« L'immunothérapie, la révolution anticancer »
Le Parisien
Le Parisien titre sur sa une : « Cancer : enfin un progrès décisif ». Le journal consacre deux pages à l’immunothérapie, « technique nouvelle qui permet de soigner tous les types de tumeurs », notant que « les plus grands chercheurs, réunis à Chicago à partir d'aujourd'hui, croient en [ce] nouveau traitement. Il est fondé sur la réaction de notre système immunitaire ».
Claudine Proust observe ainsi qu’« un grand changement arrive dans le traitement des cancers. Il a pour nom l'immunothérapie. Et ses résultats sont prometteurs. Soigner les cancers, les réduire, les contenir par des trithérapies, comme on l’a fait pour le VIH, n’a plus rien d’une utopie ».
La journaliste relève qu’« alors que s’ouvre aujourd’hui […] le congrès annuel de l’Asco, grand-messe mondiale des spécialistes du cancer, médecins et chercheurs s’y précipitent avec une «excitation scientifique» sans précédent, face à ce qu’ils qualifient unanimement de «bouleversement» ».
« Parmi les plus de 4.800 études qui doivent y être dévoilées, ressort la promesse d’un changement d’approche radical d’une maladie que l’on a longtemps soignée organe par organe », poursuit Claudine Proust.
La journaliste constate que « les thérapies ciblées ont ouvert la voie à ce changement. Mais la révolution, à laquelle l’édition 2015 de ce congrès ouvre la porte en grand, et dont peuvent déjà bénéficier certains malades pourtant atteints de tumeurs redoutables, «c’est la confirmation éclatante de la place centrale de l’immunothérapie dans l’arsenal thérapeutique», souligne le Pr François Sigaux, directeur de la recherche et de l’innovation à l’Institut national du cancer (INCa) ».
Le spécialiste remarque que « pendant des années, les chercheurs ont travaillé sur le côté positif : comment produire une réponse immunitaire plus forte. Les résultats sur les animaux promettaient beaucoup, mais l’espoir est retombé : à trop booster cette réponse, on provoque aussi des maladies auto-immunes. La trouvaille, c’est d’avoir compris qu’il fallait aussi s’intéresser au côté négatif : au verrou qu’enclenche la tumeur pour freiner la réponse immunitaire ».
Claudine Proust note que « trois traitements ont déjà été découverts. «La réserve de recherche est encore grande», estime le Pr Sigaux. Ethique oblige, ces nouvelles approches sont d’abord mises à l’essai chez les patients en phase très avancée, en échec thérapeutique. Mais les résultats sont si prometteurs que les médecins prédisent des traitements innovants, incluant l’immunothérapie, de plus en plus précoces. […] Les études montrent que les thérapies ciblées doivent être utilisées de plus en plus tôt en combinaison entre elles ou avec des chimiothérapies classiques ».
Dans un entretien, le Pr Gilles Vassal, directeur de la recherche clinique à l’institut Gustave-Roussy, déclare notamment : « Ce qui est totalement nouveau, c’est que l’immunothérapie permet des traitements efficaces contre des cancers très agressifs, pour lesquels on ne disposait que de peu de solutions. […] On n’a jamais connu tel bouleversement, et ce n’est pas de l’emphase de ma part ».
Friday, May 29, 2015
Wednesday, May 27, 2015
27/5/2015
Palliative pharmacological sedation for terminally ill adults.
Palliative pharmacological sedation for terminally ill adults.
Beller EM , van Driel ML, McGregor L, Truong S, Mitchell G.
Abstract Terminally ill people experience a variety of symptoms in the last hours and days of life, including delirium, agitation, anxiety, terminal restlessness, dyspnoea, pain, vomiting, and psychological and physical distress. In the terminal phase of life, these symptoms may become refractory, and unable to be controlled by supportive and palliative therapies specifically targeted to these symptoms. Palliative sedation therapy is one potential solution to providing relief from these refractory symptoms. Sedation in terminally ill people is intended to provide relief from refractory symptoms that are not controlled by other methods. Sedative drugs such as benzodiazepines are titrated to achieve the desired level of sedation; the level of sedation can be easily maintained and the effect is reversible. To assess the evidence for the benefit of palliative pharmacological sedation on quality of life, survival, and specific refractory symptoms in terminally ill adults during their last few days of life. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 11), MEDLINE (1946 to November 2014), and EMBASE (1974 to December 2014), using search terms representing the sedative drug names and classes, disease stage, and study designs. We included randomised controlled trials (RCTs), quasiRCTs, nonRCTs, and observational studies (e.g. beforeandafter, interruptedtimeseries) with quantitative outcomes. We excluded studies with only qualitative outcomes or that had no comparison (i.e. no control group or no withingroup comparison) (e.g. single arm case series). Two review authors independently screened titles and abstracts of citations, and full text of potentially eligible studies. Two review authors independently carried out data extraction using standard data extraction forms. A third review author acted as arbiter for both stages. We carried out no metaanalyses due to insufficient data for pooling on any outcome; therefore, we reported outcomes narratively. The searches resulted in 14 included studies, involving 4167 adults, of whom 1137 received palliative sedation. More than 95% of people had cancer. No studies were randomised or quasirandomised. All were consecutive case series, with only three having prospective data collection. Risk of bias was high, due to lack of randomisation. No studies measured quality of life or participant wellbeing, which was the primary outcome of the review. Five studies measured symptom control, using four different methods, so pooling was not possible. The results demonstrated that despite sedation, delirium and dyspnoea were still troublesome symptoms in these people in the last few days of life. Control of other symptoms appeared to be similar in sedated and nonsedated people. Only one study measured unintended adverse effects of sedative drugs and found no major events; however, four of 70 participants appeared to have druginduced delirium. The study noticed no respiratory suppression. Thirteen of the 14 studies measured survival time from admission or referral to death, and all demonstrated no statistically significant difference between sedated and nonsedated groups. There was insufficient evidence about the efficacy of palliativesedation in terms of a person's quality of life or symptom control. There was evidence thatpalliative sedation did not hasten death, which has been a concern of physicians and families in prescribing this treatment. However, this evidence comes from low quality studies, so should be interpreted with caution. Further studies that specifically measure the efficacy and quality of life in sedated people, compared with nonsedated people, and quantify adverse effects are required. PMID: 25879099 [P
Palliative pharmacological sedation for terminally ill adults.
