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Thierry Philip

Publications and source records attributed to Thierry Philip.

34 records · Page 2Linked to original sources
PubMed2004

[An evidence-based patient information and patient education programme: the SOR SAVOIR PATIENT].

The development of good-quality patient information is a major challenge to improve quality of cancer care. The SOR SAVOIR PATIENT program aims to improve patients' understanding of cancer treatment and to facilitate their participation in clinical decisions. This programme develops evidence-based information for cancer patients based on clinical practice guidelines in oncology, the "Standards, Options and Recommendations" (SOR) which are used as primary information sources. "Translation" of SOR guidelines to laymen uses a multidisciplinary approach involving specialists in cancer care, psychologists, linguists and anthropologists. The development actively involves cancer patients using focus group methods, individual interviews and postal surveys. The SOR SAVOIR PATIENT program is conducted by the FNCLCC and the 20 French regional cancer centres, with active participation of specialists (public and private), learned societies and institutions, collaborating in multidisciplinary working groups. The leaflets Understanding scanner and Understanding Magnetic Resonance Imaging available in this edition of Bulletin du Cancer have been developed by a multidisciplinary group (radiologist, oncologist, methodologist, health care practioners, psychologist, linguist) and 30 patients, experienced patients and caregivers. These leaflets stem from a collection of patients documents on radiological examinations (Understanding mammography, Ultrasound, etc.) which have been developed to help patients and caregivers to better understand these examinations.

Decision Making↗
PubMed2004

Cryopreservation with hydroxyethylstarch (HES) + dimethylsulfoxide (DMSO) gives better results than DMSO alone.

This study compares the cryopreservation of PBSC by means of HES 3% + DMSO 5% ina mechanical freezer with the cryopreservation of PBSC by means of DMSO 10% in an automated rate controlled freezer. The cells harvested from the same patient were divided in two equal parts and frozen according to both methods. Cryopreservation with HES +DMSO is better than DMSO alone in terms of viability (p<0.001) and Granulocyte Macrophage Colony Forming Unit (GM-CFU) activity (p<0.05). The freezing curves differ essentially in the slope down after the surfusion peak. However, surfusion peaks are similar in both conditions. The relevance of mechanical freezing is the saving of time and the safety of such a procedure.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

Increased risk of systemic relapses associated with bone marrow micrometastasis and circulating tumor cells in localized ewing tumor.

PURPOSE: The presence of metastasis is a major prognostic factor in Ewing tumor (ET). The relapse pattern of patients with localized tumors has long indicated that cases with disseminated ET cells escape detection at diagnosis. ET cells are characterized by specific gene fusions that can be detected with high sensitivity and specificity by reverse transcriptase polymerase chain reaction (RT-PCR). PATIENTS AND METHODS: RT-PCR targeting EWS-FLI-1 or EWS-ERG transcripts was used to search for occult tumor cells in peripheral blood (PB) and bone marrow (BM) at diagnosis in 172 patients with ET, and the prognostic significance of this parameter was assessed. RESULTS: As we suggested previously in a smaller series of patients, RT-PCR positivity of the BM was correlated with a high risk of adverse outcome in the overall study population (P =.007). More interestingly, among patients with otherwise localized tumors, BM micrometastasis also predicted significantly poorer disease-free survival rates (P =.043). The presence of circulating tumor cells (CTC) was more frequently observed in patients with large tumors (P =.006). CTC were associated with a poor outcome among patients with clinically localized disease (P =.045). Patients with clinically localized disease and peripheral occult tumor cells as evidenced by BM and/or PB RT-PCR positivity had axial or proximal tumors and experienced relapses at a systemic rather than at a local level. CONCLUSION: Patients with localized ET and BM micrometastasis or CTC are comparable to patients with metastases in terms of the localization of the primary tumor, outcome, and relapse pattern.

Adolescent↗
PubMed2003

[The cost of cancer in France: macroeconomic and microeconomic approaches, evolution towards a prospective payment system].

In this article we have reviewed the cost of cancer in France, based on a literature review. The cost of the treatment of cancer is estimated to be 10 thousand million euros for 75,000 lives saved annually. The increasing number of economic evaluations of cancer use both a macro economic approach, based on DRG data, and a micro economic approach, based on cost result analysis. These cost studies provide the elements for a decision aid in the context of social demands, budget constraints and the evolution towards a DRG's prospective payment system which characterises present organisation of health care in France.

Cost-Benefit Analysis↗
PubMed2002

Detection of N-myc amplification by FISH in immature areas of fixed neuroblastomas: more efficient than Southern blot/PCR.

