Search

Oncology may be practiced full or part time by physicians with complementary expertise in a number of different fields, including surgery, medicine, and biology. Full-time practice in oncology mainly concerns medical and radiation oncologists (about 1,100 in France), as well as a variety of others (a few hundred physicians) working in institutions specializing in oncology. Part-time practice involves a large number of physicians, some of whom (about 2500) are skilled in oncology. Initial training is acquired through the French diplôme d’études spécialisées/specialized studies degree (DES) in oncology (5 years), with three options (medical oncology, radiation oncology and haematology-oncology), and the diplôme d’études spécialisées complémentaires/specialized complementary studies degree (DESC) in oncology (2 years, including 1 year during the DES), which leads to additional expertise limited to the original specialty. The French national Cancer Plan has stressed the need for more physicians trained in oncology. It was a good way to accelerate the necessary changes to the DES and DESC in oncology. These changes will take effect in 2007. The Cancer Plan also spearheaded an increase in the number of academic positions in oncology. [ABSTRACT FROM AUTHOR]

Copyright of Oncologie (Tech Science Press) is the property of Tech Science Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Focuses on the project methodology of the Standards, Option and Recommendations (SOR) undertaken by French National Federation of Cancer Centers, France. Development of evidence-based clinical practice guidelines in oncology by SOR; Steps involved in the formulation SOR.

Legislation governing patients' rights and health care quality (March 2002) provided for the creation of healthcare networks intended to improve the management of patients with complex and/or chronic diseases. As defined in the Cancer Plan, activated in March 2003, an oncological healthcare network covers a particular French region, with the aim of offering patients equal access to the best available care and accompaniment, based on caregiver coordination, shared multidisciplinary tools, and communication. ONCOLOR, the regional cancer network launched in the Lorraine region in 1993, complies with these objectives. Nevertheless, its future development depends on continued dynamism, durable financial support, and regular evaluation of the benefits for patients and caregivers. The key words are professionalism and consensus.

Oncolor, network in oncology in Lorraine, was born ten years ago, from a group of professionals in the field of oncology who worked closed together with regional administrative authorities. Oncolor was created with respect of equilibrium between the different regional partners avoiding struggle for power. Oncolor was conducting different actions: recognition of hospital sites according to three levels based on technical and humans means at disposal (highly specialised sites, specialised sites, and associated sites); the definition of good practice for hospital pharmacies leading to the generalization of centralized preparation of chemotherapy under responsibility of a pharmacist; the organization of multidisciplinary practice through the written and implementation of clinical guidelines accessible on the web site of the network (www.oncolor.org) even by the patients (86 guidelines on line today); creation and access to a software to help physicians for decision called Kasimir; the formalization of multidisciplinary meetings with a common process. All these tools help physicians in their relationship with the patient. The web site was opened to professionals but also to patients in December 2001. Oncolor was also implicated in different training programs for physicians, pharmacists, nurses and other professionals. The annual budget increased from 47,000 euros in 1998 up to more than 700,000 euros in 2002. To conclude, to build a network in oncology is an exciting task. It must become more professional, keeping in mind the original objective: every patient, whatever his place of consultation is, have to benefit of the best treatment adapted to his personal situation., (Copyright John Libbey Eurotext 2003.)

Oncolor, the French regional cancer network of Lorraine, proposes clinical guidelines for the diagnosis, the treatment and the follow-up of cancers. In addition to paper documents, two computerized supports, a web site and the Kasimir software have been developed to make the use of these guidelines and their updating easier. This study aims at evaluating these three tools in breast and prostate cancer and to determine if computerized supports provide an additional help and an added value. From May to July 2001, 25 physicians of the Oncolor network have analysed, by consulting the guidelines on each of the 3 supports, 23 clinical cases of breast cancer and 22 cases of prostate cancer, i.e. in total 1,293 cases. We observe for breast cancer a response rate consistent with the guideline significantly higher with the Kasimir software compared to paper (87.1% versus 77.8%) or to Internet (87.1% versus 75.8%), an optimisation of the recourse to a specialised physician or a pluridisciplinary committee and globally a good satisfaction of the users. These results induce us to continue with the Kasimir experiment, to develop it for other cancers, especially those with a complex management and to evaluate its impact on medical practices.

