Résumé
Les soins de support (SS) médicamenteux ou non médicamenteux ont une place de plus en plus importante dans l’arsenal de prise en charge holistique des patients ayant un cancer. À ce titre, ...l’évaluation de l’efficacité de ces interventions médicamenteuses ou non doit reposer sur des études cliniques développées selon une méthodologie optimale à l’instar des traitements dits curatifs. L’un des freins au développement de SS non médicamenteux consiste en l’évaluation méthodologique de leur efficacité, mais de façon similaire à ce que l’on observe dans le processus du développement du médicament: de la phase I à la phase III. La question de l’évaluation conjointe des SS et des traitements potentiellement curatifs est également une approche méthodologique à investiguer afin d’étudier les interactions et proposer, si besoin, une prise en charge adaptée propre à optimiser l’efficacité des traitements. À ce jour, il n’existe pas de guidelines spécifiques en cancérologie pour l’évaluation des SS. La complexité de la méthodologie requise pour mener à bien des études d’évaluation nécessite une réflexion et l’élaboration d’un cadre structuré de type CONSORT stands for Consolidated Standards of Reporting Trials ainsi qu’une collaboration multidisciplinaire impliquant également les patients.
Few data are available on long-term fatigue (LTF) and quality of life (QoL) among epithelial ovarian cancer survivors (EOCS). In this case–control study, we compared LTF, symptoms and several QoL ...domains in EOCS relapse-free ≥3years after first-line treatment and age-matched healthy women.
EOCS were recruited from 25 cooperative GINECO centers in France. Controls were randomly selected from the electoral rolls. All participants completed validated self-reported questionnaires: fatigue (FACIT-F), QoL (FACT-G/O), neurotoxicity (FACT-Ntx), anxiety/depression (HADS), sleep disturbance (ISI), and physical activity (IPAQ). Severe LTF (SLTF) was defined as a FACIT-F score <37/52. Univariate and multivariate logistic regressions were conducted to analyze SLTF and its influencing factors in EOCS.
A total of 318 EOCS and 318 controls were included. EOCS were 63-year-old on average, with FIGO stage I/II (50%), III/IV (48%); 99% had received platinum and taxane chemotherapy, with an average 6-year follow-up. There were no differences between the two groups in socio-demographic characteristics and global QoL. EOCS had poorer FACIT-F scores (40 versus 45, P<0.0001), lower functional well-being scores (18 versus 20, P=0.0002), poorer FACT-O scores (31 versus 34 P<0.0001), and poorer FACT-Ntx scores (35 versus 39, P<0.0001). They also reported more SLTF (26% versus 13%, P=0.0004), poorer sleep quality (63% versus 47%, P=0.0003), and more depression (22% versus 13%, P=0.01). Fewer than 20% of EOCS and controls exercised regularly. In multivariate analyses, EOCS with high levels of depression, neurotoxicity, and sleep disturbance had an increased risk of developing SLTF (P<0.01).
Compared with controls, EOCS presented similar QoL but persistent LTF, EOC-related symptoms, neurotoxicity, depression, and sleep disturbance. Depression, neuropathy, and sleep disturbance are the main conditions associated with severe LTF.
Analysis of the quality of sexual life after total laryngectomy (TL) for cancer.
The Cochrane, PubMed, Embase, ClinicalKey and Science Direct databases were searched using the keywords: “total ...laryngectomy, sexual function, sexual behavior, sexual complications, sexual dysfunction, sexuality, intimacy”. The abstracts of 69 articles were read by two of the authors and 24 articles were selected. The main endpoint was the impact of impairment of quality of sexual life after TL for cancer and the methods used to assess this. The secondary endpoints were the type of sexual impairment, associated variables and their treatment.
