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Discipline Clinique. Introduction et but de l’etude La nutrition parenterale (NP) necessite un encadrement strict, du fait de ses possibles complications. La SNFEP a propose en 2012 une grille d’evaluation des pratiques professionnelles a ce sujet. L’objectif de l’etude est d’evaluer la pertinence et la qualite des prescriptions de nutrition parenterale en hospitalisation d’oncologie medicale a l’Institut de cancerologie de l’Ouest–site Rene-Gauducheau (CRG) a Nantes. Materiel et methodes L’ensemble des prescriptions de nutrition parenterale realisees entre le 01/01/15 et le 31/12/16 en hospitalisation d’oncologie medicale a ete analyse retrospectivement. L’evaluation portait sur l’indication, le bilan pre-therapeutique, les modalites d’administration et la surveillance du traitement. Resultats et analyse statistique Parmi les quatre-vingt-deux dossiers analyses (78 patients), 40 etaient des hommes (48,8 %) et 42 des femmes (51,2 %). Leur âge median etait de 62,1 ans (36–85 ans). Les localisations primitives du cancer les plus representees sont ovaire (17 patients, 20,7 %), estomac et œsophage (16 patients, 19,5 %), digestif bas (10 patients, 12,2 %) et pancreas, poumon et sein (7 patients pour chaque localisation, 8,5 %). Le Performans status de l’OMS etait a 0 ou 1 pour 22 patients (26,8 %), a 2 pour 28 patients (34,1 %), a 3 pour 23 patients (28,1 %) et a 4 pour 4 patients (5 %). L’IMC moyen etait de 21,7 et median de 21,6 (amplitude de 13,7 a 34,1). Parmi ces 82 patients, la prise en charge palliative active concernait 75 patients (91,4 %), et les problematiques digestives representaient la premiere cause d’hospitalisation (53,7 %). Le tube digestif etait fonctionnel chez 11 patients (13,4 %), la nutrition enterale a ete testee dans un premier temps pour 8 d’entre eux, mais relayee par une nutrition parenterale du fait d’une complication. L’indication etait pertinente pour 96,3 % des patients. La duree entre la prescription initiale et la date de deces etait de 66 jours en mediane (amplitude 7 a 491 jours). Le deces survenait dans les 90 jours apres la prescription pour 49 patients (59,8 %). La NP a dure moins de 7 jours pour 10 patients. La duree mediane de NP etait de 18 jours. Le motif d’arret le plus frequent etait l’arret des soins. L’evaluation nutritionnelle etait complete (IMC, poids a 1 et 6 mois) pour 68,3 % des patients, et le bilan pre-therapeutique pour 50 %. Les apports etaient conformes aux recommandations (1,2 a 1,5 g/kg/jour de proteines et 30 a 35 kcal/kg/j) pour seulement 3 des 41 patients en NP exclusive. La surveillance clinico-biologique etait insuffisante pour 90,1 % des patients, principalement du fait d’une frequence insuffisante des bilans biologiques et du poids. Aucun des patients en NP n’a beneficie d’une consultation avec un medecin nutritionniste alors que 5 patients ont recu plus de 3 mois de NP. Conclusion Nos resultats, meilleurs qu’au CRG en 2009 et que dans d’autres centres, restent insuffisants, en particulier concernant le suivi clinico-biologique. La mise en place d’une consultation de surveillance dediee semble indispensable.

The "Standards, Options and Recommendations" (SOR) project, started in 1993, involves a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Regional Cancer Centres, some French public university and general hospitals and private Clinics and medical scientific societies. Its main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on a literature review followed by a critical appraisal by a multidisciplinary group of experts to produce the draft guidelines which are then validated by specialists in cancer care delivery.To develop clinical practice guidelines for hospital catering for cancer patient using the methodology developed by the Standards, Options and Recommendations project.Data were identified by a literature search of Medline and the reference lists of experts in the groups. After the guidelines were drafted, they were validated by independent reviewers.The main recommendations are: 1) While taking into consideration the specific needs of cancer patients, the dietician is responsible for the hygiene, the sanitary quality of alimentation, the equilibrium and nutritional quality of the hospital catering. 2) Ordering and distribution of meals, and clearing up afterwards contribute to the quality of hospital catering and the personnel who do this should have time and be willing to listen to the patients. 3) The ordering of meals should be adapted to individual patient's requirements and must take into account the patient's medication. 4) The method of transporting the food chosen by the institution (cold or warm method) should be respected. The personnel responsible should receive regular and specific training to use the method correctly. 5) The intake of patients with nutritional follow-up should be reliably and reproducibly evaluated by the personnel after every meal. 6) Patient satisfaction should be assessed once a year and the results of this assessment used to improve the quality of hospital catering. 7) The dietician is the interface between the accounts department, the medical wards, the hospital catering department and the patients.

The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCL CC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feed-back from specialists in cancer care delivery.To develop clinical practice guidelines according to the definitions of Standards, Options and Recommendations for the dietetic consultation for cancer patient.Data have been identified by literature search wing Medline and the expert groups personal reference lists. Once the guidelines were defined, the document was submitted for review to 74 independent reviewers, and to the medical committees of the 20 French Cancer Centres.The main recommendations for the referral of cancer patients for dietary advice are: I) in oncology, there are 3 types of dietetic consultation: diagnostic, preventive and therapeutic; 2) the following cancer patients must have a dietetic consultation: i) those with, or at risk of malnutrition, ii) those without malnutrition but in need of counseling and iii) those at risk of treatment-related nutritional side effects; 3) a nutritional assessment is standard at the time of the first dietetic consultation. Patients must be given individualized and written advice; 4) the dietetic opinion and advice should be brought to the attention of medical staff to facilitate a multidisciplinary approach to cancer treatment; 5) patient's relatives should be involved in the dietetic management; 6) the efficacy of dietetic advice can be assessed by monitoring weight, gastrointestinal signs and patient satisfaction.