[Experience of medical oncologists when telling a patient to be referred to a palliative care unit]. / Vécu chez les oncologues médicaux de l'annonce du transfert en unité de soins palliatifs à l'un de leurs patients.

INTRODUCTION: The announcement of the cessation of cancer treatments is a moment unanimously recognized as difficult for oncologists. More rarely analyzed, the announcement of a transfer to palliative care units is just as much. However, understanding the experience of oncologists during this announcement could make it possible to optimize it. MATERIALS AND METHODS: Qualitative, prospective, monocentric study with medical oncologists. Semi-structured interviews with 7 open questions. RESULTS AND DISCUSSION: Twelve interviews were conducted with a sex ratio of seven women for five men and an average age of 41.9 years. Six themes emerge after horizontal analysis of the verbatim and triangulation of the data. The experience of oncologists is dominated by a feeling of guilt, of fear of causing death anxiety in the patient, and of failure and helplessness in in front of a short-term vital risk. There is also a feeling of frustration at not being able to go through with the care. Facing the escape of the disease, oncologists feel resigned. We also observe projections on the part of oncologists with patients and paramedics. Finally, the existential question of death is an omnipresent concern with the feeling of abandoning the patient and a questioning of skills. However, it seems that the collaboration with the mobile palliative care team (EMSP) and the prospect of creating an internal palliative care unit (USP) at the center are perceived as a help.

Agreement for depression diagnosis between DSM-IV-TR criteria, three validated scales, oncologist assessment, and psychiatric clinical interview in elderly patients with advanced ovarian cancer.

BACKGROUND: Depression, a major outcome in cancer patients, is often evaluated by physicians relying on their clinical impressions rather than patient self-report. Our aim was to assess agreement between patient self-reported depression, oncologist assessment (OA), and psychiatric clinical interview (PCI) in elderly patients with advanced ovarian cancer (AOC). METHODS: This analysis was a secondary endpoint of the Elderly Women AOC Trial 3 (EWOT3), designed to assess the impact of geriatric covariates, notably depression, on survival in patients older than 70 years of age. Depression was assessed using the Geriatric Depression Scale-30 (GDS), the Hospital Anxiety Depression Scale, the distress thermometer, the mood thermometer, and OA. The interview guide for PCI was constructed from three validated scales: the GDS, the Hamilton Depression Rating Scale, and the Montgomery Asberg Depression Rating Scale (MADRS). The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised (DSM) criteria for depression were used as a gold standard. RESULTS: Out of 109 patients enrolled at 21 centers, 99 (91%) completed all the assessments. Patient characteristics were: mean age 78, performance status ≥2: 47 (47%). Thirty six patients (36%) were identified as depressed by the PCI versus 15 (15%) identified by DSM. We found moderate agreement for depression identification between DSM and GDS (κ=0.508) and PCI (κ=0.431) and high agreement with MADRS (κ=0.663). We found low or no agreement between DSM with the other assessment strategies, including OA (κ=-0.043). Identification according to OA (yes/no) resulted in a false-negative rate of 87%. As a screening tool, GDS had the best sensitivity and specificity (94% and 80%, respectively). CONCLUSION: The use of validated tools, such as GDS, and collaboration between psychologists and oncologists are warranted to better identify emotional disorders in elderly women with AOC.