RESUMEN
INTRODUCTION: General practitioners (GPs) play a central role in the management and coordination of care of patients with malignant tumors and blood diseases. Civilian GPs encounter certain difficulties during the care of such patients. The practice of unit medicine in a military environment differs from that in a civilian context through expertise in fitness to serve and to deployment and the target population. We identified the difficulties encountered by "unit" physicians during and after cancer treatment. MATERIALS AND METHODS: We conducted a multicenter cross-sectional descriptive study from July 2, 2021, to September 30, 2022, targeting all military GPs belonging to the French Armed Forces Health Service. We sent a questionnaire consisting of 1 open- and 16 closed multiple-choice questions describing the population of unit physicians and their patients (questions 1-5), the difficulties encountered by physicians in the follow-up of military personnel with cancer (Questions 6, 7, 11, 12, and 13), and the potential information networks accessible to physicians (questions 8-10, 14, and 17). RESULTS: Three hundred and ninety physicians completed the questionnaires. Among the 700 military GPs, 390 physicians responded to the questionnaire and 327 completed it exhaustively. The questionnaire response rate was 55%. Of the responding physicians, 49% and 70% reported following patients with an "active" malignant tumor and a malignant tumor pathology in remission, respectively. Thirty-one percent of the physicians encountered difficulties with these patients as follows: 26% concerning fitness for duty, 17% in medical follow-up, 14% in addressing the psychological aspect, 11% concerning specialist accessibility for advice, 10% in managing deconditioning to effort, 9% in addressing the social aspect, 7% in medical management, and 6% concerning other issues. CONCLUSIONS: Difficulties in the follow-up of patients with cancer affect military doctors. They mainly concern fitness for duty and medical follow-up.
Asunto(s)
Médicos Generales , Personal Militar , Neoplasias , Humanos , Estudios Transversales , Estudios de Seguimiento , Neoplasias/terapiaAsunto(s)
Antineoplásicos/uso terapéutico , Carbolinas/uso terapéutico , Carcinoma de Células Pequeñas/tratamiento farmacológico , Compuestos Heterocíclicos de 4 o más Anillos/uso terapéutico , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Anciano , Carcinoma de Células Pequeñas/diagnóstico por imagen , Carcinoma de Células Pequeñas/secundario , Humanos , Masculino , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/diagnóstico por imagen , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
BACKGROUND: The management of older cancer patients has been highly challenging for clinicians in a health-care system operating at maximum capacity during the COVID-19 pandemic. PATIENTS AND METHODS: We analyzed data from 9 different institutions. The primary endpoint was to assess the prevalence of adapted patient care during the pandemic for elderly cancer patients. The secondary endpoint was to assess the incidence of hospitalization and mortality due to COVID-19. All patients were older than 65years of age. RESULTS: We analyzed data from 332 outpatients' case files between 9th of March and 30th of April 2020. The median age was 75years (range: 65-101) and 53% were male. Because of the COVID-19 pandemic, more than half of the outpatients received modified patient care, defined as postponement or cancellation of surgery, irradiation scheme adapted, systemic treatment or the use of telemedicine. Among patients with localized cancer, 60% had a change in management strategy due to the pandemic. Changes in management strategy were made for 53% of patients at the metastatic stage. GCSF was used , in 83% of patients, increasing considerably in the context of the pandemic. Sixty-nine percent of physicians used telemedicine. In the final analysis, only one patient was hospitalized for COVID-19 infection. No deaths due to COVID-19 were reported in elderly cancer patients during this time period. CONCLUSION: Our study is the first to assess modification of patient care in elderly cancer outpatients during an epidemic. With this unprecedented crisis, our objective is to protect our patients from infection via protective barrier measures and social distancing, but also to guarantee the continuity of cancer care without overexposing this fragile population. Physicians were able to adapt their practice and used new forms of management, like telemedicine.
