An Integrated Cancer Prevention Strategy: the Viewpoint of the Leon Berard Comprehensive Cancer Center Lyon, France.

This article describes some of the key prevention services in the Leon Berard Comprehensive Cancer Center (CLB) Lyon, France, which are based on clinical prevention services, outreach activities, and collaboration with professional and territorial health communities. In addition, research is embedded at all stages of the prevention continuum, from understanding cancer causes through to the implementation of prevention interventions during and after cancer. Health promotion activities in the community and dedicated outpatient primary cancer prevention services for individuals at increased risk have been implemented. The CLB's experience illustrates how prevention can be integrated into the comprehensive mission of cancer centers, and how in turn, the cancer centers may contribute to bridging the current fragmentation between cancer care and the different components of primary, secondary, and tertiary prevention. With increasing cancer incidence, the shift toward integrated prevention-centered cancer care is not only key for improving population health, but this may also provide a response to the shortage of hospital staff and overcrowding in cancer services, as well as offer opportunities to reduce carbon emissions from cancer care.

Resilience at Work among Healthcare Professionals in Oncology during and beyond the Pandemic: Report from A Deliberative Multi-Stakeholder Reflexive Symposium.

The chronic distress faced by healthcare professionals (HCPs) in oncology was exacerbated by the COVID-19 pandemic, heightening the need to improve their resilience. The Entretiens Jacques Cartier symposium provided an opportunity for participants from France and Quebec to share perspectives on resilience at work and discuss interventions at individual and organizational levels to support HCP health and well-being. Fifty-eight stakeholders were invited to the symposium, including HCPs, government decision-makers, researchers, and patient representatives. The symposium began with presentations on the nature of professional resilience at work in oncology and promising interventions developed in France and Quebec. Participants were then engaged in deliberation on how evidence and experiential knowledge could contribute to workplace strategies to strengthen resilience. Small-group reflexive sessions using the photovoice method, and an intersectoral roundtable, elicited the expression and deliberation of multiple perspectives on the nature and building blocks of resilience. Four main themes emerged from the discussions: (1) that resilience remains a muddy concept and can be associated pejoratively with "happycracy"; (2) that resilience must contend with bounded autonomy and captors; (3) that it relies on a sense of coherence at work; and (4) that patients play a role in improving HCP resilience. Stakeholders from healthcare systems in different countries view resilience at work as a means of equipping teams to handle chronic and punctual stresses in cancer care. The symposium emphasized the importance of better defining what resilience at work means and pursuing explorations of multicomponent interventions to support oncology HCPs and the patients they care for. The themes raised by participants at the symposium suggest pathways for furthering this exploration.

[Management of patients treated with immunotherapy through city-hospital coordination]. / Prise en charge des patients traités par immunothérapie grâce à la coordination ville-hôpital.

The evolution of therapies and practices in oncology has made exchanges and city-hospital coordination in the patient's care pathway essential. As part of the system introduced by Article 51 of the Social Security Financing Act for 2018, the Léon-Bérard Center in Lyon (69), supported by its supervisory authorities, is experimenting with a new organizational method via its home immunotherapy project. An initial review, conducted two years after its launch, demonstrates the benefits for patient quality of life and safety.

The Ambulatory Medical Assistance (AMA) programme during active-phase treatment in patients with haematological malignancies: A cost-effectiveness analysis.

