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'Regards croisés 2009' survey was conducted following the first French Cancer Plan, on 300 cancer patients with chemotherapy-induced anemia and 359 health professionals (physicians and nurses), to evaluate and compare their perceptions of fatigue and chemotherapy-induced anemia management. The patients included were diagnosed with breast, lung or colorectal cancer, or non-myeloid malignant hemopathy, their anemia (defined by an Hb level < 11 g/dl according to 2007 European recommendations) was either treated or not. The main populations' analysis and secondary subgroups' analysis, by types of cancer and physician specializations, have been reported in previous articles. This article aims to present the results of an exploratory analysis of subgroups classified by age (< 70 and ≥ 70 years of age) and of a typological analysis performed in order to identify patient profiles with similar attitude and/or behaviour regarding fatigue. Subgroup analysis by age did not show any difference related to age, concerning perception of fatigue and expectations of its management. Fatigue in elderly patients must therefore be managed in the same way as fatigue in young patients. The typological analysis has identified four types of patients with clearly defined differences in their attitude and behavior towards fatigue: 'highly fatigued and demanding' (33%), 'highly fatigued andmoderately demanding' (30%), 'coping with fatigue' (26%), 'relatively undemanding' (11%). Identification of patients' profiles during consultation may enable fatigue management adapted to their expectations. A typological analysis of physicians is also briefly presented. It emphasizes differences in physicians' attitudes toward patients' fatigue, irrespective of their overall involvement in fatigue management. The 'Regards croisés 2009' survey thus provides valuable insights on the perception of fatigue and the improvements required at the dawn of the second Cancer Plan. [ABSTRACT FROM AUTHOR]

L’enquête ≪ Regards croisés ≫ a été réalisée en 2009, auprès de patients atteints de cancer et de professionnels de santé, pour évaluer et comparer leur perception de la prise en charge de la fatigue et de l’anémie chimioinduite. Les 300 patients inclus présentaient une tumeur solide (cancer du sein, du poumon ou colorectal) ou une hémopathie maligne non myéloïde. Ils étaient traités par chimiothérapie et présentaient ou avaient présenté une anémie (Hb < 11 g/dl). Tous les patients ont complété un auto-questionnaire remis par leur médecin. Les 359 professionnels de santé inclus étaient en charge de patients cancéreux (250 médecins: oncologues, hématologues, gastroentérologues, pneumologues; 109 infirmières) et ont répondu à un entretien téléphonique. La fatigue est l’effet indésirable de la chimiothérapie le plus souvent cité par les patients (77 %). Comme décrit dans les enquêtes précédentes, la fatigue reste en tête des complications qui affectent le plus la vie quotidienne des patients (37 %). La perception des professionnels de santé sur la fatigue et sa nécessaire prise en charge est proche de celle des patients, ce qui montre une évolution des mentalités. Les professionnels de santé ont aujourd’hui conscience que la fatigue et les causes de cette fatigue doivent être prises en compte dans le suivi des patients traités par chimiothérapie. L’intégralité des résultats de l’enquête sera détaillée dans les publications suivantes. [ABSTRACT FROM AUTHOR]

To evaluate, according to the histologic type and initial stage, the mean cost (MC) of managing patients with lung cancer and the costs of the different management phases. A Markov approach was used to model these costs, based on the management of a representative nation-wide sample of 428 patients with newly diagnosed lung cancer. The 18-month MC ranged from US$ 20?691 (95% CI: 5777-50?380 for diffuse non-small-cell lung cancer (NSCLC) to US$ 31?833 (95% CI: 15?866-64?455) for localised small-cell lung cancer (SCLC); first-line treatment costs ranged from 33.8% of MC for medically inoperable localised NSCLC to 74.6% for diffuse SCLC; second- or third-line treatment costs ranged from 7.8% of MC for surgically treated localised NSCLC to 32% for locally advanced NSCLC; and the cost of palliative care ranged from 9.1% of MC for locally advanced NSCLC to 39.9% for medically inoperable localised NSCLC. The cost of first-line chemotherapy and the percentage of actively treated patients impacted more on MC than did the cost of second- or third-line chemotherapy regimens or the cost of palliative care. In conclusion, this model provides a robust economic analysis of the cost of lung cancer management, and will be useful for assessing the economic consequences of future changes in patient management.British Journal of Cancer (2004) 90, 397-402. doi:10.1038/sj.bjc.6601547 www.bjcancer.com [ABSTRACT FROM AUTHOR]

