Addressing the quality of life needs of older patients with cancer: a SIOG consensus paper and practical guide.

Around 60% of people living with cancer are aged 65 years or older. Older cancer patients face a unique set of age-associated changes, comorbidities and circumstances that impact on their quality of life (QoL) in ways that are different from those affecting younger patients. A Task Force of the International Society of Geriatric Oncology recommends and encourages all healthcare professionals involved in cancer care to place greater focus on the QoL of older people living with cancer. This paper summarizes current thinking on the key issues of importance to addressing QoL needs of older cancer patients and makes a series of recommendations, together with practical guidance.

The development of a prediction tool to identify cancer patients at high risk for chemotherapy-induced nausea and vomiting.

BACKGROUND: Despite the availability of effective antiemetics and evidence-based guidelines, up to 40% of cancer patients receiving chemotherapy fail to achieve complete nausea and vomiting control. In addition to type of chemotherapy, several patient-related risk factors for chemotherapy-induced nausea and vomiting (CINV) have been identified. To incorporate these factors into the optimal selection of prophylactic antiemetics, a repeated measures cycle-based model to predict the risk of ≥ grade 2 CINV (≥2 vomiting episodes or a decrease in oral intake due to nausea) from days 0 to 5 post-chemotherapy was developed. PATIENTS AND METHODS: Data from 1198 patients enrolled in one of the five non-interventional CINV prospective studies were pooled. Generalized estimating equations were used in a backwards elimination process with the P-value set at <0.05 to identify the relevant predictive factors. A risk scoring algorithm (range 0-32) was then derived from the final model coefficients. Finally, a receiver-operating characteristic curve (ROCC) analysis was done to measure the predictive accuracy of the scoring algorithm. RESULTS: Over 4197 chemotherapy cycles, 42.2% of patients experienced ≥grade 2 CINV. Eight risk factors were identified: patient age <60 years, the first two cycles of chemotherapy, anticipatory nausea and vomiting, history of morning sickness, hours of sleep the night before chemotherapy, CINV in the prior cycle, patient self-medication with non-prescribed treatments, and the use of platinum or anthracycline-based regimens. The ROC analysis indicated good predictive accuracy with an area-under-the-curve of 0.69 (95% CI: 0.67-0.70). Before to each cycle of therapy, patients with risk scores ≥16 units would be considered at high risk for developing ≥grade 2 CINV. CONCLUSIONS: The clinical application of this prediction tool will be an important source of individual patient risk information for the oncology clinician and may enhance patient care by optimizing the use of the antiemetics in a proactive manner.

[Use of sorafenib in patients with hepatocellular or renal carcinoma]. / Bon usage du sorafénib chez les patients pris en charge pour un carcinome hépatocellulaire ou un cancer du rein.

Therapeutic approaches of cancers have been recently improved by the development of targeted therapies. Amongst these new drugs, some anti-angiogenic molecules have been approved by either the EMEA or the Food and Drug Administration. Sorafenib, one of these inhibitors of angiogenesis, has been established as the standard of care for advanced hepatocellular and renal carcinoma. This paper reviews the safety profile of sorafenib and presents guidelines for the prevention and the treatment of the main side effects associated with this molecule.

Evidence-based management of chemotherapy-induced nausea and vomiting: a position statement from a European cancer nursing forum.

Chemotherapy-induced nausea and vomiting (CINV) is a common, but now often overlooked side effect of cancer treatment, and one that can be largely prevented through the implementation of international evidence-based guidelines. The European CINV Forum, comprising nurses from France, Germany, Portugal, Spain and the UK, discussed the use of CINV preventive strategies in routine practice, and the factors that affect optimal delivery of antiemetic therapies. Based on these discussions, they developed a series of recommendations for optimal, evidence-based management of CINV. These state that all patients receiving chemotherapy should undergo full assessment of their risk of CINV and receive appropriate prophylactic treatment based on guidelines from the Multinational Association of Supportive Care in Cancer (MASCC) and the National Comprehensive Cancer Network (NCCN), which were both updated in 2011. Other recommendations, aimed at raising awareness of CINV and its management, include timely updates of relevant local practice guidelines and protocols, translation of the MASCC and NCCN guidelines into all European languages and their dissemination through accessible articles in nursing journals and newsletters and via nursing conferences and study days, improved training for nurses on CINV, collaboration between the European Oncology Nursing Society and national nursing organisations to promote consistent practice, the development of a CINV toolkit, information provision for patients, local audits of CINV management, and a survey of CINV management between and within European countries.