Home telemonitoring in smart rurality: results from the HIS2R interreg feasibility pilot study.

AIMS: The Health in Smart Rurality Interreg project aims to assess the feasibility of telemonitoring in rural areas across the Franco-Belgian border among patients affected by heart failure or chronic obstructive pulmonary disease. The objectives were to better understand strengths or barriers to implementing telemonitoring for early detection of potential adverse events, for improving quality of life, communication, and care coordination. METHODS: Using a prospective 6-month observational design, interconnected pads were provided to community-dwelling adults aged over 60 years. The device monitored daily body weight, temperature, cardiac rate, blood pressure, and oxygen saturation. Using predefined warning thresholds, data were analyzed by a nurse case-manager who also provided therapeutic education during their contacts. RESULTS: Out of 87 eligible and screened patients, 21 (24%) were included in the study. At the end of the follow-up, 19 patients (90%) were re-assessed. The rate of hospitalization and mortality was high (32% and 10%, respectively). A total of 644 alerts were recorded (median of 29 alerts/patients) with a high rate of technically-related alerts (TRA) (26%). Out of the 475 non-TRA, 79% and 1% have led to an intervention by the case-manager or the physician, respectively. Therapeutic adjustment was proposed for 12 patients during that period. CONCLUSION: Telemonitoring appears to be a promising solution for the follow-up of patients living far from medical resources. The contribution of a case-manager is of added-value in managing alerts, therapeutic education, and coaching. Many questions remain open such as the improvement of technical aspects and long-term compliance in a real-world setting.

Association between hospital admission either directly or via the emergency department, and readmission rates at 30 days in older adults in two rural hospitals: a retrospective cohort study.

INTRODUCTION: Older patients are frequently re-admitted to the hospital after attending the emergency department (ED). We investigated whether direct admission to the hospital was associated with a lower risk of readmission at 30 days compared to admission via the ED, in patients aged ≥ 75 years. METHODS: Retrospective multicenter cohort study from 01/01/2018 to 31/12/2019, including patients aged ≥ 75 years from two hospitals. Patients admitted directly were matched 1:1 with patients admitted via the ED for center, age category, sex, major diagnosis category, type of stay (medical/surgical), and severity. We compared readmission at 30 days (primary outcome) and length of stay (secondary outcome) between groups. RESULTS: A total of 1486 matched patients with an available outcome measure were included for analysis. We observed no significant difference in 30-day readmission rate between those admitted directly (102/778, 13.1%) and those admitted via the ED (87/708, 12.3%, p = 0.63). There was a significant difference in length of stay between both groups: median 5 days [Q1-Q3: 2-8] vs 6 days [2-11] for direct and ED admissions, respectively (effect size: 0.11, p < 0.001). By multivariate analysis, only moderate to severe denutrition was associated with the risk of readmission at 30 days (Odds Ratio 2.133, 95% Confidence Interval 1.309-3.475). CONCLUSION: The mode of entry to the hospital of patients aged 75 years and older was not associated with the risk of readmission at 30 days. However, those admitted directly had a significantly shorter length of stay than those admitted via the ED.

Cholinergic Antagonists and Behavioral Disturbances in Neurodegenerative Diseases.

Cholinergic antagonists interfere with synaptic transmission in the central nervous system and are involved in pathological processes in patients with neurocognitive disorders (NCD), such as behavioral and psychological symptoms of dementia (BPSD). In this commentary, we will briefly review the current knowledge on the impact of cholinergic burden on BPSD in persons with NCD, including the main pathophysiological mechanisms. Given the lack of clear consensus regarding symptomatic management of BPSD, special attention must be paid to this preventable, iatrogenic condition in patients with NCD, and de-prescription of cholinergic antagonists should be considered in patients with BPSD.