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COVID-19/epidemiología , Hospitalización/estadística & datos numéricos , Neoplasias/terapia , Pandemias , Anciano , Anciano de 80 o más Años , COVID-19/mortalidad , Causas de Muerte , Femenino , Francia/epidemiología , Humanos , Masculino , Neoplasias/mortalidad , Telemedicina/estadística & datos numéricosRESUMEN
INTRODUCTION: The maintenance of military surgeons' operative skills is challenging. Different and specific training strategies have been implemented in this context; however, little has been evaluated with regard to their effectiveness. Cancer surgery is a part of military surgeons' activities in their home hospitals. This study aimed to assess the role of oncological surgery in the improvement of military surgeons' operative skills. METHODS: Between January and June 2019, the surgical activities of the departments of visceral, ear, nose, and throat, urological, and thoracic surgery were retrospectively reviewed and assessed in terms of the operative time (OT). All surgeons working at the Sainte Anne Military Teaching Hospital were sent a survey to rate on a 5-point scale the current surgical practices on their usefulness in improving surgical skills required for treating war injuries during deployment (primary endpoint) and to compare on a 10-point visual analog scale the influence of cancer surgery and specific training on surgical fluency (secondary endpoint). RESULTS: Over the study period, 2,571 hours of OT was analyzed. Oncological surgery represented 52.5% of the surgical activity and almost 1,350 hours of cumulative OT. Considering the primary endpoint, the mean rating allocated to cancer surgery was 4.53 ± 0.84, which was not statistically different than that allocated to trauma surgery (4.42 ± 1.02, P = 0.98) but higher than other surgery (2.47 ± 1.00, P < 0.001). Considering the secondary endpoint, cancer surgery was rated higher than specific training by all surgeons, without statistically significant difference (positive mean score of + 2.00; 95% IC: 0.85-3.14). CONCLUSION: This study demonstrates the usefulness of cancer surgery in improving the operative skills of military surgeons.
Asunto(s)
Cirugía General , Personal Militar , Neoplasias , Cirujanos , Traumatología , Competencia Clínica , Humanos , Neoplasias/cirugía , Estudios Retrospectivos , Traumatología/educaciónAsunto(s)
Carcinoma/secundario , Neoplasias Orbitales/secundario , Neoplasias de la Próstata/patología , Neoplasias Craneales/secundario , Hueso Esfenoides , Anciano de 80 o más Años , Carcinoma/diagnóstico por imagen , Carcinoma/cirugía , Exoftalmia/diagnóstico por imagen , Exoftalmia/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/diagnóstico por imagen , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Orbitales/cirugía , Neoplasias de la Próstata/diagnóstico , Neoplasias Craneales/diagnóstico por imagen , Neoplasias Craneales/cirugía , Hueso Esfenoides/diagnóstico por imagenAsunto(s)
Antivirales/uso terapéutico , Hepatitis E/tratamiento farmacológico , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Pirazoles/uso terapéutico , Pirimidinas/uso terapéutico , Ribavirina/uso terapéutico , Adenina/análogos & derivados , Anciano , Alemtuzumab/uso terapéutico , Antineoplásicos Inmunológicos/uso terapéutico , Enfermedad Crónica , Progresión de la Enfermedad , Hepatitis E/complicaciones , Hepatitis E/diagnóstico , Hepatitis E/virología , Virus de la Hepatitis E/efectos de los fármacos , Humanos , Leucemia Linfocítica Crónica de Células B/complicaciones , Leucemia Linfocítica Crónica de Células B/genética , Leucemia Linfocítica Crónica de Células B/patología , Masculino , PiperidinasAsunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Óseas/tratamiento farmacológico , Carcinoma de Mama in situ/tratamiento farmacológico , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/tratamiento farmacológico , Furanos/uso terapéutico , Cetonas/uso terapéutico , Neoplasias Hepáticas/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab/administración & dosificación , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Carcinoma de Mama in situ/diagnóstico por imagen , Carcinoma de Mama in situ/secundario , Neoplasias de la Mama/patología , Capecitabina/administración & dosificación , Carcinoma Ductal de Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/secundario , Femenino , Fluorouracilo/administración & dosificación , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Persona de Mediana Edad , Vinblastina/administración & dosificación , Vinblastina/análogos & derivados , VinorelbinaAsunto(s)
