Laure Copel

Prevalence and associated factors of sexual problems after early-stage breast cancer treatment: results of a French exploratory survey.

Objective: The objective of this study was to assess the prevalence and associated factors of sexual activity, sexual problems or sexual satisfaction in French early‐stage breast cancer survivors (BCS).

Recommendations for bowel obstruction with peritoneal carcinomatosis.

This article reports on the clinical practice guidelines developed by a multidisciplinary group working on the indications and uses of the various available treatment options for relieving intestinal obstruction or its symptoms in patients with peritoneal carcinomatosis. These guidelines are based on a literature review and expert opinion. The recommended strategy involves a clinical and radiological evaluation, of which CT of the abdomen is a crucial component. The results, together with an analysis of the prognostic criteria, are used to determine whether surgery or stenting is the best option. In most patients, however, neither option is feasible, and the main emphasis, therefore, is on the role and administration of various symptomatic medications such as glucocorticoids, antiemetic agents, analgesics, and antisecretory agents (anticholinergic drugs, somatostatin analogues, and proton-pump inhibitors). Nasogastric tube feeding is no longer used routinely and should instead be discussed on a case-by-case basis. Recent studies have confirmed the efficacy of somatostatin analogues in relieving obstruction-related symptoms such as nausea, vomiting, and pain. However, the absence of a marketing license and the high cost of these drugs limit their use as the first-line treatment, except in highly selected patients (early recurrence). When these medications fail to alleviate the symptoms of obstruction, venting gastrostomy should be considered promptly. Rehydration is needed for virtually every patient. Parenteral nutrition and pain management should be adjusted according to the patient needs and guidelines.

Screening for distress and supportive care needs during the initial phase of the care process: a qualitative description of a clinical pilot experiment in a French cancer center

Objective: To provide a qualitative description of a clinical pilot experiment in a French cancer center, conducted by a nurse after the treatment decision consultation attended by new cancer patients during the initial phase of the care process.

Place of death of adolescents and young adults with cancer: first study in a French population.

OBJECTIVE To improve the palliative care and more effectively meet the needs of young patients and their families at the end of life, the authors investigated the place of death of adolescents and young adults treated in their institution and identified some of the factors influencing the choice of place of death. METHODS The parents and/or partners of adolescents and young adults (15 to 25 years old) who died at Institut Curie (cancer center) between 2000 and 2003 were contacted. Twenty-one families agreed to participate in the interview between October 2005 and April 2006. Analysis of the interviews comprised a descriptive part and a thematic part. RESULTS Nineteen out of 21 (90%) families declared that they did not really choose their childs place of death due to lack of time. However, all families said that they preferred the hospital. No family attended a bereavement group after their childs death and only 3 families (14%) consulted a mental health care professional. Thematic analysis showed that representations and beliefs concerning life and death at least partly determined the familys capacity to discuss the place of death with their child. SIGNIFICANCE OF RESULTS Although progress has been made over recent years in France, there is still considerable room for improvement of palliative care to more effectively meet the needs of young patients and their families at the end of life.

A potentially neuroprotective role for erythropoietin with paclitaxel treatment in ovarian cancer patients: a prospective phase II GINECO trial

PurposeA prospective phase II multicenter study was performed in two steps in paclitaxel-treated ovarian cancer patients in France. A French version of the four-item Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) questionnaire was validated. This was then used to evaluate neurotoxicity in relation to erythropoietin treatment.MethodsPatients received standard second-line paclitaxel-based chemotherapy and erythropoietin for anemia. Neurotoxicity and hemoglobin levels were evaluated every cycle with the FACT/GOG-Ntx and NCI-CTCAE. The translated questionnaire was tested in 20 patients to confirm the translation accuracy. The final questionnaire was validated in 98 patients with internal consistency (Cronbach’s coefficient) and item correlation (Pearson’s r coefficient) tests. Neurotoxicity severity was analyzed according to erythropoietin intake (first three cycles versus no or late intake) and correlated with anemia.ResultsPatients received a median of six paclitaxel cycles (range 1–9). Neurotoxicity was validated in 484 questionnaires. Internal consistency was excellent with Cronbach’s coefficients of ≥0.89 at inclusion, after 3 cycles and at study end. Inter-question correlation was high with Pearson’s coefficients of 0.65–0.85. FACT/GOG-Ntx and NCI-CTCAE severity scoring was similar. Globally, the incidence of severe neurotoxicity (FACT/GOG-Ntx and NCI-CTCAE) was found significantly higher in patients with severe anemia. Of 98 evaluable patients, 31 received erythropoietin during the first three cycles. Mean hemoglobin level was significantly lower in this group from baseline to cycle 4; however, these anemic patients with early EPO intake did not develop an increase rate of severe neurotoxicity.ConclusionsThe French FACT/GOG-Ntx questionnaire is a reliable and valid tool for assessing chemotherapy-induced neuropathy. This study raises the possibility that erythropoietin might play a neuroprotective role when administered with paclitaxel.

