[Quantitative and qualitative evaluation of a specific grid of head and neck post-cancer with user healthcare professionals]. / Évaluation quantitative et qualitative d'une grille spécifique de l'après-cancer des voies aérodigestives supérieures auprès des professionnels de santé utilisateurs.

INTRODUCTION: The post-cancer period is a delicate one, as it does not necessarily mean good health and/or a return to life as it was "before". Over the past twenty years, a number of initiatives have been launched to improve support for people after cancer. We have created a post-cancer care pathway for patients with head and neck cancer, based on a nursing interview and the use of a post-cancer grid. MATERIALS AND METHODS: The steps involved in creating the pathway and the grid, the fruit of a working group involving the educational team, five patient associations and two expert patients, with the support of a health promotion engineering resource association, were explained. A quantitative and qualitative evaluation of the use of the grid was carried out. RESULTS: Sixty-five patients benefited. Individual interviews with the nurses involved in the post-cancer process showed that the grid was complete, easy to follow and based on the semi-directive interview model, but that care had to be taken not to follow it to the letter, so as not to impair the quality of the interview. CONCLUSION: Our post-cancer approach for upper aerodigestive tracts, anchored in a dedicated grid, highlights the often underestimated significance of this crucial phase in patients' journeys. While the grid is a valuable tool in development, its use requires caution, with further research needed to confirm its effectiveness. We encourage adaptation by teams, respecting fundamental principles.

[How to reconcile therapeutic patient education and care pathology in oncology: Application in head and neck neoplams]. / Comment concilier éducation thérapeutique des patients et parcours de soin en cancérologie : application pour les voies aérodigestives supérieures.

Therapeutic education is an educational approach that allows the patient and his entourage to acquire or maintain the skills necessary to manage their daily lives. It requires a global care of patients and caregivers and is much broader than a learning of technical gesture. While their development is encouraged in the plan cancer 2014-2018, few programs exist in cancer surgery because the process is very cumbersome to implement due to a very strict administrative framework. In the absence of permission from the Regional health agency, "therapeutic education" term should not be used under penalty of a fine. The aim of this article is to present the principles and rules of therapeutic education defined by the french « Haute Autorité de Santé ¼ and to illustrate them through the example of our therapeutic education program for patients with tracheostomy and/or gastrostomy. The patient pathway with the chronology, the speakers, the competency references, the possible interactions with the announcement scheme as desired by the French National Cancer Institute are specified. This information will facilitate the filling of the program authorization in order to participate in the development of therapeutic education in our specialty.

A retrospective, multicenter study of the tolerance of induction chemotherapy with docetaxel, Cisplatin, and 5-Fluorouracil followed by radiotherapy with concomitant cetuximab in 46 cases of squamous cell carcinoma of the head and neck.

PURPOSE: To investigate, in a multicenter study, the tolerance of induction chemotherapy (ICT) and external radiotherapy (ERT) with concomitant cetuximab in the treatment of patients with squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS: Clinical data from 46 patients with Stage III or IV nonmetastatic SCCHN who received docetaxel, cisplatin, and 5-fluorouracil as ICT, followed by ERT with concomitant cetuximab, were retrospectively analyzed. Clinical safety (weight, allergy, mucositis, and dermatitis) and paraclinical safety (levels of hemoglobin, polynuclear neutrophils, and creatinine clearance) were studied. The primary objective was the proportion of patients who completed the protocol. RESULTS: The percentage of patients completing ICT was 73.9%, ERT 93.5%, and cetuximab 69.6%. Induction chemotherapy was better tolerated than that previously reported. The rates of temporary suspensions of radiation (39.1%, mean duration of 13 days) and hospitalization (26.1%) during ERT with concomitant cetuximab were high. Weight loss during treatment (21.4% of patients lost >10% of their body weight), radiodermatitis, and radiomucositis were the main causes of temporary suspension of treatment, although Grade 4 dermatitis was not experienced. There were no allergic reactions to cetuximab. CONCLUSION: The completed protocol rate for SCCHN patients receiving ICT and ERT with concomitant cetuximab is high and the toxicity acceptable. Future improvements to protocol will be possible through early action and systematic implementation of nutritional support coupled with antibiotic treatment upon the first signs of radiodermatitis. These data could be useful for prospective studies on the safety and efficacy of this protocol.

Larynx transplantation: laryngectomees' opinion poll.

BACKGROUND: In 1998, Strome et al. performed the first human larynx transplantation in a patient with larynx traumatism. L'Association Nationale des Mutilés de la Voix, a French association of laryngectomees, estimates that the number of laryngectomees in France has reached 20,000. The main goal of the study was to determine the potential number of patients ready to benefit from larynx transplantation in France. METHODS: We carried out a public opinion poll among 420 total laryngectomees in Rhone-Alpes, in the southeast of France. The questionnaire could be divided into three parts: demographic data; incapacities and deficiencies of the patients; and acceptability of larynx transplantation according to short-, medium-, and long-term implications. RESULTS: We received 205 answers from 420 questionnaires (48.8%). Sixty-three patients (i.e., 30.7%) would accept larynx transplantation, especially the younger patients. The patients more willingly accepted the medical constraints (e.g., medical follow-up, rehabilitation) than they did vital (after the operation or because of the treatments) or functional (risk of permanent canula, no guarantee of laryngeal voice, no guarantee of swallowing) risks. CONCLUSIONS: Even though this opinion poll has intrinsic bias and acceptance rate is low, by interpolation, larynx transplantation would interest many patients in France. Larynx transplantation is an intervention that should be proposed to a certain number of patients in the future with the help of new immunosuppressor treatments.