Feasibility of perforator flaps in Day surgery. A retrospective study through a two-years' experience.

BACKGROUND: Day surgery is developing and its popularity is increasing for a variety of reasons: economic constraints, changes in professional practices, a greater adhesion of the patient. In an era of progress in surgical procedures, pedicled-perforator flaps reducing donor site morbidity and avoiding micro-anastomosis could take their place in Day surgery if planned and managed by an experienced team. METHODS: In the period January 2019 to January 2021, we performed perforator flaps for soft tissue coverage in ambulatory setting. The patients were included retrospectively and data were collected by reviewing the medical records. Major and minor complications were recorded. RESULTS: The retrospective cohort included 32 surgical procedures in 32 patients. In all cases, perforator flaps were realized for resurfacing soft tissue defects consequent to oncodermatology surgery (84.3%), soft tissue sarcoma surgery (12.5%), invasive ductal breast carcinoma (3.1%). Major complications needing a surgical revision overcame 3/32 times (9.4%). In these cases, a failure requiring the drop off the flap overcame once. The average wound healing time was of 33 days (15-90) and the mean duration of follow-up was 9.6 months (1-22). CONCLUSION: The low complication rate in our series suggests that this first experience on perforator flaps in outpatient surgery is promising in terms of safety and feasibility. Day surgery could be a practical option for this type of surgical procedures avoiding the conventional department's saturation and allowing the delivery of proper surgical cares.

[Overwiew of compounding oncology pharmacy in France in 2021]. / États des lieux de la pharmacotechnie oncologique en France en 2021.

The pharmacotechnical expert group of the French Society of Oncological Pharmacy presents the results of its national survey carried out in 2021 in the form of an inventory of pharmaceutical compounding units dedicated to oncology. Premises, equipment, controls, production flows and trends are described in this article, providing an overview of the sector at a time when the new Good Manufacturing Practices (GMP) are applicable. This overview will allow us to better address the needs and expectations of production pharmacists regarding the application of GMP and the development of their units.

Comprehensive medication management (CMM): Application of a new pharmaceutical practice in onco-hematology.

The integration of a large number of drugs, such as antineoplastic agents and cancer-related supportive care drugs, into the management of cancer patients exposes them to an increased number of drug-related problems (DRP). Clinical pharmacists contribute to drug management by actively intervening in detected DRP. The aim of this study is to assess the impact of the applying a clinical pharmacist-driven comprehensive medication management (CMM) service to onco-hematology patients. This prospective interventional study was carried out over six-month duration, specifically from November 06, 2022 to April 5, 2023 in the oncology and hematology departments of the EHU Oran. The adherence to treatment was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS). Whereas data related to the patient's general condition and medication history was assessed using the Pharmaceutical Care Network Europe (PCNE) Classification for Drug-Related Problems V9.1. Among the 130 patients included in the study, a total of 879 DRP were identified, with a mean of 6.78 (±1.72) DRP/patient, half of which were related to efficacy (51%). Almost half of our sample (44.6%) did not adhere to their treatment. The most frequent cause of DRP, accounting for (19.9%) of the cases, was the inappropriate administration by a health professional. A total of 875 pharmaceuticals interventions (PI) were proposed, 67.2% of which were focused at the drug level. The PI acceptance rate was 94.1%. The integration of CMM services in onco-hematology played an important role in optimizing dosing regimen and treatment administration methods, as well as preventing iatropathology in the management of cancer patients.

Complications of catheters with an implantable chamber: About 26 cases.

BACKGROUND: Implant port catheters have became essential tools in the management of patients receiving intravenous chemotherapy. However; these devices expose to significant complications. We report an experiment aimed at studying the prevalence of complications induced by implant port catheters and the risk factors that result. METHODS: This is a retrospective study over one year (from January, to December 2019) including 100 patients treated in the carcinology department of our hospital and having presented complications from their port catheters implantable. RESULTS: During the study period, 100 patients benefited from placement of the implantable chamber catheter. The average age is 53years with extremes of 25years and 72years. Twenty-six percent of patients had at least one complication. Those complications were mechanical in 53.84% of the patients, infectious in 19.23% and thromboembolic in 19.23%. DISCUSSION: Patients experiencing complication did not differ with respect to age, body mass index, cancer category, medical and surgical history, and insertion side of the implantable chamber catheter.

