Training in communication of oncology clinicians: a position paper based on the third consensus meeting among European experts in 2018.

Background: Since there is sound evidence that communication skills training (CST) programs modify communication behavior of oncology clinicians, they have been widely implemented over the last decades. However, more recently, certain aspects of this training have been criticized. Methods: Based on this background, a call to re-launch a discussion about the future of CST led to the third European consensus meeting on communication in cancer care, organized by the Swiss Cancer League. During this meeting, which brought together European experts in the field of clinical communication and training of communication in the oncology setting, oncology clinicians, representatives of the European Society of Medical Oncology and a member of the European Oncology Nursing Society, the recommendations of the second European consensus meeting were updated and expanded. Results: The expanded recommendations recall the guiding principles of communication in cancer care, underline the important role of clinician's self-awareness, and of relational and contextual factors in clinical communication, and provide direction for the further development of communication training. Conclusion: This third European consensus meeting defines key elements for the development of a next generation of communication training for oncology clinicians.

[Evolution of symptoms and quality of life of patients after surgery of digestive endometriosis]. / Évolution des symptômes et de la qualité de vie des patientes après chirurgie de l'endométriose digestive.

OBJECTIVES: Prospective evaluation of symptoms and quality of life before and after surgical treatment of endometriosis with bowel involvement. PATIENTS AND METHODS: Changes in symptoms, sexuality and quality of life before and after surgery of 41 patients operated for bowel endometriosis at the centre hospitalier de Versailles (CHV) were assessed with a self-assessment questionnaire. Pains were assessed using five visual analog scales, symptoms using 26 questions with a four-level Likert item, sexuality using the SEXACQ, and quality of life using the EHP-5 and the EQ-5D VAS. RESULTS: Surgical treatment improves pain: VAS scores for main pain (P<0.0001), dysmenorrhea (P=0.0039), defecation pain (P=0.0312), non-cyclic pelvic pain (P=0.0002), and dyspareunia (P=0.0084). Twelve intestinal symptoms are improved, including three significantly. It also improves SEXACQ score (P=0.0068) and quality of life scores EHP-5 and EQ-5D VAS (P=0.0001 and P=0.0003 respectively). No difference was found between disk resection and segmental resection in terms of symptoms, sexuality and quality of life. Histological analysis suggests that when a segmental resection is done, the stage of the endometriosis bowel involvement is more advanced. DISCUSSION AND CONCLUSION: Surgery of bowel endometriosis improves symptoms and quality of life. When the stage of the bowel endometriosis is advanced, a segmental resection should be done. Moreover, self-assessment questionnaire used at the CHV seems an appropriate tool to evaluate functional outcome.

[Pregnancy after breast cancer: an update]. / Grossesse après cancer du sein : mise à jour des connaissances en 2012.

Breast cancers account for one third of cancer patients of childbearing age. Given the trend for women to delay childbearing, many of them will not fulfill their parental project at diagnosis of a potential breast cancer. Thus, planning pregnancies in young patients with a history of breast cancer is increasingly becoming a common situation. In this difficult context, several issues have to be discussed with the patient, such as post-chemotherapy premature ovarian failure, fertility-sparing techniques, risk of cancer recurrence or optimal time between cancer and future pregnancy. Potential obstetrical complications, long-term teratogenicity of anti-cancer drugs or breast-feeding are another points that have to be discussed with the patient and her husband. The aim of this updated review of literature was to provide answers to the numerous questions that may be encountered in this type of highly difficult situation. Thus, planning a pregnancy in breast cancer patients seems to be possible with, in one hand, a multidisciplinary approach in order to answer different questions and to avoid side effects of chemotherapy. In the other hand, a close and specialized obstetrical monitoring should be proposed in order to anticipate potential obstetrical complications.

The effect of inactivated Lactobacillus LB fermented culture medium on symptom severity: observational investigation in 297 patients with diarrhea-predominant irritable bowel syndrome.

