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Bull Cancer. 2018 Feb 6. Evaluation of the feasibility of a program of adapted physical activity in day hospital of digestive oncology: From the point of view of patients.

INTRODUCTION: 

Adapted physical activity (APA) is recognized as an effective supportive care for asthenia and quality of life in oncology. Before an APA program was organized, the feasibility of such a program was evaluated among the patients.

METHODS: 

Descriptive, prospective, semi-qualitative, single-center study over a 3-month period in patients treated with ambulatory chemotherapy for digestive cancer. A self-questionnaire was offered to all patients to evaluate their practice and knowledge about APA. In ten patients, fatigue, anxiety and depression were assessed, before and after 9 weeks of hospital-based APA. The scores were compared by matched Student test.

RESULTS: 

Of the 123 patients treated, 80 questionnaires (65%) were exploitable. Before the diagnosis of cancer, 40 patients (50%) were physically active, 20% after (n=16). The reasons for not practicing were: lack of interest/not the idea (42%), lack of time (34%), do not believe in profit (9%), too expensive (8%). Fifty-three patients (66%) were interested in the program. In 10 patients, the APA program significantly reduced the depression score (P=0.024) and a non-significant improvement in anxiety and fatigue.

DISCUSSION: 

This study shows that patients treated with chemotherapy are unaware of the usefulness of APA and that medical information can improve adherence to such a program. The establishment of an intra-hospital APA program proved to be possible and relevant.

Support Care Cancer. 2017 Jul. Supportive Care Organization in France: a national in-depth survey among patients and oncologists.

PURPOSE: 

Medical doctors' (MDs), but not patients', perception of supportive care in cancer (SCC) in France has been previously assessed in a national survey. This study evaluated MDs and patients' perceptions of the SCC organization and implementation in France.

METHODS: 

The French SCC Association conducted two observational studies: study 1 (S1), containing a 30-point questionnaire sent to 2263 MDs, and study 2 (S2), containing a 40-point questionnaire sent to 2000 patients.

RESULTS: 

Overall, 711 MDs completed S1 and 1562 patients completed S2. In S1, 81% of MDs reported relying on a SCC organization and 76% attended SCC multidisciplinary discussions. MDs considered palliative (98%), psychological (98%), and social care (98%) as the top 3 SCC areas of importance for patients. In contrast, patients' priorities were psychology (61%), nutrition (55%) and organization of intake consultations (55%). The concept of SCC was familiar to 34% of patients; according to MDs, this concept was introduced mainly by MDs (78%) and admission nurses (41%). Outpatients identified as professional resources for SCC information general practitioners (84%), nurses (58%), and pharmacists (52%). Patients reported supportive treatment being prescribed in 63% of cases, with 64% receiving information on the negative side-effects. Among MDs, 87% reported proposing palliative and 41% adjuvant SCC treatment. Furthermore, 72% of MDs recommended SCC treatment at the metastatic stage, and 36% immediately following diagnosis.

DISCUSSION: 

Oncologists play a vital role in enhancing SCC efficacy. This can be increased by implementing a multidisciplinary integrated approach or by assuring the availability of patient information.

Crit Rev Oncol Hematol. 2016. Natural products and complementary therapies for chemotherapy-induced peripheral neuropathy: A systematic review.

Chemotherapy-induced peripheral neuropathy (CIPN) is a serious dose-limiting side-effect without any FDA-approved treatment option. Prior reviews focus mostly on pharmacological interventions, but nonpharmaceutical interventions have also been evaluated. A Web of Science and PubMed database search to identify relevant RCTs from January 2005 to May 2015 included the terms: CIPN, cancer; and supplements, vitamin E, goshajinkigan, kampo, acetyl-L-carnitine, carnitine, alpha-lipoic acid, omega-3, glutamine, or glutamate; or massage, acupuncture, mind-body practice, yoga, meditation, Tai-Chi, physical activity, or exercise. Of 1465 publications screened, 12 RCTs evaluated natural products and one evaluated electroacupuncture. Vitamin E may help prevent CIPN. L-Glutamine, goshajinkigan, and omega-3 are also promising. Acetyl-L-carnitine may worsen CIPN and alpha-lipoic acid activity is unknown. Electroacupuncture was not superior to placebo. No RCTs were published regarding other complementary therapies, although some studies mention positive incidental findings. Natural products and complementary therapies deserve further investigation, given the lack of effective CIPN interventions.

