RESUMEN
INTRODUCTION: The current new SARS-CoV-2 pandemic has had a profound impact on medical practice. The objective was to analyse the ethical questions raised by the French ENT community during the first wave of COVID-19 infections. METHODS: Four open-ended questions concerning ethical considerations in ENT were sent out in April 2020: (i) difficulties to care for COVID-19 positive patients; (ii) impact of the health crisis on COVID-19 negative patients; (iii) communication within the healthcare teams and with hospital staff; and (iv) management of information by the press, or national ENT societies. A thematic analysis was carried out and crossed with the epidemiological data of each respondent. RESULTS: Thirty-one responses from 13 different French Departments, including 21 from public institutions and 10 from private practice, median age of 45 and 17 men for 14 women, were analysed. The main ethical considerations concerned the management by ENTs of COVID-19 positive patients, the modification of practices in consultation and in the operating room, the fear of loss of chance for COVID-19 negative patients, the appropriate use of teleconsultations and teleworking and the consequences of fake-news for the population. CONCLUSION: In preparation of possible future pandemic outbreaks, key ethical aspects are to adapt patient management to local resources and infection prevalence, and circulate clear institutional guidelines.
RESUMEN
BACKGROUND: Few data are available on long-term fatigue (LTF) and quality of life (QoL) among epithelial ovarian cancer survivors (EOCS). In this case-control study, we compared LTF, symptoms and several QoL domains in EOCS relapse-free ≥3 years after first-line treatment and age-matched healthy women. PATIENTS AND METHODS: EOCS were recruited from 25 cooperative GINECO centers in France. Controls were randomly selected from the electoral rolls. All participants completed validated self-reported questionnaires: fatigue (FACIT-F), QoL (FACT-G/O), neurotoxicity (FACT-Ntx), anxiety/depression (HADS), sleep disturbance (ISI), and physical activity (IPAQ). Severe LTF (SLTF) was defined as a FACIT-F score <37/52. Univariate and multivariate logistic regressions were conducted to analyze SLTF and its influencing factors in EOCS. RESULTS: A total of 318 EOCS and 318 controls were included. EOCS were 63-year-old on average, with FIGO stage I/II (50%), III/IV (48%); 99% had received platinum and taxane chemotherapy, with an average 6-year follow-up. There were no differences between the two groups in socio-demographic characteristics and global QoL. EOCS had poorer FACIT-F scores (40 versus 45, P < 0.0001), lower functional well-being scores (18 versus 20, P = 0.0002), poorer FACT-O scores (31 versus 34 P < 0.0001), and poorer FACT-Ntx scores (35 versus 39, P < 0.0001). They also reported more SLTF (26% versus 13%, P = 0.0004), poorer sleep quality (63% versus 47%, P = 0.0003), and more depression (22% versus 13%, P = 0.01). Fewer than 20% of EOCS and controls exercised regularly. In multivariate analyses, EOCS with high levels of depression, neurotoxicity, and sleep disturbance had an increased risk of developing SLTF (P < 0.01). CONCLUSION: Compared with controls, EOCS presented similar QoL but persistent LTF, EOC-related symptoms, neurotoxicity, depression, and sleep disturbance. Depression, neuropathy, and sleep disturbance are the main conditions associated with severe LTF.