INTRODUCTION: Little is known about the intensity of symptoms of diarrhea-predominant IBS (IBS-D) or the consequences of the disease on patients' health-related quality of life (HRQOL). This observational investigation assessed the symptoms (abdominal pain, bloating, number of stools per day, and stool consistency), impact on HRQOL, and consequence on anal continence in 297 patients with IBS-D before and after 1 month of probiotic treatment with Lacteol (inactivated Lactobacillus LB plus fermented culture medium). METHODS: Functional assessment using a standardized visual analogue scale in order to quantify abdominal pain, bloating, and quality of life before and after 1 month of treatment with 2 capsules/day of Lacteol. The number of symptomatic days per week, number of stools, consistency of stools, secondary fecal incontinence rate, and potential trigger effect of food were quantified. A χ2 test was used to compare qualitative data and the variance of quantitative criteria was analyzed. RESULTS: The pain score decreased from 4.46±0.15 on a scale of 0-10 before treatment to 2.8±0.14 after treatment (p<0.0001). Bloating decreased from 4.49±0.18 to 2.5±0.15 on a scale of 0-10 (p<0.0001). The HRQOL score, which is inversely correlated with quality of life, decreased from 5.99±0.14 to 3.92±0.16 (p<0.0001). In this cohort study, the fecal incontinence rate secondary to diarrhea was clearly higher than that of the general population: 18% versus a prevalence of 9-10%, according to different studies. The mean number of stools per week decreased from 17.59 to 12.83 after treatment (p<0.0001). Before treatment, 54% of patients had watery stools and 46% had smooth stools; at the end of treatment, only 18.5% of patients still had watery stools, and 34% had normal stools. 52% of patients attributed their symptoms to their diet: 34% to vegetables, 29% to fruit, 15% to milk, 15% to fat, 6% to peppers and spices, and 4% to sugar. CONCLUSION: This observational investigation shed new light on patients with IBS-D, the HRQOL of which is altered by a fecal incontinence rate twice as high as that of the general population. Correlation with diet is confirmed by 1 out of 2 patients reporting poor tolerance of fiber and dairy products. Nutritional management should thus be part of these patients' treatment. Inactivated Lactobacillus LB plus fermented culture medium is a probiotic drug that has been used by physicians for a long time to treat patients with diarrhea. Strongly concentrated, it has no side effects and seems to help these patients. Due to a strong placebo effect in patients with this pathology, however, a controlled study is necessary to confirm this result.

European Oncology Nursing Society extravasation guidelines.

An infrequent, but potential complication of chemotherapy is vesicant chemotherapy extravasation. Vesicants have the potential to cause blistering and ulceration when they extravasate from the vein or are inadvertently administered into the tissue. In 2007, the European Oncology Nursing Society published guidelines for extravasation prevention, detection, and management. Recommended management includes topical heating for plant alkaloid extravasations and topical cooling for anthracycline and other antitumor antibiotic vesicants. For treatment of antracycline extravasations topical dimethylsulfoxide (DMSO), sodium thiosulfate, and hyaluronidase have been described in the literature but due to lack of evidence to support their use as vesicant extravasation antidotes, it is recommended that these agents are studied further. Furthermore, Savene (dexrazoxane) is the only registered drug for the treatment of antracycline extravasation. Nurses need to be aware of current evidence-based guidelines for detecting and managing vesicant extravasations and need to be prepared to administer evidence-based treatment.

Use of complementary and alternative medicine in cancer patients: a European survey.

BACKGROUND: The aim of this study was to explore the use of complementary and alternative medicine (CAM) in cancer patients across a number of European countries. METHODS: A descriptive survey design was developed. Fourteen countries participated in the study and data was collected through a descriptive questionnaire from 956 patients. RESULTS: Data suggest that CAM is popular among cancer patients with 35.9% using some form of CAM (range among countries 14.8% to 73.1%). A heterogeneous group of 58 therapies were identified as being used. Herbal medicines and remedies were the most commonly used CAM therapies, together with homeopathy, vitamins/minerals, medicinal teas, spiritual therapies and relaxation techniques. Herbal medicine use tripled from use before diagnosis to use since diagnosis with cancer. Multivariate analysis suggested that the profile of the CAM user was that of younger people, female and with higher educational level. The source of information was mainly from friends/family and the media, while physicians and nurses played a small part in providing CAM-related information. The majority used CAM to increase the body's ability to fight cancer or improve physical and emotional well-being, and many seemed to have benefited from using CAM (even though the benefits were not necessarily related to the initial reason for using CAM). Some 4.4% of patients, however, reported side-effects, mostly transient. CONCLUSIONS: It is imperative that health professionals explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.

Deformation-induced injury of alveolar epithelial cells. Effect of frequency, duration, and amplitude.

The onset of ventilator-induced lung injury (VILI) is linked to a number of possible mechanisms. To isolate the possible role of alveolar epithelial deformation in the development of VILI, we have developed an in vitro system in which changes in alveolar epithelial cell viability can be measured after exposure to tightly controlled and physiologically relevant deformations. We report here a study of the relative effect of deformation frequency, duration, and amplitude on cell viability. We exposed rat primary alveolar epithelial cells to a variety of biaxial stretch protocols, and assessed deformation-induced cell injury quantitatively, using a fluorescent cell viability assay. Deformation-induced injury was found to depend on repetitive stretching, with cyclic deformations significantly more damaging than tonically held deformations. In cyclically deformed cells, injury occurred rapidly, with the majority of cell death occurring during the first 5 min of deformation. Deformation-induced injury was increased with the frequency of sustained cyclic deformations, but was not dependent on the deformation rate during a single stretch. Reducing the amplitude of cell deformations by superimposing small cyclic deformations on a tonic deformation significantly reduced cell death as compared with large-amplitude deformations with the same peak deformation.