Support Care Cancer. 2016 Mar. Management of anemia and iron deficiency in a cancer center in France.

PURPOSE: 

Anemia affects most patients treated for cancer by chemotherapy. It is a known major contributor to fatigue and loss of quality of life and is likely to have a negative effect on prognosis and mortality from cancer. The main purpose of this study was to characterize the management of anemia and iron deficiency in a French oncology day-care center.

METHODS: 

A retrospective study was conducted between May and November 2012 in the oncology day unit of the Jean Godinot Cancer Center (France). The 133 patients included were all over the age of 18 and being treated by chemotherapy and had mild, moderate, or severe anemia.

RESULTS: 

Over half (58%) the patients were shown to be receiving no specific treatment for anemia. Iron balance was assessed in 71 patients and iron deficiency diagnosed in 37. Stepwise logistic regression showed that patients with severe to moderate anemia were nearly four times more likely to have an iron balance assessment than those with mild anemia (OR, 3.78; 95% CI, 1.84-7.76; P = 0.0003). Classical logistic regression shows that older patients (≥70) are three times less likely to have an iron balance assessment than patients <70 years (OR, 0.32; 95% CI, 0.12-0.86; P = 0.06).

CONCLUSION: 

An ideal medical setting for the management of anemia and iron deficiency, and the associated quality-of-life concerns, has yet to be defined for patients with cancer. Screening and treatment of mild to moderate anemia are inadequate, despite the advent of erythropoiesis-stimulating agents. Large scale, multicenter studies are required to define a clear medical framework for the management of anemia and iron deficiency.

Crit Rev Oncol Hematol. 2015 . Role of physical activity and sport in oncology: scientific commission of the National Federation Sport and Cancer CAMI.

This overview reports published data about the interaction between physical activity and sport during and after cancer on one hand and improvement in psychological parameters, survival and biological mechanisms underlying this effect on the other hand. Practising physical activity and sport during cancer modifies parameters assessing fatigue and quality of life and reduces symptoms of depression. An association also exists between the practise of physical activity and sport and overall and cancer-specific survivals, especially after breast cancer, colon cancer and prostate cancer. These benefits seem to be mediated by a modification of circulating levels of estrogens, insulin, IGF-1 and by a decrease in insulin-resistance, by alterations in the secretion of adipokines, and by a reduction in chronic inflammation through decreased levels of cytokines. There exist some obstacles to the practise of physical activity. These obstacles are mainly related to a fear of pain induced by physical activity and to overweight. These programmes of physical activity and sport cannot be offered to all patients since there are several contra-indications, with some being present since the initial visit and others appearing during cancer management either due to disease progression or related to iatrogenic effects. Whereas benefits from physical activity and sport among cancer patients seem obvious, there are still several pending clinical and biological issues.

JCO 2015. Feasibility of a multi-disciplinary rehabilitation program for post treatment cancer patients: A pilot study.

