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OBJECTIVES A lung transplant is the final treatment option for end-stage lung disease. We evaluated the individual risk of 1-year mortality at each stage of the lung transplant process. METHODS This study was a retrospective analysis of patients undergoing bilateral lung transplants between January 2014 and December 2019 in 3 French academic centres. Patients were randomly divided into development and validation cohorts. Three multivariable logistic regression models of 1-year mortality were applied (i) at recipient registration, (ii) the graft allocation and (iii) after the operation. The 1-year mortality was predicted for individual patients assigned to 3 risk groups at time points A to C. RESULTS The study population consisted of 478 patients with a mean (standard deviation) age of 49.0 (14.3) years. The 1-year mortality rate was 23.0%. There were no significant differences in patient characteristics between the development (n = 319) and validation (n = 159) cohorts. The models analysed recipient, donor and intraoperative variables. The discriminatory power (area under the receiver operating characteristic curve) was 0.67 (0.62–0.73), 0.70 (0.63–0.77) and 0.82 (0.77–0.88), respectively, in the development cohort and 0.74 (0.64–0.85), 0.76 (0.66–0.86) and 0.87 (0.79 – 0.95), respectively, in the validation cohort. Survival rates were significantly different among the low- (< 15%), intermediate- (15%–45%) and high-risk (> 45%) groups in both cohorts. CONCLUSIONS Risk prediction models allow estimation of the 1-year mortality risk of individual patients during the lung transplant process. These models may help caregivers identify high-risk patients at times A to C and reduce the risk at subsequent time points.

Sarcomas are rare, heterogeneous, ubiquitously localized malignancies with many histologic subtypes and genomic patterns. The survival of patients with sarcoma has rarely been described based on this heterogeneity; therefore, the authors' objective was to estimate survival outcomes in patients who had sarcomas using the 2020 version of the World Health Organization classification of soft tissue and bone tumors.Patients older than 15 years who had incident sarcoma diagnosed between 2005 and 2010 were extracted from 14 French population-based cancer registries covering 18% of the French metropolitan population. Vital status for each patient was actively followed up to June 30, 2013. Net survival (NS) was estimated using the unbiased Pohar-Perme method.Overall, 4202 patients were included. NS declined with increasing age at diagnosis. According to topographic groups, large 5-year NS disparities were observed, ranging from 47% among women with gynecologic sarcomas to 89% among patients with skin sarcomas. Patients with soft tissue, bone, and gastrointestinal sarcomas had 5-year NS rates of 53%, 61%, and 70%, respectively. Similar heterogeneity was observed according to histologic subtypes, with 5-year NS ranging from 19% for patients with angiosarcomas to 96% for patients with dermatofibrosarcomas. Patients with sarcoma who displayed missense mutations had a better 5-year NS (74%); those with MDM2-amplified sarcomas had the worst NS (45%).NS rates in patients with sarcoma are presented here for the first time based on the 2020 World Health Organization classification applied to population-based registry data. Large prognostic heterogeneity was observed based on age, topographic and histologic groups, and genomic alteration profiles, constituting a benchmark for future studies and clinical trials.

Infection of SARS-CoV-2 among health workers (HWs) in contact with cancer patients has been a major issue since the beginning of the pandemic. We aimed to assess the serological immune status of SARS-CoV-2 infection among these HWs. A prospective cohort study was initiated in the comprehensive cancer center of the Nouvelle-Aquitaine region (NA, France). Volunteer HWs working on March 2020 without active infection or symptoms of COVID-19 completed a self-questionnaire and had a blood test at inclusion, at 3 and 12 months. Positive serological status of SARS-CoV-2 infection was defined by anti-nucleocapsid antibodies and/or IgG anti-spike antibodies, except at 12 months due to vaccine. Half of the HWs were included (N = 517) and 89% were followed for three months (N = 500) and one year (N = 462). Seroprevalence of SARS-CoV-2 infection was 3.5% (95% CI: 1.9–5.1), 6.2% (95% CI: 4.1–8.3), and 10% (95% CI: 7.2–12.7) on June–September 2020, September 2020–January 2021, and June–October 2021, respectively. At 12 months, 93.3% had detectable antibodies with 80% vaccinated in the first three months of vaccine availability. The COVID-19-free policy of the institution, respect for barrier gestures, high and early vaccination of HWs, and low prevalence of SARS-CoV-2 in NA may explain the low rate of seropositivity among the HWs of the Institut Bergonié.

Objectives More than half of cancer patients require palliative care; however, inequality in access and late referral in the illness trajectory are major issues. This study assessed the cumulative incidence of first hospital-based palliative care (HPC) referral, as well as the influence of patient-, tumor-, and care-related factors. Study design This is a retrospective population-based study. Methods The study included patients from the 2014 population-based cancer registry of Gironde, France. International Classification of Diseases, Tenth Revision, coding for palliative care identified HPC referrals from 2014 to 2018. The study included 8424 patients. Analyses considered the competing risk of death and were stratified by initial cancer prognosis (favorable vs unfavorable [if metastatic or progressive cancer]). Results The 4-year incidence of HPC was 16.7% (95% confidence interval, 16.6–16.8). Lung cancer led to more referrals, whereas breast, colorectal, and prostatic locations were associated to less frequent HPC compared with other solid tumors. Favorable prognosis central nervous system tumors and unfavorable prognosis hematological malignancies also showed less HPC. The incidence of HPC was higher in tertiary centers, particularly for older patients. In the favorable prognosis subgroup, older and non-deprived patients received more HPC. In the unfavorable prognosis subgroup, the incidence of HPC was lower in patients who lived in rural areas than those who lived in urban areas. Conclusions One-sixth of cancer patients require HPC. Some factors influencing referral depend on the initial cancer prognosis. Our findings support actions to improve accessibility, especially for deprived patients, people living in rural areas, those with hematological malignancies, and those treated outside tertiary centers. In addition, consideration of age as factor of HPC may allow for improved design of the referral system.

Background Previous studies have reported on the higher risk of functional decline among older patients with cancer. However, few have focused on factors of functional decline in older persons with cancer and are mainly hospital-based and focus on consequences of cancer treatment. The aim of the study was to identify determinants of functional decline in older subjects with cancer in a population-based study. Methods Using cancer registries, we identified older subjects (age ≥ 65 years) with cancer in three prospective cohort studies from Gironde, a French department. Functional status was measured using the Instrumental Activities of Daily Living (IADL) and the basic Activities of Daily Living (ADL) scales, and functional decline was measured between cancer pre- and post-diagnosis visits. Studied variables were demographic and socioeconomic (age at diagnosis, sex, living alone, education), cancer-related (stage at diagnosis, treatment received), smoking status, health-related (polypharmacy, depressive symptomatology), and geriatric-specific (cognitive impairment or dementia). Analyses were performed using logistic regression models. Results Age (≥85 years), cognitive impairment or dementia, and advanced stage at diagnosis were associated with a higher risk of ADL limitations, whether considering death or not. Age (≥85 years), education and polypharmacy were associated with a higher risk of ADL and/or IADL limitations. Conclusions We identified factors that could impact on ADL and/or IADL limitations in older patients with cancer. The information on these determinants is useful in clinical settings to identify patients with cancer at high risk of functional decline.

