Cancer Center Henri Becquerel

Sotteville-lès-Rouen, France

Cancer Center Henri Becquerel

Sotteville-lès-Rouen, France
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Sebban C.,Cancer Center Leon Berard | Lefranc A.,Biostatistics Unit | Perrier L.,University of Lyon | Perrier L.,Cancer Center Leon Berard | And 11 more authors.
European Journal of Cancer | Year: 2012

Aim: To evaluate in a multicentre randomised study the effect on duration of febrile neutropenia (FN), the safety and cost-effectiveness of a single subcutaneous pegfilgrastim injection compared with daily injections of filgrastim after peripheral blood stem cell transplantation in patients receiving high dose chemotherapy for myeloma and lymphoma. Methods: Patients were randomly assigned to a single dose of pegfilgrastim at day 5 (D5) or daily filgrastim from D5 to the recovery of absolute neutrophil count (ANC) to 0.5 G/L. Duration of FN, of neutrophil and platelet recovery, transfusion and antibiotic requirements were the main end-points of the study. Costs were calculated from D0 until transplant unit discharge. The incremental cost-effectiveness ratio was expressed as the cost per day of FN prevented. Probabilistic sensitivity analysis was performed by non-parametric bootstrap methods. Results: Between October 2008 and September 2009, 10 centres enrolled 151 patients: 80 patients with lymphoma and 71 patients with myeloma. The mean duration of FN was 3.07 days (standard deviation (SD) 1.96) in the pegfilgrastin arm and 3.29 (SD 2.54) in the filgrastim one. Mean total costs were 23,256 and 25,448 euros for pegfilgrastim and filgrastim patients, respectively. There was a 62% probability that pegfilgrastim strictly dominates filgrastim. Concluding statement: Pegfilgrastim after PBSC transplantation in myeloma and lymphoma is safe, effective when compared with filgrastim and could represent a cost-effective alternative in this setting. © 2011 Elsevier Ltd. All rights reserved.


Goodin B.S.,Cancer Institute of New Jersey | Goodin B.S.,Ohio State University | Goodin B.S.,University of Toronto | Goodin B.S.,University of Montréal | And 100 more authors.
Journal of Oncology Practice | Year: 2011

Although there has been a significant increase in the availability and use of oral chemotherapeutic agents, the guidelines around their safe handling are still evolving. Although oral chemotherapy is associated with ease of administration, it has the same exposure risks to health care practitioners, patients, and their caregivers as intravenous formulations, and because it is administered in the home, to the families of patients. However, the general misconception appears to be that exposure risk is low and therefore oral chemotherapeutic agents present little risk and are safer to handle. In a series of three roundtable meetings, a team of international pharmacists from North America and Europe reviewed existing guidelines and identified gaps in recommendations that we believe are important for safe handling. The present article is a compilation of these gaps, especially applicable to manufacturers and distributors, storage and handling, and patient education regarding safe handling. These recommendations, on the basis of our experience and of best practices, provide an international perspective and can be adapted by institutions and practices for development of standardized procedures specific to their needs for the safe handling of oral chemotherapeutic agents. Copyright © 2011 by American Society of Clinical Oncology.


Perrier L.,French National Center for Scientific Research | Lefranc A.,Biostatistics Unit | Perol D.,Biostatistics Unit | Quittet P.,Montpellier University | And 11 more authors.
Applied Health Economics and Health Policy | Year: 2013

