Influence of cirrhosis on outcomes of patients with advanced intrahepatic cholangiocarcinoma receiving chemotherapy.

BACKGROUND: Cirrhosis is a risk factor for intrahepatic cholangiocarcinoma (iCC). However, its exact prevalence is uncertain and its impact on the management of advanced disease is not established. METHODS: Retrospective analysis of patients treated with systemic chemotherapy for advanced iCC in the 1st-line setting at 2 tertiary cancer referral centres. Cirrhosis was diagnosed based on at least one element prior to any treatment: pathological diagnosis, baseline platelets <150 × 109/L, portal hypertension and/or dysmorphic liver on imaging. RESULTS: In the cohort of patients (n = 287), 82 (28.6%) had cirrhosis (45 based on pathological diagnosis). Patients with cirrhosis experienced more grade 3/4 haematologic toxicity (44% vs 22%, respectively, P = 0.001), and more grade 3/4 non-haematologic toxicity (34% vs 14%, respectively, P = 0.001) than those without. The overall survival (OS) was significantly shorter in patients with cirrhosis: median 9.1 vs 13.1 months for those without (HR = 1.56 [95% CI: 1.19-2.05]); P = 0.002), confirmed on multivariable analysis (HR = 1.48 [95% CI: 1.04-2.60]; P = 0.028). CONCLUSION: Cirrhosis was relatively common in patients with advanced iCC and was associated with increased chemotherapy-induced toxicity and shorter OS. Formal assessment and consideration of cirrhosis in therapeutic management is recommended.

[Incidence, characteristics and survival of patients with pneumocystis pneumonia in solid oncology]. / Incidence, caractéristiques et survie des patients présentant une pneumocystose en oncologie solide.

INTRODUCTION: Pulmonary pneumocystis causes interstitial lung disease, particularly in patients with solid cancers. The aim of this study is to clarify its incidence, which remains poorly understood, and to identify patients at risk and prognostic factors. METHODS: Data on patients with solid tumors and pulmonary pneumocystis were retrospectively collected from January 1, 2014 to December 31, 2019 in two hospitals in Rennes. Incidence was estimated via the Poisson model. Survival data were estimated using Kaplan-Meier method and Log-rank test. A multivariate Cox model was performed to identify risk factors for death. RESULTS: The incidences of pulmonary pneumocystis in metastatic cancer patients receiving parenteral systemic therapy are 198 and 349 cases per 100,000 patients per year in these two centers, respectively. Most patients were being treated with corticosteroids and chemotherapy at the time of pulmonary pneumocystis. The mortality rate for patients with pulmonary pneumocystis is 38%. Median overall survival was 2,7 months. Risk factors for death are corticotherapy greater than 20mg, prednisone equivalent, daily and chemotherapy. DISCUSSION: Pulmonary pneumocystis pneumonia is rare but not exceptional and has a poor prognosis in solid oncology. It frequently occurs in patients treated with long-term corticosteroids. Oncologists need to be better informed to discuss prophylaxis whenever corticosteroids are prescribed for several weeks.

Evolution of parenteral nutrition practices in a comprehensive cancer center: Comparative audits.

INTRODUCTION: Malnutrition affects 20% to 70% of oncology patients depending on the patient's age, type and stage of cancer. Two audits were carried out in 2016 and 2019 to evaluate the practice of Parenteral Nutrition (PN). METHODS: Records of adult medical inpatients who received PN between January 1, 2018 and April 30, 2019 were retrospectively analysed. Twenty criteria were defined. We conducted a statistical analysis to compare the two audit data. RESULTS: Between January 1, 2018 and April 30, 2019, 86 hospitalizations with a PN prescription were analysed. Of the 69 patients, 66% were female, the mean and median age was 60 years. These were most often medical oncology patients in palliative care. Gynecological and digestive tumors were the two main tumor localization. Bowel obstruction and palliative care management were the two main reasons for hospitalization. Nutritional assessment, amount of energy prescribed, monitoring, and duration of PN remain with poor results. CONCLUSION: Our study seems to show improvements in the relevance of PN indications, the prescription, and monitoring in patients due to the computerization of prescription and training of professionals. PN remains often prescribed in exclusive palliative situations. We need to continue our improvements, particularly for the initial clinical and biological assessment, and the monitoring. It requires a referral team to improve management of patients treated with PN.

[Feelings of cancer patients in exclusive palliative care: Towards a general practitioner, oncologist pairing?] / Ressenti des patients atteints de cancer en soins palliatifs exclusifs: vers un binôme médecin généraliste, cancérologue?

INTRODUCTION: In palliative care, cancer patients' thoughts about support given by their general practitioner are poorly described in the literature. General practitioners are involved in the management of cancer patients in palliative care, but when contact with the oncologist become less frequent, the place of the patient's different doctors becomes difficult to define. The objective of our work is to analyze the patient's perception of the place and role of the general practitioner. METHODS: Qualitative study by individual semi-directed interviews, with voluntary patients with solid cancer in palliative care. Patients were selected by palliative care physicians. A thematic analysis was performed on the basis of the patients' verbatim transcripts. RESULTS: Seventeen patients were interviewed and four main themes were highlighted: a perception of abandonment, a resignation to call the general practitioner, an omnipresence of the oncologist who seems not to leave the place to the general practitioner and a search for global support. The general practitioner did not appear to be empathetic nor supportive enough and was not available enough. DISCUSSION: Patients are looking for empathy and for their doctors to listen. Our work shows a certain disappointment of the patients regarding the place and role of their general practitioner. This disappointment reflects the insufficient coordination between hospital and community care setting. While the early integration of palliative care is becoming a standard of care, the patients' testimony commits us to improve the articulation between the oncologist and the general practitioner.

Hepato-splenic candidiasis confirmed following splenectomy: a case report.

We report a case of severe refractory hepato-splenic candidiasis confirmed following splenectomy in an immunocompromised 54-year-old woman treated for acute lymphoblastic leukemia. Liver biopsies did not contribute to identifying the etiology of the multiple hepato-splenic lesions. In view of the lack of improvement after several lines of antifungal treatments, a splenectomy was performed and confirmed splenic candidiasis. PET/CT scan was used to monitor the evolution of hepato-splenic hypermetabolism. Splenectomy can be envisaged to establish fungal infection in immuno-compromised patients, to exclude relapse, and to guide the choice of antifungal agents.