Effect of enhanced home support: a retrospective study of the « Ehpad-@-Dom ¼ project / Effet du maintien à domicile renforcé : étude rétrospective du projet « Ehpad-@-Dom ¼

Introduction: The growing needs related to the loss of autonomy of elderly people should be the opportunity to imagine alternatives to nursing homes. In this context, our study aimed to assess the effect of a reinforced home care model on the evolution of frailty in elderly people whose health conditions could have justified entering a nursing home. Methods: A retrospective observational study focusing on the evolution of the SEGA score and other variables reflecting the frailty of people over 75 years old according to classic home care, institutionalization, or reinforced home care. Results: The average SEGA scores of the Ehpad-@-Dom (reinforced home care) and SAD (classic home care) groups are significantly better than that of the Ehpad group after 6 months (T6: Ehpad-@-Dom vs Ehpad, p =0.01 and SAD vs Ehpad, p=0.039) and 12 months (T12: Ehpad-@-Dom vs Ehpad, p=0.021). Conclusion: "Reinforced home care" seems to be an alternative to the classic nursing home model.

Introduction: Face aux besoins liés à la perte d'autonomie des personnes âgées vieillissantes, des alternatives à l'institutionnalisation doivent être imaginées. Dans ce contexte, notre étude visait à évaluer l'effet d'un modèle de maintien à domicile renforcé sur l'évolution de la fragilité de personnes âgées dont l'état de santé aurait pu justifier une institutionnalisation. Méthodes: Étude observationnelle rétrospective s'intéressant à l'évolution du score SEGA et d'autres variables reflétant la fragilité de personnes âgées de plus de 75 ans en fonction d'un maintien à domicile classique, une institutionnalisation, ou un maintien à domicile renforcé. Résultats: Les score SEGA moyens des groupes Ehpad-@-Dom (maintien à domicile renforcé) et SAD (maintien à domicile classique) sont significativement meilleurs que celui du groupe Ehpad après 6 mois (T6 : Ehpad-@-Dom vs Ehpad, p = 0,01 et SAD vs Ehpad, p = 0,039) et 12 mois (T12 : Ehpad-@-Dom vs Ehpad, p = 0,021). Conclusion: Le « maintien à domicile renforcé ¼ semble être une alternative à l'entrée classique en Ehpad.

Plasma amyloid beta predicts conversion to dementia in subjects with mild cognitive impairment: The BALTAZAR study.

INTRODUCTION: Blood-based biomarkers are the next challenge for Alzheimer's disease (AD) diagnosis and prognosis. METHODS: Mild cognitive impairment (MCI) participants (N = 485) of the BALTAZAR study, a large-scale longitudinal multicenter cohort, were followed-up for 3 years. A total of 165 of them converted to dementia (95% AD). Associations of conversion and plasma amyloid beta (Aß)1-42 , Aß1-40 , Aß1-42 /Aß1-40 ratio were analyzed with logistic and Cox models. RESULTS: Converters to dementia had lower level of plasma Aß1-42 (37.1 pg/mL [12.5] vs. 39.2 [11.1] , P value = .03) and lower Aß1-42 /Aß1-40 ratio than non-converters (0.148 [0.125] vs. 0.154 [0.076], P value = .02). MCI participants in the highest quartile of Aß1-42 /Aß1-40 ratio (>0.169) had a significant lower risk of conversion (hazard ratio adjusted for age, sex, education, apolipoprotein E ε4, hippocampus atrophy = 0.52 (95% confidence interval [0.31-0.86], P value = .01). DISCUSSION: In this large cohort of MCI subjects we identified a threshold for plasma Aß1-42 /Aß1-40 ratio that may detect patients with a low risk of conversion to dementia within 3 years.

A qualitative study of the perception of nursing home practitioners about the implementation of quality indicators for drug consumption in nursing homes.

