ACACIAS 1: The physiological and subjective impacts of high fidelity simulation of the breaking of bad news.

STUDY OBJECTIVE: Breaking bad news (BN) is difficult and necessitates targeted training. To be effective, training may call for High Fidelity Simulation (HFS). This prospective study was conducted to objectively assess the impact of HFS as a tool conducive to the development of clinical competence in situations involving the delivery of bad news. METHODS: This feasibility study was conducted from January to May 2021 and included students in medical oncology and digestive surgery. The subjective and objective impacts of HFS were evaluated by means of a self-administered questionnaire and a wristband, Affect-tag, which recorded several indicators: emotional power (EP), emotional density (DE) and cognitive load (CL) in students undergoing training. RESULTS: Forty-six (46) students with a median age of 25 years (21-34 years) were included. While the participants were effectively and emotionally involved in the HFS training, they were not completely overwhelmed by their emotions, a possible occurrence in this type of program. After two training programs, the students presented with lower EP (P<0.001) and higher DE (P=0.005), while their CL remained stable (P=0.751). The information given in the self-administered questionnaires and the evaluations by outside professionals (actor, nurse, psychologist…) highlighted improved skills. CONCLUSION: Taking into account the emotional parameters observed and the questionnaires collected, HFS can be considered as a suitable and effective tool in the breaking of bad news.

Predictors of women's attendance in a home-based adapted physical activity program during localized breast cancer treatment.

PURPOSE: The objective of this study is to evaluate predictors for attendance in a home-based adapted physical activity (APA) program for women with breast cancer during chemotherapy and radiotherapy treatment. METHODS: This retrospective study was based on two prospective studies (SAPA and APAC), including a total of 73 patients with localized breast cancer during their treatment period. The same APA program lasting 27 weeks was proposed and registered. It consisted of three physical activity sessions (two aerobic and one strength training) per week. The predictors (age, height, body weight, body mass index (BMI), VO2peak, 6-min walking test distance (6MWT), fatigue (MFI), quality of life (EORTC-QLQ), anxiety and depression (HADS), and previous physical activity (IPAQ)) were evaluated before the APA program. RESULTS: According to the multivariate regression analysis, the baseline 6MWT distance and quality of life were predictive of good attendance in the APA program. The univariate analysis showed that initial VO2peak, body weight, BMI, and fatigue influenced attendance in the APA program. CONCLUSIONS: This study helps to better understand the profile of patients who would be participative or non-participative in an APA program. 6MWT distance and quality of life accounted for 19% of attendance in an APA program before the start of treatment. These correlations between the initial predictors of women with breast cancer and their attendance in the APA program during their treatment period make it possible to adapt physical activity professional practices to these patients.

Two cases of cutaneous drug eruption associated with temozolomide therapy for glioblastoma.

Glioblastoma is the most common form of primary brain cancer. Its treatment involves surgery, radiotherapy, and chemotherapy with temozolomide (tmz), which is an oral alkylating agent. To the best of our knowledge, few dermatologic side effects of tmz have been described. We report two cases of cutaneous drug eruption caused by tmz during and after radiochemotherapy treatment. In the first case, all tests were negative, but the clinical history and the time of onset supported an allergy to tmz. In the second case, an allergy to tmz was proved by a positive lymphocyte activation test. In this context, our study is one of a very few trying to determine dermatologic side effects by applicable tests used in routine practice.

Pharmacokinetics and exposure-effect relationships of capecitabine in elderly patients with breast or colorectal cancer.

