PubMed | Center Francois Baclesse, Brest University Hospital Center, University of Limoges, Institute Paoli Calmettes and 8 more.
Type: Journal Article | Journal: Lung cancer (Amsterdam, Netherlands) | Year: 2015
In advanced non-small cell lung cancer (NSCLC), maintenance therapy has emerged as a novel therapeutic reference for patients with non-progressive disease after platinum-based induction chemotherapy. However, the use of double maintenance (DM) with pemetrexed and bevacizumab is still being evaluated in terms of its clinical benefits and safety profile. The objective of this retrospective study was to describe the reasons for DM discontinuation in a real-world setting.Patients with advanced non-squamous NSCLC were eligible if they had received at least 4 cycles of induction chemotherapy, followed by at least 1 cycle of DM. They were identified by using the oncology pharmacy database of 17 French centers.Eighty-one patients who began a DM after induction chemotherapy were identified from September 2009 to April 2013. Among the 78 patients who had stopped DM at the time of the analysis, the main reasons for discontinuation were disease progression (42%), adverse events (33%), and personal preference (8%). The most frequent toxicity responsible for DM discontinuation was renal insufficiency (54%).For patients with advanced NSCLC eligible for DM therapy, a particular attention should be paid to potential renal failure. Kidney function should be monitored carefully before and during DM to detect and manage early this adverse event.
PubMed | Center Paul Strauss, Institute of Veille Sanitaire, University of Caen Lower Normandy, Center Hospitalier University and 6 more.
Type: Journal Article | Journal: Oral oncology | Year: 2015
To provide head and neck squamous cell carcinoma (HNSCC) survival estimates with respect to patient previous history of cancer.Data from ten French population-based cancer registries were used to establish a cohort of all male patients presenting with a HNSCC diagnosed between 1989 and 2004. Vital status was updated until December 31, 2007. The 5-year overall and net survival estimates were assessed using the Kaplan-Meier and Pohar-Perme estimators, respectively. Multivariate Cox regression models were used to assess the effect of cancer history adjusted for age and year of HNSCC diagnosis.Among the cases of HNSCC, 5553 were localized in the oral cavity, 3646 in the oropharynx, 3793 in the hypopharynx and 4550 in the larynx. From 11.0% to 16.8% of patients presented with a previous history of cancer according to HNSCC. Overall and net survival were closely tied to the presence, or not, of a previous cancer. For example, for carcinoma of the oral cavity, the five-year overall survival was 14.0%, 5.9% and 36.7% in case of previous lung cancer, oesophagus cancer or no cancer history, respectively. Multivariate analyses showed that previous history of cancer was a prognosis factor independent of age and year of diagnosis (p<.001).Previous history of cancer is strongly associated with survival among HNSCC patients. Survival estimates based on patients previous history of cancer will enable clinicians to assess more precisely the prognosis of their patients with respect to this major comorbid condition.
PubMed | University of Versailles, University Claude Bernard Lyon 1, University of Strasbourg, University Paris Est Creteil and 3 more.
Type: | Journal: Journal of cancer epidemiology | Year: 2015
Background. In a French large population-based case-control study we investigated the dose-response relationship between lung cancer and occupational exposure to diesel motor exhaust (DME), taking into account asbestos exposure. Methods. Exposure to DME was assessed by questionnaire. Asbestos was taken into account through a global indicator of exposure to occupational carcinogens or by a specific JEM. Results. We found a crude dose response relationship with most of the indicators of DME exposure, including with the cumulative exposure index. All results were affected by adjustment for asbestos exposure. The dose response relationships between DME and lung cancer were observed among subjects never exposed to asbestos. Conclusions. Exposure to DME and to asbestos is frequently found among the same subjects, which may explain why dose-response relationships in previous studies that adjusted for asbestos exposure were inconsistent.