INTRODUCTION: Nursing homes (NHs) are an ideal environment in which to implement interventions aimed at reducing inappropriate prescriptions. Quality indicators (QIs) may be useful to standardize practices, but it is unclear how they mediate change. In the framework of a quantitative study aimed at reducing the prescription of anticholinergic drugs among NH residents using QIs, we performed a qualitative study to describe the investigators' perception of the utility of QIs. METHODS: Qualitative study using focus group methodology. Focus groups were recorded and transcribed, and analyzed by thematic analysis. Participants were purposefully recruited from among the medical directors of the NHs in the quantitative study. RESULTS: Five medical directors participated in two focus group meetings. The main themes to emerge were: (1) communication is key to introducing new practices and achieving lasting uptake; (2) improved coordination and communication provided useful information to help interpret the quantitative results observed: e.g., participants reported that they were able to obtain contextual and patient-specific information that explained why some prescribers had consistently, but justifiably "poor" performance on the quantitative indicators; (3) negative aspects reported included reluctance to change among prescribers and the tendency to shirk responsibility. CONCLUSION: From the point of view of medical directors of NHs participating in an interventional program to reduce inappropriate prescriptions of anticholinergic drugs, the main factor driving the success of the program was communication, which is key to achieving adherence. Improved communication provides useful insights into the reasons why no quantitative reduction is observed in objective quality indicators.

[Study of the impact of MAIA management on the rehospitalisation of patients aged 75 and over]. / Étude de l'impact d'une prise en charge MAIA sur la réhospitalisation des patients âgés de 75 ans et plus.

Discharge from hospital is a key moment in the care of patients over 75 years of age. The organisation of the transition from hospital to home by home help and care management networks can be effective. Our aim was to evaluate impact of a case management program on 30 days rehospitalisation rates. Retrospective study of the multicentre cohort type carried out on patients monitored by the MAIA of Aube between 2018 and 2020. The risk of re-hospitalisation was significantly lower at 30 days among MAIA patients (1.6% vs. 19.5%; p < 0.0001), as well as at 90 days (4.8 % vs. 35.8 %; p < 0.0001). On the other hand, lengths of stay were longer in this group (20.9 vs. 11 days; p = 0.005) and the patients consulted the emergency department more often (40.8 % vs. 17.1 %; p < 0.0001). We could not conclude on mortality and falls. A positive impact of the Aube MAIA scheme on early and late readmission to hospital was shown.

Risk Indicators Improve the Prescription Quality of Drugs with Anticholinergic Properties in Nursing Homes.

AIM: The objective of this study was to assess the impact of a collaborative therapeutic optimization program on the rate of potentially inappropriate prescription of drugs with anticholinergic properties in nursing homes. METHODS: Quasi-experimental study in 37 nursing homes in France. The intervention included the use of quality indicators for prescriptions combined with educational sessions and dedicated materials for nursing home staff (unlimited access to study material for staff, including nurses, general practitioners, pharmacists). Indicators were calculated based on routine data collected from an electronic pill dispenser system. The primary outcome was the presence of at least one prescription containing ≥1 drug from a list of 12 drugs with anticholinergic properties. A difference-in-differences analysis was conducted at 18 months as well as propensity score weighting to minimize any potential indication bias. A generalized estimating equation model estimated the probability of being prescribed at least one target drug at any time during a 9-month period for each resident. RESULTS: In total, 33 nursing homes (intervention group: n = 10; control group: n = 23) were included, totalling 8137 residents. There was a decrease in the use of drugs with anticholinergic properties over time in both groups, as well as a decline in the intervention group compared to the control group (Odds Ratio: 0.685, 95% CI: 0.533, 0.880; p < 0.01) that was attributable to the intervention. An estimated 49 anticholinergic properties drug prescriptions were avoided by the intervention. CONCLUSION: This study found that an intervention based on indicators derived from routine prescription data was effective in reducing use of drugs with anticholinergic properties prescriptions in nursing homes.

No impact of a prescription booklet on medication consumption in nursing home residents from 2011 to 2014: a controlled before-after study.