N-myc amplification is a major prognostic factor in neuroblastomas and is systematically investigated by Southern blot or polymerase chain reaction (PCR). A retrospective study of N -myc amplification has been carried out using fluorescence in situ hybridization (FISH) in 97 fixed neuroblastomas. For each tumour, FISH was performed on the area that contained the most immature neuroblasts. Among these 97 neuroblastomas, 16 were amplified and 12 were not interpretable. FISH was not interpretable in six cases. All neuroblastomas with N-myc amplification detected by Southern blot/PCR were amplified with FISH, except three that were not interpretable. Four tumours that were not interpretable in Southern blot/PCR contained more than five copies of N-myc by FISH: one was aneuploid and three were truly amplified, containing more than ten copies of N-myc. Among these three patients, two died in a short time of their tumours. Ten cases were not amplified by Southern blot/PCR and showed more than five copies by FISH: four were aneuploid and two showed heterogeneous amplification, with a few cells clearly amplified whereas most were not. Four cases were amplified, of which two patients died of their tumours. This study confirms that when applied to the most immature areas of fixed neuroblastomas, FISH displayed a higher sensitivity than molecular techniques (p < 0.001) and could detect heterogeneous amplification. FISH could therefore become an important complementary procedure in assessing prognosis in neuroblastomas.

Blotting, Southern↗
PubMed2002

High-dose chemotherapy and autologous bone marrow transplantation in diffuse intermediate- and high-grade non-Hodgkin lymphoma.

This is a review of data published in the literature on the role of marrow ablative treatment and blood or marrow transplantation for high-grade and intermediate-grade lymphoma. Timing and epidemiology are reviewed before the various clinical situations (primary refractory partial responses, complete responses and relapses). The Lyon consensus conference held in 1998 has also extensively been used and quoted.

Adult↗
PubMed2002

[Cancer networks].

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

Ethics↗
PubMed2002

[Public health: a true concern in the French political scene].

A recent report of the Senate revealed the difficulties of elaborating an effective cancer policy in France. Senators particularly pointed to the necessity of establishing cancer care priorities and to the tremendous need for medical coordination. This paper will develop the annual state debate on social security funding. The authors will show that health policy is entirely dependent on health economics. We believe that health priorities and health outcomes should be defined before any financial decision is made, this preliminary debate being an essential contribution to evidence-based policy-making in public health.

France↗
PubMed2002

[Adjuvant therapy for breast cancer patients: treatment decision tree from a French cancer network].

Although the benefit of adjuvant therapy has largely been demonstrated for patients with local breast cancer, therapeutic indications remain controversial. The French regional cancer network Oncora investigated the decision-making process for this disease. Based on a thorough review of the literature, the risk of relapse and the potential benefit of adjuvant treatments for each group of patients were evaluated. A consensus decision-tree was drawn in which chemotherapy is proposed only to patients in whom it is expected to decrease the risk of relapse by at least 5 %. This approach, based on a widely accepted decision-making model, makes it possible to offer all patients of the network homogeneous treatment options. However, due to the subjectivity of risk/benefit estimations, patients themselves should become more involved in the decision-making process.

Age Factors↗
PubMed2002

[A study based on national DRG data to evaluate work load, practice and cost relating to paediatric oncology in French hospitals].

OBJECTIVES: To assess if our methodology previously used for all cancers remains valid when only 1% of cancers are analysed, we used childhood cancer in French hospitals based on national DRG data. MATERIALS AND METHODS: With a specific algorithm we extracted from the 1999 national DRG data (16,539,352 hospitalisations) the cancer data (2,947,471 hospitalisations) and the reduced cancer data (2,711,025 hospitalisations). We used this reduced cancer data to identify the 77 350 hospitalisations for childhood cancers. RESULTS: The majority of hospitalisations (83%) and the Activity Synthetic Index (ISA) for childhood cancers are concentrated on University hospitals and regional cancer centres. The cost of childhood cancers was estimated to be 136 million euros, with haematology costing 60 million euros. Chemotherapy, which accounted for almost 50% of the ISA is the predominant therapy. DISCUSSION AND CONCLUSION: Our results appear to be consistent with the incidence and the clinical practices described by the population registries and the registry of the French Society for Paediatric Oncology. They correspond also with the organisation of the care of those patients which converges towards the global care of the patient in which the concept of health networks and patient's trajectories are pivotal. However, an investigation inside the hospitals is required to see if our results correspond with the reality. This is the objective of our next study.

Algorithms↗