Asunto(s)
Supervivientes de Cáncer/estadística & datos numéricos , Carcinoma Epitelial de Ovario/epidemiología , Fatiga/epidemiología , Neoplasias Ováricas/epidemiología , Calidad de Vida/psicología , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/epidemiología , Ansiedad/etiología , Carcinoma Epitelial de Ovario/fisiopatología , Carcinoma Epitelial de Ovario/psicología , Carcinoma Epitelial de Ovario/terapia , Estudios de Casos y Controles , Terapia Combinada , Estudios Transversales , Depresión/epidemiología , Depresión/etiología , Fatiga/etiología , Femenino , Francia/epidemiología , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/fisiopatología , Neoplasias Ováricas/psicología , Neoplasias Ováricas/terapia , Encuestas y Cuestionarios , Adulto JovenRESUMEN
PURPOSE: Oral anticancer therapies have an important place in the therapeutic arsenal, but factors influencing adherence to oral treatment are poorly documented in oncology. The objective of this study was to assess the impact of anxio-depressive symptoms and cognitive functioning on oral medication adherence. METHODS: This prospective study included cancer patients initiating a first oral therapy. Before initiation of treatment, an assessment of depression, anxiety, and cognition was performed. Using self-report questionnaires, we collected information on socio-demographic conditions and the non-adherence at 1 (M1) and 3 months (M3) after the beginning of treatment. RESULTS: Among 129 patients enrolled, median age was 70 years and 81% of patients were treated for metastatic cancer. Before initiating treatment, 16% and 8% of patients presented respectively depression and anxiety symptoms. Global cognitive impairment was observed in 51% of patients. Ten percent of the patients were non-adherent at M1 and 13% at M3. Depression was strongly associated with non-adherence at M1 (P = 0.046) and M3 (P = 0.014), but not anxiety. Non-adherence was associated with lower working memory (P = 0.037) and digit memory (P = 0.018) at M1 and short-term memory (P = 0.04) at M3. Patients with more than eight co-medications were more often non-adherents (P = 0.055). CONCLUSIONS: Non-adherence to oral anticancer therapies was mainly associated to depression. Focusing on depressive symptoms before initiation of oral anticancer therapy could help to identify patient profiles more likely to fail self-management. Working memory, digit memory, and short-term memory also seem to play a role in non-adherence. Further studies should include a more specific population, especially according to age.
Asunto(s)
Ansiedad/psicología , Cognición/fisiología , Depresión/psicología , Cumplimiento de la Medicación/psicología , Memoria/fisiología , Neoplasias/tratamiento farmacológico , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/psicología , Trastorno Depresivo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Autoinforme , Encuestas y CuestionariosRESUMEN
BACKGROUND: The aim of the study was to analyse efficacy, safety, and health-related quality of life (HRQoL) for sorafenib treatment in patients with metastatic uveal melanoma. METHODS: A multicentre, single-arm phase II trial was conducted. The primary objective was to determine the non-progression rate (RECIST) at 24 weeks for patients receiving sorafenib at a dose of 800 mg per day. Secondary endpoints included progression-free survival (PFS), overall survival (OS), toxicity, and HRQoL. RESULTS: Thirty-two patients were included. Ten patients showed non-progression at 24 weeks (31.2%) without objective tumour responses. The estimated 24-week PFS was 31.2% (95% CI: 14.8%-47.6%) and the estimated 24-week OS was 62.5% (95% CI: 45.4%-79.6%). Ten patients (34.3%) had at least one grade 3 or 4 adverse reaction and 12 patients (41.4%) required dose modifications due to toxicity. At 24 weeks, no patient had an improvement in global HRQoL and 87.5% experienced a permanent increase in physical fatigue. CONCLUSIONS: Sorafenib demonstrated non-progression at 24 weeks in 31.2% of patients. However, 41.4% of patients required dose modifications due to toxicity and no improvement in HRQoL was demonstrated.