BACKGROUND: Older persons are particularly exposed to adverse events from medication. Among the various strategies to reduce polypharmacy, educational approaches have shown promising results. We aimed to evaluate the impact on medication consumption, of a booklet designed to aid physicians with prescriptions for elderly nursing home residents. METHODS: Among 519 nursing homes using an electronic pill dispenser, we recorded the daily number of times that a drug was administered for each resident, over a period of 4 years. The intervention group comprised 113 nursing homes belonging to a for-profit geriatric care provider that implemented a booklet delivered to prescribers and pharmacists and specifically designed to aid with prescriptions for elderly nursing home residents. The remaining 406 nursing homes where no such booklet was introduced comprised the control group. Data were derived from electronic pill dispensers. The effect of the intervention on medication consumption was assessed with multilevel regression models, adjusted for nursing home status. The main outcomes were the average daily number of times that a medication was administered and the number of drugs with different presentation identifier codes per resident per month. RESULTS: 96,216 residents from 519 nursing homes were included between 1 January 2011 and 31 December 2014. The intervention group and the control group both decreased their average daily use of medication (- 0.05 and - 0.06). The booklet did not have a statistically significant effect (exponentiated difference-in-differences coefficient 1.00, 95% confidence interval 0.99-1.02, P = .45). CONCLUSION: We observed an overall decrease in medication consumption in both the control and intervention groups. Our analysis did not provide any evidence that this reduction was related to the use of the booklet. Other factors, such as national policy or increased physician awareness, may have contributed to our findings.

Incremental Value of CSF Biomarkers in Clinically Diagnosed AD and Non-AD Dementia.

Background: Cerebrospinal fluid (CSF) biomarkers are used to diagnose Alzheimer disease (AD), especially in atypical clinical presentations. No consensus currently exists regarding cut-off values. This study aimed, firstly, to define optimal cut-off values for CSF biomarkers, and secondly, to investigate the most relevant diagnostic strategy for AD based on CSF biomarker combinations. Methods: A total of 380 patients were prospectively included: 140 with AD, 240 with various neurological diagnoses (non-AD). CSF biomarkers were measured using ELISA. Univariate and multivariate analyses were performed using random forest and logistic regression approaches. Results: Univariate receiver operating curve curves analysis of T-Tau, P-Tau181, Aß42, Aß40 concentrations, and Aß42/Aß40 ratio levels showed AD cut-off values of ≥355, ≥57, ≤706, ≥10,854, and ≤0.059 ng/L, respectively. Multivariate analysis using random forest and logistic regression found that the algorithm based on P-Tau181, Aß42 concentrations and Aß42/Aß40 ratio yielded the best discrimination between AD and non-AD populations. The cross-validation technique of the final model showed a mean accuracy of 0.85 and a mean AUC of 0.89. Conclusion: This study confirms that the Aß42/Aß40 ratio was more useful than the Aß40 concentration in discriminating AD from non-AD populations in daily practice. These results indicate that the Aß42/Aß40 ratio should be assessed in all cases, independently of Aß42 concentrations.

Predictive capacity of the modified SEGA frailty scale upon discharge from geriatric hospitalisation: a six-month prospective study.

The aim of this study was to describe the predictive role of the modified SEGA frailty scale on nursing home admission, readmission to hospital, falls and mortality. MATERIAL AND METHODS: We performed a prospective, single-centre cohort study in patients discharged from a geriatric hospital ward between July 2016 and February 2017, with follow-up of six months. Patients aged 65 and over who were returning home from hospital were included. The primary outcome measure was admission to a nursing home at six months. We used a Cox model to explore the predictive nature of the variables. RESULTS: Thirty-three patients (18.4%) with a mean age of 80.9 years (± 6.5) were classified as not very frail and 146 (81.6%) with a mean age of 86 years (± 6.5) as frail/very frail. After six months, 13.5% of the frail/very frail patients and 1.2% of the not very frail patients had entered a nursing home (p = 0.169). Frailty status was significantly associated with readmission to hospital at three months (p = 0.026) and single or multiple falls at six months (p = 0.003). CONCLUSION: The modified SEGA scale may predict the occurrence of adverse events and improve the transition to home.