Life after cancer: Another state of vulnerability?: New issues to face, new problems to think about for professional caregivers [Vivre après un cancer: un autre état de vulné rabilité ?: De nouvelles difficultés à affronter, de nouvelles problématiques à penser pour les soignants]
Masson A.,Center Hospitalier Public du Cotentin
Psycho-Oncologie | Year: 2013
Advances in diagnostic techniques and therapies has enabled there to be better care for cancer patients. As there is always the risk of relapse, the word recovery is not used, rather the term remission, which implies regular monitoring. Post-cancer, as with time after-treatment, is therefore a time spent in uncertainty. Under these circumstances, a return to what is called a normal life is not really selfevident. The person has to set new goals, (re-)establish their own place in society. There is a hint of ambivalence to this post-cancer period: relief but also apprehension, the feeling of abandonment, a fear of what the future holds. It is these difficulties, that follow on from therapeutic treatment, which give rise to a new state of vulnerability. Particular attention needs to be paid to those who are more fragile, as they were not feeling ill at the time of diagnosis, in cases where, fortuitously, cancer has been discovered early, in the absence of clinical signs at a regular screening, for example. Healthcare professionals often feel helpless when faced with the concerns of past patients, as is the case for their loved ones, who do not always understand the ill-feeling felt by those they have supported. It is the duty of the carers to anticipate this suffering and recognise it, in order to help alleviate it. Thinking about life post-cancer is a requirement that should be carefully considered throughout the whole care process. But how can you plan for this after time, especially as it cannot be guaranteed at the time the announcement of the illness is made? Over the last few years, particular attention has been paid, at the start of the disease, with how the diagnosis is delivered. Consideration should also be given to the end of treatments, with some support on leaving the disease behind and entry into remission. © 2013 Springer-Verlag France.
Potier J.,Center hospitalier public du Cotentin
Nephrologie et Therapeutique | Year: 2010
Removal of the middle molecules (MM) weight toxins, and particularly of beta-2-microglobuline (b2M) is made first by convection technique with membranes habitually used in hemodiafiltration online (HDFOL). AN69 was in standard hemodialysis (HD) the reference membrane for the removal of b2M mostly (60%) by adsorption. Its use with convective methods is generally restricted to low efficiency modalities with low substitution rates (Qs), either with continuous HF or HDF for acute renal failure, or with acetate free biofiltration (AFB) for chronic renal failure. So-called adsorptive membranes do not have, at the present time, a well-defined indication for high efficiency HDFOL, which necessitates substitution rates (Qs) higher than 15 litres per session. The objective of this study is to demonstrate the feasibility of such an association between polyethyleneimine (PEI) surface treated AN69 and HDFOL both in qualitative and quantitative terms. Five patients were dialysed, respectively, with Nephral 500ST (AN69, PEI, surface 2.15 m2, Hospal France) in HD (HDNEP), postdilution HDF (PostNEP), predilution HDF (PreNEP) and as a reference, with FX80 (Helixone, surface 1,8 m2, Fresenius) in PostD (PostFX). For the small molecules (SM), equilibrated Kt/V (Kt/VEq) and the phosphorus (Ph) reduction ratio (RR)Ph have been measured. Considering the predominating adsorption of b2M by AN69, the removal of MM - b2M and myoglobine (Myo) - was also assessed by their RR (RRb2M and RRMyo). Results are convincing in terms of behaviour in relation to convective techniques, the 2.15 m2 membrane used during 4 hour sessions accepting Qs up to 25 litres with PostD and up to 59 litres with PreD, without any alarm of transmembrane pressure (TMP) or any fiber coagulation incident, proving without any ambiguity the absence of deleterious membrane plugging and its compatibility with high efficiency HDFOL. The behaviour of AN69 in HDFOL in relation to SM does not differ from HDNEP or FXPost. For MM, results for b2M are significantly lower (P = 0.01) for PostNEP (RR = 71.4%) in comparison with PostFX (RR = 79.3%), but the behaviour of AN69 is above all particular for higher molecular weight substances since results are significantly reversed (P = 0.03) for Myo (PM = 17,800 Da) in favour of PostNEP (RR = 73.6%) compared to PostFX (RR = 65.7%). These results open up new horizons for HDFOL and encourage us to focus future studies on the consequences of an optimized removal, mainly by absorption, of high molecular weight toxins, such as factor D, C3a, C3b and cytokines (IL-1 and TNF). The expected beneficial consequences concern complications linked to inflammation and oxidative stress, which could account notably, beyond the mere quantitative removal of b2M, for the quasi disappearance of any clinical expression of dialysis-related amyloidosis. © 2009 Association Société de néphrologie.
