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Pironi L, Cuerda C, Jeppesen PB, Joly F, Jonkers C, Krznarić Ž, Lal S, Lamprecht G, Lichota M, Mundi MS, Schneider SM, Szczepanek K, Van Gossum A, Wanten G, Wheatley C, Weimann A. ESPEN guideline on chronic intestinal failure in adults - Update 2023. Clin Nutr 2023; 42:1940-2021. [PMID: 37639741 DOI: 10.1016/j.clnu.2023.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND & AIMS In 2016, ESPEN published the guideline for Chronic Intestinal Failure (CIF) in adults. An updated version of ESPEN guidelines on CIF due to benign disease in adults was devised in order to incorporate new evidence since the publication of the previous ESPEN guidelines. METHODS The grading system of the Scottish Intercollegiate Guidelines Network (SIGN) was used to grade the literature. Recommendations were graded according to the levels of evidence available as A (strong), B (conditional), 0 (weak) and Good practice points (GPP). The recommendations of the 2016 guideline (graded using the GRADE system) which were still valid, because no studies supporting an update were retrieved, were reworded and re-graded accordingly. RESULTS The recommendations of the 2016 guideline were reviewed, particularly focusing on definitions, and new chapters were included to devise recommendations on IF centers, chronic enterocutaneous fistulas, costs of IF, caring for CIF patients during pregnancy, transition of patients from pediatric to adult centers. The new guideline consist of 149 recommendations and 16 statements which were voted for consensus by ESPEN members, online in July 2022 and at conference during the annual Congress in September 2022. The Grade of recommendation is GPP for 96 (64.4%) of the recommendations, 0 for 29 (19.5%), B for 19 (12.7%), and A for only five (3.4%). The grade of consensus is "strong consensus" for 148 (99.3%) and "consensus" for one (0.7%) recommendation. The grade of consensus for the statements is "strong consensus" for 14 (87.5%) and "consensus" for two (12.5%). CONCLUSIONS It is confirmed that CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for the underlying gastrointestinal disease and to provide HPN support. Most of the recommendations were graded as GPP, but almost all received a strong consensus.
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Affiliation(s)
- Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Center for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Francisca Joly
- Center for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Cora Jonkers
- Nutrition Support Team, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Željko Krznarić
- Center of Clinical Nutrition, Department of Medicine, University Hospital Center, Zagreb, Croatia
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, United Kingdom
| | | | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), United Kingdom
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany
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SINPE Position Paper on the use of home parenteral nutrition in cancer patients. Support Care Cancer 2022; 30:2909-2914. [PMID: 35037119 DOI: 10.1007/s00520-021-06785-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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SINPE Position Paper on the use of home parenteral nutrition in cancer patients. Nutrition 2022; 95:111578. [DOI: 10.1016/j.nut.2021.111578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/17/2021] [Indexed: 11/20/2022]
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Folwarski M, Kłęk S, Szlagatys-Sidorkiewicz A, Wyszomirski A, Brzeziński M, Skotnicka M. Trend Observations in Home Parenteral Nutrition. Prevalence, Hospitalizations and Costs: Results from a Nationwide Analysis of Health Care Provider Data. Nutrients 2021; 13:nu13103465. [PMID: 34684466 PMCID: PMC8539115 DOI: 10.3390/nu13103465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The population of patients on home parenteral nutrition (HPN) worldwide is growing. Since only a few counties provide data from national registries long-term observations are valuable to address this specific area of nutrition support. This study is a nationwide analysis determining the trends in the epidemiology of HPN (prevalence, age distribution, death rates), indications for HPN, causes for hospitalizations, and cost analysis of HPN reimbursement in Poland between 2010-2020. METHODS A retrospective analysis of data obtained from the national health fund (NHF) of Poland on adult patients on HPN. RESULTS The prevalence of adult patients on HPN in Poland in 2020 was 53.26 per million citizens with a 2.99-fold increase and a growing trend observed from 2010. Significant decrease in the percentage of patients between 18-34, 45-54 and an increase in patients between 65-74 and patients over 75 years old was observed. Trend analysis showed an increase in new patients between 65-74 and a decrease between 35-54. Malnutrition (34.28%), postprocedural disorders of the GI tract (19.61%), intestinal malabsorption/other intestinal diseases (20.41%) and GI obstruction due to cancer (17.36% as primary and 23.16% as secondary diagnosis) were mostly reported as the primary indications for HPN. Cancer patients were mostly gastric, ovarian and colon cancer (34.74%, 17.83% and 12.3%). HPN and total health cost reimbursement increase was 2.6 and 2.57-fold respectively. Costs of HPN and total health care costs in 2020 per patient were € 10,015 and € 16,038, respectively. Overall death risk rate during the first year of nutrition was 0.59 with a significant increase in the observation period p-trend < 0.004. A significant increase in the death rate was observed in patients above 75 years old (estimate 1.629, p-trend < 0.030). Cancer, infection, malnutrition and GI symptoms were the most common indications for hospitalizations of HPN patients. The rate of patients with a maximal length of HPN of 5 months in 2010 was 54.9% and was growing up to 78.1% in 2020. CONCLUSIONS The prevalence of HPN in Poland is growing. Trends of age distribution show increasing numbers of patients with more advanced age and shorter survival. Costs of HPN are comparable with other European data.
