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Sainte-Foy-lès-Lyon, France

Rhondali W.,University of Texas M. D. Anderson Cancer Center | Rhondali W.,Center Hospitalier Of Lyon Sud | Burt S.,University of Texas M. D. Anderson Cancer Center | Wittenberg-Lyles E.,University of Kentucky | And 2 more authors.
Palliative and Supportive Care | Year: 2013

Objective: In a simultaneous care model, patients have concurrent access to both cancer-directed therapies and palliative care. As oncologists play a critical role in determining the need/timing of referral to palliative care programs, their understanding of the service and ability to communicate this with patients is of paramount importance. Our study aimed to examine oncologists' perceptions of the supportive care program at M.D. Anderson Cancer Center, and to determine whether renaming palliative care to supportive care influenced communication regarding referrals. Method: This qualitative study used semi-directed interviews, and we analyzed data using grounded theory and qualitative methods. Results: We interviewed 17 oncologists. Supportive care was perceived as an important time-saving application, and symptom control, transitioning to end-of-life care, family counseling, and improving patients' ability to tolerate cancer therapies were cited as important functions. Although most claimed that early referrals to the service are preferable, oncologists identified several challenges, related to the timing and communication with patients regarding the referral, as well as with the supportive care team after the referral was made. Whereas oncologists stated that the name change had no impact on their referral patterns, the majority supported it, as they perceived their patients preferred it. Significance of results: Although the majority of oncologists favorably viewed supportive care, communication barriers were identified, which need further confirmation. Simultaneous care models that effectively incorporate palliative care with cancer treatments need further development. © Cambridge University Press 2013.

Rhondali W.,University of Houston | Rhondali W.,Center Hospitalier Of Lyon Sud | Perez-Cruz P.,University of Houston | Perez-Cruz P.,University of Santiago de Chile | And 6 more authors.
Cancer | Year: 2013

BACKGROUND Code status discussions are important in cancer care, but the best modality for such discussions has not been established. The objective of this study was to determine the impact of a physician ending a code status discussion with a question (autonomy approach) versus a recommendation (beneficence approach) on patients' do-not-resuscitate (DNR) preference. METHODS Patients in a supportive care clinic watched 2 videos showing a physician-patient discussion regarding code status. Both videos were identical except for the ending: one ended with the physician asking for the patient's code status preference and the other with the physician recommending DNR. Patients were randomly assigned to watch the videos in different sequences. The main outcome was the proportion of patients choosing DNR for the video patient. RESULTS A total of 78 patients completed the study, and 74% chose DNR after the question video, whereas 73% chose DNR after the recommendation video. Median physician compassion score was very high and not different for both videos. All 30 of 30 patients who had chosen DNR for themselves and 30 of 48 patients who had not chosen DNR for themselves chose DNR for the video patient (100% versus 62%). Age (odds ratio = 1.1/year) and white ethnicity (odds ratio = 9.43) predicted DNR choice for the video patient. CONCLUSIONS Ending DNR discussions with a question or a recommendation did not impact DNR choice or perception of physician compassion. Therefore, both approaches are clinically appropriate. All patients who chose DNR for themselves and most patients who did not choose DNR for themselves chose DNR for the video patient. Age and race predicted DNR choice. © 2013 American Cancer Society.

Rhondali W.,University of Texas M. D. Anderson Cancer Center | Rhondali W.,Center Hospitalier Of Lyon Sud | Nguyen L.,University of Texas M. D. Anderson Cancer Center | Palmer L.,University of Texas M. D. Anderson Cancer Center | And 3 more authors.
Journal of Pain and Symptom Management | Year: 2013

Context: Constipation is often inadequately assessed and underdiagnosed in patients with advanced cancer. Many studies use patient-reported constipation (PRC) as an outcome. Objectives: The aim was to compare the accuracy of PRC as compared with the modified Rome III (ROME) criteria and to determine the agreement between PRC, physician assessment of constipation, and objective assessment of constipation by modified ROME criteria among outpatients with advanced cancer. Methods: Patients with advanced cancer attending a supportive care clinic were screened. Constipation was assessed using the modified ROME criteria, patient report (yes or no and rated 0-10; 10 = worst possible symptom), and physician assessments (yes or no and rated 0-10). Results: One hundred patients were enrolled, and 50 of 100 patients (50%) met the modified ROME criteria for constipation. Disagreement between ROME criteria and the patient report (yes/no) was found in 33 patients (33%) and between ROME criteria and the physician assessment (yes/no) in 39 patients (39%). The best combination of sensitivity (0.84) and specificity (0.62) was found with scores ≥3/10 for PRC. Conclusion: We found a high frequency of constipation. The limited agreement with modified ROME criteria suggests that a patient's self-report as yes or no is not useful for clinical practice. Patient self-rating on a 0 to 10 scale (score of three or greater) seems to be the best tool for constipation screening among this population. More research is needed to identify the best way to assess constipation in patients with advanced cancer. © 2013 Published by Elsevier Inc. on behalf of U.S. Cancer Pain Relief Committee.