[Supporting caregivers of children and adolescents with cancer]. / Accompagner les soignants auprès des enfants et adolescents atteints de cancer.

Caring for a child or adolescent with cancer remains a perilous professional exercise. Caregivers are not only subject to high technical demands (oncological treatments, surgery and resuscitation, rehabilitation and equipment) but also to an emotional and relational involvement inherent to their function. However, the regulation and transformation of affects mobilize a great deal of psychic energy in professionals who must preserve their internal resources as best they can. The point of view of the clinical psychologist will shed light on the mechanisms to be considered in order to support the capacity of the teams to care for and accompany sick children and their families throughout the care process.

[RNAseq in routine oncology]. / Le RNAseq en oncologie de routine.

High throughput RNA sequencing, also know as RNAseq, can easily be performed on the gold-standard technique of formalin-fixed paraffin-embedded tissue, which has long been successfully used in routine practice by pathologists. For this reason, RNAseq has been fully adopted in a very short period of time in most French molecular platforms of cancer genotyping, generating "high throughput" data, both qualitative (mutations, fusions) and quantitative (gene expression profiles). This technique opens new perspectives in oncology practice: from a diagnostic point of view (some gene fusions are specific of some diagnoses, some transcriptomic signatures suggest some types of cancer), but also from a prognostic point of view (gene expression profile of an aggressive tumor, or conversely of an indolent one), and above all from a predictive point of view, guiding the choice of potential targeted therapies (example of ALK, ROS1 or NTRK translocations). This technical approach has many advantages, first and foremost it detects, at one go, a plethora of molecular alterations which were previously analyzed sequentially using heterogenous assays (immunohistochemistry, DNA genotyping, fluorescent in situ hybridization, etc.). However, it also presents several drawbacks which may easily be overcome if certain pre-analytic parameters are correctly controlled, mainly aiming at the preservation of the quality of nucleic acids. In any event, the widespread use of RNAseq has had a profound impact on the algorithms of tumor tissue processing, shaping a new, holistic era in oncology.

[IMPACTCHIMIO: Development and multicentric validation of a tool for collecting pharmaceutical interventions carried out within chemotherapy reconstitution units]. / IMPACTCHIMIO : élaboration et validation multicentrique d'un outil de recueil des interventions pharmaceutiques réalisées au sein des unités de reconstitution de chimiothérapies.

OBJECTIVES: To develop and validate prospectively a specific tool for pharmaceutical interventions performed in centralized cytotoxic preparation units. METHODS: A pharmaceutical intervention is defined as a type of intervention performed in relation to a problem encountered. ImpactChimio is derived from the Act-IP® (SFPC) tool. The initial version (version 1) was developed from the pharmaceutical interventions collected over 1 year by the pilot centre. Its validation was carried out by the Delphi method via a prospective multicentric collection to assess its robustness (real life pharmaceutical interventions) and reproducibility (50 pharmaceutical interventions classified by pharmacists naive or not to the tool and study of classification divergences). RESULTS: The development of the tool (version 1) was based on the analysis of 412 pharmaceutical interventions. For its validation, 196 pharmaceutical interventions were provided by 6 centers for 5 months. The changes have been incorporated into the new versions of the tool (version 2 and version 3). Six naive and six non-naive pharmacists then tested reproducibility by reclassifying 50 selected pharmaceutical interventions into version 3. A total of 136 discrepancies (11.3 %) were found out of 1200 responses: 66 related to the problem encountered and 70 to the type of intervention. No statistically significant differences were found between naive and non-naive pharmacists. CONCLUSIONS: ImpactChimio is the first pharmaceutical interventions' specific tool for centralized cytotoxic preparation units, developed and validated by a multicentric study using the Delphi method. It makes possible to enhance the value of the analysis activity and to identify training areas for the teams.

[Initiating and maintaining appropriate physical activity with cancer]. / Initier et maintenir une activité physique adaptée avec un cancer.

The benefits of regular physical activity (PA) are essential and recognized, including for cancer patients, during and after treatment. The OncoNormandie regional cancer network therefore offers an adapted physical activity support system that facilitates access for cancer patients.