BackgroundSpatial inequalities in cancer management have been evidenced by studies reporting lower quality of care or/and lower survival for patients living in remote or socially deprived areas. NETSARC+ is a national reference network implemented to improve the outcome of sarcoma patients in France since 2010, providing remote access to specialized diagnosis and Multidisciplinary Tumour Board (MTB). The IGéAS research program aims to assess the potential of this innovative organization, with remote management of cancers including rare tumours, to go through geographical barriers usually impeding the optimal management of cancer patients.MethodsUsing the nationwide NETSARC+ databases, the individual, clinical and geographical determinants of the access to sarcoma-specialized diagnosis and MTB were analysed. The IGéAS cohort (n = 20,590) includes all patients living in France with first sarcoma diagnosis between 2011 and 2014. Early access was defined as specialised review performed before 30 days of sampling and as first sarcoma MTB discussion performed before the first surgery.ResultsSome clinical populations are at highest risk of initial management without access to sarcoma specialized services, such as patients with non-GIST visceral sarcoma for diagnosis [OR 1.96, 95% CI 1.78 to 2.15] and MTB discussion [OR 3.56, 95% CI 3.16 to 4.01]. Social deprivation of the municipality is not associated with early access on NETSARC+ remote services. The quintile of patients furthest away from reference centres have lower chances of early access to specialized diagnosis [OR 1.18, 95% CI 1.06 to 1.31] and MTB discussion [OR 1.24, 95% CI 1.10 to 1.40] but this influence of the distance is slight in comparison with clinical factors and previous studies on the access to cancer-specialized facilities.ConclusionsIn the context of national organization driven by reference network, distance to reference centres slightly alters the early access to sarcoma specialized services and social deprivation has no impact on it. The reference networks’ organization, designed to improve the access to specialized services and the quality of cancer management, can be considered as an interesting device to reduce social and spatial inequalities in cancer management. The potential of this organization must be confirmed by further studies, including survival analysis.

Objective The aim of this study was to assess internal antineoplastic drugs (ADs) contamination in the nursing staff in French hospital centers, using highly sensitive analytical methods. Methods This cross-sectional study included nurses practicing in care departments where at least one of the five ADs studied was handled (5-fluorouracil, cyclophosphamide, doxorubicin, ifosfamide, methotrexate). The nurses study participation lasted 24 h including collection of three urine samples and one self-questionnaire. All urine samples were assayed by ultra-high-performance liquid chromatography-tandem mass spectrometry methods with very low value of the lower limit of quantification (LLOQ). Results 74 nurses were included, 222 urine samples and 74 self-questionnaires were collected; 1092 urine assays were performed. The percentage of nurses with internal AD contamination was 60.8% and low levels of urinary concentrations were measured. Regarding nurses with internal contamination (n = 45), 42.2% presented internal contamination by methotrexate, 37.8% by cyclophosphamide, 33.3% by ifosfamide, 17.8% by 5-fluorouracil metabolite and 6.7% by doxorubicine. Among the positive assays, 17.9% (n = 26/145) were not explained by exposure data from the self-questionnaire but this could be due to the skin contact of nurses with contaminated work surfaces. Conclusions This study reported high percentage of nurses with internal ADs contamination. The low LLOQ values of the used analytical methods, allowed the detection of ADs that would not have been detected with the current published methods: the percentage of contamination would have been 17.6% instead of the 60.8% reported here. Pending toxicological reference values, urine ADs concentrations should be reduced as low as reasonably achievable (ALARA principle).

Screening (secondary prevention) is a public health action aimed at identifying diseases at their earliest stages, before the onset of signs and symptoms and, thus, avoiding or mitigating their negative consequences. The abnormality can be a genetic defect, an infection or the preclinical phase of a chronic disease such as cancer. We discuss elements common to the cancer screening debate: vocabulary about screening, overdiagnosis, and program indication criteria. Finally, we present some significant evolutions on the programs since their implementation in France.

Introduction Ductal carcinoma in situ (DCIS) accounts for 15% of all breast cancers and generally, the prognosis is good if treated optimally. The standard treatment includes breast conservative surgery along with adjuvant radiotherapy. Skin-sparing mastectomy (SSM) preserves the breast skin envelope but its oncological safety poses a few concerns. Moreover, no DCIS-specific studies have compared the local recurrence (LR) rate following total mastectomy (TM) or SSM. We evaluated the LR rate in DCIS patients who underwent either TM or SSM. Methods This is a retrospective study on women who underwent mastectomy with or without immediate breast reconstruction or secondary reconstruction for pure DCIS of the breast. All patients treated at Institut Bergonie by mastectomy for DCIS from January 1990 to December 2010 were included. LR and overall survival (OS) rates were estimated. Results The study population included 399 patients who were categorized into two groups, 207 in the TM group and 192 in the SSM group. At 10 years of follow-up, the LR rate was 0.97% in the TM group and 1.04% in the SSM group (p = NS). The OS of the entire population was 94.7% [95% CI; 91.6–96.7], 92.8% [95% CI, 87.9–95.8] for the TM group and 96.8% [95% CI, 91.6–98.8] for the SSM group. Conclusions In our study, the LR rate following mastectomy is low, regardless of the surgical technique used, with an excellent OS at 10 years.

Introduction Neoadjuvant chemotherapy (NAC) is proposed for locally advanced breast cancer (LABC) to increase the breast conservative treatment (BCT). In France, mastectomy is the risk-reducing prophylactic surgical strategy only for pre-symptomatic germline BRCA-mutated (gBRCAm) patients. On the other hand, BCT is proposed to all patients following NAC based on clinical response, regardless the gBRCAm status. The aim of this retrospective study is to evaluate the risk of local recurrence (LR) according to BRCA status. Patients and methods Inclusion criteria were: (i) patients treated for unilateral LABC, T2-3, N≥0, M0 by NAC, and (ii) patients who underwent germline BRCA screening. , using targeted next-generation screening, was carried out either during NAC (rapid process) or after surgery. Deleterious mutations were confirmed using Sanger sequencing before passing on the results to the clinical geneticist. Some gBRCAm patients from Olympia study were also included. Patients were followed-up over a long term for overall survival, LR and disease-free survival. Chi-square and Fischer test were used to generate statistical comparison. Results Between 2007 and 2015, 988 women were treated for LABC at our institution. Among them, 151 patients underwent clinical genetic testing for gBRCAm based on these criteria: young age at diagnosis or familial history of breast or ovarian cancer or histological characteristics as grade 2/3, Her2-3+ or basal like. A total of 122 patients were included in the study; 28 patients had gBRCAm status and no mutations were detected in 94 patients (wtBRCA). Significant differences between the two groups (gBRCAm vs wtBRCA) were observed for Mean age, (36.7 vs 40.1y (p=0.0032) , Intrinsic tumor subtypes basal like (64.3% vs 42.5%, p=0.0432) ER are more often negative (21.4% vs 46.8%, p=0.0165). Among the 30 patients who underwent BRCA screening during NAC and eligible for BCT, 8 of the 9 patients with gBRCAm choose mastectomy (88%). Among the 92 patients with screening mutation after breast cancer treatment, 5 of the 19 patients with gBRCAm had a mastectomy (28%). In the 28 gBRCAm patients, 15 had a BCT and 13 a mastectomy. In the 94 wtBRCA patients, 67 had a BCT and 27 a mastectomy. After a follow-up of 4.32 years, we observed 8 relapses, 5 LRs after BCT and 3 contro-lateral relapses. Of the 5 LRs, 3 came from 15 gBRCAm with BCT and 2 of the 67 wtBRCA (p=0.0403). Discussion In this selected subgroup of patients, gBRCAm rate is higher (23%) than the rate based on familial criteria for BRCA testing (12%). Regarding the rationale for BCT or mastectomy procedure in LABC and pre-symptomatic gBRCAm patients, this study led us to establish mastectomy as risk-reducing strategy in a sole surgery procedure for gBRCAm patients. Moreover, 88% gBRCAm patients chose mastectomy; the mastectomy rate was lower when the patient was unaware of their BRCA status (26%). The LR rate was higher in the gBRCAm vs wtBRCA with a statistical difference. In LABC patients with high genetic risk, the knowledge of mutation status could influence patients' and surgeons' choice of surgery. In case of gBRCAm status, mastectomy is recommended to decrease LR risk. Citation Format: Tunon de Lara C, Leroux J, Bonnet F, Debled M, Barrouk-Simonet E, Quenel-Tueux N, Lagarde P, Chassaigne F, Esnaud T, Fournier M, Bubien V, Breton-Callu C, Charitansky H, Petit A, Mathoulin-Pelissier S, Macgrogan G, Longy M, Sevenet N. Risk reducing strategy in germline BRCA mutated patients with locally advanced breast cancer. Establishing mastectomy as a preventing procedure of local recurrence [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-07.