Asunto(s)
Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Melanoma/tratamiento farmacológico , Niacinamida/análogos & derivados , Compuestos de Fenilurea/efectos adversos , Compuestos de Fenilurea/uso terapéutico , Neoplasias de la Úvea/tratamiento farmacológico , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Niacinamida/efectos adversos , Niacinamida/uso terapéutico , Calidad de Vida , SorafenibRESUMEN
STUDY QUESTION: How does the successful cryopreservation of semen affect the odds of post-treatment fatherhood among Hodgkin lymphoma (HL) survivors? SUMMARY ANSWER: Among 334 survivors who wanted to have children, the availability of cryopreserved semen doubled the odds of post-treatment fatherhood. WHAT IS KNOWN ALREADY: Cryopreservation of semen is the easiest, safest and most accessible way to safeguard fertility in male patients facing cancer treatment. Little is known about what proportion of patients achieve successful semen cryopreservation. To our knowledge, neither the factors which influence the occurrence of semen cryopreservation nor the rates of fatherhood after semen has been cryopreserved have been analysed before. STUDY DESIGN, SIZE, DURATION: This is a cohort study with nested case-control analyses of consecutive Hodgkin survivors treated between 1974 and 2004 in multi-centre randomized controlled trials. A written questionnaire was developed and sent to 1849 male survivors. PARTICIPANTS/MATERIALS, SETTING, METHODS: Nine hundred and two survivors provided analysable answers. The median age at treatment was 31 years. The median follow-up after cryopreservation was 13 years (range 5-36). MAIN RESULTS AND THE ROLE OF CHANCE: Three hundred and sixty-three out of 902 men (40%) cryopreserved semen before the start of potentially gonadotoxic treatment. The likelihood of semen cryopreservation was influenced by age, treatment period, disease stage, treatment modality and education level. Seventy eight of 363 men (21%) used their cryopreserved semen. Men treated between 1994 and 2004 had significantly lower odds of cryopreserved semen use compared with those treated earlier, whereas alkylating or second-line (chemo)therapy significantly increased the odds of use; no other influencing factors were identified. We found an adjusted odds ratio of 2.03 (95% confidence interval 1.11-3.73, P = 0.02) for post-treatment fatherhood if semen cryopreservation was performed. Forty-eight out of 258 men (19%) who had children after HL treatment became a father using cryopreserved semen. LIMITATIONS, REASONS FOR CAUTION: Data came from questionnaires and so this study potentially suffers from response bias. We could not perform an analysis with correction for duration of follow-up or provide an actuarial use rate due to lack of dates of semen utilization. We do not have detailed information on either the techniques used in cryopreserved semen utilization or the number of cycles needed. STUDY FUNDING/COMPETING INTERESTS: Lance Armstrong Foundation, Dutch Cancer Foundation, René Vogels Stichting, no competing interests.
Asunto(s)
Criopreservación , Fertilidad , Enfermedad de Hodgkin/terapia , Preservación de Semen , Semen , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Estudios de Cohortes , Enfermedad de Hodgkin/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , SobrevivientesRESUMEN
OBJECTIVES: Analysis of the quality of sexual life after total laryngectomy (TL) for cancer. MATERIAL AND METHODS: The Cochrane, PubMed, Embase, ClinicalKey and Science Direct databases were searched using the keywords: "total laryngectomy, sexual function, sexual behavior, sexual complications, sexual dysfunction, sexuality, intimacy". The abstracts of 69 articles were read by two of the authors and 24 articles were selected. The main endpoint was the impact of impairment of quality of sexual life after TL for cancer and the methods used to assess this. The secondary endpoints were the type of sexual impairment, associated variables and their treatment. RESULTS: The study population consisted of 1511 TL patients aged 21 to 90 years, with a male/female sex ratio of 7.49. One of the 7 validated Likert scales was used in 79% of the articles to evaluate impairment of sexual quality of life. Impaired quality of sexual life was reported by 47% of patients on average (range, 5-90%). Erectile and ejaculatory function and ejaculatory behavior of male patients decreased after TL. Other impairments comprised decreases in libido, frequency of sexual intercourse and satisfaction. Tracheostomy, advanced disease stage, young age and associated depression were factors for impairment. In all, 23% of patients reported lack of postoperative support in this area. CONCLUSION: The quality of sexual life is severely impacted by TL for cancer. The present data are a source of information and should be taken into account before carrying out TL. A common information tool needs to be developed. There is patient demand for improved management of sexuality.