A French Perspective on Hospital Ethics Committees

The growth of bioethics and ethics committees in France is very different from that in the United States and elsewhere.1 In our country, ethics committees emerged in the 1980s as the result of two movements, a political movement with the creation of a permanent Comite Consultatif National d’Ethique (CCNE) (National Ethics Committee) and a professional movement, with the development of local ethics committees. The CCNE, created in 1983 by the French President, was given the mission “to express its opinion on moral issues raised by research in the fields of biology, medicine and health, whether these issues concerned individuals, social groups or society as a whole.” Between 1983 and 1993, one third of CCNE opinions concerned medically assisted procreation and the embryo, one third concerned research on human beings, and one third concerned genetics.2 At the same time, ethics committees were formed in teaching hospitals in response to the requirements of international scientific journals for better control of research protocols. After several years of debate on the role of these committees, the French Parliament voted the so-called Huriet-Serusclat law in 1988, which defined the framework of research. It created Comites Consultatifs pour la Protection des Personnes dans la Recherche Biomedicale (Institutional Review Boards), CCPPRB now called CPP. Following the application of this law at the beginning of the 1990s, almost all of the old local committees disappeared and were replaced by the new CCPPRB. It is important to stress several characteristics of bioethics and ethics committees development in France. First is the prominent place in the birth of French bioethics devoted to problems of research and biology, particularly medically assisted procreation and genetics. Although the creation of the CCNE can be interpreted as a denial of the role of the official representative body of the French Medical Association (Conseil de l’Ordre des Medecins), it was not,

La place du choix des patients concernant leur lieu de décès

Lorsqu’un patient atteint d’une maladie chronique incurable arrive a la phase ultime de sa vie, les soignants et ses proches se sentent souvent tres demunis devant l’impossibilite qu’ils ont de trouver une solution pour guerir le patient — ou au minimum pour ameliorer sa survie. Leurs priorites se recentrent alors le plus souvent sur deux objectifs: i) permettre au patient d’acceder a un confort maximal avec des traitements symptomatiques adaptes; ii) exaucer les souhaits du malade lorsqu’ils sont realistes. Selon une etude realisee en France en 2003, 57 % des personnes interrogees sur leur lieu de deces souhaite repondent a domicile (Beuzart, 2003). Cette enquete faite en population generale (pour des personnes a priori en bonne sante) est corroboree par les resultats retrouves aupres de patients suivis dans le cadre d’un reseau de soins palliatifs parisien (Ensemble) ou 60 % des patients expriment le souhait de deceder a domicile (21 % en hospitalisation et 19 % n’abordent pas le sujet) (Mauviel, 2005). Les recherches faites a l’etranger montrent des resultats relativement similaires: en Grande-Bretagne, jusqu’a 58 % des patients en phase terminale souhaitent deceder a domicile (Seale, 1994). Actuellement, seuls 26 % des Francais decedent a domicile et rarement dans le contexte d’une maladie chronique (Insee, 2000). Dans cet article, nous allons donc etudier successivement les facteurs qui peuvent participer au choix du lieu de fin de vie pour un patient cancereux dans le contexte francais actuel puis les facteurs pronostiques qui permettent a un patient ayant eu la possibilite de choisir le domicile de rester chez lui jusqu’a son deces.

Le Projet éthique de l'Institut Curie : une aide à la réflexion des professionnels

Ni comite d’experts, ni structure de formation, le Projet ethique de l’Institut Curie ouvre une nouvelle voie a la demarche ethique en soutenant la reflexion des professionnels dans leurs prises de decision.