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Introduction Les situations de fievre ou de syndrome inflammatoire biologique inexplique sont un defi diagnostique. Il existe de tres nombreuses etiologies possibles, reparties en causes infectieuses, inflammatoires non infectieuses, neoplasiques ou diverses. Dans certains cas le diagnostic reste indetermine. La Tomographie a Emissions de Positons au 18 F-Fluorodesoxyglucose couplee a la Tomodensitometrie (TEP-TDM au 18F-FDG) permet d’orienter le diagnostic, de cibler la realisation de biopsie et in fine d’orienter la prise en charge therapeutique [1] . Il existe des donnees limitees concernant les etiologies chez les sujets âges [2] . Il n’y a pas d’element dans la litterature concernant la place de la TEP-TDM au 18F-FDG dans cette population. Le but etait de determiner de facon pragmatique, quelle etait la prise en charge therapeutique mise en place au sein d’une cohorte de sujets âges explores par TEP-TDM au 18F-FDG presentant une fievre ou un syndrome inflammatoire inexplique. Materiels et methodes Cette etude retrospective a ete menee dans un centre hospitalo-universitaire, incluant des patients de 75 ans et plus, pris en charge entre 2013 et 2018, en medecine interne, maladies infectieuses, immunologie, rhumatologie, dermatologie, nephrologie ou geriatrie. Tous avaient eu une TEP-TDM au 18F-FDG, pour l’exploration d’une fievre ou d’un syndrome inflammatoire biologique inexplique, quelle qu’en soit la duree d’evolution. Nous avons recherche la presence d’une modification therapeutique dans les 6 mois (introduction ou arret d’un traitement prealablement introduit pour la fievre ou le syndrome inflammatoire). Resultats Sur les 3351 TEP-TDM au 18F-FDG realisees dans cette tranche d’âge pendant cette periode, 93 patients remplissaient les criteres de selection. Environ la moitie etait des hommes et l’âge median etait de 82 [78–85] ans. La plupart vivait a domicile (94,6 %) et etait hospitalisee (92,4 %). Environ 20 % etaient immunodeprimes (n = 19). Le delai median entre la demande et realisation de l’examen etait de 20 [6–35] jours. La quasi-totalite des patients (96,7 %) avait un syndrome inflammatoire biologique et 33 patients (35,9 %) avaient de la fievre. Aucun diagnostic n’avait pu etre identifie chez 38 patients (41,8 %). Les causes infectieuses et inflammatoires concernaient chacune le meme nombre de patients (n = 18 soit 19,8 %). Une cause neoplasique etait retrouvee chez 13 patients (14,3 %). Un nouveau traitement a ete introduit chez 27 patients (33,3 %). Huit patients (10 %) etaient concernes par un arret de traitement. Pour la moitie de ces derniers, il y avait une introduction concomitante d’un nouveau traitement. Quatre patients (5 %) necessitaient une prise en charge palliative. Une modification de la prise en charge therapeutique a donc ete retrouvee chez 31 patients (38,8 %). Le fait d’avoir de la fievre etait significativement lie a la presence d’une modification therapeutique (OR 3,77 ; IC95 % 1,39 ; 10,77 ; p = 0,001). Pres de 40 % des patients avaient eu au moins un examen complementaire supplementaire cible par des anomalies visibles a la TEP-TDM au 18F-FDG (n = 33). Un examen histologique etait disponible chez 28 patients (35 %), pour 18 d’entre eux la biopsie etait ciblee par le resultat de la TEP-TDM au 18F-FDG. Pour 12 patients (15,2 %), la TEP-TDM au 18F-FDG avait oriente vers une fausse piste. Conclusion La place de la TEP-TDM au 18F-FDG semble importante en cas de fievre ou de syndrome inflammatoire biologique inexplique chez le sujet âge. Nous avons note un impact therapeutique chez pres de 40 % des patients de notre cohorte, soit par l’arret d’une therapeutique jugee inutile et/ou l’introduction d’un nouveau traitement a visee curative. Il est necessaire de prendre en compte le niveau de fragilite de ces patients qui conditionne les possibilites de prise en charge.