Suction-assisted lipectomy for the correction of stomal dysfunction.

Poorly fitting appliances for urinary or fecal stream stomas can lead to frequent leaking and subsequent social embarrassment, stomal stenosis, hyperkeratosis, skin breakdown, and increased cost secondary to frequent changing. Obese patients with abnormal skin folds frequently are more prone to these problems. Herein is described the use of suction-assisted lipectomy for abdominal wall contouring in an effort to improve and simplify appliance application as well as lengthen appliance life. Between 1989 and 1996, five patients (three females, two males) ages 13 to 47 years, were treated with abdominal wall suction-assisted lipectomy in an attempt to improve stomal function. Preoperatively, an average of 1.25 appliance changes a day were required for leaking. Three patients had one procedure removing 400 to 600 cc of fat. Two patients had staged suction, removing a total of 900 to 1600 cc of fat. At 6-month follow-up, the average appliance life was 4 days, and the incidence of skin problems and leaking was markedly reduced. The technique of suction-assisted lipectomy is a simple outpatient procedure with low morbidity that can successfully be used to improve stomal function in obese patients with poorly fitting appliances secondary to skin folds, poor body habitus, or abdominal scarring.

Marsupialization of the pancreas for infected pancreatic necrosis.

Infected pancreatic necrosis is a devastating and lethal complication of acute pancreatitis. Late death is usually a result of sepsis. W.A. Altemeier and J.W. Alexander established in 1963 that open drainage of the necrotic pancreas is mandatory for survival (Arch Surg 1963;87:96-105). In 1981, E.D. Davidson and E.L. Bradley III concluded that "marsupialization" is the most effective method of open drainage (Surgery 1981;89:252-6). At our institution, we have a series of 10 patients who have undergone marsupialization for treatment of infected pancreatic necrosis. Our mortality rate was 30 per cent. One death resulted from sepsis after an infected necrotic pancreas was found with a colonic anastomotic leak at emergency exploratory celiotomy. Of note, further debridement was not performed. A second death occurred in a female with idiopathic pancreatitis and leukocytopenia, and we are uncertain whether that played a role in the failure of surgical intervention. The third death was in a young alcoholic with hyperlipidemia and severe pancreatitis who was septic 8 days before surgery. The patient died on postoperative day 1. Of the survivors, some were old, many were septic, and all but one returned for further debridement. Our series supports open debridement of infected pancreatic necrosis as a life-saving maneuver and marsupialization as an effective means of open drainage.

Combined laser-steroid therapy in blue rubber bleb nevus syndrome: case report and review of the literature.

We report the case of a 7-year-old boy with blue rubber bleb nevus syndrome and frequent digestive tract hemorrhage. Gastrointestinal hemangiomas were treated with laser therapy. Intermittent steroid therapy was administered from the age of 6 years. The results are compared to the relevant medical literature.

Non-A, non-B fulminant viral hepatitis in France in returnees from Asia and Africa.

Among 61 patients admitted for non-A, non-B fulminant viral hepatitis to Hôpital Beaujon, 10 had returned from Asia or Africa, and 51 had not been outside France, within the month preceding jaundice. This suggests that hepatitis might have been contracted in Asia or Africa in the former, and in France in the latter. The interval between the onset of jaundice and the onset of hepatic encephalopathy was 10 days in the former and 26 days in the latter (P less than 0.03). The serum of the patient returning from Asia contained, and the sera of the nine patients returning from Africa did not contain, antibodies to a virus isolated from the stools of patients suffering from an epidemic fecal-oral non-A, non-B viral hepatitis in Central Asia. It is concluded that infection with Asian-African non-A, non-B viruses can be the cause of fulminant hepatitis in persons returning from these countries, that the course of this type of non-A, non-B fulminant viral hepatitis is shorter than that of non-A, non-B fulminant hepatitis contracted in France, and that different viruses might be responsible for non-A, non-B hepatitis in Asia and Africa.

[Severe constipation indicative of pseudohypoparathyroidism and resolved after normalization of the blood calcium]. / Constipation sévère révélatrice d'une pseudo-hypoparathyroïdie et résolutive après normalisation de la calcémie.

Hypocalcemia does not appear among the endocrine and metabolic causes of constipation. The work-up of a severe constipation has disclosed a pseudo-hypoparathyroidism according to the clinical picture described by Albright, associating signs of hypo-parathyroidism, a characteristic dysmorphic syndrome, mental deficiency and normal PTH dosages. The resolve of the constipation along with the return to a normal calcemia suggests that hypocalcemia should be added to the long list of endocrine and metabolic causes of constipation.