Asunto(s)
Coito , Neoplasias Laríngeas , Humanos , Masculino , Femenino , Calidad de Vida , Laringectomía/métodos , Conducta Sexual , Neoplasias Laríngeas/cirugíaRESUMEN
Fungal contamination of indoor environments can cause respiratory diseases and induce damages to building materials. Among the fungal species found in mold-damaged homes, Penicillium brevicompactum, P. chrysogenum and P. crustosum can be considered as recurrent strains. In this study, we therefore propose a rapid and novel qPCR-based method in order to allow the monitoring of these three fungal species. The method developed allows the quantification of the target DNA of these three Penicillium species with a limit of quantification of 0.01 ng/µL without significant difference with spectrophotometry quantification assay for DNA concentrations between 5 and 100 ng/µL. This technique also enables the rapid detection of these three species in complex mixtures of DNA extracted from 15 bioaerosols collected in mold-damaged homes and previously cultured on agar plate. This new sensitive and specific qPCR technique can thus be easily integrated into bioaerosol studies.
Asunto(s)
Aerosoles/análisis , Penicillium/aislamiento & purificación , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Microbiología del Aire , Vivienda , Penicillium/clasificación , Penicillium/genética , Vacunas contra la Tuberculosis , Vacunas de ADNRESUMEN
Purpose: Patient education constitutes a relevant strategy to improve pain management. In the field of therapeutic patient education (TPE), we aimed 1) to assess pain impact in cancer patients, 2) to identify patients' educative needs in pain management, and 3) to refine research criteria for its future evaluation. Patients and methods: Pain intensity, relief and interference were assessed in 75 cancer patients with unbalanced background pain. Self-assessment questionnaire evaluated i) patients' pain management and ii) their knowledge and needs in TPE. Results: Most patients experienced pain for more than 6 months and 41.6% reported adequate pain relief. Understanding pain and pain management were major patients' preferences (>58%). Most patients declared they knew their pain treatments, but fewer than half of them were able to name them. However, education concerning pain treatment was considered as essential in <30% of patients. Almost all patients (97.1%) stated pain education as beneficial, with a preference for individualized sessions (41.2%). In addition, the assessment criteria for its future evaluation were refined. Conclusion: Targeted population mainly concerned patients with persistent pain. Only half of patients reported pain relief despite antalgics. Patient education was declared as beneficial for almost all participants. Practice implications: Tailoring a pain TPE on patients' needs has the potential to help them to optimally manage their pain daily.
RESUMEN
To investigate the exposure of livestock and farm workers to mycotoxins during the last months of silage use, the mycoflora and the mycotoxins in a mature silage (11-months-old) were studied. A multimycotoxin method was developed to evaluate the toxigenic in vitro ability of fungal strains. The screening of potentially toxigenic fungi isolated from the mature silage showed that six Fusaria (Fusarium culmorum, Fusarium equiseti, Fusarium graminearum, Fusarium oxysporum, Fusarium solani and Fusarium verticillioides) and one Aspergillus (Aspergillus fumigatus) were able to produce mycotoxins on nutrient agar. Seven major mycotoxins (aflatoxin B(1), citrinin, deoxynivalenol, fumonisin B(1), gliotoxin, ochratoxin A and zearalenone) were also searched in the corn silage by high-performance liquid chromatography coupled to mass spectrometry (HPLC-MS). Among the three mycotoxins (citrinin, gliotoxin and deoxynivalenol) detected in the silage, gliotoxin, a strongly immunosuppressive mycotoxin, occurred in the mature silage at level up to 877 ppb, which was associated with the presence of A. fumigatus in the silage.