The complexity of legislation and the obstacle race run by all promoters in search of approval and funding for their projects could have greatly hindered the development of healthcare networks in France, or at least discouraged many promoter. Yet social and health professionals, along with certain healthcare service staff, considered these networks highly useful for decompartmentalising the French healthcare system. They would favour patient-oriented projects. It is not a surprise that the number of networks in the field of oncology is expanding rapidly, with more than 60 projects registered by public authorities by the end of 1999. Cancers are chronic diseases which often bring into play the patient's vital prognosis, as well as psychological and social consequences - sometimes dreadful - for patients and their relatives. Cancer patient management calls for a multidisciplinary approach in elaborating the therapeutic project and providing psychological support. Continuity and consistency of care require a partnership between different care providers from different specialities, with different medical practice and environments - hospital or home care, public or private practice. Though so much information has become available in the medical literature, quality of care demands that each healthcare professional keeps fully aware of the latest diagnostic or therapeutic findings and techniques in his/her field. Certain cancer networks have become a place where care providers and establishments can share methods and medical practice. Network promoters and members have thus been able to regain control over the functioning and the future of their profession. Patients have also obtained a place in decisions concerning their own health. Setting up healthcare networks will certainly shake up the tranquil system which the WHO has reported as the world's best health care system at the dawn of this century. However, this will also probably contribute to maintaining this excellence.

With the objective of improvement of quality in oncology, an assessment of chemotherapy practice in hospital pharmacies in public and private hospitals was carried out by the regional committee of oncology in Lorraine. The 36 hospitals reporting using chemotherapy, had varied practices. The results of this survey lead to the elaboration of guideline for hospital pharmacies in the oncology regional network Oncolor. This paper describes the different aspects of the hospital pharmacies in public and private hospitals included in the network Oncolor from 1996 to 2000. In 1996, 9 hospital pharmacies had centralized preparation for chemotherapy, whereas at the end of 2000, 26 pharmacies on 28 will fulfill the guidelines.

Purpose: To evaluate the feasibility of dose escalation in a multi-institutional study in prostate cancer patients., Methods and Materials: Between October 1995 and October 1998, 164 patients with localized adenocarcinoma of the prostate were treated with 3-dimensional conformal radiotherapy at one of five French institutions. The dose of radiation was escalated from 66 to 80 Gy (ICRU point). The maximum dose to the rectal wall was limited to 75 Gy., Results: Results were compared in two groups, one (group 1) receiving the standard dose (n = 46 patients; 66 to 70 Gy) and the other (group 2) receiving the escalated dose (n = 118 patients; 74 to 80 Gy). There was no difference in the characteristics of patients between the two groups. The mean follow-up time was 32 months in group 1 and 17.5 months in group 2. No statistical difference between the two groups was observed in the incidence of late gastrointestinal and urinary toxicities. The probability of achieving a posttreatment prostate-specific antigen nadir of

The incidence of cancer will continue to increase more rapidly than the population in both industrialized and developing countries. The number of older patients will rise. Cancer will be a major health challenge in the future. Patients will become more and more involved in decisions relating to their care and their quality of life, behaving in a more adult way than hitherto. Specific treatments will continue to develop, leading to more cures and to longer survival for patients who are not cured. The fight against cancer could be organized in such a way as to make it possible to provide global care of patients through comprehensive cancer networks. Supportive care could increasingly take the form of continuous care covering every step in the fight against cancer, starting with prevention and screening.

