Background. Malnutrition worsens health-related quality of life (HRQoL) and the prognosis of patients with advanced cancer. This study aimed to assess the clinical benefits of parenteral nutrition (PN) over oral feeding (OF) for patients with advanced cancer cachexia and without intestinal impairment. Material and Methods. In this prospective multicentric randomized controlled study, patients with advanced cancer and malnutrition were randomly assigned to optimized nutritional care with or without supplemental PN. Zelen's method was used for randomization to facilitate inclusions. Nutritional and performance status and HRQoL using the European Organization for Research and Treatment of Cancer QLQ-C15-PAL questionnaire were evaluated at baseline and monthly until death. Primary endpoint was HRQoL deterioration-free survival (DFS) defined as a definitive deterioration of ≥10 points compared with baseline, or death.

Purpose The identification and referral of patients in need of palliative care should be improved. The French society for palliative support and care recommended to use the PALLIA‐10 questionnaire and its score greater than 3 to refer patients to palliative care. We explored the use of the PALLIA‐10 questionnaire and its related score in a population of advanced cancer patients. Methods This prospective multicentric study is to be conducted in authorized French comprehensive cancer centers on hospitalized patients on a given day. We aimed to use the PALLIA‐10 score to determine the proportion of palliative patients with a score >3. Main secondary endpoints were to determine the proportion of patients already managed by palliative care teams at the study date or referred to palliative care in six following months, the prevalence of patients with a score greater than 5, and the overall survival using the predefined thresholds of 3 and 5. Results In 2015, eighteen French cancer centers enrolled 840 patients, including 687 (82%) palliative patients. 479 (69.5%) patients had a score >3, 230 (33.5%) had a score >5, 216 (31.4%) patients were already followed‐up by a palliative care team, 152 patients were finally referred to PC in the six subsequent months. The PALLIA‐10 score appeared as a reliable predictive (adjusted ORRef≤3: 1.9 [1.17‐3.16] and 3.59 [2.18‐5.91]) and prognostic (adjusted HRRef≤3 = 1.58 [95%CI 1.20‐2.08] and 2.18 [95%CI 1.63‐2.92]) factor for patients scored 4‐5 and >5, respectively. Conclusion The PALLIA‐10 questionnaire is an easy‐to‐use tool to refer cancer inpatients to palliative care in current practice. However a score greater than 5 using the PALLIA‐10 questionnaire would be more appropriate for advanced cancer patients hospitalized in comprehensive cancer center.

No abstract

An ideal medical setting for the management of anemia and iron deficiency, and the associated quality-of-life concerns, has yet to be defined for patients with cancer. Screening and treatment of mild to moderate anemia are inadequate, despite the advent of erythropoiesis-stimulating agents. Large scale, multicenter studies are required to define a clear medical framework for the management of anemia and iron deficiency.

L’objectif de ce travail est d’évaluer la place de la crénothérapie dans l’offre de soins de support de l’après-cancer. Une enquête a été menée dans un Centre de lutte contre le cancer, l’Institut de cancérologie Godinot à Reims, pour connaître le point de vue des praticiens et des patients. Les résultats de l’enquête montrent que l’offre post-cancer, initiée en 2008 par la station de La Roche-Posay, a modifié le point de vue des praticiens sur la crénothérapie : alors que 7/10 d’entre eux déclarent que les cures conventionnées sont sans intérêt, tous connaissent l’offre thermale post-cancer et ils sont 9/10 à lui reconnaître un intérêt Le taux de participation des patients à l’enquête est de 71 %. Ils sont 56 % à se déclarer intéressés pour bénéficier d’une cure thermale dans les suites de leur maladie, avec des différences selon le sexe : 61 % pour les femmes et 43 % pour les hommes, et selon la localisation du cancer. Le bénéfice attendu d’une cure post-cancer exprimé en première position, quel que soit le type de cancer, est de retrouver un “bien-être global physique et mental”. Des particularités dans les attentes apparaissent ensuite selon la localisation. Les médecins et les patients ne connaissent qu’une seule indication à la crénothérapie postcancer : les suites de cancer du sein. La crénothérapie a de nombreuses indications sur les séquelles observées dans les suites de cancer : lésions cutanéo-muqueuses et cicatricielles, lymphœdème, douleurs musculo-squelettiques, surpoids et obésité, troubles anxio-dépressifs… Une cure conventionnée sera prescrite selon l’orientation concernée, le conseil d’y associer un programme post-cancer se fera pour une population ciblée. La crénothérapie, thérapeutique reconnue scientifiquement, fait partie intégrante des soins oncologiques de support et sa prescription devrait trouver sa place dans le Programme personnalisé de l’après-cancer.