67 expression), the number of cases identified as having a high recurrence risk with a potential indication for adjuvant chemotherapy increased by 20% (P < 0.001). Adjuvant chemotherapy was 9% less likely to be recommended by a multidisciplinary board when using the current criteria compared with using a combination of the St. Gallen criteria and Ki67 and uPA/PAI-1 status (P = 0.03). Conclusions Taken together, our data show discordance among markers in identifying the risk of recurrence, even though each marker may prove to be independently valid.
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Affiliation(s)
- Elise Deluche
- Department of Medical Oncology, University Hospital, 2 avenue Martin Luther King, F-87042, Limoges, France.
| | - Laurence Venat-Bouvet
- Department of Medical Oncology, University Hospital, 2 avenue Martin Luther King, F-87042, Limoges, France
| | - Sophie Leobon
- Department of Medical Oncology, University Hospital, 2 avenue Martin Luther King, F-87042, Limoges, France
| | | | - Joelle Mollard
- Department of Gynaecology, Mother and Child Hospital, F-87042, Limoges, France
| | - Nadira Saidi
- Department of Radiotherapy, University Hospital, F-87042, Limoges, France
| | - Isabelle Jammet
- Department of Senology, Mother and Child Hospital, F-87042, Limoges, France
| | - Yves Aubard
- Department of Gynaecology, Mother and Child Hospital, F-87042, Limoges, France
| | - Nicole Tubiana-Mathieu
- Department of Medical Oncology, University Hospital, 2 avenue Martin Luther King, F-87042, Limoges, France
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Deluche E, Girault S, Jesus P, Monzat S, Turlure P, Leobon S, Abraham J, Daly N, Dauriac O, Bordessoule D. Assessment of the nutritional status of adult patients with acute myeloid leukemia during induction chemotherapy. Nutrition 2017; 41:120-125. [DOI: 10.1016/j.nut.2017.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 04/10/2017] [Accepted: 04/22/2017] [Indexed: 12/18/2022]
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Deluche E, Venat-Bouvet L, Leobon S, Fermeaux V, Aubard Y, Saïdi N, Jammet I, Tubiana-Mathieu N. Abstract P2-05-26: uPA/PAI-1 and adjuvant chemotherapy decision-making in early breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-26] [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: 11/16/2022]
Abstract
Abstract
Background: Adjuvant chemotherapy decisions are relatively simple using clinicopathological parameters (Goldhirsch et al. 2007), some cases require the addition of biomarkers as in patients with node negative or micrometastatic (N0), grade II (GII) breast cancer. The objective of this study was to evaluate the impact of uPA/PAI-1 compared to classical criteria +/- KI67 in adjuvant treatment decision-making in this population.
Methods: This retrospective study included patients, treated from March 2008 to May 2016 in the Department of Medical Oncology at Limoges University Hospital (France). Ki67 and uPA/PAI-1 were analyzed on the initial specimen tumor. Optimal cut-off of Ki67 was defined at 20% (Coates et al. 2015). The positivity thresholds of uPA and PAI-1 were 3 ng/mg and 14 ng/mg respectively (Look et al. 2002). A positive uPA/PAI-1 level was defined as the elevation of at least one of these markers above the positivity threshold. All clinicopathological parameters were recorded prospectively.
Results: 2364 patients with breast cancer were screened. Among these patients, 256 N0, GII breast cancer patients were included with a median age of 62 years (32-87). Discordance between the two markers uPA/PAI-1 and KI67 was observed in 58% of tumors. Adding KI67 to the other classical clinicopathological parameters, 143 cases were defined as high risk versus 111 cases without KI67; low risk were defined in 113 cases versus 145 cases without KI67. Considering Ki67 status, the indication to perform adjuvant chemotherapy was increased by 29% compared to clinicopathological parameters. uPA/PAI-1 level was positive in these 143 high risk tumors in 93 cases and negative in 50 cases; in the 113 low risk tumors uPA/PAI-1 was positive in 72 cases and negative in 41 cases. uPA/PAI-1 increased indication to perform adjuvant chemotherapy by 15% compared to St Gallen criteria (including KI67) and by 49% compared to St Gallen criteria (excluding KI67). Using these two markers the final decision of chemotherapy by the multidisciplinary board was increased by 3% compared to St Gallen criteria (including KI67).
Conclusions: This study highlighted that uPA/PAI-1 and Ki67 assessment provides additional information for adjuvant chemotherapy decision-making. This study confirms the difficulty to assess the level of importance (weighting) of these biomarkers in adjuvant chemotherapy decision-making. The use of uPA/PAI-1 was feasible, cost-effective in N0, GII breast cancer's patients.
