[Patient-held health records: impact on breast cancer follow-up in the Rhône-Alpes region. Project Archimed]. / Le dossier de santé détenu par le patient : impact sur le suivi du cancer du sein dans la région Rhône-Alpes. Projet Archimed.

BACKGROUND: The conditions of use and access to medical records have become an important source of interest in the last decade. In this context, our main objective was to assess the impact of a paper patient-held records, shared with healthcare professionals. METHODS: In the particular case of breast cancer management, we identified the expectations of practitioners and patients. Secondly and according to a Delphi method, we defined the content and size of a medical record, which could be held by the patient. Following these preliminary studies, we conducted a randomized controlled trial, comparing patients with usual follow-up to others holding the new record containing essential information for coordination of care. RESULTS: The patient-held record favoured membership and satisfaction of both patients and health professionals. It was used as a communication tool between physicians and patients, but could also cause anxiety to some patients. Patient quality of life, data confidentiality and costs of care remained identical in the two arms. With its benefits for both patients and healthcare professionals, a new concept of medical records was revealed by this study. CONCLUSION: New models for healthcare organization deeply modify the roles and relationships of all the actors in the healthcare system. Further research on patient-held records is needed to evaluate the full range of its benefits and limits.

[Role of gynecologists in the care of women with breast cancer]. / La place des médecins gynécologues libéraux dans la prise en charge des femmes atteintes de cancer du sein.

OBJECTIVES: To describe the role of gynecologists in the care of women with breast cancer, their relationship with hospital specialists and with patients, and their expectations in terms of the quality of this relationship. MATERIALS AND METHODS: A descriptive cross-sectional study was performed in 2002. Two hundred and fifty gynecologists from Rhone Alpes region were randomly selected and received a questionnaire. RESULTS: Sixty-four percent of the polled practitioners answered. Forty-two percent of gynecologists had about 25-50 patients with breast cancer. Their participation in the care principally concerned the phases of diagnosis (99%) and remission (98.5%). Eight percent took part in therapeutic decision making. Ninety-two percent of the gynecologists wanted to receive systematically feedback concerning any consultation or hospitalization and 98% wanted to know the name and address details of the care coordinator. CONCLUSION: Gynecologists are willing to participate in the care of breast cancer patients. This for, they want to have more details about therapy, follow-up and the level of information given to the patients.

A randomized double blind placebo controlled multicenter study of mesalazine for the prevention of acute radiation enteritis.

BACKGROUND AND PURPOSE: Symptoms of acute radiation enteritis (ARE), dominated by diarrhea, occur in more than 70% of patients receiving pelvic irradiation. Eicosanoids and free radicals release have been implicated in the pathogenesis. Mesalazine (5-ASA) is a potent inhibitor of their synthesis in the mucosa and could therefore be of some interest in preventing ARE. PATIENTS AND METHODS: The study was performed in six radiotherapy units in France who agreed on standardized irradiation procedures. One hundred and fifty-three patients planned for external beam radiotherapy to the pelvis > or = 45 Gy for prostate (n = 97) or uterus (n = 54) cancer were randomized on a double blind basis to receive prophylactic 5-ASA (4 g/day Pentasa) or placebo. Patients with concomitant chemotherapy were excluded. Prostate and uterus cancers were chosen since these centropelvic tumors require a similar radiotherapy protocol during the first step of treatment and involve a comparable volume of small intestine. The symptoms of ARE and their severity were assessed every week during irradiation, and 1 and 3 months after its end. All patients followed a low fiber and low lactose diet. End points were diarrhea, use of antidiarrheal agents, abdominal pain, and body weight. Effficacy was evaluated using intention to treat. RESULTS: (means +/- SD) Groups did not differ for age (mean 64 +/- 9 years), sex, tumor site, or irradiation procedure. During irradiation, diarrhea occurred in 69% and 66% of the 5-ASA and placebo groups, respectively (chi2, P = 0.22). Curves of survival without diarrhea did not differ between groups (logrank P = 0.09). Severity of diarrhea did not differ between groups except at d15 where it was significantly more severe in the 5-ASA group (ANOVA P = 0.006). Duration of diarrhea did not differ (22 +/- 15 days in both groups, P = 0.88). Abdominal pain was less frequently reported in the 5-ASA group at d28 (34% vs. 51%, P = 0.048). Use of antidiarrheal agents and body weight did not differ between groups. CONCLUSION: Mesalazine 4 g/day did not decrease the symptoms of ARE.