Palliative pharmacological sedation for terminally ill adults.
Beller EM , van Driel ML, McGregor L, Truong S, Mitchell G.
Abstract Terminally ill people experience a variety of symptoms in the last hours and days of life, including delirium, agitation, anxiety, terminal restlessness, dyspnoea, pain, vomiting, and psychological and physical distress. In the terminal phase of life, these symptoms may become refractory, and unable to be controlled by supportive and palliative therapies specifically targeted to these symptoms. Palliative sedation therapy is one potential solution to providing relief from these refractory symptoms. Sedation in terminally ill people is intended to provide relief from refractory symptoms that are not controlled by other methods. Sedative drugs such as benzodiazepines are titrated to achieve the desired level of sedation; the level of sedation can be easily maintained and the effect is reversible. To assess the evidence for the benefit of palliative pharmacological sedation on quality of life, survival, and specific refractory symptoms in terminally ill adults during their last few days of life. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 11), MEDLINE (1946 to November 2014), and EMBASE (1974 to December 2014), using search terms representing the sedative drug names and classes, disease stage, and study designs. We included randomised controlled trials (RCTs), quasiRCTs, nonRCTs, and observational studies (e.g. beforeandafter, interruptedtimeseries) with quantitative outcomes. We excluded studies with only qualitative outcomes or that had no comparison (i.e. no control group or no withingroup comparison) (e.g. single arm case series). Two review authors independently screened titles and abstracts of citations, and full text of potentially eligible studies. Two review authors independently carried out data extraction using standard data extraction forms. A third review author acted as arbiter for both stages. We carried out no metaanalyses due to insufficient data for pooling on any outcome; therefore, we reported outcomes narratively. The searches resulted in 14 included studies, involving 4167 adults, of whom 1137 received palliative sedation. More than 95% of people had cancer. No studies were randomised or quasirandomised. All were consecutive case series, with only three having prospective data collection. Risk of bias was high, due to lack of randomisation. No studies measured quality of life or participant wellbeing, which was the primary outcome of the review. Five studies measured symptom control, using four different methods, so pooling was not possible. The results demonstrated that despite sedation, delirium and dyspnoea were still troublesome symptoms in these people in the last few days of life. Control of other symptoms appeared to be similar in sedated and nonsedated people. Only one study measured unintended adverse effects of sedative drugs and found no major events; however, four of 70 participants appeared to have druginduced delirium. The study noticed no respiratory suppression. Thirteen of the 14 studies measured survival time from admission or referral to death, and all demonstrated no statistically significant difference between sedated and nonsedated groups. There was insufficient evidence about the efficacy of palliativesedation in terms of a person's quality of life or symptom control. There was evidence thatpalliative sedation did not hasten death, which has been a concern of physicians and families in prescribing this treatment. However, this evidence comes from low quality studies, so should be interpreted with caution. Further studies that specifically measure the efficacy and quality of life in sedated people, compared with nonsedated people, and quantify adverse effects are required. PMID: 25879099 [P
Cochrane Database Syst Rev. 2015 Jan 2;1:.
Palliative pharmacological sedation for terminally ill adults.