Akhtar S.,King Faisal Specialist Hospital And Research Center |
El Weshi A.,Center Hospitalier Public du Cotentin |
Rahal M.,King Fahad Specialist Hospital |
Abdelsalam M.,King Faisal Specialist Hospital And Research Center |
And 2 more authors.
Bone Marrow Transplantation | Year: 2010
Fifty-eight adolescent patients with relapsed or primary refractory Hodgkin's lymphoma underwent high-dose chemotherapy (HDC) and autologous SCT (ASCT). The median age at ASCT was 17 years (range 14-21). The disease had relapsed in 24 patients (41) and was refractory to initial chemotherapy in 34 (59). ESHAP salvage chemotherapy before ASCT resulted in 88 response. After ASCT, complete remission (CR; including CR-unconfirmed) was seen in 41 patients (71) and partial remission in 7 (12). The overall response rate was 83. One patient did not respond and nine (15) had progressive disease. Three more patients achieved CR after consolidative radiation post-ASCT. There was no transplant-related mortality. At a median follow-up of 43 months from ASCT, 31 patients (53) are alive in CR, 5 (9) are alive with disease and 22 (38) have died (21 from disease and 1 unrelated). The actuarial probabilities of event-free and overall (OS) survival are 45 and 55 at 11 years. The only negative prognostic factor for OS was the presence of B symptom at relapse or progression (11-year OS 27 vs 60, P0.003). © 2010 Macmillan Publishers Limited.
PubMed | Center Hospitalier Public du Cotentin, University of Caen Lower Normandy, General Cancer Registry of Lille and its area, General Cancer Registry of Somme and 2 more.
Type: | Journal: BMC cancer | Year: 2016
In the context of early detection of head and neck cancers (HNC), the aim of this study was to describe how people sought medical consultation during the year prior to diagnosis and the impact on the stage of the cancer.Patients over 20years old with a diagnosis of HNC in 2010 were included from four French cancer registries. The medical data were matched with data regarding uptake of healthcare issued from French National Health Insurance General Regime.In 86.0% of cases, patients had consulted a general practitioner (GP) and 21.1% a dentist. Consulting a GP at least once during the year preceding diagnosis was unrelated to Charlson index, age, sex, dpartement, quintile of deprivation of place of residence. Patients from the quite privileged, quite underprivileged and underprivileged quintiles consulted a dentist more frequently than those from the very underprivileged quintile (p=0.007). The stage was less advanced for patients who had consulted a GP (OR=0.42 [0.18-0.99]) - with a dose-response effect.In view of the frequency of consultations, the existence of a significant association between consultations and a localised stage at diagnosis and the absence of a socio-economic association, early detection of HNC by GPs would seem to be the most appropriate way.
PubMed | Center Francois Baclesse, University of Rouen, Clinique Armoricaine, Center Hospitalier Public du Cotentin and 2 more.