L'infirmière pivot associée à une expérience de soins oncologiques positive et à une satisfaction accrue des patients.

CONTEXTE ET OBJECTIFS: Un nombre croissant de résultats probants indique que l'infirmière pivot en oncologie (IPO) joue un rôle de premier plan dans l'optimisation des processus et des résultats de soins. Il faudra toutefois mener des études d'envergure pour comparer les perceptions de l'expérience de soins liés au cancer des patients traités par des infirmières pivots et de ceux qui n'ont pas bénéficié de ce type de suivi. MÉTHODOLOGIE: Des participants (N = 2 858) traités au cours des six derniers mois dans un centre de traitement du cancer situé à Montréal, au Québec, et affilié à une université ont répondu au sondage sur la satisfaction des patients en traitement anticancéreux ambulatoire, c'est-à-dire le Ambulatory Oncology Patient Satisfaction Survey (AOPSS). RÉSULTATS: L'expérience des soins oncologiques était significativement plus positives et la satisfaction plus élevée dans le groupe suivi par une infirmière pivot (n = 2 003) pour les six domaines de soins (différences moyennes de 3,32 à 8,95) et les quatre fonctions infirmières (différences moyennes de 5,64 à 10,39), comparativement au groupe sans IPO (n = 855). DISCUSSION: L'infirmière pivot joue un rôle important dans l'amélioration de l'expérience de soins et la satisfaction des patients. Les recherches futures devront explorer les potentielles relations de cause à effet entre les infirmières pivots, les processus de soins et les résultats des patients.

Avoir sa santé en main : le sentiment d'habilitation tel que perçu par les jeunes adultes souffrant d'un cancer avancé.

CONTEXTE: Le sentiment d'habilitation sur sa santé (health related empowerment) est un concept fondamental des soins centrés sur la personne. Toutefois, on en sait peu sur la manière dont ce concept s'articule chez les jeunes adultes ayant un diagnostic de cancer avancé. OBJECTIF: Explorer le sentiment d'habilitation à la lumière des expériences de soins de santé vécues par les jeunes adultes en phase de cancer avancé. CADRE ET PARTICIPANTS: Douze jeunes adultes (âgés de 21 à 39 ans) ont été recrutés dans un grand centre de cancérologie de Montréal, au Québec. MÉTHODOLOGIE: Des entretiens en profondeur durant entre 36 et 90 minutes ont été menés individuellement, enregistrés et retranscrits mot pour mot, puis analysés par thèmes. RÉSULTATS: Tout au long de l'expérience du cancer, les participants ont témoigné du désir soutenu de participer activement à leur traitement et à leurs soins. Quatre thèmes sont ressortis des données décrivant les processus d'attente, de prise en charge de la maladie, de mise en action et de recadrage. Sous-jacents à ces thèmes se trouvent les notions de conscience du corps, les obstacles à surmonter pour obtenir des soins, l'optimisation de la santé et la réflexion sur l'héritage qu'on laisse derrière soi. CONCLUSIONS: De façon générale, les participants voulaient demeurer en contrôle de la situation malgré les multiples difficultés inhérentes à un cancer de stade avancé. Si elles sont corroborées par d'autres recherches, ces conclusions pourraient orienter les approches de soins en oncologie afin qu'elles soient véritablement adaptées aux besoins des jeunes adultes.

[Cross-cultural experience of knowledge sharing in relation to pain]. / Expérience interculturelle de partage de savoirs autour de la douleur.

Health professionals working in paediatric oncology met in Bamako, Mali, as part of a healthcare partnership between the Gabriel-Touré Hospital in Bamako and the Curie Institute in Paris. Open to dialogue and intercultural encounters, the hospital medical and paramedical teams exchanged views on their practices with a particular focus on pain management.

The Beginnings of the Canadian Cooperative Clinical Cancer Trials Program and the American Influences, 1962-76.

