Identification of resources and skills developed by partners of patients with advanced colon cancer: a qualitative study

PURPOSE

Family caregivers play an important role in caring for patients with advanced cancer. To become competent, individuals must draw on and mobilise an adequate combination of resources. Our goal was to identify the skills developed by caregivers of patients with advanced cancer and the associated resources mobilised. We chose to do it with partners of patients with colon cancer.

METHODS

The study used a cross-sectional qualitative design based on 20 individual interviews and a focus group. Partners were recruited from patients treated in three hospitals of France. Semi-structured interviews were conducted until data saturation was achieved. Each interview was transcribed verbatim, and thematic analyses were performed to extract significant themes and subthemes.

RESULTS

Results from the individual and focus group interviews showed that the skills implemented by the partners (in domains of social relationships and health, domestic, organisational, emotional and well-being dimensions) were singular constructs, dependant on if resources (personal, external and schemes) may have been missing and insufficient. In addition, partners may have had these resources but not mobilised them.

CONCLUSION

The identification of the skills and associated resources could allow healthcare professionals better identifying and understanding of the difficulties met by partners in taking care of patients. This could enable them to offer appropriate support to help the caregivers in their accompaniment.

Influence of the geriatric oncology consultation on the final therapeutic decision in elderly subjects with cancer: analysis of 191 patients

OBJECTIVES

Evaluate the impact of the Geriatric Oncology Consultation on the final therapeutic management of cancer in elderly patients aged 70 and older.

DESIGN

Retrospective study.

SETTING

The Pilot Coordination Unit in Geriatric Oncology of Côte d'Or, Burgundy, France.

PARTICIPANTS

From January 2010 to December 2010, 191 patients with cancer aged 70 and older.

MEASUREMENTS

The concordance between the treatments proposed following the Tumor Board, those proposed following the Geriatric Evaluation (GE) and those actually given to the patients was evaluated using the Kappa agreement test.

RESULTS

One hundred and ninety-one patients were included. Mean age was 81.5. The most frequent cancer locations were breast (31.9%), colon-rectum (14.1%) and lung (10.5%). Concordance between the cancer treatments proposed by the Tumor Board and those suggested after the GE was excellent except for chemotherapy and targeted therapy, which were recommended less frequently by the geriatrician (Kappa = 0.67), and support care, which was more often proposed after the GE (Kappa = 0.61). However, concordance between treatments proposed by the geriatrician and treatment actually given was not so good for chemotherapy (Kappa = 0.58), and surgery (Kappa = 0.61), since both were often replaced by a less aggressive treatment.

CONCLUSION

Concordance between the therapies proposed during the Tumor Board or after the Geriatric Oncology Consultation and the treatment actually given was satisfactory. However, the role of the oncologist remains determinant in the final choice, especially for chemotherapy.

[Type 2 diabetes in the elderly, which specific features?]

Type 2 diabetes, whose prevalence has increased among elderly aged over 75 years, has a number of specific features which differ from that in young people: heterogeneous population, association with other cardiovascular risk factors and several comorbidities, different therapeutic constraints and risks, and lower life expectancy. By using a standardized geriatric assessment it is possible to determine therapeutic and glycemic goals for each patient. In the elderly, main complications of diabetes are hypoglycemia and foot lesions. In order to avoid malnutrition, lifestyle and dietary rules should not be too strict. Recommendations for the prescription of oral antidiabetic agents are the same for both elderly and young subjects, but with increased monitoring in the elderly because of the high risk of complications including iatrogenic hypoglycemia. Insulin therapy should be preferred.