6541 Background: Health literacy (HL) is defined as the motivation and skills to access, understand, evaluate, and use information to make appropriate health decisions. The level of LS is low in Europe, including in France. For chronic patients, a low literacy is associated with limited skills in the self-management of the disease, the monitoring of treatments and is an obstacle in therapeutic education. In France, there is no study on patients with cancer. However, our pilot study with older adults with cancer showed that 72% had a low level of LS, a level defined by a questionnaire validated in French (Functional, Communicative and Critical Health Literacy-FCCHL, a score ≤ 4 = low level). The objective of this multicenter study is to evaluate HL in 2 cohorts of cancer patients: adults aged 65 and over (OLD) and adults aged 18 to 64 (Y). Methods: This multicenter cross-sectional study enrolled 1,518 patients aged 18 and over from 27/09/21 to 29/10/21 in 26 centers. Patients were either admitted in outpatient unit, or seen in oncology/geriatric oncology consultation, and with a treatment plan. They completed the FCCHL and 11 questions on the use of digital. Demographic and health data were also collected. The FCCHL consists of 3 subscales evaluating functional (access to information – 5 items), interactive (understanding of information – 5 items) and critical (use of information – 4 items) HL. The score for each subscale is calculated by taking the sum obtained for each item divided by the number of items and varies from 1 (low) to 5 (high). The overall score is calculated from the subscale scores. The primary endpoint was the rate of patients with an overall score of HL ≤ 4 (no. of subjects estimated at 420 per cohort, considering non-evaluable patients and an expected rate of HL ≤ 4 from 70% to 80%). Patients’ characteristics and their use of digital have been described. In addition, a multivariate exploratory analysis of the factors associated with an LS≤ 4 in the OLD cohort was performed. Results: Most patients (1,327(87%)) had completed all the FFCHL items (658 (84%) OLD cohort; 669 (91%) Y cohort). The proportion of men was higher in the OLD cohort (48% vs 34% Y cohort). Many of the patients lived at home in the 2 cohorts (98%) and half in urban area (56% cohort OLD vs 52% cohort Y). The patients had an advanced stage of cancer (70% OLD cohort vs 61% Y cohort). A low level of HL was reported in 70% of the Y cohort and in 78.7% of the OLD cohort. The use of digital tools was lower in the OLD cohort: 41% had never used the internet for their health vs. 14% in cohort Y; this use was very low for online consultations (respectively 83 and 64% never used them). For the OLD cohort, only advanced and/or metastatic cancer stage was associated with HL≤ 4 (after center adjustment). Conclusions: These results show a low level of HL in older as in the younger population. Actions need to be implemented for the detection of moderate or weak HL in the way to reduce barriers in the management of cancer treatments.

Background: Establishing an accurate prognosis remains challenging in older cancer patients because of the population’s heterogeneity. Using machine learning, we developed and externally validated a new predictive score (the “Geriatric Cancer Scoring System”, GCSS) to refine individualized prognosis for older patients with cancer during the first year following a geriatric assessment (GA). Methods: Data were collected from two French prospective multicentre cohorts of cancer patients aged 70 and over referred for GA: ELCAPA (training set, n=2012) and ONCODAGE (validation set, n=1397). Candidate predictors included baseline oncological and geriatric factors and routine biomarkers. Predictive models were built using Cox regression, single decision tree (DT), and random survival forest (RSF) methods, comparing their predictive performance for 3-, 6- and 12-month mortality by computing externally validated Harrell’s C-indices. Findings: At 12 months, respectively 875 (43%) and 219 (16%) patients in the training and validation sets had died (mean age at baseline: 81±6 and 78±5, respectively; women: 47% and 70%; metastatic cancer: 50% and 34%). Tumour site/metastatic status, cancer treatment, weight loss >3 kg (previous 3 months), 5 or more prescription drugs, Eastern Cooperative Oncology Group-Performance Status ≥2, Activities of Daily Living score ≤5, impaired timed up-and-go test, low creatinine clearance and elevated CRP/albumin were identified as independent predictors in the Cox model. DT and RSF identified more complex combinations of features, with the G-8 score, the tumour site/metastatic status and the CRP/albumin ratio contributing most to the predictions. The RSF approach gave the highest C-index (3 months: 0.91 [RSF], 0.88 [Cox], 0.87 [DT]; 12 months: 0.86 [RSF], 0.82 [Cox], 0.81 [DT]) and was thus retained as the final model. Interpretation: The GCSS based on a random forest machine learning approach gave an accurate externally validated 3-, 6- and 12-month mortality prediction. The GCSS might improve decision-making processes and counselling in older cancer patients. Funding Information: The ELCAPA study was funded by the French National Cancer Institute (Institut National du Cancer, INCa); Canceropole Ile-de-France; and Gerontopole Ile-de-France (Gerond’If). The ONCODAGE project was funded by the French National Cancer Institute (Institute National du Cancer); and SIRIC BRIO (Site de Recherche Integree sur le Cancer – Bordeaux Recherche Integree Oncologie; grant: INCa-DGOS-Inserm 6046). Declaration of Interests: None declared. Ethics Approval Statement: Two French prospective multicentre cohorts were considered in the present study. The study protocols were approved by the appropriate independent ethics committees (ELCAPA: CPP Ile-de-France I, Paris, France; ONCODAGE: CPP Sud-Ouest et Outre Mer III).