Background: Use of the recombinant human granulocyte colony-stimulating factor (rhG-CSF) filgrastim accelerates neutrophil recovery following myelosuppressive chemotherapy. Since filgrastim requires multiple daily administrations, forms of rhG-CSF with a longer half life, including pegfilgrastim, have been developed. Pegfilgrastim is safe and effective in supporting neutrophil recovery and reducing febrile neutropenia after conventional chemotherapy. Pegfilgrastim has also been successfully used to support patients undergoing peripheral blood stem cell (PBSC) transplantation for haematological malignancies. To our knowledge, no cost-effectiveness analysis (CEA) of pegfilgrastim in this setting has been published yet. Objective: We undertook a CEA to compare a single injection of pegfilgrastim versus repeated administrations of filgrastim in patients who had undergone PBSC transplantation for lymphoma or myeloma. The CEA was set in France and covered a period of 100 ± 10 days from transplant. Methods: The CEA was designed as part of an open-label, multicentre, randomized phase II trial. Costs were assessed from the hospital's point of view and are expressed in 2009 euros. Costs computation focused on inpatient, outpatient, and home care. Costs in the two arms of the study were compared using the Mann-Whitney test. When differences were statistically significant, multiple regression analyses were performed in order to identify cost drivers. Incremental cost-effectiveness ratios (ICER) were calculated for the major endpoints of the trial; i.e., duration of febrile neutropenia (absolute neutrophil count [ANC] <0.5 × 109/L and temperature ≥38 C), duration of neutropenia (ANC <1.0 × 109/L and ANC <0.5 × 109/L), duration of thrombopenia (platelets <50 × 109/L and <20 × 109/L), and days with a temperature ≥38 C). Uncertainty around the ICER was captured by a probabilistic analysis using a non-parametric bootstrap method. Results: 151 patients were enrolled at ten French centres from October 2008 to September 2009. The mean total cost in the pegfilgrastim arm of the study (n = 74) was €25,024 (SD 9,945). That in the filgrastim arm (n = 76) was €28,700 (SD 20,597). Pegfilgrastim strictly dominated filgrastim for days of febrile neutropenia avoided, days of neutropenia (ANC <1.0 × 109/L) avoided, days of thrombopenia (platelets <20 × 109/L) avoided, and days with temperature ≥38 C) avoided. Pegfilgrastim was less costly and less effective than filgrastim for the number of days with ANC <0.5 × 109/L avoided and the number of days with platelets <50.0 × 109/L avoided. Taking uncertainty into account, the probabilities that pegfilgrastim strictly dominated filgrastim were 67 % for febrile neutropenia, 86 % for neutropenia (ANC <1.0 × 109/L), 59 % for thrombopenia (platelets <20 × 10 9/L), 86 % for temperature ≥38 C, 32 % for neutropenia (ANC <0.5 × 109/L), and 43 % for thrombopenia (platelets <50 × 109/L). Conversely, the probability that filgrastim strictly dominated pegfilgrastim for neutropenia (ANC <0.5 × 109/L) is 5 %. Conclusion: This study found no evidence that the use of pegfilgrastim is associated with greater cost in lymphoma and myeloma patients after high-dose chemotherapy and PBSC transplantation. © 2013 Springer International Publishing Switzerland.


Vigneron J.,University of Lorraine | Astier A.,University of Lorraine | Trittler R.N.R.,University Hospital Freiburg | Hecq J.-D.,Cliniques Universitaires Mont Godinne | And 4 more authors.
European Journal of Oncology Pharmacy | Year: 2014

The recommendations for the practical stability of anticancer drugs published in 2010 by the French Society of Oncology Pharmacy (SFPO) and the European Society of Oncology Pharmacists (ESOP) have been updated. Ten new molecules—asparaginase, azacitidine, bevacizumab, clofarabine, eribuline mesylate, folinate sodium, levofolinate calcium, nelarabine, rituximab, temsirolimus—have been included. © 2014 Pharma Publishing and Media Europe. All rights reserved


Daouphars M.,Cancer Center Henri Becquerel | Ouvry M.,Cancer Center Henri Becquerel | Lenain P.,Cancer Center Henri Becquerel | Rouvet J.,Cancer Center Henri Becquerel | And 3 more authors.
Pharmacotherapy | Year: 2013