Calcium, phosphorus, vitamin D, dairy products and colorectal carcinogenesis: a French case--control study

A protective effect of calcium against colorectal cancer has been described in Anglo-Saxon but not in Latin communities, and no such effect has been observed regarding adenomas. We investigated the relationship between calcium, dairy products and the adenoma-carcinoma sequence in a French region by comparing small adenoma ( < 10 mm, n = 154), large adenoma (n = 208) and polyp-free (n = 426) subjects, and cancer cases (n = 171) with population controls (n = 309). There was no protective effect of calcium against colorectal tumours except for low fat calcium and large adenomas in men (OR for highest quintile = 0.3, P for trend = 0.06). There was even a trend towards an increased risk of cancer with dairy calcium in men and non-dairy calcium in women. Vitamin D was inversely related to the risk of small adenomas in women (OR for highest quintile = 0.4, P for trend = 0.04). Regarding dairy products, only consumption of yoghurt displayed an inverse relationship with risk of large adenomas, in both men and women. These data failed to demonstrate a protective effect of calcium against colorectal carcinogenesis. They suggest that the type of dairy product might be the important factor with regard to prevention of colorectal tumours.

[MRI in the early diagnosis of spinal metastases of bronchial cancer]

MRI of the whole spine and radionuclide bone scan were performed prospectively on 50 consecutive patients with newly diagnosed non small-cell lung carcinoma. The final diagnosis of vertebral metastasis was made by means of follow-up studies. The prevalence of vertebral metastasis was 24% (12/50 patients). The sensitivity of MR imaging (92%) was superior to that of radionuclide bone scan (67%) in the detection of vertebral involvement, the specificity was the same (94%). MRI of the spine was not useful as a screening procedure before treatment, but offered advantages over radionuclide bone scan in patients with symptoms and when bone scintigraphy detected abnormal foci, including identification of additional vertebral metastatic foci and better analysis of the extent of metastatic involvement within vertebrae.

Family history of colorectal tumours and implications for the adenoma-carcinoma sequence: a case control study

Family history of colorectal cancer is a risk factor for sporadic colorectal cancer, but it is not known which step of the adenoma-carcinoma pathway it influences. This case control study investigated the relation between family history of cancer and colorectal adenomas and cancers. Family history of colorectal cancer (FHCRC) was as frequent in small (< 10 mm) adenoma patients (11.7%, n = 154) as in polyp free patients (10.6%, n = 426), whereas it was more frequent in patients with large adenoma(s) (18.8%, n = 208; p < 0.01). Odds ratios for FHCRC were 1.2 (p > 0.10) for small adenomas and 2.1 (p < 0.01) for large adenomas. Family history of other (non-colorectal) cancers (FHOC) was similar in the three groups. Patients with a colorectal cancer (n = 171) had more frequently a family history of cancer, both colorectal (15.8%; p < 0.01) and other cancers (35.7%; p < 0.001) than general population controls (n = 309; FHCRC: 8.1%; FHOC: 21.7%). In a logistic model, both factors were independently related to colorectal cancers (odds ratios: 1.9 (p < 0.05) for FHCRC and 2.1 (p < 0.001) for FHOC). These data suggest that family history of colorectal cancer influences only the growth of adenomas or their malignant transformation. The finding of a further predisposition to any type of cancer needs to be confirmed.

Tobacco, alcohol, and colorectal tumors: a multistep process

A case-control study in the Côte d'Or area of France used the multistep concept of colorectal carcinogenesis to compare lifetime tobacco consumption and present alcohol consumption in patients with small adenomas (less than 1 cm, n = 154) or large adenomas (n = 208) and in polyp-free controls (n = 427). Cancer patients (n = 171) were compared with population controls (n = 309). In men, smoking was associated with the risk of adenomas (odds ratio = 3.6 over 20 pack-years vs. nonsmokers, p < 0.001). Alcohol was a risk factor for large adenomas only, with relative risks of 4.2 (p < 0.01), 3.0 (p < 0.05), and 4.4 (p < 0.01) for consumptions of 20-39, 40-59, and 60 g/day compared with less than 10 g/day. When patients with large adenomas were compared with polyp-free controls, both alcohol and tobacco were independently related to the risk of tumor. There was no association between tobacco or alcohol intakes and cancer risk. In women, consumption was much lower in all groups, and no significant association with either risk factor was observed. These data suggest for the first time that there is an independent effect of alcohol and tobacco in men at different early steps of the adenoma-carcinoma sequence. They demonstrate the usefulness of such a model for etiologic studies on cancer.