ABSTRACT
BACKGROUND: Patients undergoing neoadjuvant chemotherapy before surgery for advanced ovarian cancer may have impaired functional capacity, nutritional status, and emotional well-being. PRIMARY OBJECTIVES: TRAINING-01 aims to determine if a connected pre-habilitation program during neoadjuvant chemotherapy for patients treated for an advanced ovarian cancer will improve physical capacity before major abdomino-pelvic surgery. STUDY HYPOTHESIS: A pre-habilitation program during neoadjuvant chemotherapy will bring a fitter patient to surgery and will decrease treatment morbidity and improve oncological outcomes. TRIAL DESIGN: This study is a prospective, multi-center, phase III study. The pre-habilitation program consists of providing multi-dimensional support during neoadjuvant chemotherapy using connected devices. The control group will receive usual care. MAJOR INCLUSION/EXCLUSION CRITERIA: Eligible patients will be women with International Federation of Gynecology and Obstetrics stage III-IV advanced ovarian cancer undergoing neoadjuvant chemotherapy. Patients must be able to perform a cardiopulmonary exercise test. PRIMARY ENDPOINTS: The primary endpoint will be the comparison of the variation in maximum oxygen uptake (VO2 max) between baseline and surgery in the pre-habilitation group and control groups. SAMPLE SIZE: 136 patients (68 per arm) will be recruited to demonstrate a medium standardized effect d=0.5 in the variations of VO2 max between baseline and surgery. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: The duration of the study includes 24 months of recruitment and 5 years of follow up. We anticipate reporting primary endpoint results in 2024. TRIAL REGISTRATION: TRAINING-01-IPC 2018-039 (NCT04451369).
Subject(s)
Neoadjuvant Therapy/methods , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/therapy , Preoperative Exercise/psychology , Female , Humans , Prospective StudiesABSTRACT
Donor lymphocyte infusion has been used in the management of relapsed hematologic malignancies after allogeneic hematopoietic cell transplantation. It can eradicate minimal residual disease or be used to rescue a hematologic relapse, being able to induce durable remissions in a subset of patients. With the increased use of haploidentical hematopoietic cell transplantation, there is renewed interest in the use of donor lymphocytes to either treat or prevent disease relapse post transplant. Published retrospective and small prospective studies have shown encouraging results with therapeutic donor lymphocyte infusion in different haploidentical transplantation platforms. In this consensus paper, finalized on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation, we summarize the available evidence on the use of donor lymphocyte infusion from haploidentical donor, and provide recommendations on its therapeutic, pre-emptive and prophylactic use in clinical practice.
Subject(s)
Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Consensus , Humans , Lymphocytes , Prospective Studies , Retrospective StudiesABSTRACT
Cancer patients commonly experience psychological distress that may increase with the current COVID-19 pandemic. This prospective study aimed to measure post-traumatic stress disorder (PTSD) and anxiety in cancer patients following France's first COVID-19-related lockdown, together with associated factors. Cancer patients receiving outpatient treatment or post-treatment follow-up completed a questionnaire which measured, among other things, PTSD (IES-R), anxiety (State-Trait Anxiety Inventory), and fear of cancer recurrence (FCR). Of the 1097 patients included in the study, 14.7% and 30.5% suffered from PTSD and anxiety, respectively. Patients afraid to come to hospital due to the risk of COVID-19 transmission (OR = 3.49, p < 0.001), those with a negative lockdown experience (OR = 0.98, p < 0.001), women (OR = 1.97; p = 0.009), and patients living alone (OR = 1.63, p = 0.045) were all more likely to have PTSD. Older patients (OR = 1.65, p = 0.020), women (OR = 1.62, p = 0.018), those with a higher FCR score (OR = 5.02, p < 0.001), patients unsatisfied with their cancer management (OR = 2.36, p < 0.001), and those afraid to come to hospital due to COVID-19 (OR = 2.43, p < 0.001) all had a higher risk of anxiety. These results provide a greater understanding of the psychological consequences of the COVID-19 pandemic in cancer patients and highlight the need to better integrate psychosocial support in pandemic response measures in order to guide health systems.