Study Objectives. To develop and validate a self-assessment adherence tool for imatinib in patients with chronic myeloid leukemia (CML), and to correlate the use of this tool with response to treatment and adverse effects. Design. Retrospective cohort study. Setting. Regional cancer center in France. Patients. Forty-six patients with chronic phase CML treated with imatinib for 6 months or longer as of July 1, 2009. Measurements and main results. We developed a self-assessment questionnaire consisting of 10 questions to identify patients who were nonadherent to their cancer treatment. Each answer was worth 1 point, resulting in a possible maximum score of 10. The questionnaire was validated in patients receiving imatinib, using an objective adherence evaluation: a patient's score on the self-assessment questionnaire was correlated with prescription refills, expressed as a medication possession ratio. A score of less than 8 was associated with a positive predictive value of 0.83 to have a medication possession ratio below 90%. With use of this questionnaire, half of the patients receiving imatinib would be identified as being nonadherent (sensitivity 0.5). Few adherent patients would be falsely identified as nonadherent, as the questionnaire's specificity was 0.97. Conclusion. This self-assessment questionnaire was validated for the first time in patients receiving imatinib for CML treatment. It provides a simple practical tool for health care professionals to assess patient adherence during their routine clinical practice and to propose targeted interventions for those identified as possibly nonadherent.


Daouphars M.,Cancer Center Henri Becquerel
Clinical journal of oncology nursing | Year: 2012

Although several studies have evaluated the frequency and consequences of medication errors, few have explored their causes. In particular, nurses' knowledge regarding medications has been evaluated minimally. This survey was conducted to determine how nurses master medications prescribed to their patients to determine problems nurses may have with prescribed drugs and identify possible support tools. A questionnaire was created and presented to nurses in a French cancer center. A majority of the respondents correctly identified pharmaceutical classes and medications, as well as administration and storage conditions. However, side effects, contraindications, and drug-drug interactions were not adequately identified. Nurses reported facing problems mainly related to drug administration, drug storage, and generic drugs and their therapeutic equivalence. Multiple tools are in development to help nurses in these areas. This collaborative study between pharmacy and care wards identifies some difficulties nurses have regarding drugs and will help to establish improvement measures within the hospital.


PubMed | Cancer Center Henri Becquerel
Type: Journal Article | Journal: Clinical journal of oncology nursing | Year: 2012

Although several studies have evaluated the frequency and consequences of medication errors, few have explored their causes. In particular, nurses knowledge regarding medications has been evaluated minimally. This survey was conducted to determine how nurses master medications prescribed to their patients to determine problems nurses may have with prescribed drugs and identify possible support tools. A questionnaire was created and presented to nurses in a French cancer center. A majority of the respondents correctly identified pharmaceutical classes and medications, as well as administration and storage conditions. However, side effects, contraindications, and drug-drug interactions were not adequately identified. Nurses reported facing problems mainly related to drug administration, drug storage, and generic drugs and their therapeutic equivalence. Multiple tools are in development to help nurses in these areas. This collaborative study between pharmacy and care wards identifies some difficulties nurses have regarding drugs and will help to establish improvement measures within the hospital.


PubMed | Cancer Center Henri Becquerel
Type: Journal Article | Journal: Pharmacotherapy | Year: 2013

To develop and validate a self-assessment adherence tool for imatinib in patients with chronic myeloid leukemia (CML), and to correlate the use of this tool with response to treatment and adverse effects.Retrospective cohort study.Regional cancer center in France.Forty-six patients with chronic phase CML treated with imatinib for 6months or longer as of July 1, 2009.We developed a self-assessment questionnaire consisting of 10 questions to identify patients who were nonadherent to their cancer treatment. Each answer was worth 1 point, resulting in a possible maximum score of 10. The questionnaire was validated in patients receiving imatinib, using an objective adherence evaluation: a patients score on the self-assessment questionnaire was correlated with prescription refills, expressed as a medication possession ratio. A score of less than 8 was associated with a positive predictive value of 0.83 to have a medication possession ratio below 90%. With use of this questionnaire, half of the patients receiving imatinib would be identified as being nonadherent (sensitivity 0.5). Few adherent patients would be falsely identified as nonadherent, as the questionnaires specificity was 0.97.This self-assessment questionnaire was validated for the first time in patients receiving imatinib for CML treatment. It provides a simple practical tool for health care professionals to assess patient adherence during their routine clinical practice and to propose targeted interventions for those identified as possibly nonadherent.

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