Raphaël Remonnay

Radiothérapie guidée par l’image

The IGRT is described in its various equipment and implementation. IGRT can be based either on ionizing radiation generating 2D imaging (MV or kV) or 3D imaging (CBCT or MV-CT) or on non-ionizing radiation (ultrasound, optical imaging, MRI or radiofrequency). Adaptive radiation therapy is then presented in its principles of implementation. The function of the technicians for IGRT is then presented and the possible dose delivered by the on-board imaging is discussed. The quality control of IGRT devices is finally described.

Cancer patients’ willingness to pay for blood transfusions at home: results from a contingent valuation study in a French cancer network

Home blood transfusion may be an interesting alternative to hospital transfusion, especially when given with curative or palliative intent or for terminal care in advanced-stage cancer patients. However, there is limited information about patients’ attitude toward this type of care. The purpose of this study was to measure French cancer patients’ willingness to pay (WTP) for home blood transfusion and to analyze determinants of their choice. A contingent valuation survey was administered to 139 patients receiving transfusions in the framework of a regional home care network or in the hospital outpatient department. Participation was high (90%). Most patients (65%) had received home care, including 43% blood transfusions. Just under half of the patients gave a zero WTP, among which we identified 8 protest bidders. The median WTP for home blood transfusion was 26.5 € per patient. In multivariate analysis, long home–hospital distance, poor quality of life, and previous experience of home care were identified as important factors in determining how much more patients would be willing to pay for transfusion at home. These results demonstrate the benefits of developing domiciliary services to improve patient well-being, notably for the weakest among them. The significant impact of previous home care experience on WTP is probably related to the strong involvement of physicians from the blood center and to their active contribution to a high-level homecare network. Some of our findings could be useful for policy decision-making regarding home care.

Analyzing multiple learning effects in health care using multilevel modeling: Application to radiotherapy at an early stage of innovation

OBJECTIVES Learning effects may have considerable influence on the performance of new health technologies, thereby on cost-effectiveness and ultimately on resource allocation. In the area of radiotherapy, equipment is becoming increasingly costly and the analysis of learning effects is complex given that sequential treatments are necessary, with multiple sessions for each patient. Our study aimed at analyzing learning effects in radiotherapy at an early stage of innovation. METHODS We used multilevel analysis to separate out the different learning effects of the new technique. Statistical analysis of observational data collected in a French National prospective survey was performed using an individual growth model. Intrapatient learning was modeled at level 1, and two types of interpatient learning were considered at level 2, regarding possible influences of professional experience on (i) the duration of each patients first session in a given setting and (ii) the rate of change of session duration over time for a given patient. Conventional radiotherapy was also considered for comparison. RESULTS Our results demonstrate a substantial type-1 interpatient learning effect and an even higher intrapatient learning effect. No type-2 interpatient learning was at work: professional experience did not impact intrapatient learning. Moreover, some intrapatient learning was also reported with conventional radiotherapy and was not significantly modified by innovation. Session duration was in any case strongly influenced by disease. CONCLUSIONS Because professionals highly underestimated the learning phenomenon, assessment of learning cannot be based on professional statements and it requires careful analysis of observational data.

Les prises en charge à domicile pour les patients cancéreux: quelle prise en compte et quelle amélioration du bien-être des patients et des proches?

Les prises en charge a domicile (PAD), solution alternative a l’hospitalisation, voient leur developpement encourage par les pouvoirs publics qui leur assignent notamment des objectifs en termes de reduction des couts, de rationalisation de la production des soins ou d’amelioration du bien-etre du patient. Trois modalites d’organisation de la PAD sont possibles: l’hospitalisation a domicile, les soins a domicile par des liberaux en dehors de tout cadre ou la coordination par un reseau ville/hopital. En meme temps que nous presentons les differentes dimensions constitutives de la satisfaction du patient, nous montrons comment les PAD sont en mesure d’influencer chacune de ces dimensions. Sur la base de la litterature et de notre experience, nous dressons enfin un bilan positif des PAD relativement a la satisfaction du patient, malgre des limites methodologiques.