Citation Format: Deluche E, Venat-Bouvet L, Leobon S, Fermeaux V, Aubard Y, Saïdi N, Jammet I, Tubiana-Mathieu N. uPA/PAI-1 and adjuvant chemotherapy decision-making in early breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-26.
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Affiliation(s)
- E Deluche
- University Hospital, Limoges, France; Mother and Child Hospital, Limoges, France
| | - L Venat-Bouvet
- University Hospital, Limoges, France; Mother and Child Hospital, Limoges, France
| | - S Leobon
- University Hospital, Limoges, France; Mother and Child Hospital, Limoges, France
| | - V Fermeaux
- University Hospital, Limoges, France; Mother and Child Hospital, Limoges, France
| | - Y Aubard
- University Hospital, Limoges, France; Mother and Child Hospital, Limoges, France
| | - N Saïdi
- University Hospital, Limoges, France; Mother and Child Hospital, Limoges, France
| | - I Jammet
- University Hospital, Limoges, France; Mother and Child Hospital, Limoges, France
| | - N Tubiana-Mathieu
- University Hospital, Limoges, France; Mother and Child Hospital, Limoges, France
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Deluche E, Venat-Bouvet L, Leobon S, Fermeaux V, Aubard Y, Saidi N, Jammet I, Tubiana-Mathieu N. KI67 expression and uPA/PAI-1 level: adjuvant chemotherapy markers in intermediate risk early breast cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e23234] [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: 11/20/2022] Open
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Cornette T, Vincent F, Mandigout S, Antonini MT, Leobon S, Labrunie A, Venat L, Lavau-Denes S, Tubiana-Mathieu N. Effects of home-based exercise training on VO2 in breast cancer patients under adjuvant or neoadjuvant chemotherapy (SAPA): a randomized controlled trial. Eur J Phys Rehabil Med 2016; 52:223-232. [PMID: 25986222] [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: 06/04/2023]
Abstract
BACKGROUND Breast cancer chemotherapy is associated with a decline in measured cardiorespiratory fitness and increased fatigue. Physical activity has emerged as a feasible intervention to limit these side effects. Quantitative evaluation is necessary to propose a better-adapted physical activity and to evaluate efficacy. AIM We undertook a prospective study to assess the effects of a home-based adapted physical activity (APA) program on aerobic capacity, strength, and fatigue in women treated with adjuvant or neoadjuvant chemotherapy for breast cancer versus usual care. DESIGN This was an open two-arm, randomized controlled trial. SETTING Study included outpatient groups in the Department of Physiology and Medical Oncology of a hospital in France. POPULATION Forty-four patients treated with adjuvant or neoadjuvant chemotherapy for breast cancer. METHODS Patients were randomly assigned to a control group or an APA group. Intervention consisted of a 3-week, home-based, supervised, combined APA program (endurance and resistance training) during 27 weeks. The primary endpoint was cardiopulmonary function assessed by maximal peak oxygen consumption (VO2peak). Secondary endpoints included a 6-minute Walking Test (6MWT), and assessment of muscular strength, fatigue, quality of life, physical activity level, and anxiety/depression. RESULTS At 27 weeks, VO2peak increased by 1.83±0.68 ml.min-1.kg-1 in the APA group (P=0.009) and decreased by 1.31±0.65 mL.min-1.kg-1 in the control group (P=0.046). The difference between the two groups was not significant (2.26±1.53 mL.min-1.kg-1, P=0.140) in intention-to-treat analysis, but it was significant in per protocol analysis (3.49±1.64 mL.min-1.kg-1, P=0.049). At 27 and 54 weeks, no significant differences were observed between the two groups for the cardiopulmonary exercise test, 6MWT, quadriceps strength, or quality of life. CONCLUSIONS In breast cancer patients, a home-based supervised program during chemotherapy and radiotherapy treatment may be safe, feasible and increase VO2peak. In this study, heavy evaluation tests explain patient's non-adherence and do not permit to obtain statistically significant results between APA and control groups. CLINICAL REHABILITATION IMPACT Aerobic home-based adapted physical activity is beneficial on aerobic capacity.