Encefalopatías/tratamiento farmacológico , Pirazoles/uso terapéutico , Pirimidinas/uso terapéutico , Macroglobulinemia de Waldenström/tratamiento farmacológico , Adenina/análogos & derivados , Anciano , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Encefalopatías/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Piperidinas , Síndrome , Resultado del Tratamiento , Macroglobulinemia de Waldenström/diagnóstico por imagenAsunto(s)
Anemia Macrocítica/tratamiento farmacológico , Desensibilización Inmunológica/métodos , Erupciones por Medicamentos/prevención & control , Factores Inmunológicos/uso terapéutico , Lenalidomida/uso terapéutico , Anciano , Anemia Macrocítica/inmunología , Deleción Cromosómica , Cromosomas Humanos Par 5/inmunología , Esquema de Medicación , Erupciones por Medicamentos/etiología , Femenino , Humanos , Factores Inmunológicos/efectos adversos , Lenalidomida/efectos adversosAsunto(s)
Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/complicaciones , Carcinoma Hepatocelular/complicaciones , Leucocitosis/complicaciones , Neoplasias Hepáticas/complicaciones , Ácido Úrico/efectos adversos , Lesión Renal Aguda/patología , Anciano , Carcinoma Hepatocelular/patología , Humanos , Leucocitosis/patología , Neoplasias Hepáticas/patología , MasculinoAsunto(s)
Inhibidores de la Angiogénesis/efectos adversos , Colon Sigmoide/lesiones , Indoles/efectos adversos , Perforación Intestinal/diagnóstico , Pirroles/efectos adversos , Recto/lesiones , Inhibidores de la Angiogénesis/administración & dosificación , Carcinoma de Células Renales/tratamiento farmacológico , Colon Sigmoide/cirugía , Humanos , Indoles/administración & dosificación , Perforación Intestinal/cirugía , Neoplasias Renales/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pirroles/administración & dosificación , Radiografía , Recto/cirugía , Retroneumoperitoneo/diagnóstico por imagen , SunitinibRESUMEN
BACKGROUND: Acute myeloid leukemia (AML) in first relapse is associated with a poor outcome even when treated with intermediate- to high-dose cytarabine (IHDAraC). Gemtuzumab ozogamycin (GO) used as a single agent has clinical activity in relapsed and refractory AML. Various combination regimens of GO have been developed, but few data are available regarding their efficacy compared with IHDAraC-based regimens. METHODS: The authors performed a retrospective analysis of response and survival in 90 AML patients in first relapse treated with either IHDAraC (n = 56) or IHDAraC + GO (n = 34). Patient characteristics of the two groups were comparable. RESULTS: Median follow-up was 37 months. Compared with IHDAraC, IHDAraC + GO induction was associated with a better response rate (68% vs 45%, P = .04), a better overall survival (median, 35 months vs 6 months, P = .001), and a better event-free survival (24 months vs 6 months, P = .002). This effect was limited to patients with low-risk and intermediate-risk cytogenetics. In multivariate analysis, age, cytogenetic risk, first complete remission duration, and the use of IHDAraC + GO were independently associated with better results. CONCLUSIONS: This study showed that the addition of GO to IHDAraC is associated with a better efficacy for patients in first relapse of AML with low- or intermediate-risk cytogenetics. Prospective controlled studies of GO in this population are warranted. Patients with high-risk cytogenetics should be offered investigational new drugs.
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Aminoglicósidos/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Citarabina/administración & dosificación , Análisis Citogenético , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/genética , Adulto , Anciano , Aminoglicósidos/efectos adversos , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Citarabina/efectos adversos , Estudios de Seguimiento , Gemtuzumab , Humanos , Leucemia Mieloide Aguda/mortalidad , Leucemia Mieloide Aguda/patología , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Recurrencia , Estudios Retrospectivos , Riesgo , Terapia Recuperativa , Resultado del Tratamiento , Adulto JovenRESUMEN
Primary meningeal osteosarcomas are exceedingly rare. We report a case of a 51-year-old man with a chondroblastic osteosarcoma treated with pre-operative embolization, surgical removal, followed by adjuvant chemotherapy and radiation therapy. Patient is alive without any recurrence 43 months after diagnosis.