The study population consisted of 1511 TL patients aged 21 to 90 years, with a male/female sex ratio of 7.49. One of the 7 validated Likert scales was used in 79% of the articles to evaluate impairment of sexual quality of life. Impaired quality of sexual life was reported by 47% of patients on average (range, 5–90%). Erectile and ejaculatory function and ejaculatory behavior of male patients decreased after TL. Other impairments comprised decreases in libido, frequency of sexual intercourse and satisfaction. Tracheostomy, advanced disease stage, young age and associated depression were factors for impairment. In all, 23% of patients reported lack of postoperative support in this area.
The quality of sexual life is severely impacted by TL for cancer. The present data are a source of information and should be taken into account before carrying out TL. A common information tool needs to be developed. There is patient demand for improved management of sexuality.
Agricultural activities involve daily use of maize silage as feed for livestock, which can be contaminated by mycotoxigenic molds. To evaluate fungal contamination, and the production of mycotoxins ...in maize silage we propose a multi-disciplinary approach utilizing PCR methods with genes of the aflatoxin (
ver-1,
omt-1 and
apa-2), fumonisin (
FUM1) and trichothecene (
TRI6) biosynthesis pathways. To detect
Aspergillus fumigatus, a 26S/intergenic spacer region of the rDNA complex was amplified. These specific PCR assays allowed three major groups of toxigenic fungi-like aflatoxin-producing
Aspergilli, fumonisin and trichothecene-producing
Fusaria, and the ubiquitous mold
A. fumigatus, to be targeted. A multimycotoxin method is also proposed to simultaneously quantify seven mycotoxins (
i.e., aflatoxin B
1, citrinin, deoxynivalenol, fumonisin B
1, gliotoxin, ochratoxin A, zearalenone) in maize silage by high-performance liquid chromatography coupled to mass spectrometry (HPLC–MS). These microbiological and analytical tools revealed three potentially toxigenic groups of fungi and
A. fumigatus grown from mature maize silage (11 month old) that was collected in Normandy (France) and the mycotoxins aflatoxin B
1 (7.0–51.3
μg/kg), citrinin (10.1–14.2
μg/kg), deoxynivalenol (128.0–181.0
μg/kg) and gliotoxin (6.6–11.9
μg/kg). Results indicate that the combination of PCR and HPLC–MS can be used to assess fungal quality of maize silages.
To investigate the exposure of livestock and farm workers to mycotoxins during the last months of silage use, the mycoflora and the mycotoxins in a mature silage (11-months-old) were studied. A ...multimycotoxin method was developed to evaluate the toxigenic
in vitro ability of fungal strains. The screening of potentially toxigenic fungi isolated from the mature silage showed that six
Fusaria (
Fusarium culmorum,
Fusarium equiseti,
Fusarium graminearum,
Fusarium oxysporum,
Fusarium solani and
Fusarium verticillioides) and one
Aspergillus (
Aspergillus fumigatus) were able to produce mycotoxins on nutrient agar. Seven major mycotoxins (aflatoxin B
1, citrinin, deoxynivalenol, fumonisin B
1, gliotoxin, ochratoxin A and zearalenone) were also searched in the corn silage by high-performance liquid chromatography coupled to mass spectrometry (HPLC-MS). Among the three mycotoxins (citrinin, gliotoxin and deoxynivalenol) detected in the silage, gliotoxin, a strongly immunosuppressive mycotoxin, occured in the mature silage at level up to 877
ppb, which was associated with the presence of
A. fumigatus in the silage.
Abstract The purpose of this study was to identify tools for the assessment of nutritional status in head and neck cancer patients, to evaluate the impact of malnutrition on therapeutic management ...and quality of life and to propose a simple screening approach adapted to routine clinical practice. The authors conducted a review of the literature to identify tools for the assessment of nutritional status in head and neck cancer patients published in French and English. Articles were obtained from the PubMed database and from the references of these articles and selected journals, using the keywords: “nutritional assessment”, and “head and neck” and “cancer”. Anthropometric indices, laboratory parameters, dietary intake assessment, clinical scores and nutritional risk scores used in patients with head and neck cancers are presented. The relevance of these tools in clinical practice and in research is discussed, together with the links between nutritional status and quality of life. This article is designed to help teams involved in the management of patients with head and neck cancer to choose the most appropriate tools for assessment of nutritional status according to their resources and their objectives.