Background: Evidence suggested that lifestyle factors included physical activity (PA) and diet are associated with better outcomes in cancer patient (pt). Thus, gain weight after treatment (trt) increased the risk of recurrence in breast and colorectal cancer pt. These data prompt us to integrate PA and healthier diet in cancer care. Our aim was to assess the feasibility of a multi-disciplinary coordinated pilot program, including PA, nutritional and psychological counseling after cancer trt.  Methods: A pilot study was conducted in pts who completed trt for at least 1 month. Pts entered in this program after a dedicated medical consultation. Exclusion criteria were cardiorespiratory or muscular/articular limits for PA. Participants follow a personalized pre-specified exercise schedule: 12 sessions of 60 minutes resistance training and aerobic exercises, twice a week during 6 weeks, combined with 3 sessions of dietary counseling (calory and nutrient intake, weight) and psychological support. Maximal oxygen consumption (V02max), maximum aerobic speed (MAS) and maximum power (Pmax) were assessed on a cycle ergometer at baseline, week 3 and 6. Fatigue was estimated with the Brief Fatigue Inventory (BFI) at the same time.  Results: Between 01/2013 and 12/2014, we enrolled 40 pts (women: 23 ; median age: 54.5 years [21.7-73.1y]) with breast (24%), ovarian (21%), sarcoma (18%), lung (15%), others (22%) cancers. 5 (15.2%) pts were metastatic. All pts were PS 0-1. 67% of the pts had a normal BMI. Last cancer trt prior inclusion was: chemotherapy (52%), radiotherapy (24%), surgery (15%). Median time between last trt and inclusion was 5.9 months. 33 pts (82.5%) achieved the whole program. Mean duration for the 12 training sessions was 9.2 weeks (4.6-16). At the end of training period, aerobic function improved with an increase of V02max (25.45 vs 21.71 ml/min/kg ; p = 0 ,0004), MAS (8.83 vs 7.4 km/h ; p < 0.0001) and Pmax (170.93 vs 153.89 W ; p = 0,0001). BFI scores decreased significantly (21.1 vs 34.2 ; p = 0,0001).  Conclusions: A multi-disciplinary rehabilitation program is feasible in pre-treated cancer pt. Significant impact was observed on physical outcomes and confirmed the positive effect on fatigue.

BMC Cancer. 2015 Dec 23 - Prevalence of hepatitis B and C and sensibility of a selective screening questionnaire in patients receiving chemotherapy for solid tumors.

BACKGROUND: 

Reactivation of hepatitis B or C virus can occur in patients undergoing chemotherapy. Recommendations for selective or systematic hepatitis B virus testing prior chemotherapy for solid tumors differ. The primary aim was to determine the seroprevalence of hepatitis B or C in a low endemic country. The second objective was to assess the relevance of a questionnaire on hepatitis B/C risk factors to consider a selective screening.

METHODS: 

Patients were prospectively tested for hepatitis B/C markers. HBs antigen positive patients and isolated anti-HBc positive patients with detectable viral load received antiviral preventive treatment. Patients or physicians completed the questionnaire on infection risk factors.

RESULTS: 

Among the 450 patients included, 388 were tested for all serological markers and had gastrointestinal (63.7%), lung (31.2%) and skin (4.6%) cancers. The prevalence of subjects exposed to hepatitis B virus was 8.5% (33/388). One patient tested positive for HBs antigen and received preventive treatment. Prevalence of subjects exposed to hepatitis C was 1.3% (5/388). The questionnaire sensitivity was 45.5%, 100% and 50% for detecting carriers of hepatitis B, C and one or the other, respectively.

CONCLUSIONS: 

Seroprevalence of hepatitis B was low. Selective screening with the questionnaire was insufficiently sensitive. Systematic screening with serological tests prior to chemotherapy in patients with solid tumors is therefore relevant.

Bull Cancer. 2014 Jun. External review of integrative oncology or complementary therapies use. Based on US academic cancer center

The Integrative Medicine department at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City was created more than ten years ago by the founding director, Barrie.R Cassileth, PhD. Integrative medicine in oncology is defined as the use of complementary therapies to control physical and emotional symptoms associated with cancer and cancer treatment, and improves quality of life of patients and family members. It represents a range of interventions who are non invasive, evidence-based and used with mainstream treatment opposed to “alternative therapies” wich are used instead of mainstream treatment and potentially harmful. In this review we introduce the most common such interventions, including mind-body therapies (meditation, music therapy, Qi Gong and touch (massage) therapy), acupuncture treatment, physical activity, diet and nutrition. Then we describe the organization of this department, which can guide us in France to promote evidence-bases complementary medicine in cancer care.

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