Dev R.,University of Texas M. D. Anderson Cancer Center | Coulson L.,University of Texas M. D. Anderson Cancer Center | Del Fabbro E.,Virginia Commonwealth University | Palla S.L.,University of Texas M. D. Anderson Cancer Center | And 3 more authors.
Journal of Pain and Symptom Management | Year: 2013

Context: Limited research has taken place examining family conferences (FCs) with patients with advanced cancer and their caregivers in the palliative care setting. Objectives: To characterize the FCs involving cancer patients in a palliative care unit at a comprehensive cancer center and examine the effects of patient participation on emotional expression by the participants and end-of-life discussions. Methods: A data collection sheet was completed immediately after 140 consecutive FCs that documented the number of participants, caregiver demographics, expressions of emotional distress, dissatisfaction with care, and the topics discussed. Patient demographics and discharge disposition also were collected. Results: Seventy (50%) patients were female, 64 (46%) were white, and 127 (91%) had solid tumors. Median age of patients was 59 years. Patients participated in 68 of 140 FCs (49%). Primary caregivers (n = 140) were female (66%), white (49%), and the spouse/partner (59%). Patients verbalized distress frequently (73%). Primary caregivers' verbal expression of emotional distress was high (82%) but not significantly affected by patient presence (82% vs. 82%, P = 0.936). Verbal expressions of emotional distress by other family members were more common when patients were absent (87%) than when present (73%), P = 0.037. Questions concerning advance directives (21%), symptoms anticipated at death (31%), and caregiver well-being (29%) were infrequent. Patient presence was significantly associated with increased discussions regarding goals of care (P = 0.009) and decreased communication concerning prognosis (P = 0.004) and what symptoms dying patients may experience (P < 0.001). Conclusion: There was a high frequency of expression of emotional distress by patients and family members in FCs. Patient participation was significantly associated with decreased verbal emotional expression by family members but not the primary caregiver and was associated with fewer discussions regarding prognosis and what dying patients may experience. © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Spano J.-P.,Groupe hospitalier de la Pitie Salpetriere | Falandry C.,University of Lyon | Chaibi P.,Groupe Hospitalier de la Pitie Salpetriere Charles Foix | Freyer G.,Center Hospitalier Of Lyon Sud
Oncologist | Year: 2011

The incidence of breast cancer is two to three times higher in women aged≥65 years than in the whole population, whereas their mortality rate is threefold to fourfold higher. Targeted therapies allow significantly longer disease-free survival times. Nevertheless, in an elderly population, these treatments need to be prescribed with caution. This paper reviews the treatments of breast cancer in the elderly, and the issues of targeted therapies and their toxicities. Patients with human epidermal growth factor receptor (HER)-2+ breast cancer benefit from trastuzumab; although cardiotoxic effects are observed in<5% of pa-tients when given alone, they affect ~25% of patients when combined with anthracyclines. Bevacizumab leads to a longer progression-free survival time and lower risk for progression in patients with metastatic breast cancer when added to paclitaxel or docetaxel. Although generally well tolerated, it is associated with a higher risk for arterial thromboembolism and hypertension. Lapatinib is approved for the treatment of advanced or metastatic breast cancer in patients not responding to trastuzumab, combined with capecitabine chemotherapy. The most frequent side effects concern the gastrointestinal system and dermatologic symptoms. The life expectancy of breast cancer patients should be taken into account to determine the appropriateness of treatments. The quality of life of elderly cancer patients must be assessed with an appropriate tool. Older patients exhibit greater vulnerability, suggesting identification and exclusion of patients at high cardiac risk. Future recommendations for the treatment of elderly women with breast cancer should include a multidisciplinary approach and a global geriatric assessment before treatment with anti-HER-2 therapy or bevacizumab.

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