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Affiliation(s)
- Marcin Folwarski
- Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, 80-210 Gdańsk, Poland
- Home Enteral and Parenteral Nutrition Unit, General Surgery Department, Nicolaus Copernicus Hospital, 80-803 Gdańsk, Poland
- Correspondence: ; Tel.: +48-58-349-27-23
| | - Stanisław Kłęk
- Surgical Oncology Clinic, Maria Sklodowska-Curie National Cancer Institute, 31-501 Kraków, Poland;
| | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (A.S.-S.); (M.B.)
| | - Adam Wyszomirski
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Michał Brzeziński
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (A.S.-S.); (M.B.)
| | - Magdalena Skotnicka
- Department of Commodity Science, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
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5
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The economic costs of home parenteral nutrition: Systematic review of partial and full economic evaluations. Clin Nutr 2021; 40:339-349. [DOI: 10.1016/j.clnu.2020.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 02/08/2023]
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Arhip L, Camblor M, Bretón I, Motilla M, Serrano-Moreno C, Frías L, Velasco C, Carrascal ML, Morales Á, Cuerda C. Social and economic costs of home parenteral nutrition. Clin Nutr ESPEN 2020; 40:103-109. [PMID: 33183521 DOI: 10.1016/j.clnesp.2020.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Home parenteral nutrition (HPN) is a lifesaving treatment for people with chronic intestinal failure. Although HPN has been studied from an economic point of view, the categories of costs usually included direct costs, frequently excluding personal costs and productivity costs. The purpose of the present paper was to study the total costs of HPN from a societal perspective. METHODS Observational, retrospective, transverse study of all adult patients who were on HPN for more than 3 months and were treated at Gregorio Marañón University Hospital (Madrid, Spain), from June 2018-2019. Data on personal costs and productivity costs were collected from questionnaires completed by patients receiving HPN. We also updated the direct healthcare and non-healthcare costs studied by our group previously to Euros (€) for the year 2019. RESULTS Twenty-two patients were included. Personal costs were €729.49 per patient (€3.45 per patient per day) and productivity costs were €256.39 per patient (€1.21 per patient per day). Total HPN costs amounted to €14,460.87 per patient (€131.58 per patient per day). The direct healthcare and non-healthcare costs accounted for 96.46% of overall costs, the personal costs for the patients receiving HPN accounted for 2.62% and productivity costs for 0.92%. CONCLUSIONS From a societal perspective, the direct healthcare and non-healthcare costs accounted for the majority of HPN expenditure, followed by personal costs and productivity costs.
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Affiliation(s)
- Loredana Arhip
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - Miguel Camblor
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Irene Bretón
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Marta Motilla
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Clara Serrano-Moreno
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Laura Frías
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Cristina Velasco
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Luisa Carrascal
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ángela Morales
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Arhip L, García-Peris P, Romero RM, Frías L, Bretón I, Camblor M, Motilla M, Velasco C, Morales A, Carrascal ML, Herranz A, Sanjurjo M, Cuerda C. Direct costs of a home parenteral nutrition programme. Clin Nutr 2018; 38:1945-1951. [PMID: 30005903 DOI: 10.1016/j.clnu.2018.06.972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/06/2018] [Accepted: 06/21/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Home parenteral nutrition (HPN) is a lifesaving treatment for people with chronic intestinal failure and its cost has been reported to be very high. The purpose of the present paper was to study the direct healthcare and non-healthcare costs associated with the HPN programme managed by a tertiary hospital. METHODS Observational, retrospective study of all adult patients on HPN from 11.1.2014 to 10.31.2015 treated at Gregorio Marañón University Hospital (Madrid, Spain). An economic evaluation was undertaken to calculate the direct healthcare (HPN provision, outpatient monitoring and management of complications) and non-healthcare costs (transportation process) of the HPN programme. The variables were collected from medical records, the dispensary and the hospital's financial services. The unit costs were taken from official price lists. RESULTS Thirty-two patients met the inclusion criteria. Total direct healthcare and non-healthcare costs amounted to €13,363.53 per patient (€124.02 per patient per day). The direct healthcare costs accounted for 98.32% of overall costs, while the non-healthcare costs accounted for the remaining 1.68%. HPN provision accounted for the majority of the costs (74.25%), followed by management of complications (21.85%) and outpatient monitoring (2.23%). CONCLUSIONS The direct healthcare costs accounted for the majority of HPN expenditure, specifically HPN provision was the category with the highest percentage.
