ABSTRACT
PURPOSE: The identification and referral of patients in need of palliative care should be improved. The French society for palliative support and care recommended to use the PALLIA-10 questionnaire and its score greater than 3 to refer patients to palliative care. We explored the use of the PALLIA-10 questionnaire and its related score in a population of advanced cancer patients. METHODS: This prospective multicentric study is to be conducted in authorized French comprehensive cancer centers on hospitalized patients on a given day. We aimed to use the PALLIA-10 score to determine the proportion of palliative patients with a score >3. Main secondary endpoints were to determine the proportion of patients already managed by palliative care teams at the study date or referred to palliative care in six following months, the prevalence of patients with a score greater than 5, and the overall survival using the predefined thresholds of 3 and 5. RESULTS: In 2015, eighteen French cancer centers enrolled 840 patients, including 687 (82%) palliative patients. 479 (69.5%) patients had a score >3, 230 (33.5%) had a score >5, 216 (31.4%) patients were already followed-up by a palliative care team, 152 patients were finally referred to PC in the six subsequent months. The PALLIA-10 score appeared as a reliable predictive (adjusted ORRef≤3 : 1.9 [1.17-3.16] and 3.59 [2.18-5.91]) and prognostic (adjusted HRRef≤3 = 1.58 [95%CI 1.20-2.08] and 2.18 [95%CI 1.63-2.92]) factor for patients scored 4-5 and >5, respectively. CONCLUSION: The PALLIA-10 questionnaire is an easy-to-use tool to refer cancer inpatients to palliative care in current practice. However a score greater than 5 using the PALLIA-10 questionnaire would be more appropriate for advanced cancer patients hospitalized in comprehensive cancer center.
Subject(s)
Comprehensive Health Care/standards , Adult , Aged , Aged, 80 and over , Cancer Care Facilities , Female , Humans , Male , Mass Screening , Middle Aged , Palliative Care , Prognosis , Prospective Studies , Referral and Consultation , Young AdultABSTRACT
Many regulatory rules related to home-based care for cancer patients issued during the recent years. More precisely, the French Plan cancer and the December 2004 << arrêté >> aim at << facilitating home-based chemotherapy by injection >> only << within the framework of a network of health in oncology >>, this in order to improve the quality of care and quality of life of patients. In this context, the Onco Pays-de-la-Loire network launched a project with centralised preparations of chemotherapy administred at home. We describe in this study the first results of this experiment. 41 patients have been treated and 224 cytotoxic drugs sended since january 2007 (56 % with trastuzumab, 19 % with gemcitabin, 13 % with methotrexate and 12 % with fluorouracil). No major problem was detected, 1,9 % of the preparations were destroyed. Satisfaction of outpatient healthcare professionals was good. A comparison of estimated costs revealed reductions in costs for outpatient chemotherapy. These first results validate the interest of cancer treatment at home for this kind of patients, and show the importance of nurse and pharmaceutical coordination.
Subject(s)
Antineoplastic Agents/administration & dosage , Home Care Services/organization & administration , Neoplasms/drug therapy , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal, Humanized , Deoxycytidine/administration & dosage , Deoxycytidine/analogs & derivatives , Female , Fluorouracil/administration & dosage , France , Humans , Male , Methotrexate/administration & dosage , Middle Aged , Trastuzumab , GemcitabineABSTRACT
Recent combinations of chemotherapy have significantly improved the response rate and survival time for patients with metastatic colorectal cancer. This improvement has been initially demonstrated with the combination of fluorouracil (5-FU)/leucovorin and irinotecan (CPT-11, Camptosar), which now is considered and recommended as first-line treatment. The combination of improved efficacy with survival benefit should translate into a better cure rate in patients with resected, locally advanced, nonmetastatic colorectal cancer for whom adjuvant chemotherapy with 5-FU/leucovorin is of proven benefit. Several randomized phase III trials are ongoing in Europe or would begin shortly to assess the potential benefit of a 5-FU/leucovorin-irinotecan combination in the adjuvant setting for patients with stage II or III colorectal cancer. This article will review the inclusion criteria and goal of these European trials. An update on accrual and on tolerance will also be provided.