Abstract
BACKGROUND:
OBJECTIVES:
SEARCH METHODS:
SELECTION CRITERIA:
DATA COLLECTION AND ANALYSIS:
MAIN RESULTS:
AUTHORS' CONCLUSIONS:
- PMID:
- 25879099
- [PubMed - in process]
Implementing the New Commission on Cancer Standard on Palliative Care Services
CJON 2014, 18(1), 37-38 DOI: 10.1188/14.CJON.S1.37-38
Oncology nurses know that improving quality of life is essential for patients with cancer. Optimizing quality of life requires excellence in symptom management, such as relief from physical symptoms (e.g., pain), as well as addressing the psychosocial and spiritual needs of patients and their families. Improving quality of life and relieving suffering are priorities across the disease spectrum from diagnosis, treatment, survivorship, and end-of-life care to bereavement support for families. Interdisciplinary teams are needed to address the multiple dimensions of physical, psychological, and spiritual care. Nurses are integral members of cancer care teams, and their inclusion in the new accreditation standards for cancer centers highlights the contributions of the profession and the specialties of oncology nursing and palliative care. Different approaches to implementing the new standard for palliative care services are described in the next two articles. Each article explores the roles of oncology nurses and advanced practice nurses (APRNs) on palliative care teams. The articles describe how oncology nurses, by virtue of their education and clinical expertise, need to be involved in the Commission on Cancer (CoC) standard implementation regarding palliative care across hospital and community settings.
Implementation of National Comprehensive Cancer Network Evidence-Based Guidelines to Prevent and Treat Cancer-Related Infections
CJON 2012, 16(3), E111-E117 DOI: 10.1188/12.CJON.E111-E117
Clinical practice guidelines are an important result of evidence-based research. However, current clinical practice remains out of step with the rapid pace of research advancements. Often, decades pass before research is translated into clinical practice. The National Comprehensive Cancer Network (NCCN) has created evidence-based clinical guidelines to promote effective clinical practice. Formerly, the NCCN established guidelines to reduce cancer-related infections only for neutropenic patients; however, they have expanded their guidelines beyond neutropenia to prevent and treat cancer-related infections. Implementing scientific evidence into clinical practice is challenging and complex, and healthcare professionals should understand barriers to implementing clinical practice guidelines to ensure successful translation into practice. This article provides a brief review of NCCN guidelines and describes common barriers encountered during implementation. In addition, a conceptual framework is offered to help identify and address potential concerns before and after adoption of guidelines.
The Development of Evidence-Based Supportive Therapy Guidelines for Symptom Management
CJON 2012, 16(4), 343-345 DOI: 10.1188/12.CJON.343-345
Systematic incorporation of toxicity assessment and grading during cancer treatment and subsequent provision of evidence-based patient interventions according to national standards for excellence are daunting tasks. To accomplish those goals, the authors' institution developed evidence-based supportive therapy guidelines for symptom management. This article describes how the guidelines provided concise, user-friendly standardization of toxicity grading and immediate clinical application of evidence-based care.
The Role of the Acute Care Nurse Practitioner in the Implementation of the Commission on Cancer's Standards on Palliative Care
CJON 2014, 18(1), 39-44 DOI: 10.1188/14.CJON.S1.39-44
https://cjon.ons.org/cjon/18/1/supplement/role-acute-care-nurse-practitioner-implementation-commission-cancers-standards#sthash.Kdb3RMc7.dpuf
Tuesday, May 26, 2015
http://www.ctvnews.ca/health/fda-approves-new-alternative-painkiller-aimed-at-curbing-opioid-abuse-1.1929679
http://www.ctvnews.ca/health/fda-approves-new-alternative-painkiller-aimed-at-curbing-opioid-abuse-1.1929679
http://www.ctvnews.ca/health/fda-approves-new-alternative-painkiller-aimed-at-curbing-opioid-abuse-1.1929679
Monday, May 25, 2015
Difference Between Oxycontin and Oxycodone
http://www.differencebetween.net/science/difference-between-oxycontin-and-oxycodone/
http://www.differencebetween.net/science
/difference-between-oxycontin-and-oxycodone/http://www.differencebetween.net/science/difference-between-oxycontin-and-oxycodone/
Assessing anxiety and depression with respect to the quality of life in cancer inpatients receiving palliative care
Choose an option to locate/access this article:
Abstract
Purpose
The study aimed at assessing the presence of anxiety and depression in cancer inpatients receiving palliative care at an oncology department using the Hospital Anxiety and Depression Scale (HADS) and determining whether anxiety and depression contribute to a lower quality of life controlled for pain and illness severity.
Method
This cross-sectional study comprised 225 advanced cancer inpatients (a mean age of 65.1 years). Data were collected with the HADS, EORTC QLQ-C30 and Karnofsky Performance Status scale.
Results
Anxiety (HADS-a ≥8) was found in 33.9% and depression (HADS-d ≥8) in 47.6% of patients. Higher anxiety scores were observed in patients living with a partner (p = 0.042) and non-religious patients (p = 0.045). Correlations were found between anxiety, depression and all quality of life dimensions (r = 0.31–0.63). Multiple regression analysis showed that anxiety and depression contribute to lower physical and emotional functioning. Patients with anxiety (HADS-a ≥8) and depression (HADS-d ≥8) reported a lower total quality of life (p < 0.01).
Conclusion
Management of anxiety and depression in cancer patients receiving palliative care may contribute to improvement in certain quality of life dimensions.
Keywords
- Depression;
- Anxiety;
- Quality of life;
- Palliative care;
- Advanced cancer
Subscribe to:
Posts (Atom)