To evaluate the results, prognostic factors and especially side-effects of the treatment for subdiaphragmatic Hodgkin's disease (SHD) a retrospective study was conducted in the Haematology Departments and in the Cancer Centres of Nancy and Strasbourg between 1976 and 1990; 55 patients corresponding to the IA to IIB SHD stages were analysed. The median age was 45 years. In accordance with Ann Arbor classification, we observed 12 CS IA (21.3%), 2 CS IB (3.5%), 14 CS IIA (25.4%) and 27 CS IIB (49.7%). Twenty-five patients (45.4%) underwent laparotomy with spleen involvement in 10 cases. Fifteen patients (27.3%) had exclusive radiotherapy, 10 by inverted-Y field with or without splenic field, 5 by limited field to inguinal and homolateral iliac nodes. Forty patients had prior chemotherapy, 18 by MOPP protocol, 18 by hybrid MOPP/ABVD protocol and 4 by other schemes. The total dose delivered ranged from 26 to 45 Gy. With a median follow-up of 8 years, the overall and disease specific survival rates are respectively 61% and 83% at 10 years. Nine patients relapsed (16.4%), 4 among the 15 (26.6%) treated by exclusive irradiation and 5 among the 40 (12.5%) treated by combined therapy. We observed 8.3%, 21.4% and 18.5% of relapses respectively among the clinical stages IA, IIA and IIB. Eleven patients (20%) developed a second cancer. Twenty-six long-term complications were noted, nine of which concerned the digestive system. The only significant prognostic factor is age, with 10-year specific survival rates of 96% and 66% respectively for patients younger and older than 50 years (p=0.0003). Our data confirm that the most appropriate treatment for stage IA is exclusive radiotherapy and combined therapy for all other cases. With the use of CT-scan and eventually lymphography, the laparotomy is reserved only for cases with an uncertain diagnosis. Tobacco use is also clearly a risk factor in our series for late vascular complications and second cancers.

In 1993, in Centre Alexis Vautrin, we took quite easily the census of 3,170 patients transfused between 1980 and 1985. In our institution, the systematic long-term follow-up of patients treated allowed to select rapidly the patients alive and to ask family doctors to inform and propose screening tests for a possible contamination by HIV and HCV viruses. Out of 802 patients alive, 703 accepted the tests. No contamination by the AIDS virus was detected. Conversely, the survey evidenced positive serology for the virus of Hepatitis C in 16 cases (2.4%).

We report 5 years of systematic measurements of the dose delivered to each patient undergoing radiotherapy treatment with photon beams in order to detect any systematic error that may have escaped the different checks performed at each step of planning and calculation prior to the first treatment session, or may have arisen during the set-up or the treatment delivery. For each patient the target-absorbed dose is derived from the entrance and exit doses measured by silicon diodes, on the beam axis at the patient's skin. Depending on the discrepancies observed between the measured and expected doses we have set decision levels for the corrective actions to be taken. In addition these measurements allow us to obtain information on the overall accuracy or on the quality of a specific treatment. During 5 years, 7519 patients have been measured and 79 errors were detected. Half could have induced a variation of over 10% in the dose delivered. Seventy-eight out of 79 errors were of human origin. As part of an overall quality assurance programme, it is of the utmost importance to check the dose delivered for each patient undergoing radiotherapy treatment in order to avoid systematic underdosing or overdosing.

Mixed Mullerian Tumours (MMT) of the endometrium have a bad reputation as far as prognosis is concerned. We have studied 34 cases of MMT treated between 1976 and 1988 and have compared their outcome with a matched series of 68 cases of adenocarcinoma (ADC). These were taken out of 880 cases of ADC treated during this period of time after matching them for the stage, the type of treatment, the year of treatment and the age of the patient. The curves of survival and the totals of survival were determined using Kaplan-Meier's method and also compared using Logrank's test. The 5-years overall survival was 18% for MMT as against 55% for ADC (p less than 0.001). The difference was equally significant statistically in terms of specific survival without recurrences. The 16 patients in stages I and II who were treated with the same protocol as used for ADC were matched against 32 cases of ADC taken out of the 680 cases ADC in stages I and II and treated by the same protocol (84%). After five years MMT had a higher number of survivors (35% overall, 45% with specific survival and 35% without recurrences), but the difference with survival of ADC was as significant (respectively 75, 85, 85%). Recurrences of MMT were frequent (62%), with metastases in 9 out of 10 and early (50%), in every respect opposed with recurrences of ADC (16%) which were in three out of five cases localized and late (after 10 months). These figures make one have to think of modifying the way MMT is treated. External pelvic radiotherapy should be carried out before any other treatment. The place for other methods of therapy is to be discussed.