[Radiation tolerance of patients after pneumonectomy for bronchial cancer: role of pulmonary function tests]. / Tolérance à l'irradiation des patients ayant eu une pneumonectomie pour cancer bronchique: place de l'exploration fonctionnelle respiratoire.

Radiation is often necessary after pneumonectomy, either immediately or due to local cancer recurrence. High radiation doses represent a challenge due to the limited tolerance of the lung and the necessity of preserving and protecting the remaining lung parenchyma. The use of CT scan based-treatment planning allows delivery of high radiation doses. To evaluate the radiation tolerance of the lung after high radiation dose, we compared pulmonary function tests performed before surgery and after radiation therapy. Ten male patients (mean age, 56 years old; age range, 45-73) were irradiated after pneumonectomy for lung cancer. All patients had a CT scan-based treatment planning. The mean radiation dose was 56 Gy (45-66 Gy) delivered with a linear accelerator and multiple complex fields. Two or more sets of pulmonary function tests were available (before surgery and 2 to 6 months after radiation). No patient developed clinical radiation pneumonitis and most of the patients had a minimal paramediastinal fibrosis at CT scan. Postirradiation pulmonary lung tests were compared to the theoretical values of the estimated defect observed after pneumonectomy. No significant decrease in forced expiratory volume in 1 s/inspiratory vital capacity (FEV1/IVC) was observed in ten evaluable patients; the observed values were comparable to those expected after pneumonectomy without irradiation (FEV1/IVC: 61 to 100%), showing that irradiation did not alter pulmonary function. Computerized tomography-based treatment planning and the use of complex beam positioning allowed optimal lung parenchymal preservation. Through this procedure, high doses of radiation can be delivered to the mediastinum and bed tumor. Comparison of pulmonary function tests performed before surgery and after radiation showed no alteration of lung function, even after high doses. Optimal tools required for the evaluation of radiation on lung parenchyma are still to be defined.

Quality control of radiotherapeutic treatment of medulloblastoma in a multicentric study: the contribution of radiotherapy technique to tumour relapse. The French Medulloblastoma Group.

Between 06.86 and 11.89, 88 medulloblastoma or primitive neuroectodermic tumour (PNET) localised in the posterior fossa have been included in the M7 multicentric protocol, 82 received the totality of the radiotherapy treatment and were evaluable for this study. Twenty-two of these 82 patients relapsed: their radiotherapy treatment is analysed in the present study. In 10 cases out of the 22 relapses treatment failure was probably due to a radiotherapeutic imperfection. This study confirms the necessity of a strict radiotherapy control, particularly in multicentric study.

[Seminoma of testis. Analysis of failures and development of therapeutic strategies. Apropos of a Lyons series of 117 cases]. / Le séminome du testicule. Analyse des échecs et évolution des stratégies thérapeutique. A propos d'une série lyonnaise de 117 cas.

From Jan.61 to Dec.81, 117 patients with seminoma of testis were treated in the Leon Berard Centre, Lyon. All had undergone lymphography during investigation of possible extension, 19 were treated with 200 KV up 1966, 64 with Cobalt up to 1978 and 29 with photons x of 18 MV since that date. From 1979 adjuvant chemotherapy has always included cisplatinum. The 5 years survival rate was 95% of stage I (51/54 cases), 72% of stage II (26/36 cases) and 1/7 of stage III. Unsuccessful treatment of neoplasm was noted in 23 patients, in 80% of cases during the first two years and involving mainly pulmonary metastases. Three patients had mediastinal metastases while recovery surgery was possible in 4 cases. Three fatal iatrogenic complications were observed. Since the use of high energies, particularLy x beams of 18 MV there has been almost total absence of radic complications. Therapy now proposed is as follows: stage I: surgery plus radiotherapy; stage II A-B: surgery and irradiation avoiding mediastinum; stage II C and III: primary chemotherapy.