Clinical cancer research in Canada entered a new phase in 1971. In that year, the National Cancer Institute of Canada agreed to initiate and support a multidisciplinary cooperative clinical trials program. The first collaborative randomized controlled trial (RCT) for the treatment of advanced Hodgkin's disease was launched in medical centres across the country in December 1971. Simultaneously, in the United States, the National Cancer Act came into effect. To what extent were these Canadian and American developments coincidental? I argue that the cooperative clinical trials program in Canada was timed to coincide with the US declaration of war on cancer, but it was not its corollary. Against the background of this American anti-cancer campaign, the cooperative clinical trials program emerged as a link between the strong radiotherapy tradition in Canada and the new trial infrastructure of chemotherapeutic regimes in the United States. The evolution of the Hodgkin's disease trial serves as a good example to demonstrate how growing collaboration among Canadian and American physician-investigators brought about a large-scale national study. The latter became a prototype of further cooperative oncological RCTs in Canada during the 1970s.

[Tumor banks and complex data management: Current and future challenges]. / Biobanques tumorales et gestion des données complexes : enjeux actuels et futurs.

Tumor banks are asked to clinical and translationnal research project development in oncology. They strongly participate to the assessment, then to the validation of diagnostic, prognostic and predictive biomarkers. The progressive change of these structures leads to induce a professionalization of their functioning and to identify them as key actors in oncology by the stakeholders of the public and private worlds. The progresses made in biotechnologies and therapeutics are rapidly modifying the impact and the proper functioning of the biobanks. These latter are now facing different challenges, in particular for their sustainability. Among the major issues, the integration of the clinical and biological data becoming increasingly complex leads to urgently consider an optimization of the role of different biobanks in France. Their goal is to be an attractive counterpart face to the international competition. The purpose of this review is to briefly describe the current evolution of the biobanks, then their present and future challenges, and finally the role made by the pathologists in these new issues in oncology field.

[Enhanced recovery after robotic partial nephrectomy: Evaluation of patient's satisfaction]. / Réhabilitation précoce après tumorectomie rénale robot-assistée : quelle satisfaction des patients ?

INTRODUCTION: Several enhanced recovery protocols after surgery showed a benefit for postoperative recovery and reduction of hospital lengths of stay. Very few studies evaluated patient's satisfaction about these enhanced recovery protocols. The aim of this study was to evaluate patient's satisfaction about our enhanced recovery protocol for robotic-assisted partial nephrectomy (RAPN). METHODS: A validated survey EORTC In PATSAT32 with a specific questionnaire about protocol was sent to the first patients included in the enhanced recovery protocol for RAPN. The survey was sent after the postoperative consultation at postoperative day 30. Responses were anonymous. Satisfaction's scores for EORTC questionnaire were calculated for each dimension with Likert's method. Scores were transformed linearly into a scale ranging from 0 to 100, where 100 represent the highest level of care satisfaction (EORTC method). RESULTS: A total of 21 patients (50%) returned the completed questionnaire. The overall satisfaction score was 75.1% (37.3; 100) in the EORTC survey. In total, 71.4% of patients (n=15) were satisfied with the discharge at postoperative day 2 (POD2) and 5 patients (23.8%) found this premature. None of the patients had a negative impression on the clinical pathway. The average overall evaluation on the protocol by patients, on a satisfaction scale of 1 to 10 was 8.9/10. CONCLUSION: In this study, patients included in the enhanced recovery protocol after RAPN were very satisfied with their pre-, per- and postoperative care. Given patients satisfaction, reduction of LOS, patient's safety and the medicoeconomic advantage, these enhanced recovery protocol have become a priority to develop and evaluate. More large studies are needed to assess the patient's experience with these clinical pathways. LEVEL OF EVIDENCE: 4.

[The monitoring of oral anticancer medicines administered at home]. / Le suivi des thérapies anticancéreuses à domicile.

Anticancer medicines evolve in terms of their mode of action as well as their galenics. The advent of oral therapies has multiple benefits such as the possibility of taking the treatments at home. However, what are the implications with regard to compliance, the management of side effects and the community-hospital relationship? Elderly patients, often isolated, taking several medicines and frail, are disorientated faced with all these medications and their side effects. A study was undertaken to evaluate the benefit of visits by private practice nurses to support patients taking oral cancer drugs.

[Treatment of hand-foot syndrome in the context of targeted therapies]. / Prise en charge du syndrome mains-pieds dans le cadre des thérapies ciblées.

