Medical assistance in dying law: a qualitative study of French cancer physicians.

OBJECTIVES: The legal landscape surrounding end-of-life care in France is subject to frequent changes. A proposed law to legalise euthanasia in April 2021 has raised questions about the role of physicians. If enacted, oncologists would likely be among the first professionals impacted, as data from countries with legalised euthanasia reveal that patients with cancer constitute the majority of those seeking this option. Currently, little is known about the attitudes of French oncologists towards euthanasia. Therefore, the aim of this study was to explore the position of cancer physicians on euthanasia and their experiences in dealing with patients who request it. METHODS: We conducted individual interviews with 24 cancer specialists (oncologists, radiotherapists and haematologists) at the Centre Léon Bérard in Lyon between August and October 2021. After full transcription, data were analysed thematically and for content. Data triangulation was used to establish the truthworthiness of the findings by two external researchers. RESULTS: Most cancer specialists in our study were opposed to legalising euthanasia, citing concerns about the societal, medical and ethical implications of the practice. They refused physician-assisted suicide based on their ethical duty to preserve life, avoid harm and uphold the Hippocratic Oath. Patient requests for euthanasia were rare. Surprisingly, over a quarter of the physicians interviewed did not rule out receiving active assistance in dying themselves in cases of unbearable or hopeless situations. CONCLUSIONS: This study highlights the complex and diverse attitudes of cancer physicians towards euthanasia and physician-assisted suicide, reflecting the challenges of integrating individual and collective perspectives on end-of-life issues.

The Supportive Care sCore (SCC): trigger alert validation study in solid tumours.

OBJECTIVES: Patients' needs are still underestimated during the course of cancer. The development of a simple and accessible screening tool to screen supportive care needs is an innovative approach to improve the cancer care pathway. The Supportive Care sCore (SCC) is a new tool developed to trigger alerts on the main supportive care needs, such as social, nutritional, physical, pain or psychological disorders. We aimed to develop and validate the SCC tool in identifying supportive care needs. METHODS: The SCC, the Edmonton Symptom Assessment System (ESAS) and the EuroQol-5 Dimension (EQ-5D) questionnaire (for quality of life) were distributed to patients with cancer over a week in an ambulatory hospital of an oncology department. Acceptability was measured by assessing the fill rate. Validity of alerts generated by the SCC was assessed by their consistency with the ESAS and EQ-5D scores. RESULTS: One hundred patients were included, with an average age of 67.2 years. Acceptability was good with a fill rate of over 90%. For a priori-defined risk groups by SCC with alert or not, the ESAS symptom score and quality of life differed significantly (p<0.05) between groups. We observed higher ESAS symptom scores in the alert group (nutritional alert-appetite: 4 (SD 2.4) vs 0 (SD 2.6), p<0.001; physical alert-fatigue: 4 (SD 1.7) vs 2 (SD 2.2), p<0.001; psychological alert-depressed: 3.5 (SD 2.7) vs 0 (SD 1.5), p<0.001). Quality of life was poorer in each domain of the EQ-5D in the alert group. CONCLUSIONS: Our study demonstrates the construct validity of SCC, which holds promise in identifying supportive care needs.

[Supportive care in oncology: definition, organization, limits]. / Soins de support oncologiques : définition, organisation, limites.

Supportive care in oncology: Definition, organization, limits. Supportive care have been introduced in France at the start of the 21st century, in the context of first French cancer act. They represent a coordination of health caregivers upon multidisciplinarity. Their organization follows cross disciplinary meetings and specific devoted programs like inpatients bed units or home care. The patient reported outcomes programs are in the next future of the quality of care involvement.

Soins de support oncologiques : Définition, organisation, limites. Les soins oncologiques de support ont été introduits en France au début des années 2000 dans le cadre du 1er Plan cancer. Ils correspondent à une coordination des soins et s'appuient sur la multidisciplinarité. Leur organisation repose sur les réunions de concertation pluridisciplinaire ainsi que sur des programmes d'unités dédiées à l'hôpital comme en ville et incluent des projets de liaison ville-hôpital en passant par le numérique.

[Nausea and vomiting induced by chemotherapy]. / Nausées et vomissements induits par la chimiothérapie.

Nausea and vomiting induced by chemotherapy. Nausea and vomiting induced by chemotherapy impact heavily anticancer treatment safety. It is necessary to define correctly, assess frequently and treat perfectly, following national or international guidelines. New treatment are currently developed in the field of emesis protection. Old drugs may help patients. Physicians as well as nurses and caregivers have to be involved in emesis protection. It is one of the key topic in cancer care management.

Nausées et vomissements induits par la chimiothérapie. Les nausées et vomissements chimio-induits peuvent être prévenus par des règles hygiéno-diététiques mais également par de nombreuses thérapeutiques, anciennes ou récentes. Il existe un réel effort de recherche dans ce domaine, tant pour élargir les indications que pour mieux comprendre l'administration des thérapeutiques modernes et développer de nouvelles molécules. Des recommandations nationales et internationales existent, souvent méconnues ou mal suivies, afin de protéger au maximum le patient de cet effet indésirable évitable.

Treatment and Prevention of Cancer-Associated Thrombosis in Frail Patients: Tailored Management.

Advanced age is one of the major determinants of frailty in patients with cancer-associated thrombosis. However, multiple other factors contribute to frailty in these patients. The identification of frailty in patients with cancer-associated thrombosis is critical as it influences the complexity of the anticoagulant treatment in this population at high risk of venous thromboembolism and bleeding. Factors that contribute to frailty in patients with cancer-associated thrombosis include age, type of cancer, comorbidities such as chronic kidney disease, poly-pharmacotherapy, treatment compliance, cognitive impairment, anemia, thrombocytopenia, mobility, nutritional status, Eastern Cooperative Oncology Group grade, risk of falls, and reduced life expectancy. In the absence of specific clinical studies current anticoagulant treatment guidelines for the management are not fully applicable to frail patients with cancer. The anticoagulant treatment should therefore benefit from a tailored approach based on an algorithm that takes into account the specificities of the malignant disease.