CONTEXT: The need for patient navigator is growing, and there is a lack of cost evaluation, especially during survivorship. OBJECTIVE: The objective of this study is to evaluate the cost-effectiveness of an Ambulatory Medical Assistance (AMA) programme in patients with haematological malignancies (HM). DESIGN: A cost-effectiveness analysis of the AMA programme was performed compared to a simulated control arm. SETTING: An interventional, single-arm and prospective study was conducted in a French reference haematology-oncology centre between 2016 and 2020. PARTICIPANTS: Adult patients were enrolled with histologically documented malignant haematology, during their active therapy phase, and treated either by intravenous chemotherapy or oral therapy. METHODS: An extrapolation of the effectiveness was derived from a similar nurse monitoring programme (CAPRI study). Cost effectiveness of the programme was evaluated through adverse events of Grade 3 or 4 avoided in different populations. RESULTS: Included patient (n = 797) from the AMA programme were followed during 125 days (IQR: 0-181), and adverse events (Grade 3/4) were observed in 10.1% of patients versus 13.4% in the simulated control arm. The overall cost of AE avoided was estimated to €81,113, leading to an ICER of €864. CONCLUSION: The AMA programme was shown to be cost-effective compared to a simulated control arm with no intervention.

[Ensuring continuity of cancer treatment despite the COVID-19 epidemic]. / Assurer la continuité des traitements anticancéreux malgré l'épidémie de Covid-19.

A real organisational challenge for the teams working alongside people being treated for cancer, the continuity of treatment and care has mobilised all those involved in care since the beginning of the COVID-19 epidemic. To ensure the safety of these patients, who are more vulnerable due to their illness, and to ensure that they do not lose any chances against their cancer, the care providers of the Lyon Regional Cancer Centre have innovated and adapted their practices, both in the city and in the hospital.

High mortality rate in cancer patients with symptoms of COVID-19 with or without detectable SARS-COV-2 on RT-PCR.

BACKGROUND: Cancer patients presenting with COVID-19 have a high risk of death. In this work, predictive factors for survival in cancer patients with suspected SARS-COV-2 infection were investigated. METHODS: PRE-COVID-19 is a retrospective study of all 302 cancer patients presenting to this institute with a suspicion of COVID-19 from March 1st to April 25th 2020. Data were collected using a web-based tool within electronic patient record approved by the Institutional Review Board. Patient characteristics symptoms and survival were collected and compared in SARS-COV-2 real-time or reverse-transcriptase PCR (RT-PCR)-positive and RT-PCR-negative patients. RESULTS: Fifty-five of the 302 (18.2%) patients with suspected COVID-19 had detectable SARS-COV-2 with RT-PCR in nasopharyngeal samples. RT-PCR-positive patients were older, had more frequently haematological malignancies, respiratory symptoms and suspected COVID-19 pneumonia of computed tomography (CT) scan. However, respectively, 38% and 20% of SARS-COV-2 RT-PCR-negative patients presented similar respiratory symptoms and CT scan images. Thirty of the 302 (9.9%) patients died during the observation period, including 24 (80%) with advanced disease. At the median follow-up of 25 days after the first symptoms, the death rate in RT-PCR-positive and RT-PCR-negative patients were 21% and 10%, respectively. In both groups, independent risk factors for death were male gender, Karnofsky performance status <60, cancer in relapse and respiratory symptoms. Detection of SARS-COV-2 on RT-PCR was not associated with an increased death rate (p = 0.10). None of the treatment given in the previous month (including cytotoxics, PD1 Ab, anti-CD20, VEGFR2…) correlated with survival. The survival of RT-PCR-positive and -negative patients with respiratory symptoms and/or COVID-19 type pneumonia on CT scan was similar with a 18.4% and 19.7% death rate at day 25. Most (22/30, 73%) cancer patients dying during this period were RT-PCR negative. CONCLUSION: The 30-day death rate of cancer patients with or without documented SARS-COV-2 infection is poor, but the majority of deaths occur in RT-PCR-negative patients.

[Therapeutic education and pathway of the allograft patient]. / Éducation thérapeutique et parcours du patient allogreffé.

After intensive chemotherapy followed by an allograft of haematopoietic stem cells, patients are immunocompromised for several months, or even years. They are vulnerable to bacteria and viral and fungal infections, and they must be made aware of the strict hygiene precautions to follow before they return home. Working alongside these patients in a therapeutic education approach, the nurse informs and guides them on the practices to adopt and the warning signs to look out for in the event of complications.