The drugs used to treat cancers can cause side effects. This is the case of hand-foot syndrome, particularly debilitating for patients, caused by certain chemotherapies or targeted therapies. Feedback from a clinical research nurse, working in oncology, on a nursing care protocol developed in conjunction with dermatologists.

[Another way to care for cancer]. / Prendre en charge le cancer autrement.

Seeking to reinforce personalised support for cancer patients, a mobile palliative care team has developed an innovative care facility. The Approche intégrative oncologique (Aion) offers comprehensive and alternative medical care to support patients in an active dimension of the disease. Illustration of these principles with follow-up of a patient called Mr. M.

[PD1/PD-L1 immunohistochemistry in thoracic oncology: Where are we?] / Immunohistochimie PD-1/PD-L1 en oncologie thoracique : où en sommes-nous ?

The assays for the assessment of the PD-L1 status by immunohistochemistry are available in clinical studies in thoracic oncology to predict response to immunotherapies targeting the PD-1/PD-L1 pathway. With the arrival of this new class of molecules in second line and very soon in first line of treatment for patients with advanced or metastatic non-small cell lung cancer, these tests will certainly be required in routine once these new drugs will be granted marketing authorization. The rapid introduction of these "companion" or "complementary" tests seems essential to select patients to benefit from these effective but also expensive and sometimes toxic therapies. Although challenged by some oncologists (as some patients not expressing PD-L1 may sometimes respond to PD-1/PD-L1 blockade), the anti-PD-L1 immunohistochemically approach seems inevitable in 2017. This new activity developed in the pathology laboratories raises several questions: which anti-PD-L1 clone should be used? On which device? What threshold of positivity should be considered? Should PD-L1 expression be assessed on tumor cells as well as on the immune cells? What controls should be used? Comparative studies are underway or have been already implemented in order to answer some of these questions. This review addresses the different evaluation criteria for immunohistochemistry using the main anti-PD-L1 antibodies used to date as well the recently published studies using these antibodies in thoracic oncology.

[Key concepts of survival analysis: Checking appropriateness]. / Le concept de l'analyse de survie : vérifier l'applicabilité.

Analysis of cancer survival data and related outcomes is necessary to assess cancer treatment. The survival analysis, although considered a cornerstone of oncology papers, is the weak point for the interpretation of results when used without robust data, without verifying the conditions of usage, and without defining the terminology we are using; leading to missing the real message. Unfortunately, a lot of scientific papers dealing with oncology violates the assumptions necessary for the usage of these tests, consequently, the conclusions in these papers cannot be assumed by the methodology used.

Reference centres for adults with rare and complex cancers - Policy recommendations to improve the organisation of care in Belgium.

BACKGROUND: Rare and/or complex cancers call for a very specific expertise and adequate infrastructure. In Belgium, every hospital with a programme in oncology can deliver care for adults with rare and/or complex cancer types, without having demonstrated a specific know-how to adequately manage these patients. Therefore, the Minister of Health ordered a scenario for the organisation of care for adults with rare and/or complex cancers, taking into account the current Belgian situation and relevant foreign experience. METHODS: Combined methods were used in this study: a literature review, the consultation of stakeholders, in depth discussions in 14 multidisciplinary groups leading to concrete proposals for several rare/complex cancers and the consultation of a panel of expert pathologists. RESULTS: The core recommendation is the set-up of shared care networks around reference centres, with multidisciplinary teams of recognised expertise in specific rare/complex cancers. The definition of minimum caseloads for hospitals and medical specialists, the evaluation of the quality of care, a model of diagnostic confirmation and the set-up of a national portal website which provides information on rare and/or complex cancers and reference centres are highly recommended. CONCLUSION: It is no longer practicable, efficient or ethical that every hospital or every practitioner continues to offer care for every rare/complex cancer. Improving the quality of rare/complex cancer care requires to concentrate expertise and sophisticated infrastructure in reference centres. Furthermore, the formation of networks between reference centres and peripheral centres will allow a delivery of care combining expertise and proximity. The next step is the translation of the recommendations into policy decisions. It is very well realised that this will take some courage and that a certain degree of resistance will have to be surmounted, but eventually, the best interest of the patient should prevail.