with a median age of diagnosis of 65 years. Data from randomized controlled trials suggest similar choice of chemotherapy drugs, toxicities and feasibility in young and older patients. There was a lack of observational data from real-life setting. Objectives: To assess 1) associated factors of prescription of the combination of gemcitabine and cisplatin (GC), 2) chemotherapy feasibility in older patients aged 70 years or more with metastatic bladder cancer and 3) prognostic value of feasibility of chemotherapy. Methods: Between1999and2011, consecutive patients aged70 years ormorewithmetastatic bladder cancer referred to four teaching hospitals in France (Creteil, Lyon, Montpellier and Villejuif) were included. At baseline, we recorded clinical and biological parameters (nutrition, functional status assessed by Performance Status PS, creatinine clearance, hemoglobin level) and tumor characteristics (histologic subtype, grade and number of metastases). Non-feasibility was defined by a number of cycles less than 3. We used a propensity score method to assess probability of initial prescription of GC. Multivariate logistic regression and Cox Proportional Hazard Model were used to estimate predictors of chemotherapy non-feasibility and overall 1-year mortality. Results: 193 patients were included (mean age 76 ± 4.3 years, 85% males, 92.2% urothelial carcinoma, 96.3% grade 3) with two metastases in median [1–3]. Among them 25.3% had PS of ≥2, 42.1% had poor nutritional status and 43% had renal dysfunction. For first cycle prescription, 43.5% had GC, 36.3% had a combination of gemcitabin and carboplatin and 20.2% had gemcitabin alone. Probability of GC prescription decreased with age independent of functional status and creatinine clearance, respectively 0.59 for [70– 75] years, 0.32 for [75–80] years and 0.13 for ≥70 years (p b 0.0001). In multivariate analysis, factors associated with chemotherapy nonfeasibility were age (adjusted odds ratio (aOR)1 year increase = 1.11; CI 95% = 1.02–1.20; p = 0.01) and PS ≥2 (aOR = 2.10; 1.36–6.06; p = 0.005). Median survival was 9.6 months [5.2–15.4]. In a multivariate analysis, factors associated with overall 1-year mortality were chemotherapy non-feasibility (adjusted hazard ratio (aHR) = 4.52; 2.60–7.85 for patients with PS b2 and aHR= 24.87; 11.40–54.54 for patients with PS ≥2; p b 0,0001), age (aHR= 1.06; 1.01–1.13; p= 0.02), number of metastases (aHR= 1.2; 1.01–1.42; p= 0.03) and hemoglobin decrease (aHR1 point decrease = 1.19; 1.03–1.37; p= 0.01). Conclusion: The prescription of a combination of gemcitabine and cisplatin decreased with age independent of functional status and creatinine clearance in patients aged 70 years or more with metastatic bladder cancer. Increasing age was an independent predictor of chemotherapy non-feasibility. The association between non-feasibility and overall 1-year mortalitywasmodified by baseline functional status. Disclosure of interest: None declared.

Aim To identify patient and carer expectations regarding information necessary for the first therapeutic leave. This is part of a Patient Education Program on therapeutic leave for patients with brain injury. Patients and methods Questionnaires designed by the multidisciplinary team were given to 30 hospitalised patients and their families before or after the first leave. A semi-quantitative, 4 level scale was used to evaluate the relevance of information received before the first leave, and the choice of information methods. Results Twenty patients (5 before and 15 after the first leave) and 16 carers (5 before and 11 after) filled in the questionnaire. The results highlighted a need for information on medication (15/20; 75% patients–12/16; 75% carers) and what to do if a problem arose (11/20; 55% patients–11/16; 68.8% carers). Carers reported a need for information regarding emotional (12/16; 75%), cognitive and behavioural (10/16; 62.5%) disorders. Discussion with a professional was the preferred method of information (7/17; 41.2% patients–10/16; 62.5% carers) followed by an information leaflet (5/17; 29.4% patients–3/16; 18.8% carers) and a presentation by a professional (4/17; 23.5% patients–2/16; 12.5% carers). These methods were preferred to a presentation from a professional from out with the hospital (1/1; 5.9% patients–1/16; 6.3% carers). The sub-group of patients who had not yet been on leave preferred the information leaflet (2/5; 40.0%). Discussion-conclusion The study highlighted the benefit of discussion time with a professional to prepare the first therapeutic leave. Patient education is thus relevant in this context and follows the recommendations of the French Health Authority (HAS1).