Fungal contamination of indoor environments can cause respiratory diseases and induce damages to building materials. Among the fungal species found in mold-damaged homes, Penicillium brevicompactum, ...P. chrysogenum and P. crustosum can be considered as recurrent strains. In this study, we therefore propose a rapid and novel qPCR-based method in order to allow the monitoring of these three fungal species. The method developed allows the quantification of the target DNA of these three Penicillium species with a limit of quantification of 0.01 ng/μL without significant difference with spectrophotometry quantification assay for DNA concentrations between 5 and 100 ng/μL. This technique also enables the rapid detection of these three species in complex mixtures of DNA extracted from 15 bioaerosols collected in mold-damaged homes and previously cultured on agar plate. This new sensitive and specific qPCR technique can thus be easily integrated into bioaerosol studies.
•Indoor air quality is a major concern in industrialized and developing countries.•Penicillium species present in bioaerosols can be involved in respiratory diseases.•P. brevicompactum, P. chrysogenum and P. crustosum are among the most recurrent.•A qPCR method was developed to detect and quantify these three Penicillium species.•This new method opens up new prospects in bioaerosols study and monitoring.
Purpose
Oral anticancer therapies have an important place in the therapeutic arsenal, but factors influencing adherence to oral treatment are poorly documented in oncology. The objective of this ...study was to assess the impact of anxio-depressive symptoms and cognitive functioning on oral medication adherence.
Methods
This prospective study included cancer patients initiating a first oral therapy. Before initiation of treatment, an assessment of depression, anxiety, and cognition was performed. Using self-report questionnaires, we collected information on socio-demographic conditions and the non-adherence at 1 (M1) and 3 months (M3) after the beginning of treatment.
Results
Among 129 patients enrolled, median age was 70 years and 81% of patients were treated for metastatic cancer. Before initiating treatment, 16% and 8% of patients presented respectively depression and anxiety symptoms. Global cognitive impairment was observed in 51% of patients. Ten percent of the patients were non-adherent at M1 and 13% at M3. Depression was strongly associated with non-adherence at M1 (
P
= 0.046) and M3 (
P
= 0.014), but not anxiety. Non-adherence was associated with lower working memory (
P
= 0.037) and digit memory (
P
= 0.018) at M1 and short-term memory (
P
= 0.04) at M3. Patients with more than eight co-medications were more often non-adherents (
P
= 0.055).
Conclusions
Non-adherence to oral anticancer therapies was mainly associated to depression. Focusing on depressive symptoms before initiation of oral anticancer therapy could help to identify patient profiles more likely to fail self-management. Working memory, digit memory, and short-term memory also seem to play a role in non-adherence. Further studies should include a more specific population, especially according to age.
The aim of the study was to analyse efficacy, safety, and health-related quality of life (HRQoL) for sorafenib treatment in patients with metastatic uveal melanoma.
A multicentre, single-arm phase II ...trial was conducted. The primary objective was to determine the non-progression rate (RECIST) at 24 weeks for patients receiving sorafenib at a dose of 800 mg per day. Secondary endpoints included progression-free survival (PFS), overall survival (OS), toxicity, and HRQoL.
Thirty-two patients were included. Ten patients showed non-progression at 24 weeks (31.2%) without objective tumour responses. The estimated 24-week PFS was 31.2% (95% CI: 14.8%-47.6%) and the estimated 24-week OS was 62.5% (95% CI: 45.4%-79.6%). Ten patients (34.3%) had at least one grade 3 or 4 adverse reaction and 12 patients (41.4%) required dose modifications due to toxicity. At 24 weeks, no patient had an improvement in global HRQoL and 87.5% experienced a permanent increase in physical fatigue.
Sorafenib demonstrated non-progression at 24 weeks in 31.2% of patients. However, 41.4% of patients required dose modifications due to toxicity and no improvement in HRQoL was demonstrated.
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