PURPOSE: The aims of the present study were (1) to investigate the impact of great age on pharmacokinetics of capecitabine and its metabolites and (2) to evaluate the exposure-effect relationship of capecitabine in elderly patients. METHODS: Data collected from 20 elderly patients (75-92 years old) with breast or colorectal cancer who received oral capecitabine were analyzed. In order to study the old age effect on pharmacokinetics, data collected from two phase I studies involving 40 younger adults (<75 years old) with metastatic cancer who received oral capecitabine were added in the database. The population pharmacokinetic analysis was based on a four-compartment model describing the sequence of capecitabine and three of its metabolites. RESULTS: The absorption rate constant was found lower in the oldest patient group (≥75 years) compared with the youngest group, and the constant rate elimination of the 5-fluorouracil metabolite was found decreased over time (i.e., after 2 consecutive weeks of capecitabine administration). This time effect was not found different between the two age groups. In elderly patients, the exposure-safety analysis showed, from the second cycle of chemotherapy, significantly higher median exposures of capecitabine and its metabolites (5'-deoxy-5-fluorocytidine, 5'-deoxy-5-fluorouridine and 5-fluorouracil) in patients who experienced hand-foot syndrome compared with patients who did not. CONCLUSION: This study puts forward new arguments for the treatment of elderly cancer patients who could benefit from capecitabine chemotherapy with acceptable toxicity.

Effects of a home-based walking training program on cardiorespiratory fitness in breast cancer patients receiving adjuvant chemotherapy: a pilot study.

BACKGROUND: Breast cancer treatment is associated with a decline in measured cardiorespiratory fitness and increased fatigue. There is accumulating evidence that exercise training during adjuvant chemotherapy may contribute to prevent these changes. Additional studies are needed to explore the effectiveness of home-based walking interventions among this population. AIM: The aim of this study was to investigate the effects of a 12-week adapted home-based walking training program (WTP) on clinical rehabilitation in breast cancer patients receiving adjuvant chemotherapy. DESIGN: This was a pilot study using a single-group design. SETTING: Unit Department of Physiology and Medical Oncology, Limoges University Hospital, France. POPULATION: Thirty-nine outpatients predominantly with stage II breast cancer. METHODS: Participants performed 3 home ambulatory aerobic walking sessions per week at 50-60% of their maximum heart rate for 12 weeks. Functional capacity was assessed with an incremental cardiopulmonary exercise test during which peak oxygen consumption (VO(2peak)) was measured. A six-minute walking test (6 MWT) was performed to evaluate physical function. The revised Piper Fatigue Scale (PFS-R) was used to measure self-reported fatigue. RESULTS: Thirty-four patients (87%) completed all study procedures. Per Protocol (PP) analysis indicated that VO(2peak) recorded both before and after a 12-week adapted home-based WTP increased significantly by 2.21 mL.kg-1.min-1 (P=0.008) and 6 MWT distance increased significantly by 42 m (P=0.04). PFS-R score increased by 0.4 points, but not significantly. CONCLUSION: In breast cancer patients receiving adjuvant chemotherapy, home-based WTP is feasible and associated with significant improvements in VO(2peak), with no significant effect on fatigue score. Larger randomized trials are necessary to confirm these findings.

Chemotherapy response evaluation in metastatic colorectal cancer with FDG PET/CT and CT scans.

BACKGROUND: [18F]-fluorodeoxyglucose with positron-emission tomography (PET) and computed tomography (CT) scans were used to assess morphological and metabolic tumour response after chemotherapy in metastatic colorectal cancer. PATIENTS AND METHODS: Twenty-five patients were evaluated after 4 courses of chemotherapy (+/-target therapy), and among them 20 patients after 2 courses. Response Evaluation Criteria In Solid Tumors (RECIST) and European Organisazion for Research and Treatment of Cancer (EORTC) criteria were used to evaluate CT and PET respectively. RESULTS: Discrepancies between the two procedures were noted after 4 courses of chemotherapy in patient-based analysis. Two morphologically complete responses (CR) were correlated with metabolic response. Seven morphological partial responses (PR) were evaluated as 3 metabolic PR, 2 CR and 1 progressive disease (PD). Seventeen cases of morphologically stable disease (SD) were evaluated as 3 metabolic CR, 13 PR and 1 PD. These discrepancies were confirmed in lesion-based analysis. Perfect concordance was noted between metabolic responses obtained after 2 and 4 cycles. CONCLUSION: Morphological and metabolic imaging does not permit concordant therapeutic assessment in metastatic colorectal cancer.