[Predictive capacities at the end of hospitalisation in geriatrics of the modified SEGA frailty score: a 6-month prospective study]. / Capacités prédictives du score de fragilité de la grille SEGA modifiée en sortie d'hospitalisation de gériatrie : étude prospective à 6 mois.

The aim of this study was to describe the predictive role of the modified SEGA fragility score on nursing home admission, rehospitalization, falls and mortality. MATERIAL AND METHODS: We performed a prospective, single-center cohort study in patients leaving geriatric hospitalization between July 2016 and February 2017, with follow-up at 6 months. Patients 65 years of age and over, returning home, were included. The primary outcome measure was admission to an institution at 6 months. We realized a Cox model to explore the predictive character of the variables. RESULTS: Thirty-three patients (18.4%), mean age 80.9 years (± 6.5), were not very fragile. At 6 months, 13.5% of the fragile or very fragile patients and 1.2% of the patients who were not very fragile had entered the institution (p = 0.169). Fragility status was statistically significantly associated with rehospitalization at 3 months (p = 0.026) and single or multiple drop at 6 months) month (p = 0.003). CONCLUSION: The SEGAm grid would predict the occurrence of derogatory events and improve return home.

A Systematic Review of Thirty-One Assessment Tests to Evaluate Mobility in Older Adults.

Assessments of gait, balance, and transfer in elderly people play a valuable role in maintaining healthy aging and preventing a decline in mobility. Several evaluation tools have been proposed; however, clinicians should select the most accurate ones wisely, based on numerous criteria. This systematic review aims to identify all applicable elderly mobility assessment tests and show their measurement properties with as much detail as possible. Initially, a broad search was performed. Articles were screened based on their titles and abstracts, and only studies published in English were considered. Based on our inclusion and exclusion criteria, 31 assessment tests evaluating the mobility of healthy elderly people were found. Then, further searches were completed to identify the measurement properties of each test. These characteristics include the origin and year of establishment, several practicality factors, and validity. The analysis of our outcomes illustrates the similarities and differences between the identified tests.

[Prognostic value at one year of frailty as evaluated by the SEGA instrument for octogenarians presenting an acute coronary syndrome: PROSECO study]. / Valeur pronostique à 12 mois du niveau de fragilité évalué par la grille SEGA dans le cadre du syndrome coronaire aigu de l'octogénaire : étude PROSECO.

The SEGA instrument has demonstrated good performance in screening for frailty. However, its predictive ability in elderly patients presenting with acute coronary syndrome have never been evaluated. We aimed to study the prognostic value at one year of the frailty level assessed by the SEGA instrument, in a population of patients aged 80 years old or more hospitalised for acute coronary syndrome. All consecutive patients aged 80 years or older hospitalised for myocardial infarction type 1 between November 2016 and October 2017 were included. All underwent standardised geriatric assessment including estimation of frailty by the SEGA instrument. The primary outcome was the time to death from any cause. In all 64 patients were included for a mean age of 85.3±4 years. Using the SEGA instrument, 24% patients were classified "frail" and 44% "very frail"; 18 (28%) deaths were observed during follow-up. When adjusted for patient age, body mass index and arterial hypertension, survival status was not significantly related with frailty status (HR=1.1, 95% CI=0.4-3.1, p=0.8).

Cancer burden in the Caribbean: an overview of the Martinique Cancer Registry profile.