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Deluche E, Leobon S, Touraine F, Clavère P. Two cases of cutaneous drug eruption associated with temozolomide therapy for glioblastoma. ACTA ACUST UNITED AC 2014; 21:e779-81. [PMID: 25489267 DOI: 10.3747/co.21.2133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Glioblastoma is the most common form of primary brain cancer. Its treatment involves surgery, radiotherapy, and chemotherapy with temozolomide (tmz), which is an oral alkylating agent. To the best of our knowledge, few dermatologic side effects of tmz have been described. We report two cases of cutaneous drug eruption caused by tmz during and after radiochemotherapy treatment. In the first case, all tests were negative, but the clinical history and the time of onset supported an allergy to tmz. In the second case, an allergy to tmz was proved by a positive lymphocyte activation test. In this context, our study is one of a very few trying to determine dermatologic side effects by applicable tests used in routine practice.
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Affiliation(s)
- E Deluche
- Department of Medical Oncology, University Hospital, Limoges, France
| | - S Leobon
- Department of Medical Oncology, University Hospital, Limoges, France
| | - F Touraine
- Department of Pneumology, University Hospital, Limoges, France
| | - P Clavère
- Department of Radiotherapy, University Hospital, Limoges, France
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Laval C, Vincent F, Antonini M, Leobon S, Venat-Bouvet L, Tubiana-Mathieu N. Physical Rehabilitation in Breast Cancer Patients Which Tests to Adapt Training Program? Ann Oncol 2014. [DOI: 10.1093/annonc/mdu327.70] [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: 11/14/2022] Open
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Vénat-Bouvet L, Fermeaux V, Leobon S, Saidi N, Monteil J, Mollard J, Aubard Y, Jammet I, Tubiana-Mathieu N. Adjuvant chemotherapy in node-negative breast cancer: UPA/PAI-1 determinations for 163 cases. Anticancer Res 2014; 34:1213-1217. [PMID: 24596362] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The urokinase-type plasminogen activator (UPA) and its main inhibitor plasminogen activator inhibitor-1 (PAI-1) are involved in tumor interactions with the microenvironment. The UPA/PAI-1 content in tumor tissue can be used to identify populations at low-or high-risk of recurrence of breast cancer, even without other standard prognostic markers. MATERIALS AND METHODS The purpose of the present study was to compare adjuvant chemotherapy decisions made by a multi-disciplinary board for 163 node-negative breast cancer cases, based on clinicopathological (CP) and UPA/PAI-1 risk assessment. RESULTS The UPA/PAI-1 levels identified 37% of the population as being at low risk. Adjuvant chemotherapy indication was spared in high-CP risk in 17%, but maintained in low-CP risk in 33%. CONCLUSION The use of UPA/PAI-1 data did not consistently result in a decrease of adjuvant chemotherapy. This study highlighted the difficulties encountered in a local multi-disciplinary board in determining appropriate roles and weights of new prognostic markers (UPA/PAI-1 was not routinely employed in France) when no data are available for assessing their prognostic and predictive power compared to other prognostic factors.
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Affiliation(s)
- Laurence Vénat-Bouvet
- Department of Medical Oncology, University Hospital, 2 avenue Martin Luther King, 87042 Limoges cedex, France.
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Vincent F, Labourey JL, Leobon S, Antonini MT, Lavau-Denes S, Tubiana-Mathieu N. Effects of a home-based walking training program on cardiorespiratory fitness in breast cancer patients receiving adjuvant chemotherapy: a pilot study. Eur J Phys Rehabil Med 2013; 49:319-329. [PMID: 23480974] [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: 06/01/2023]
Abstract
BACKGROUND Breast cancer treatment is associated with a decline in measured cardiorespiratory fitness and increased fatigue. There is accumulating evidence that exercise training during adjuvant chemotherapy may contribute to prevent these changes. Additional studies are needed to explore the effectiveness of home-based walking interventions among this population. AIM The aim of this study was to investigate the effects of a 12-week adapted home-based walking training program (WTP) on clinical rehabilitation in breast cancer patients receiving adjuvant chemotherapy. DESIGN This was a pilot study using a single-group design. SETTING Unit Department of Physiology and Medical Oncology, Limoges University Hospital, France. POPULATION Thirty-nine outpatients predominantly with stage II breast cancer. METHODS Participants performed 3 home ambulatory aerobic walking sessions per week at 50-60% of their maximum heart rate for 12 weeks. Functional capacity was assessed with an incremental cardiopulmonary exercise test during which peak oxygen consumption (VO(2peak)) was measured. A six-minute walking test (6 MWT) was performed to evaluate physical function. The revised Piper Fatigue Scale (PFS-R) was used to measure self-reported fatigue. RESULTS Thirty-four patients (87%) completed all study procedures. Per Protocol (PP) analysis indicated that VO(2peak) recorded both before and after a 12-week adapted home-based WTP increased significantly by 2.21 mL.kg-1.min-1 (P=0.008) and 6 MWT distance increased significantly by 42 m (P=0.04). PFS-R score increased by 0.4 points, but not significantly. CONCLUSION In breast cancer patients receiving adjuvant chemotherapy, home-based WTP is feasible and associated with significant improvements in VO(2peak), with no significant effect on fatigue score. Larger randomized trials are necessary to confirm these findings.