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Affiliation(s)
- L Arhip
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - P García-Peris
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - R M Romero
- Pharmacy Service, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - L Frías
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - I Bretón
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Camblor
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Motilla
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - C Velasco
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - A Morales
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M L Carrascal
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - A Herranz
- Pharmacy Service, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Sanjurjo
- Pharmacy Service, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - C Cuerda
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Abstract
Intestinal failure (IF) is the inability of the gut to absorb necessary water, macronutrients (carbohydrate, protein, and fat), micronutrients, and electrolytes sufficient to sustain life and requiring intravenous supplementation or replacement. Acute IF (types 1 and 2) is the initial phase of the illness and may last for weeks to a few months, and chronic IF (type 3) from months to years. The challenge of caring for patients with IF is not merely the management of the underlying condition leading to IF or the correct provision of appropriate nutrition or both but also the prevention of complications, whether thromboembolic phenomenon (for example, venous occlusion), central venous catheter-related bloodstream infection, IF-associated liver disease, or metabolic bone disease. This review looks at recent questions regarding chronic IF (type 3), its diagnosis and management, the role of the multidisciplinary team, and novel therapies, including hormonal treatment for short bowel syndrome but also surgical options for intestinal lengthening and intestinal transplant.
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Affiliation(s)
- Philip Allan
- Translational Gastroenterology Department, University Hospitals Oxford NHS Foundation Trust, Oxford, UK
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
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Senesse P, Isambert A, Janiszewski C, Fiore S, Flori N, Poujol S, Arroyo E, Courraud J, Guillaumon V, Mathieu-Daudé H, Colasse S, Baracos V, de Forges H, Thezenas S. Management of Cancer Cachexia and Guidelines Implementation in a Comprehensive Cancer Center: A Physician-Led Cancer Nutrition Program Adapted to the Practices of a Country. J Pain Symptom Manage 2017; 54:387-393.e3. [PMID: 28778558 DOI: 10.1016/j.jpainsymman.2017.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 01/13/2023]
Abstract
CONTEXT Cancer-associated cachexia is correlated with survival, side-effects, and alteration of the patients' well-being. OBJECTIVES We implemented an institution-wide multidisciplinary supportive care team, a Cancer Nutrition Program (CNP), to screen and manage cachexia in accordance with the guidelines and evaluated the impact of this new organization on nutritional care and funding. METHODS We estimated the workload associated with nutrition assessment and cachexia-related interventions and audited our clinical practice. We then planned, implemented, and evaluated the CNP, focusing on cachexia. RESULTS The audit showed a 70% prevalence of unscreened cachexia. Parenteral nutrition was prescribed to patients who did not meet the guideline criteria in 65% cases. From January 2009 to December 2011, the CNP team screened 3078 inpatients. The screened/total inpatient visits ratio was 87%, 80%, and 77% in 2009, 2010, and 2011, respectively. Cachexia was reported in 74.5% (n = 2253) patients, of which 94.4% (n = 1891) required dietary counseling. Over three years, the number of patients with artificial nutrition significantly decreased by 57.3% (P < 0.001), and the qualitative inpatients enteral/parenteral ratio significantly increased: 0.41 in 2009, 0.74 in 2010, and 1.52 in 2011. Between 2009 and 2011, the CNP costs decreased significantly for inpatients nutritional care from 528,895€ to 242,272€, thus financing the nutritional team (182,520€ per year). CONCLUSION Our results highlight the great benefits of implementing nutritional guidelines through a physician-led multidisciplinary team in charge of nutritional care in a comprehensive cancer center.
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Affiliation(s)
- Pierre Senesse
- Department of Clinical Nutrition and Gastroenterology, Institut régional du Cancer de Montpellier (ICM), Montpellier, France; Epsylon, EA 4556 Dynamics of Human Abilities and Health Behaviors, University of Montpellier, Montpellier, France.
| | - Agnès Isambert
- Epsylon, EA 4556 Dynamics of Human Abilities and Health Behaviors, University of Montpellier, Montpellier, France
| | - Chloé Janiszewski
- Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Stéphanie Fiore
- Department of Clinical Nutrition and Gastroenterology, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Nicolas Flori
- Department of Clinical Nutrition and Gastroenterology, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Sylvain Poujol
- Department of Pharmacy, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Eric Arroyo
- Computer Information Organisation, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Julie Courraud
- Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Vanessa Guillaumon
- SIRIC Montpellier Cancer, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Hélène Mathieu-Daudé
- Medical Information Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Sophie Colasse
- Financial Affairs, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Vickie Baracos
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - Hélène de Forges
- Clinical Research Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Simon Thezenas
- Biometrics Unit, Institut régional du Cancer de Montpellier (ICM), Montpellier, France
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