Background Whole exome sequencing and RNA sequencing (WES/RNASeq) should now be implemented in the clinical practice in order to increase access to optimal care for cancer patients. Providing results to Tumour Boards in a relevant time frame—that is, compatible with the clinical pathway—is crucial. Assessing the feasibility of this implementation in the French care system is the primary objective of the Multipli study, as one of the four pilot projects of the national France Genomic Medicine 2025 (FGM 2025) plan. The Multipli study encompasses two innovative trials which will be driven in around 2400 patients suffering from a soft-tissue sarcoma (Multisarc) or a metastatic colorectal carcinoma (Acompli). Methods Prior to launching the FGM 2025 cancer pilot study itself, the performance of the Multipli genomic workflow has been evaluated through each step, from the samples collection to the Molecular Tumour Board (MTB) report. Two Multipli-assigned INCa-labelled molecular genetics centres, the CEA-CNRGH sequencing platform and the Institut Bergonie’s Bioinformatics Platform were involved in a multicentric study. The duration of each step of the genomic workflow was monitored and bottlenecks were identified. Results Thirty barriers which could affect the quality of the samples, sequencing results and the duration of each step of the genomic pathway were identified and mastered. The global turnaround time from the sample reception to the MTB report was of 44 calendar days. Conclusion Our results demonstrate the feasibility of tumour genomic analysis by WES/RNASeq within a time frame compatible with the current cancer patient care. Lessons learnt from the Multipli WES/RNASeq Platforms Workflow Study will constitute guidelines for the forthcoming Multipli study and more broadly for the future clinical routine practice in the first two France Genomic Medicine 2025 platforms.

International audience; In France, cancer is the leading cause of death. Its incidence is increasing due to the growing population and longer life expectancy. Although older adults represent most new cases, they remain underrepresented in clinical trials. Their prognosis is often worse due to delayed diagnosis and multimorbidities. Geriatric oncology has made great strides worldwide, highlighted by important studies implementing geriatric assessment in clinical research and supported by the successive national cancer plans. This paper reviews the most important actions taken in France during the last decade to improve the management of older patients with cancer.

Patients with metastatic breast cancer (MBC) often require inpatient palliative care (IPC). However, mounting evidence suggests age-related disparities in palliative care delivery. This study aimed to assess the cumulative incidence function (CIF) of IPC delivery, as well as the influence of age.The national ESME (Epidemio-Strategy-Medical-Economical)-MBC cohort includes consecutive MBC patients treated in 18 French Comprehensive Cancer Centres. ICD-10 palliative care coding was used for IPC identification.Our analysis included 12,375 patients, 5093 (41.2%) of whom were aged 65 or over. The median follow-up was 41.5 months (95% confidence interval [CI], 40.5-42.5). The CIF of IPC was 10.3% (95% CI, 10.2-10.4) and 24.8% (95% CI, 24.7-24.8) at 2 and 8 years, respectively. At 2 years, among triple-negative patients, young patients (65 yo) had a higher CIF of IPC than older patients after adjusting for cancer characteristics, centre and period (65+/65: β = -0.05; 95% CI, -0.08 to -0.01). Among other tumour sub-types, older patients received short-term IPC more frequently than young patients (65+/65: β = 0.02; 95% CI, 0.01 to 0.03). At 8 years, outside large centres, IPC was delivered less frequently to older patients adjusted to cancer characteristics and period (65+/65: β = -0.03; 95% CI, -0.06 to -0.01).We found a relatively low CIF of IPC and that age influenced IPC delivery. Young triple-negative and older non-triple-negative patients needed more short-term IPCs. Older patients diagnosed outside large centres received less long-term IPC. These findings highlight the need for a wider implementation of IPC facilities and for more age-specific interventions.

Background Metastatic breast cancer (MBC) may require inpatient palliative care (IPC) but literature suggests age-related disparities in palliative care delivery. This study, based on real-world data, aimed to assess the cumulative incidence function (CIF) of IPC delivery and if age is an independent factor, taking into account the competing risk of death. Methods The national multicenter ESME (Epidemio-Strategy-Medical-Economical)-MBC cohort includes consecutive MBC patients treated in the 18 French Comprehensive Cancer Centers. IPC identification used ICD-10 palliative care coding. Main analysis first estimated pseudo values of 2-year and 8-year CIF of IPC. Linear regression models estimated the mean changes of pseudo-values (2 models: 2-year and 8-year CIF of IPC). Results Our analysis included 12375 patients, 5093 (41.2%) of whom were aged 65 or over. The median follow-up was 41.5 months (95% CI, 40.5-42.5). The CIF of IPC was 10.3% (95% CI, 10.2-10.4) and 24.8% (95% CI, 24.7-24.8) at two and eight years, respectively. At two years, among triple-negative patients, young patients ( Conclusions We found a relatively low CIF of IPC and that age influenced IPC delivery. Young triple negative and older non-triple negative patients needed more short-term IPC. Older patients diagnosed outside large centres received less long-term IPC. These findings highlight the need for a wider implementation of IPC facilities and for more age-specific interventions. Key messages Our study highlighted particular challenge for older MBC patients diagnosed outside large French Comprehensive Cancer Centers. By identifying age at MBC diagnosis as a factor of IPC delivery, this report supports a wider implementation of IPC facilities and more age-specific interventions.

Background Cytochrome P450 1B1 (CYP1B1) is mostly expressed in tumours and displays unusual properties. Its two polymorphic forms were differently associated with anticancer drug sensitivity. We decipher here the role of this polymorphism in anticancer drug efficacy in vitro, in vivo and in the clinical setting. Methods From head-and-neck squamous cell carcinoma cell lines not expressing CYP1B1, we generated isogenic derivatives expressing the two forms. Proliferation, invasiveness, stem cell characteristics, sensitivity to anticancer agents and transcriptome were analysed. Tumour growth and chemosensitivity were studied in vivo. A prospective clinical trial on 121 patients with advanced head-and-neck cancers was conducted, and a validation-retrospective study was conducted. Results Cell lines expressing the variant form displayed high rates of in vitro proliferation and invasiveness, stemness features and resistance to DNA-damaging agents. In vivo, tumours expressing the variant CYP1B1 had higher growth rates and were markedly drug-resistant. In the clinical study, overall survival was significantly associated with the genotypes, wild-type patients presenting a longer median survival (13.5 months) than the variant patients (6.3 months) (p = 0.0166). Conclusions This frequent CYP1B1 polymorphism is crucial for cancer cell proliferation, migration, resistance to chemotherapy and stemness properties, and strongly influences head-and-neck cancer patients’ survival.

Aim Real-world data inform the outcome comparisons and help the development of new therapeutic strategies. To this end, we aimed to describe the full characteristics and outcomes in the Epidemiological Strategy and Medical Economics (ESME) cohort, a large national contemporary observational database of patients with metastatic breast cancer (MBC). Methods Women aged ≥18 years with newly diagnosed MBC and who initiated MBC treatment between January 2008 and December 2016 in one of the 18 French Comprehensive Cancer Centers (N = 22,109) were included. We assessed the full patients’ characteristics, first-line treatments, overall survival (OS) and first-line progression-free survival, as well as updated prognostic factors in the whole cohort and among the 3 major subtypes: hormone receptor positive and HER2-negative (HR+/HER2−, n = 13,656), HER2-positive (HER2+, n = 4017) and triple-negative (n = 2963) tumours. Results The median OS of the whole cohort was 39.5 months (95% confidence interval [CI], 38.7–40.3). Five-year OS was 33.8%. OS differed significantly between the 3 subtypes (p Conclusions The ESME program represents a unique large-scale real-life cohort on MBC. This study highlights important situations of high medical need within MBC patients. Database registration clinicaltrials.gov Identifier NCT032753.