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Affiliation(s)
- F Vincent
- CHU Limoges, Dupuytren Hospital, Service of Physiological Functional InvestigationLimoges, F-87042 France.
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Monteil J, Maubon A, Leobon S, Roux S, Marin B, Renaudie J, Genet D, Fermeaux V, Aubard Y, Tubiana-Mathieu N. Lymph node assessment with (18)F-FDG-PET and MRI in uterine cervical cancer. Anticancer Res 2011; 31:3865-3871. [PMID: 22110211] [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: 05/31/2023]
Abstract
BACKGROUND To assess pelvic (P) and/or paraaortic (PA) lymph node (LN) involvement in patients with primary stage IA-IVA cervical cancer, (18)F-fluorodeoxyglucose (FDG)-PET, and MRI were compared with histological results. MATERIALS AND METHODS Forty patients were prospectively evaluated. Twenty-eight patients underwent radio-chemotherapy (RT-CT) after initial staging and lymph node dissection (LND). RESULTS PLN metastases were present in 6/31 patients. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and accuracy in detecting PLN metastases were 67%, 84%, 50%, 91% and 81%, with MRI, and 33%, 92%, 50%, 85% and 81%, with FDG-PET. PALN metastases were present in 5/27 patients. Sensitivity, specificity, PPV, NPV and accuracy were 60%, 73%, 33%, 89% and 70% with MRI and 100%, 77%, 50%, 100% and 81% with FDG-PET in detecting PALN metastasis. CONCLUSION FDG-PET is less accurate than MRI for PLN, but more accurate for PALN; FDG-PET cannot replace PA surgical procedures, but could guide them.
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Affiliation(s)
- Jacques Monteil
- Department of Nuclear Medicine, University Hospital, Limoges, France
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Vincent F, Labourey J, Leobon S, Antonini M, Cornette T, Lemaire F, Venat-Bouvet L, Lavau-Denes S, Preux P, Tubiana-Mathieu N. 5190 POSTER Feasibility of Home-adapted Aerobic Exercise Training on Peak Oxygen Consumption and Fatigue in Breast Cancer Patients During Adjuvant Chemotherapy. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71632-x] [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: 10/17/2022]
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Monteil J, Mahmoudi N, Leobon S, Roudaut PY, El Badaoui A, Verbeke S, Venat-Bouvet L, Martin J, Le Brun-Ly V, Lavau-Denes S, Maubon A, Bouillet P, Pouquet M, Vandroux JC, Tubiana-Mathieu N. Chemotherapy response evaluation in metastatic colorectal cancer with FDG PET/CT and CT scans. Anticancer Res 2009; 29:2563-2568. [PMID: 19596929] [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: 05/28/2023]
Abstract
BACKGROUND [18F]-fluorodeoxyglucose with positron-emission tomography (PET) and computed tomography (CT) scans were used to assess morphological and metabolic tumour response after chemotherapy in metastatic colorectal cancer. PATIENTS AND METHODS Twenty-five patients were evaluated after 4 courses of chemotherapy (+/-target therapy), and among them 20 patients after 2 courses. Response Evaluation Criteria In Solid Tumors (RECIST) and European Organisazion for Research and Treatment of Cancer (EORTC) criteria were used to evaluate CT and PET respectively. RESULTS Discrepancies between the two procedures were noted after 4 courses of chemotherapy in patient-based analysis. Two morphologically complete responses (CR) were correlated with metabolic response. Seven morphological partial responses (PR) were evaluated as 3 metabolic PR, 2 CR and 1 progressive disease (PD). Seventeen cases of morphologically stable disease (SD) were evaluated as 3 metabolic CR, 13 PR and 1 PD. These discrepancies were confirmed in lesion-based analysis. Perfect concordance was noted between metabolic responses obtained after 2 and 4 cycles. CONCLUSION Morphological and metabolic imaging does not permit concordant therapeutic assessment in metastatic colorectal cancer.
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Affiliation(s)
- J Monteil
- Department of Nuclear Medicine, University Hospital of Limoges, France
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