BACKGROUND: Cancer indicators are essential information for cancer surveillance and cancer research strategy development. The Martinique Cancer Registry (MCR) is a population-based cancer Registry (PBCR) that has been recording cancer data since its creation in 1981. This article provides cancer incidence and mortality data for all cancers and for major tumor sites. METHODS: The registry collects all new cancer cases, details of the individual affected, tumor site and follow-up. World-standardized incidence and mortality rates were calculated, by tumor site and sex for solid tumors from the MCR database for the study period 2001-2015. RESULTS: Over the period 2001-2015, a total of 22,801 new cases were diagnosed; 13,863 in men (60.8%) and 8938 in women (39.2%). In 2011-2015, 1631 new cases were diagnosed per year. Age-standardized (to the world population) incidence rates for all cancers, were 289.8 per 100,000 men and 171.0 per 100,000 women. Breast, colon-rectum and stomach were the most common cancer sites in women. Prostate, colon-rectum and stomach were the main sites in men. Martinique has higher incidence rates of prostate and stomach cancer than mainland France. CONCLUSIONS: Prostate and stomach cancers have high incidence and rank first among the four major tumor sites. Providing data for the French zone of the Caribbean is essential to contributing to the development of high-priority public health measures for the Caribbean zone.

Post-translational modification-derived products are associated with frailty status in elderly subjects.

Background Identifying frail elderly subjects is of paramount importance in order to conduct a tailored care. The characterization of frailty status is currently based on the collection of clinical data and on the use of various tools such as Fried's criteria, which constitutes a difficult and time-consuming process. Up to now, no biological markers have been described as reliable tools for frailty characterization. We tested the hypothesis that a link between frailty and protein molecular aging existed. This study aimed therefore at determining whether post-translational modification derived products (PTMDPs), recognized as biomarkers of protein aging, were associated with frailty status in elderly subjects. Methods Frailty status was determined according to Fried's criteria in 250 elderly patients (>65 years old) hospitalized in a short-term care unit. Serum concentrations of protein-bound PTMDPs, including carboxymethyllysine (CML), pentosidine, methylglyoxal-hydroimidazolone-1 and homocitrulline (HCit), were determined by liquid chromatography coupled with tandem mass spectrometry, and tissue content of advanced glycation end-products was assessed by skin autofluorescence (SAF) measurement. Associations between PTMDPs and frailty status were analyzed using logistic regression models. Results Frail patients had significantly (p<0.01) higher CML, HCit, and SAF values compared to non-frail and pre-frail subjects. By multivariate analysis, only HCit concentrations and SAF values remained associated with frailty status (p=0.016 and p=0.002, respectively), independently of age, comorbidities, renal function, C-reactive protein and albumin concentrations. Conclusions HCit and SAF are significantly associated with frailty status in elderly subjects. This study suggests that PTMDPs constitute promising biomarkers for identifying frail patients and guiding personalized patient care.

In-home physical frailty monitoring: relevance with respect to clinical tests.

BACKGROUND: Frailty detection and remote monitoring are of major importance for slowing down, and/or even stopping the frailty process in home-dwelling older people. Taking the Fried's criteria as a reference, this work aims to compare the results produced by a technological set (ARPEGE Pack) with those obtained by usual clinical tests, as well as to discuss the ability of the Pack to be used for long-run frailty remote monitoring. METHODS: 194 participants were given a number of geriatric tests and asked to make use of the ARPEGE technological tools as well as reference clinical tools to feed Fried's indicators. Spearman or Pearson's correlation coefficients were used to compare the ARPEGE results to the reference ones, depending on data statistical characteristics. RESULTS: Good correlations were obtained for measurements of weight (0.99), grip strength (0.89) and walking speed (0.79). Results are much less satisfactory for evaluation of physical activity and exhaustion (Spearman correlation coefficients 0.25 and 0.41, respectively). CONCLUSION: Correlations regarding weight, grip strength and walking speed confirm the validity of the data produced by the ARPEGE Pack to feed Fried's criteria. Assessing activity level and exhaustion from an abbreviated questionnaire is still questionable. However, for long-run monitoring other methods of evaluation can be explored. Beyond the quantitative results, the ARPEGE Pack has been proved to be acceptable and motivating in such a long-term frailty monitoring.

Threshold for a Reduction in Anticholinergic Burden to Decrease Behavioral and Psychological Symptoms of Dementia.