BackgroundGuidelines recommend an early access to specialised palliative medicine services for patients with cancer, but studies have reported a continued underuse. Palliative care facilities deliver early care, alongside antineoplastic treatments, whereas hospice care structures intervene lately, when cancer-modifying treatments stop.AimThis review identified factors associated with early and late interventions of specialised services, by considering the type of structures studied (palliative vs hospice care).DesignWe performed a systematic review, prospectively registered on PROSPERO (ID: CRD42018110063).Data sourcesWe searched Medline and Scopus databases for population-based studies. Two independent reviewers extracted the data and assessed the study quality using Joanna Briggs Institute critical appraisal checklists.ResultsThe 51 included articles performed 67 analyses. Most were based on retrospective cohorts and US populations. The median quality scores were 19/22 for cohorts and 15/16 for cross-sectional studies. Most analyses focused on hospice care (n=37). Older patients, men, people with haematological cancer or treated in small centres had less specialised interventions. Palliative and hospice facilities addressed different populations. Older patients received less palliative care but more hospice care. Patients with high-stage tumours had more palliative care while women and patients with a low comorbidity burden received more hospice care.ConclusionMain disparities concerned older patients, men and people with haematological cancer. We highlighted the challenges of early interventions for older patients and of late deliveries for men and highly comorbid patients. Additional data on non-American populations, outpatients and factors related to quality of life and socioeconomic status are needed.

Background Few data are available on survival and predictive factors in early breast cancer (BC) patients treated with neoadjuvant endocrine therapy (NET). Methods This is a pooled analysis of two multicentre, randomised non-comparative phase 2 clinical trials evaluating neoadjuvant anastrozole and fulvestrant efficacy for postmenopausal HR+/HER2- breast cancer patients: HORGEN (NCT00871858) and CARMINA02 (NCT00629616) studies. Results In total, 236 patients were included in CARMINA02 and HORGEN trials. Modified intention-to-treat analysis was available for 217 patients. Median follow-up was 65.2 months. Relapse-free survival (RFS) and overall survival (OS) at 5 years were 83.7% (95% CI: 77.9–88) and 92.7% (95% CI: 88.2–95.6), respectively, with no difference between treatment arms. On univariate analysis, tumour staging (T2 vs T3–4; p = 0.0001), Ki-67 at surgery (≤10% vs >10%; p = 0.0093), pathological tumour size (pT1–2 vs pT3–4; p = 0.0012) and node status (pN negative vs positive; p = 0.007), adjuvant chemotherapy (p = 0.0167) and PEPI score (PEPI group I + II vs III; p = 0.0004) were associated with RFS. No events were observed in patients with pathological response according to the Sataloff classification. Multivariate analysis showed that preoperative endocrine prognostic index (PEPI) group III was associated with significantly worse RFS (p = 0.0069, hazard ratio = 3.33 (95% CI: 1.39–7.98)). Conclusions Postmenopausal HR+/HER2- breast cancer patients receiving NET generally have a favourable outcome. The PEPI score identifies a subset of patients of poorer prognosis who are candidates for further additional treatment.

BackgroundPatients with Ewing sarcoma or osteosarcoma have a median overall survival of less than 12 months after diagnosis, and a standard treatment strategy has not yet been established. Pharmacological inhibition of MET signalling and aberrant angiogenesis has shown promising results in several preclinical models of Ewing sarcoma and osteosarcoma. We aimed to investigate the activity of cabozantinib, an inhibitor of MET and VEGFR2, in patients with advanced Ewing sarcoma and osteosarcoma.MethodsWe did a multicentre, single-arm, two-stage, phase 2 trial in patients with advanced Ewing sarcoma or osteosarcoma recruited from ten centres in the French Sarcoma Group. Key eligibility criteria were aged 12 years or older, Eastern Cooperative Oncology Group performance status of 0–1, and documented disease progression (according to Response Evaluation Criteria in Solid Tumors version 1.1) before study entry. The number of previous lines of treatment was not limited. Patients received cabozantinib (adults 60 mg, children [

Introduction Several studies have reported disparities in the care management and survival of older cancer patients. The aim of our study was to identify determinants of treatment administration in this population of cancer patients aged over 65 years taking into account competing risks of death. Methods The INCAPAC study is a population-based study. Four cancer registries and three prospective cohort studies on older subjects (age ≥65 years) from Gironde, a French department, were merged to identify older cancer patients. We used a non-parametric multi-state model including three states (cancer, treatment and all-cause death). This model allowed studying determinants of treatment administration (all treatments including curative, symptomatic and palliative treatments) and mortality considering that patients can move from cancer state to death state, either directly or through the treatment phase. Studied variables were demographic and socioeconomic-, cancer-, health-, and geriatric-related. Results A total of 450 patients were included in the analyses. They were mainly aged 85 and over, men and educated. Among included patients, 372 (83%) received cancer treatment. In the final multivariate model, dementia was associated with a lower likelihood of receiving cancer treatment (HR = 0.68, 95% CI = 0.47–0.99). In treated patients, age, sex, comorbidities, dependency and stage at diagnosis were associated to all-cause mortality, and in untreated patients, diagnosis of dementia and stage at diagnosis were associated to mortality. Conclusion Further studies are necessary to understand the impact of geriatric impairments on treatment administration and to develop clinical practice guidelines.

Faced with the lack of evidence-based medicine concerning the efficacy and tolerance of cancer treatments in the extremely heterogeneous elderly population, and with no standardised geriatric evaluation in geriatric oncology clinical trials, the intergroup Dialog set itself the objective of establishing a minimal standardised geriatric evaluation for clinical trials. The evaluation must be simple, short and effective. It must comprise validated and reproducible measurement tools. The Geriatric Core Dataset, made up of seven items, has been formalised and validated by national and international experts.