Asunto(s)
Aspergillus/metabolismo , Microbiología de Alimentos , Fusarium/metabolismo , Micotoxinas/biosíntesis , Zea mays/microbiología , Cromatografía Líquida de Alta Presión , Humanos , Espectrometría de Masas , Micotoxinas/químicaAsunto(s)
COVID-19 , Neoplasias de Cabeza y Cuello , Humanos , Pandemias/prevención & control , SARS-CoV-2RESUMEN
OBJECTIVES: A 10-year retrospective study investigated factors for survival and laryngeal preservation in advanced laryngeal, hypopharyngeal or epilaryngeal neoplasia. MATERIAL AND METHOD: Two hundred and forty-six patients with advanced cancer of the larynx (17.48%), hypopharynx (48.78%) or epilarynx (33.74%) undergoing primary organ-sparing treatment were included from 1998 to 2008. Treatment comprised chemotherapy followed by radiation therapy for 92.68% of patients, isolated radiation therapy for 1.6% and concomitant or sequential radiation-chemotherapy for 5.7%. General health status, history and tumor status were recorded. Factors influencing survival were analyzed by Kaplan-Meier estimator, log-rank test and Cox models. RESULTS: Median overall survival of the population was 2.3 years and median laryngeal preservation 0.99 years in male patients and 2 years in female patients. Survival correlated significantly with body mass index (BMI; P=0.0004), WHO performance status (P=0.0064), alcohol consumption (P=0.0004) and cessation (P<0.0001) and also T stage (P=0.0038), initial laryngeal mobility (P=0.0002) and post-chemotherapy assessment (P<0.0001). Survival with functional larynx correlated with baseline BMI at first consultation (P=0.016), baseline WHO grade (P=0.0005), laryngeal mobility (P<0.0001), T staging (P=0.0009), and T and/or N chemotherapy response to a classical organ preservation protocol (P<0.0001). CONCLUSION: Over and above established criteria, the present study highlighted the importance of general health and nutritional status during treatment.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Carcinoma de Células Escamosas/terapia , Quimioterapia Adyuvante , Neoplasias Laríngeas/terapia , Laringectomía , Tratamientos Conservadores del Órgano , Radioterapia Adyuvante , Adulto , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Índice de Masa Corporal , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/mortalidad , Quimioterapia Adyuvante/métodos , Terapia Combinada , Femenino , Francia , Humanos , Estimación de Kaplan-Meier , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/mortalidad , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/métodos , Radioterapia Adyuvante/métodos , Estudios Retrospectivos , Factores de Riesgo , Fumar/efectos adversos , Resultado del TratamientoRESUMEN
The purpose of this study was to identify tools for the assessment of nutritional status in head and neck cancer patients, to evaluate the impact of malnutrition on therapeutic management and quality of life and to propose a simple screening approach adapted to routine clinical practice. The authors conducted a review of the literature to identify tools for the assessment of nutritional status in head and neck cancer patients published in French and English. Articles were obtained from the PubMed database and from the references of these articles and selected journals, using the keywords: "nutritional assessment", and "head and neck" and "cancer". Anthropometric indices, laboratory parameters, dietary intake assessment, clinical scores and nutritional risk scores used in patients with head and neck cancers are presented. The relevance of these tools in clinical practice and in research is discussed, together with the links between nutritional status and quality of life. This article is designed to help teams involved in the management of patients with head and neck cancer to choose the most appropriate tools for assessment of nutritional status according to their resources and their objectives.
Asunto(s)
Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/terapia , Desnutrición/diagnóstico , Desnutrición/etiología , Evaluación Nutricional , Estado Nutricional , Calidad de Vida , HumanosRESUMEN
OBJECTIVE: Quality of life (QoL) is now as much an assessment criterion in clinical trials in head and neck oncology as are survival and response rate. It is therefore important to be able to choose an adapted tool from the wide range of QoL instruments available. The present study presents an inventory of QoL scales validated in their French-language version, to facilitate the selection of appropriate tools showing good psychometric properties. MATERIALS AND METHODS: QoL scales cited in all 492 French and English language articles published between March 1st, 2006 and April 3rd, 2012, referenced on Medline and retrieved using the keywords "quality of life" AND "head and neck" AND "cancer", were inventoried and classified thematically in a search of the literature. RESULTS: Ninety QoL scales are presented by theme (ORL oncology, voice, swallowing and mastication, mucosities and xerostomia, etc.), specifying psychometric quality and citation level. CONCLUSION: The present report constitutes a guide to selecting QoL tools adapted to head and neck oncology studies.