Abstract: Context: Erlotinib therapy for non small-cell lung cancer (NSCLC) has mainly been evaluated in randomized trials. Method: OBSTAR was a multicenter, retrospective, observational study involving all patients treated with erlotinib in 18 French centers between June 2005 and September 2007. The analyses focused on the patients’ characteristics, previous treatments, and treatment efficacy during a three-year follow-up period. Results: 534 patients were included in this study. The median survival times were respectively 5.2 [3.7–7.4] and 4.7 [4.1–5.7] months, depending to whether erlotinib was used as second- (n =190), or ≥third-line treatment (n =305). The disease control rate were 39.1% [30.2–48.7] and 29.9% [29.6–36.9] according to the line of treatment. Factors predictive of an objective response were gender, age, and smoking status. Factors predictive of progression were age, sex, smoking status, the line of treatment, and the number of metastases. Treatment had to be interrupted for toxicity in 8.5% of cases. Conclusion: This study of erlotinib therapy in 2005–2007 confirms, in the general NSCLC patient population, the results of pivotal trials. [Copyright &y& Elsevier]

This original survey was elaborated in order to evaluate and compare the perceptions of patients and health professionals of the management of fatigue and chemotherapy-induced anemia. Itsmethodology could enable statistical comparisons between subgroups of patients according to their type of cancer, and between subgroups of physicians according to their specialization. 'Regards croisés 2009' survey was conducted among 300 cancer patients, 250 physicians (oncologists, hematologists, pneumologists, and gastroenterologists), and 109 nurses. The included patients had a diagnosis of breast, lung, or colorectal cancer, or nonmyeloid malignant hemopathy; were undergoing ambulatory chemotherapy; and presented or had presented with anemia (Hb < 11 g/dl) during chemotherapy. Subgroups comparisons showed quite homogeneous results, confirming global results of the survey previously published and demonstrating a better management of fatigue; they also showed some specificities related to the type of cancer and to the specialization of the physician concerned. A better knowledge about these specificities could help to improve the management. [ABSTRACT FROM AUTHOR]

“Regards croisés 2009” survey was conducted among 300 cancer patients, 250 physicians (oncologists, hematologists, pneumologists, and gastroenterologists) and 109 nurses, in order to evaluate and compare their perceptions of the management of fatigue and chemotherapy-induced anemia. The included patients had a diagnosis of breast, lung or colorectal cancer, or non-myeloid malignant hemopathy, were undergoing ambulatory chemotherapy, and presented or had presented with anemia (Hb < 11 g/dl) during chemotherapy. Fatigue was reported by 77% of the patients, in accordance with the literature. This survey brought new data: patients have expressed great satisfaction in their relations with health professionals, particularly in the management of cancer (notes from 7.5 to 9.1/10), but also, with a little less high notes, in the management of fatigue (notes from 6.6 to 8.4/10). Health professionals’ perceptions were close to those of patients, although they underevaluated the quality of their relations with patients. This shows the positive evolution of cancer patients’ management in France, since the first Cancer patients meeting data published in 1999, which conducted to the first Cancer Plan. General practitioner’s place was also studied according to patients: it seemed to be very important, even if patients appeared more satisfied by informations about cancer and fatigue given by oncologists and others specialists. These data mean that efforts on listening and dialogue with patients have to be enhanced, in accordance with the second Cancer Plan (2009–2013). [ABSTRACT FROM AUTHOR]

L’enquête « Regards croisés 2009 » a été réalisée auprès de 300 patients atteints de cancer, de 250 médecins (oncologues, hématologues, pneumologues et gastro-entérologues) et de 109 infirmières pour évaluer et comparer leur perception de la prise en charge de la fatigue et de l’anémie chimio-induite. Les patients inclus présentaient une tumeur solide (cancer du sein, du poumon ou colorectal) ou une hémopathie maligne non myéloïde, étaient traités par chimiothérapie et présentaient ou avaient présenté une anémie (Hb < 11 g/dl). Trois patients sur quatre (77 %) se plaignaient de fatigue. Les patients et les professionnels de santé avaient une opinion consensuelle concernant l’impact de la fatigue sur la vie quotidienne des patients. Les professionnels de santé étaient unanimes sur la priorité que représente la prise en charge de la fatigue et sur la difficulté à la réaliser. Leur perception a donc évolué depuis les précédentes enquêtes qui montraient les insuffisances de la prise en charge de la fatigue des patients atteints de cancer. Les résultats montrent aussi que les patients interrogés n’avaient pas conscience de la relation entre fatigue, chimiothérapie et anémie. Ainsi, un effort d’information des patients sur les traitements disponibles reste nécessaire. C’est une des priorités exprimées de façon unanime par les trois populations interrogées, tout comme améliorer la prise de conscience des professionnels de santé concernant la nécessité de prendre en charge la fatigue et le recours à des traitements efficaces, qui s’intègrent... [ABSTRACT FROM AUTHOR]