Background: Although video teleconsultations (TCs) have shown benefits for clinical follow up in oncology, its development appears very delayed in routine practice. The COVID pandemic has required French physicians to use them, mostly during the first lockdown period. This study aims to identify barriers to TCs development by assessing patient’s and physician’s satisfaction regarding this experience. Methods: Patients who took part in at least one TC during the 7 weeks of strict confinement (from March 7 to May 11, 2020) were asked via email to complete a questionnaire of close-ended questions (5 points Likert scale) with the possibility of additional comments. Their answers were anonymized and gathered via Sphinx, a secured statistical analysis software. A second questionnaire was sent to each physician who conducted these TCs. We then aimed to analyze each patient and physician characteristics and comments, according to their degree of overall satisfaction. Results: 531 patients and 35 physicians (oncologists, surgeons, anesthetists, radiotherapists) used TCs;307 patients (57.8%) and 31(88.5%) physicians completed the survey. Patient’s average age was 59. 140 (46.7%) of them lived in a rural area and 193 (64.3%) lived more than one hour away from their cancer center;66.9% of them were overall satisfied. Unsatisfied patients (12.1%) had the same characteristics as the overall population. Apart from the lack of clinical examination, the main complaints of this group of patients were about altered communication with their physician (44.4% vs 22%), troubles with technical set up (38.9% vs 13.5%) leading to 50% of consultations by phone. Average satisfaction rate among physician was 80.7%. They mainly reported altered relationship with their patient, mostly during tough announcements. Preferred indications were surveillance consultation and treatment monitoring. Conclusions: This study shows high rate of overall satisfaction, from both patients and physicians. TCs seem to provide a suitable alternative to standard in-person consultations, therefore improvements are needed to optimize this technique. Legal entity responsible for the study: Institut Bergonie. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Introduction Les medicaments anticancereux (MAC) sont classes « dangereux a la manipulation » par le National Institute of Occupational Safety Health (NIOSH) du fait de leurs effets cancerogene, mutagene et/ou reprotoxique (CMR). La contamination interne par les MAC pour les travailleurs les manipulant et/ou au contact de patients traites par ces MAC, constitue une preoccupation majeure pour le medecin du travail. Peu de donnees francaises sont actuellement disponibles sur cette contamination. Il n’existe pas a ce jour de valeur biologique d’interpretation. Etant donne le potentiel CMR des MAC, les niveaux de contamination interne doivent etre abaisses aussi bas qu’il est possible de les detecter. Ce travail a pour objectif d’evaluer la contamination interne du personnel infirmier (IDE) de 2 etablissements de soins (CHU de Bordeaux ; IUCT-Oncopole de Toulouse) a l’aide de methodes de dosage de haute sensibilite. Materiels et methodes C’est une etude observationnelle, descriptive, multicentrique, incluant toutes IDE exercant dans 1 des 11 services de soins selectionnes ou sont manipules au moins 1 des 5 MAC suivants : 5-fluorouracile (5-FU), cyclophosphamide (CP), doxorubicine (Dx), ifosfamide (IF), methotrexate (MTX). Pour chaque IDE, 3 prelevements urinaires (en debut de poste/0-2 h apres la fin de poste/7-10 h apres) et 1 auto-questionnaire collectant des donnees socio-demographiques et professionnelles (tâches exposantes, ports des equipements de protection,..) ont ete recueillis. Resultats Dans cette etude, 93 % des IDE sont de sexe feminin, avec un âge moyen de 34,3 ans. Le taux de contamination interne des IDE est de 60,8 % (n = 45/74), tous medicaments et prelevements confondus. Dans 50,9 % des prelevements au moins 1 MAC a ete detecte (n = 113/222). Concernant les IDE, 23 % sont contaminees au CP, 20,3 % a IF, 25,7 % au MTX, 10,8 % a l’alpha-fluoro-beta-alanine (FBAL, metabolite du 5FU) et 4,1 % a la Dx. Le nombre de MAC detectes etait de 1 pour 68,9 % des IDE contaminees, 2 pour 24,4 % et 3 pour 6,7 %. Les niveaux de concentration s’etendent des limites de quantification des methodes (CP, IF, MTX : 2,5 ng/L ; Dx : 10 ng/L ; FBAL : 20 ng/L) jusqu’a 459 ng/L pour la Dx. Conclusion Une sensibilisation est indispensable notamment quant au risque reprotoxique pour le personnel feminin en âge de procreer. Les donnees issues de l’auto-questionnaire permettront l’etude des determinants associes a cette contamination. Des prelevements de surface sont en cours pour completer cette etude. Une formation est actuellement organisee pour reduire au maximum ces contaminations. Enfin, une tracabilite de ces expositions au long cours est deployee aupres des differentes categories professionnelles exposees.

Introduction Metastatic non-small cell lung cancer is a disease with a poor prognosis and things may improve with the rise of immunotherapy. Clinical trials proved that immunotherapy had better results on survival than chemotherapy as first-line treatment for patients with metastatic lung cancer (MLC). Although clinical trials have strong internal validity, they suffer from restrictive selection criterions and it can be difficult to generalize to real-life patients. We aimed to evaluate if the results of survival when comparing immunotherapy with chemotherapy as first-line therapy for MLC in real-life data are similar to those from clinical trials. Methods All consecutive patients included in the retrospective Epidemio-Strategy Medico Economic (ESME-AMLC– NCT03848052 ) program with a non-small cell MLC treated with a systemic treatment (either chemotherapy alone or immunotherapy alone) between January 2015 and December 2018. Patients diagnosed with a tumor with EGFR, KRAS, ROS or BRAF mutation were excluded. Confounding and indication biases were taken account by analyzing causal relation between treatment allocation and survival by constructing a directed acyclic graph. Progression-free survival was analyzed as secondary outcome. Results ESME database included 21,169 patients and 5,255 individuals were included in the study: 5055 treated with chemotherapy, 200 treated with immunotherapy. Median age at diagnosis was 63 years and male represented 67.7% of the population. Median OS in immunotherapy group was 16.4 months (95% CI = [14.1–NR]) and was higher than in chemotherapy group (11.6 months; 95% CI = [11.0–12.2]). In Cox models analyzes, immunotherapy group had better results after 3 months for subjects with performance status (PS) 0–1 (HR = 0.59; 95% CI = [0.42–0.83], P = 0.003) but had poor results before 3 months for subjects with 2, 3 or 4 PS (HR = 2.28; 95% CI = [1.17–4.47], P = 0.016). Conclusion Our results were in favor of benefits on survival of the immunotherapy as first-line treatment for MLC after 3 months for patients in good health condition, as found in clinical trials.

Background Limited national information is available in Morocco on the prevalence and distribution of HPV-sub-types of cervical cancer and the role of other risk factors. The aim was to determine the frequency of HPV-sub-types of cervical cancer in Morocco and investigate risk factors for this disease. Methods Between November 2009 and April 2012 a multicentre case-control study was carried out. A total of 144 cases of cervical cancer and 288 age-matched controls were included. Odds-ratios and corresponding confidence-intervals were computed by conditional logistic regression models. Results Current HPV infection was detected in 92.5% of cases and 13.9% of controls. HPV16 was the most common type for both cases and controls. Very strong associations between HPV-sub-types and cervical cancer were observed: total-HPV (OR = 39), HPV16 (OR = 49), HPV18 (OR = 31), and multiple infections (OR = 13). Education, high parity, sexual intercourse during menstruation, history of sexually transmitted infections, and husband’s multiple sexual partners were also significantly associated with cervical cancer in the multivariate analysis. Conclusions Our results could be used to establish a primary prevention program and to prioritize limited screening to women who have specific characteristics that may put them at an increased risk of cervical cancer.

Background Classification probabilities reflect to what degree a screening test represents the true disease state and include true positive (TPF) and false positive fractions (FPF). With two tests, one can compare TPF and FPF using relative probabilities which offer advantages in terms of interpretation and statistical modeling. Our objective was to highlight how individual and relative TPF and FPF can be easily estimated and compared within a regression modeling framework. This allows the modeling of tests’ accuracy while adjusting for multiple covariates, and thus provides valuable information in addition to the crude TPF and FPF. We illustrate our purpose with the G8 and VES-13 screening tests aimed at identifying elderly cancer patients in need for a comprehensive geriatric assessment (CGA). Methods Prospective cohort with a paired design. TPF and FPF of each test, as well as relative TPF and FPF were modeled using log–linear models. Results G8 detected patients in need for CGA better than VES-13 at the expense of misclassifying a large number of normal patients. Both tests had better TPF with older age and poorer performance status (PS), and for all cancer subtypes compared with prostate cancer. Effect of age and PS on TPF was more pronounced with VES-13. Age affected FPF, but not differentially. Conclusions Regression modeling helps provide a thorough assessment of the accuracy of diagnostic tests and should be used more frequently. In the context of screening, we encourage the use of G8 as failing to identify patients in need of a CGA might be more problematic than over-detection. Moreover, although we identified variables associated with the sensitivity of these tests, this association was less pronounced for the G8.