ABSTRACT
The number of HLA-haploidentical hematopoietic cell transplants continues to increase worldwide due to recent improvements in outcomes, allowing more patients with hematological malignancies and non-malignant disorders to benefit from this procedure and have a chance to cure their disease. Despite these encouraging results, questions remain as multiple donors are usually available for transplantation, and choosing the best HLA-haploidentical donor for transplantation remains a challenge. Several approaches to haploidentical transplantation have been developed over time and, based on the graft received, can be grouped as follows: T-cell depleted haploidentical transplants, either complete or partial, or with T-cell replete grafts, performed with post-transplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis, or G-CSF-primed bone marrow graft and enhanced GVHD prophylaxis. Carefully selecting the donor can help optimize transplant outcomes for recipients of haploidentical donor transplants. Variables usually considered in the donor selection include presence of donor-specific antibodies in the recipient, donor age, donor/recipient gender and ABO combinations, and immunogenic variables, such as natural killer cell alloreactivity or KIR haplotype. Here we provide a comprehensive review of available evidence for selecting haploidentical donors for transplantation, and summarize the recommendations from the European Society for Blood and Marrow Transplantation (EBMT) on donor selection for different transplant platforms.
Subject(s)
Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Bone Marrow , Consensus , Donor Selection , Graft vs Host Disease/prevention & control , Humans , Transplantation ConditioningABSTRACT
The author proposes an anthropological and phenomenological analysis of elderly, from its reality and from its representations in our contemporary societies. Since Sophocles or Freud, and closer of us, Jankélévitch or Debray, of the West African, he follows the mysteries of the lawsuit in dependence and in orderness which is made for the elderly, shameful and subject secret forbids of our modernity which sacrifices continument in sacrosanct paradigm of the "jeunisme". He pleads in favour of a new old age which would not be any more this exiled time, anteroom of to die, but an adventure of life, with its rhythm, its place and its project in itself. double dagger.
Subject(s)
Aged/psychology , Aging/psychology , Attitude to Health , Adult , Female , Humans , Male , Middle Aged , PsychoanalysisABSTRACT
This study is a first step towards the transfer of knowledge and practices between psychological support and performance in elite sport and a patient's "social recovery" in oncology. This proposal brings together people engaged in a variety of healthcare and relationship support roles, and aims to set up a support system beyond the hospital context. It questions the ability of elite sport management and its main actors, the "Great Coaches", to contribute to the support of patients in cancer remission through an onco-coaching approach. This innovative proposal is initiated by a life coaching pilot study designed for hematologic cancer patients in remission after a hematopoietic stem cell transplantation.
Subject(s)
Health Knowledge, Attitudes, Practice , Hematologic Neoplasms/psychology , Hematologic Neoplasms/rehabilitation , Hematopoietic Stem Cell Transplantation/psychology , Mentoring/methods , Sports/psychology , Transfer, Psychology , Hematologic Neoplasms/therapy , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Interpersonal Relations , Mental Disorders/prevention & control , Pilot Projects , Program Development , Social LearningABSTRACT
The "relapse", this word so much dreaded by the patients reached of a cancer because it symbolizes the return of the disease and the treatments in the person's life and his entourage. This diagnosis once established mark the entry into a chronic phase of the cancerous disease, involving the future of people and their report at time. In this context, we believe it is important to identify the subjective and social aspects of the experience of this difficult moment in the course of the disease, by taking account the report at the time of the patients. In this article, we propose a study of these different aspects through a double analysis (lexical thematic manual and with a computer) of semi-structured interviews conducted with patients in metastatic relapse of a breast cancer. The report at time was operationalized at the same time as a variable of personality by using the scale of temporal prospect (PT) Zimbardo Time Perspective Inventory ZTPI and through the different linguistic markers, indicators of meaning in the stories of patients. The results of this double analysis highlight different aspects of the speech of the patients, reflecting investments different in the disease at the time of the relapse and and, depending on age and time profiles of patients. However, these results illustrate the links between some aspects of time focusing on the stories of patients and the strategies of adjustments which result from this, allowing an articulation of these concepts around the notion of control.