BACKGROUND: A high anticholinergic burden (AB) is associated with the occurrence of behavioral and psychological symptoms (BPSDs), which are frequent in dementia. OBJECTIVES: Our aim was to determine the threshold for a reduction in AB that would lead to a clinically significant improvement in BPSDs (in terms of frequency, severity, and disruptiveness). DESIGN: A single-center prospective study. SETTINGS: Dedicated geriatric care unit specializing in the management of patients with dementia. PARTICIPANTS: The study involved older patients with dementia, hospitalized for management of BPSDs. METHODS: One hundred forty-seven patients were included (mean age = 84.1 ± 5.2 years). The AB was assessed using 3 scales, namely, the Anticholinergic Drug Scale (ADS), the Anticholinergic Cognitive Burden scale (ACB), and the Anticholinergic Risk Scale (ARS). A clinically significant improvement in BPSDs was defined as a reduction of 4 points in the frequency × severity (F×S) score of the Neuropsychiatric Inventory-Nursing Home (NPI-NH) questionnaire. The threshold for a reduction in AB that corresponded to a clinically significant improvement in BPSDs was determined by multiple linear regression. RESULTS: One hundred forty-seven patients were included (mean age = 84.1 ± 5.2 years). Using the ADS, a reduction of 2 points in AB in patients with moderate-intensity BPSDs was associated with a clinically significant improvement in the F×S score of the NPI-NH [6.34, 95% confidence interval (CI) 4.54-8.14], and a reduction of 3 points was associated with a clinically significant improvement in the occupational disruptiveness score (4.26, 95% CI 3.11-5.41). CONCLUSIONS/IMPLICATIONS: In older patients with dementia presenting BPSDs, the risk-benefit ratio of anticholinergic drugs is debatable and, where possible, drugs with a lower AB would be preferable. Because BPSDs are a frequent cause of hospitalization, a standardized approach to analysis and reduction of AB is warranted in this population. Depending on the scale used to assess anticholinergic burden (AB), a small reduction in AB is associated with a decrease in frequency, severity, and disruptiveness of moderate-intensity BPSDs. Drugs with a high AB should be avoided where possible in older patients with dementia, and drugs with a lower AB would be preferable. Heterogeneity between the assessment scales for AB precludes generalization of the impact of a reduction in AB on BPSDs.

Pattern of care of prostate cancer patients across the Martinique: results of a population-based study in the Caribbean.

BACKGROUND: The French West-Indies rank first for both prostate cancer incidence and mortality rates. Analyzing diagnostic and therapeutic procedures among patients with prostate cancer, using data from a population-based cancer registry, is essential for cancer surveillance and research strategies. METHODS: This retrospective observational cohort study was based on data from the Martinique Cancer Registry. Records of 452 patients diagnosed with prostate cancer in 2013 were retrieved from the registry. Data extracted were: socio-demographic and clinical characteristics, circumstances of diagnosis, PSA level at diagnosis, Gleason score and risk of disease progression. Stage at diagnosis and patterns of care among prostate cancer patients were analyzed. RESULTS: Mean age at diagnosis was 67 ± 8 years; 103 (28.5%) were symptomatic at diagnosis. Digital rectal exam was performed in 406 (93.8%). Clinical stage was available in 385 (85.2%); tumours were localized in 322/385 (83.6%). Overall, 17.9% were at low risk, 36.4% at intermediate and 31.9% at high risk; 13.8% were regional/metastatic cancers. Median PSA level at diagnosis was 8.16 ng/mL (range 1.4-5000 ng/mL). A total of 373 patients (82.5%) received at least one treatment, while 79 (17.5%) had active surveillance or watchful waiting. Among patients treated with more than one therapeutic strategy, the most frequent combination was external radiotherapy with androgen deprivation (n = 102, 22.6%). CONCLUSIONS: This study provides detailed data regarding the quality of diagnosis and management of patients with prostate cancer in Martinique. Providing data on prostate cancer is essential for the development of high-priority public health measures for the Caribbean.