Introduction Arreter la consommation de tabac ou d’alcool a l’annonce du cancer permettrait d’optimiser l’efficacite et la tolerance des traitements. La reduction de ces consommations serait egalement susceptible d’affecter favorablement la qualite de vie (QdV) des patients. Objectifs Afin de comparer deux interventions (prise en charge standard versus entretien motivationnel) visant a reduire des consommations a risque de tabac/alcool chez des femmes traitees pour un cancer du sein, un essai clinique a ete mis en place avec pour objectifs a six mois : – la reduction des consommations de tabac/alcool a six mois ; – l’amelioration de la qualite de vie (QdV). Methodes Essai randomise comparatif. L’intervention etait jugee efficace en cas de reduction de consommation de tabac/alcool d’au moins 20 % a six mois. Les taux d’efficacite attendu etaient de 5 % (standard) et 20 % (entretien motivationnel). La QdV etait evaluee a partir du questionnaire « Quality of life Questionnaire-Core 30 » (QLQ-C30) developpe par l’« European Organisation for Research and Treatment of Cancer » (EORTC). Dans un premier temps, chacune des sous-echelles etait decrite et analysee via des tests de comparaison de Wilcoxon. Un score global prenant en compte l’ensemble des items a ete estime (score de Nordin [Nordin et al., Br J Cancer, 2001], mieux adapte que l’utilisation du score de sante global QLQ-C30) et compare entre les bras d’intervention a partir d’un modele lineaire mixte. La QdV a egalement ete consideree comme une variable latente, donc non directement mesurable ou observable, modelisee a partir de deux modeles mixtes a processus latent (QdV fonctionnelle et QdV symptomatique). Resultats La population etait constituee de 104 femmes : bras standard (n = 53) et experimental (n = 51). En termes de reduction des consommations, les taux d’efficacite etaient superieurs aux taux attendus a six mois (standard 32 % et motivationnel 36 %) mais sans difference significative. Concernant la QdV, quelle que soit la definition utilisee, celle-ci restait stable et similaire dans les deux bras. Conclusion Aucune association a six mois entre intervention et consommation de tabac/alcool ou QdV n’a ete mise en evidence. La participation a l’essai clinique pourrait expliquer l’excellent taux d’efficacite observe dans le bras standard. Ces taux restent cependant a confirmer dans le cadre d’une evaluation a plus long terme. La QdV initiale elevee pourrait expliquer l’absence d’amelioration observee par la suite. Ainsi, la QdV a l’inclusion pourrait d’avantage etre utilisee afin de cibler les populations susceptibles de beneficier au mieux des interventions.

Introduction La litteratie en sante est la capacite d’un individu a acceder, comprendre, analyser et utiliser l’information afin de prendre des decisions concernant sa sante. Les outils du numerique occupent une place grandissante dans l’acces a l’information medicale. Des etudes ont montre qu’une faible culture numerique et medicale augmenterait les hospitalisations et les effets indesirables. La population des personnes âgees (PA) avec un cancer est donc susceptible d’etre mise en difficulte par un faible niveau de litteratie. L’objectif principal de cette etude etait d’evaluer la faisabilite pour cette population d’un questionnaire decrivant la litteratie en sante et en sante numerique. Methodes Cette etude transversale sur deux semaines a ete faite aupres de six centres. Les patients âges de 65 ans et plus, atteints d’un cancer et sachant comprendre le francais, devaient completer le questionnaire lors d’une consultation oncogeriatrique ou d’une hospitalisation de jour. Les criteres de jugement principal et secondaire etaient respectivement le taux de refus et la completude du questionnaire. Le questionnaire comprenait la version francaise validee de l’echelle « Functional, Communicative and Critical Health Literacy » (FCCHL) ainsi que cinq questions sur l’usage des outils numeriques. L’echelle est composee de cinq items pour decrire la litteratie fonctionnelle (acceder a l’information), cinq items pour la litteratie interactive (extraire, comprendre et communiquer) et quatre items pour la litteratie critique (analyser et utiliser l’information). Pour chaque sous-echelle du FCCHL, le score de litteratie peut varier de 1 (faible) a 5 (elevee). Ce score est calcule en faisant la somme des scores obtenus a chaque item divise par le nombre d’items. Un score global a ete calcule a partir des scores des trois sous-echelles. Un score ≤ 4 correspond a un faible niveau de litteratie. Les scores ont ete decrits a partir des moyennes et ecart-types. Les questions sur le numerique ainsi que les caracteristiques du patient ont ete decrites a partir d’effectif et de frequence. Resultats Parmi les 126 patients a qui un questionnaire a ete propose, 25 % ont refuse et 13 % etaient dans l’incapacite d’y repondre. Au total, 78 patients (62 %) ont complete le questionnaire, dont 74 % de femmes. L’âge median etait de 78,5 ans (65–95 ans). L’echelle FCCHL etait complete pour 68 % des patients. Les scores moyens de litteratie fonctionnelle, interactive, critique et globale etaient respectivement de 3,5 (± 1), 3,9 (± 0,8), 3,4 (± 1) et 3,6 (± 0,6). Un faible niveau de litteratie etait present chez 72 % des patients. Concernant le numerique, chaque item etait complete par ≥ 95 % des patients. Les 2/3 avaient acces a internet et la moitie a un smartphone. Moins de la moitie realisaient des recherches sur leur sante et 1/3 ne semblaient pas connaitre la telemedecine. Conclusion Cette etude pilote montre une bonne acceptabilite du questionnaire chez les PA avec participation de l’aidant si necessaire. En comparaison avec des donnees francaises chez les adultes, le niveau de litteratie est plus faible dans cette population et la dimension critique est la plus faible. Une etude prospective nationale prendra en compte ces premiers resultats pour ajuster les criteres d’inclusion, les modalites de recueil et l’adaptation des questions sur le numerique. Elle permettra de caracteriser les populations a faible niveau de litteratie en sante pour proposer des actions aupres des centres.

Screening is the early detection of a latent disorder by a test to allow early intervention with the aim of improving prognosis. Individual and population perspectives on screening are perceived as opposing interests of patients and the population. In this article, we try to reconcile these perspectives. The individual perspective is based on the clinical experience of a better prognosis at early stages and patients with missed opportunities. In the population perspective, screening is based on a population-oriented, evidence-based model and addresses the acceptability and possible negative effects, including for people without the disorder. Known possible obstacles to a positive effect of screening include a short latent stage, lead time, overdiagnosis, lack of acceptability, poor performance of tests, and misclassification of outcome. Randomized trials of screening are challenging and need an adaptation of standards such as the Consolidated Standards of Reporting Trials (CONSORT). Simulating the effects of screening can allow the consideration of complex screening strategies and other options to help avoid biases related to treatment improvement and prevention success. Reconciling both perspectives is possible by considering that hypotheses underlying the former are prerequisites for the latter. From an evidence-based medicine and policy perspective, we suggest that recommending screening or prescribing a test is unethical if all possible obstacles are not documented by providing the best available evidence.