The goal of this study was to compare outcomes and costs of two management strategies for non-ventilator-associated nosocomial pneumonia (NP) in a medical ward. In this single-centre study, NP patients ( n = 68) were randomized to receive non-invasive management (NIM) with immediate empirical antibiotic treatment ( n = 34), or invasive management (IM) based on protected brush sampling of specimens ( n = 34). The economic analysis adopted the hospital’s perspective and took into account only direct costs. Baseline characteristics did not differ significantly between the two patient groups. The most frequently isolated organisms were Staphylococcus (25.4%), Streptococcus (23.7%) and Pseudomonas (18.6%) species. The 28-day clinical cure rate did not differ notably between the two groups (NIM, 79.4%; IM, 73.5%). Mortality at 28 days tended to be lower in the NIM group (10.0% vs. 21.8%). Mean antibiotic costs were lower in the IM group (€194 ± 355 vs. €300 ± 335, p <0.001) but overall management costs were similar (respectively, €367 ± 355 and €346 ± 363 in the IM and NIM groups, p = 0.08). With respect to both outcome and cost, this study does not support routine management of NP in medical wards using invasive procedures. [ABSTRACT FROM AUTHOR]

Failure Mode, Effects and Criticality Analysis (FMECA) is used in industry to prevent process or product failures. We studied the feasibility of this method in the hospital environment. FMECA was used to improve drug prescription in two medical wards. Failure modes were identified and classified hierarchically. Corrective actions were taken. Involvement of all the professionals concerned in this process was secured, and has resulted in real acceptance of the proposed changes and in their effective realization. [ABSTRACT FROM AUTHOR]

The mechanisms controlling erythropoietin (EPO) synthesis by the kidney in patients with chronic obstructive lung disease (COLD) or congestive left heart failure (CLHF) remain incompletely understood. Renal dysfunction occurs as a consequence of decreased renal blood flow (RBF) in these diseases. Because alterations in renal haemodynamics may affect EPO synthesis and red blood cell production, we investigated the potential relationships between renal function and plasma EPO synthesis in patients with COLD or CLHF. Thirty-two patients with COLD and 13 with CLHF underwent determination of renal physiology parameters, plasma EPO levels and haemoglobin levels. Plasma EPO concentrations were increased in patients with COLD or CLHF as compared to normal subjects, and were inversely correlated to haemoglobin concentrations. In patients with COLD or CLHF, plasma EPO was negatively correlated with both RBF and renal oxygen delivery (ROD) and positively correlated with filtration fraction. Plasma EPO was not correlated with glomerular filtration rate, fractional excretion of sodium, Po2 or Pco2. Among the patients with COLD, those with polycythemia (haemoglobin > 150 g L-1) had lower plasma EPO and higher RBF and ROD values than those with normocythemia (haemoglobin ≤ 150 g L-1). Taken together, our data suggest that in patients with COLD or CLHF the critical determinant for EPO production is impairment of renal haemodynamics. [ABSTRACT FROM AUTHOR]

Objectif de l’étude Depuis 2014, plusieurs essais randomisés ont montré la supériorité des inhibiteurs de checkpoint immunitaires, et notamment des anti PD-1, dans le traitement des cancers bronchiques non à petites cellules métastatiques, par rapport à la chimiothérapie. Ces patients reçoivent souvent de manière séquentielle rapprochée ou concomitante du nivolumab, un inhibiteur de PD-1, et une radiothérapie, souvent à visée symptomatique. Néanmoins, même si les études précliniques suggèrent une potentielle synergie entre les deux traitements, la tolérance de cette association est méconnue. Matériel et méthode Nous avons analysé rétrospectivement une large série de patients atteints d’un cancer bronchique non à petites cellules métastatiques, traités dans trois centres français et ayant reçu une radiothérapie dans les six mois précédents et une injection de nivolumab les trois mois suivant ou en concomitance. Résultats Parmi les 104 patients inclus (37 femmes, 67 hommes, d’âge médian 60,3 ans, 67 % d’indices de performance inférieur à 2, 93 % de fumeurs actifs ou sevrés) et les 144 cibles irradiées incluses, des effets secondaires ont été observés chez 62 patients (59,6 %), dont dix souffrant au moins d’une toxicité de grade III-IV. Pour neuf de ces dix patients, cette toxicité sévère était immuno-induite, en rapport avec les injections de nivolumab. Les taux de survie globale à 1 et 2 ans étaient respectivement de 48,8 % et 29,1 % et ceux de survie sans progression de 20,9 % et 10,1 %. Le délai d’administration de la radiothérapie avant ou pendant/après le nivolumab, n’influençait pas les taux de survie ou la fréquence des effets indésirables. La survie sans progression était significativement plus longue pour les patients souffrant d’effets secondaires induits par le nivolumab (p = 0,038). Conclusion Il s’agit à ce jour de la série rétrospective la plus large évaluant spécifiquement l’association de nivolumab et de radiothérapie chez les patients atteints de cancer bronchique non à petites cellules métastatiques. Cette combinaison thérapeutique est bien tolérée et ne semble pas être associée à un surcroît d’effets indésirables. [ABSTRACT FROM AUTHOR]