Type: Journal Article | Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer | Year: 2016
Chemotherapy-induced nausea and vomiting (CINV) still remain frequent. The procedure for announcing the diagnosis (PAD) was an emblematic measure of the first French Plan Cancer aiming at providing patients with time to listen, information after cancer diagnosis, and discussion on treatments and their side effects. We aimed at assessing the risk factors of CINV, focusing on patients satisfaction with the PAD.This prospective multicentre study assessed the frequency and intensity of CINV among chemonave patients during the first cycle of treatment. CINV was defined by 1 emetic episode or reported nausea intensity 3 on a 0-10 scale. Multivariate analysis was used to identify factors related to global CINV onset including satisfaction with the PAD (satisfaction score the median on a 0-10 scale).Data from 291 patients (women, 85.2%; mean age, 57 years) were analyzed. Most patients (69.4%) received highly emetogenic chemotherapy regimens and 77.7% received antiemetic drugs consistent with international guidelines. Acute, delayed and overall CINV were experienced by 40.4, 34.8 and 52.4% of patients, respectively. Sixty-seven per cent of patients were satisfied with the PAD. No relation was noted between PAD satisfaction and CINV onset. The nausea and vomiting dimension of the QLQ-C30 questionnaire before chemotherapy (OR 3.62), motion sickness history (OR 2.73), highly emetogenic CT (OR 2.73), anxiety (OR 1.99) and younger age (OR 1.96) were independent predictive factors.Although patients were mostly satisfied with the PAD, half of them experienced CINV. A state of anxiety could be identified during the PAD to be managed.
PubMed | Center Hospitalier Public du Cotentin, University of Caen Lower Normandy and Service dHematologie Biologique
Type: Journal Article | Journal: Annals of intensive care | Year: 2016
Elevation of the immature/total granulocyte (I/T-G) ratio has been reported after out-of-hospital cardiac arrest (OHCA). Our purpose here was to evaluate the prognostic significance of the I/T-G ratio and to investigate whether the I/T-G ratio improves neurological outcome prediction after OHCA.This single-center prospective cohort study included consecutive immunocompetent patients admitted to our intensive care unit over a 3-year period (2012-2014) after successfully resuscitated OHCA. The I/T-G ratio was determined in blood samples collected at admission.We studied 204 patients (77% male, median age, 58 [48-67]years), of whom 64% had a suspected cardiac cause of OHCA, 62% died in the unit, and 31.5% survived with good cerebral function. Independent outcome predictors by multivariate analysis were age, first shockable rhythm, bystander-initiated resuscitation, and I/T-G ratio. Compared to the model computed without the I/T-G ratio, the model with the ratio performed significantly better [areas under the ROC curves (AUCs), 0.78 vs. 0.83, respectively; P=0.04]. These items were used to develop the MyeloScore equation: ([0.47I/T-G ratio]+[0.023age in years])-1.26 if initial VF/VT-1.1 if bystander-initiated CPR. The MyeloScore predicted neurological outcomes with similar accuracy to the previously reported OHCA score (0.83 and 0.85, respectively; P=0.6). The ROC-AUC was 0.84, providing external validation of the MyeloScore.The I/T-G ratio independently predicts neurological outcome after OHCA and, when added to other known risk factors, improves neurological outcome prediction. The clinical performance of the MyeloScore requires evaluation in a prospective study.
PubMed | Center clesse, University of Caen Lower Normandy, Center Hospitalier Public du Cotentin, Registre general des cancers de Lille et sa region and Registre du cancer de la Somme
Type: Journal Article | Journal: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery | Year: 2016
Head and neck cancers (HNC) have a poor prognosis and a long treatment delay may have a negative impact on this. Some studies have investigated the determinants of this delay but not in the general population and rarely taking into account socio-economic factors. A high-resolution population-based study about cancer management was conducted, using registries in the north-west of France, on HNC diagnosed between 2008 and 2010. The median time between diagnosis and multidisciplinary team meeting (DMI) (N=1631) was 14days (Q1: 7 to Q3: 26). The median time between diagnosis and first treatment (DTI) (N=1519) was 35days (Q1: 21 to Q3: 54). When the first treatment was radiotherapy, the interval was 54.5days (Q1: 40 to Q3: 71). In multivariate analysis, DTI was associated with the type of first treatment and place of treatment. For advanced stage HNC, DTI was associated with comorbidities, topography of the cancer and socio-economic status, underprivileged patients being treated later than privileged ones. Given the French governmental cancer plans which set out to coordinate care pathways via nursing coordinators and to improve the availability of radiotherapy, the waiting times observed in this study still seem long. The optimal care pathway should include adapted social management but the DTI was still longer for underprivileged patients.