Summary Background The care management of colorectal cancers has evolved, particularly since the implementation of multidisciplinary team meetings (MDTm). The aim of this study was to identify factors associated with the non-presentation of colon cancer patients in MDTm (no-MDTm) and to assess the association between no-MDTm and the diagnostic and therapeutic care management, in two areas in France, in 2010. Methods Patients over 18 years diagnosed for invasive colon cancer in Gironde and Tarn during 2010 were included from the cancer registries of these two departments. We used five indicators to evaluate the care management of colon cancer patients (about diagnosis, treatment and selection of patients for chemotherapy). Results No-MDTm patients were more likely to die early after diagnosis (OR = 2.94, 95% CI = [1.52–5.66]). Elderly patients and those living in more disadvantaged areas were less often presented in MDTm (OR≥85years = 2.10, 95% CI = [1.06–4.18]; OREDI Q4-Q5 = 1.96, 95% CI = [1.23–3.14]). After adjusting for patient-related variables (age, comorbidities, deprivation) and tumor (stage at diagnosis), we found that thoracic CT scan was less often performed among no-MDTm patients (OR = 0.40, 95% CI = [0.24–0.65]). There was no association between the absence of MDTm and the therapeutic care management indicators. Conclusion In conclusion, therapeutic care management was not associated with the absence of MDTm but with patient and tumor characteristics, including age, comorbidities and level of deprivation, that influence the non-presentation in MDTm.

Faced with the lack of evidence-based medicine concerning the efficacy and tolerance of cancer treatments in the extremely heterogeneous elderly population, and with no standardised geriatric evaluation in geriatric oncology clinical trials, the intergroup Dialog set itself the objective of establishing a minimal standardised geriatric evaluation for clinical trials. The evaluation must be simple, short and effective. It must comprise validated and reproducible measurement tools. The Geriatric Core Dataset, made up of seven items, has been formalised and validated by national and international experts.

Objective The primary objective of this non-randomised phase II study was to evaluate the combination of systemic chemotherapy plus cetuximab after complete cytoreductive surgery (CCS) for treatment of isolated colorectal peritoneal carcinoma (CRPC). This multicentre, prospective phase II clinical trial was conducted in seven national cancer referral centres, however research published during study recruitment indicated cetuximab treatment as ineffective in patients with mutated KRAS genes, leading to an additional exclusion criterion to the current protocol, excluding patients with mutated KRAS genes. This significantly impacted recruitment and the study did not achieve the necessary recruitment of 46 patients. Results Fourteen patients underwent CCS and were included in the study, however one did not provide informed consent and another received only one cycle of chemotherapy leading to 12 patients in the per protocol population for analysis. Adjuvant Folfox Cetuximab was administered when CCS was achieved for patients > 18 years with histologically proven CRPC and no other metastatic disease (liver, lungs, lymphadenopathy, etc.). CRPC median index was 5.00 (range: 1–17). Median PFS was 12.3 months [95% CI (3.7–28.2)] with 8.3% [95% CI (0.5–31.1)] and 0% PFS at 3 and 5 years respectively. Median OS was 43.4 months [95% CI (16.8–60)]. Trial registration Clinical Trials NCT00766142, October 3, 2008. Retrospectively registered

IntroductionGuidelines concerning the follow-up of subjects occupationally exposed to lung carcinogens, published in France in 2015, recommended the setting up of a trial of low-dose chest CT lung cancer screening in subjects at high risk of lung cancer.ObjectiveTo evaluate the organisation of low-dose chest CT lung cancer screening in subjects occupationally exposed to lung carcinogens and at high risk of lung cancer.Methods and analysisThis trial will be conducted in eight French departments by six specialised reference centres (SRCs) in occupational health. In view of the exploratory nature of this trial, it is proposed to test initially the feasibility and acceptability over the first 2 years in only two SRCs then in four other SRCs to evaluate the organisation. The target population is current or former smokers with more than 30 pack-years (who have quit smoking for less than 15 years), currently or previously exposed to International Agency for Research on Cancer group 1 lung carcinogens, and between the ages of 55 and 74 years. The trial will be conducted in the following steps: (1) identification of subjects by a screening invitation letter; (2) evaluation of occupational exposure to lung carcinogens; (3) evaluation of the lung cancer risk level and verification of eligibility; (4) screening procedure: annual chest CT scans performed by specialised centres and (5) follow-up of CT scan abnormalities.Ethics and disseminationThis protocol study has been approved by the French Committee for the Protection of Persons. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.Trial registration numberNCT03562052; Pre-results.

International audience; PURPOSE: Clinical experience suggests that functional decline (FD) during treatment may have a major adverse impact on outcome. Geriatric assessment of older patients before cancer treatment is usually based on use of a screening tool (such as G8) followed by comprehensive geriatric assessment (CGA). However, many oncology teams cannot implement geriatric oncology management due to non-availability of geriatricians. Consequently, we decided to evaluate whether a procedure using G8 and routinely available factors could help oncologists foresee the outcome in patients >/=70: we firstly evaluated whether functional decline is a determinant of early death, then searched for predictors of early functional decline (measured before initiation of the second cycle of chemotherapy), including G8 but voluntarilly excluding CGA. METHODS: We tested the value of clinical, biological factors and early FD to predict early death on a cohort of 292 patients (>/=70years) treated with first-line chemotherapy. We then used a logistic regression model to search for pretreatment predictors of FD, including the same factors and G8 but excluding CGA. RESULTS: FD occurred in 48 patients. In multivariate analyses, early FD (OR=4.13, 95% CI [1.89; 9.04], p/=70 treated with chemotherapy, and G8 predicts for its occurrence. These data reinforce the routine use of G8 in the management of these patients.

Rare cancers are not so rare, their incidence is increasing and, as a group, they have worse survival than the common cancers. These factors emphasise the societal need to ensure sufficient focus on research into their biological basis, aetiological factors, new more effective therapies and organisation of healthcare to improve access to best practice and innovation. Accuracy of diagnosis is one of the first hurdles to be overcome, with around one third of tumours being reclassified - by type or risk group - when subject to a centralised pathology review process. Timely access to appropriate expert knowledge is a second challenge for patients - in Europe this is being addressed by the establishment of European Reference Networks (ERNs) as part of the EU cross border healthcare initiative. There are ERNs for adult solid and haematological cancers and childhood cancers, all of which are individually rare. These ERNs will facilitate creation of large databases of rare tumours that will incorporate knowledge of their molecular features and build an evidence base for the effectiveness of innovative, biology-directed therapies. With an increasing focus on 'real world' outcome data, research methodologies are evolving, to include randomised registry trials and data linkage approaches that exploit the ever-richer information held on patients in routine health care data. The inclusion of genomic analysis into cancer diagnosis, treatment and risk prediction raises many issues for the conduct of clinical research and cohort studies and personal data sharing. Sophisticated means of pseudonymisation, together with full involvement of affected and 'at risk' patients, are supporting novel research designs and access to data that will continue to build the evidence base to improve outcomes for patients with rare cancers.