Introduction Les patients âgés atteints de cancer sont particulièrement vulnérables face au risque iatrogène médicamenteux et l’implication du pharmacien dans leur prise en charge multidisciplinaire est nécessaire tout au long du parcours de soins. Cette étude vise à réaliser un état des lieux du déploiement en France des activités de pharmacie clinique intégrées à la prise en charge multidisciplinaire en oncogériatrie. Méthode Une enquête en ligne auprès des pharmaciens des sociétés savantes françaises de pharmacie clinique (SFPC) et oncologique (SFPO) a été réalisée entre le 1er mai 2023 et le 31 août 2023. Le questionnaire portait sur la description des activités de pharmacie clinique associées aux activités pluridisciplinaires en oncogériatrie développées dans l’établissement. Une réponse unique par structure était demandée. Résultats Sur 70 répondants, 65,7 % proposent une activité d’évaluation oncogériatrique multidisciplinaire. Des activités de pharmacie clinique y étaient associées dans 38,6 % des établissements et en projet dans 14,2 %. Elles sont réalisées en parallèle de l’activité médicale, majoritairement au décours de l’initiation du traitement anticancéreux et en ambulatoire. Elles comportent notamment la conciliation médicamenteuse et l’optimisation du traitement. Les principaux freins à leur développement sont le manque de ressources humaines et financières, notamment dans le cadre d’une hospitalisation complète. Discussion/Conclusion Les pharmaciens restent encore trop peu intégrés aux équipes multidisciplinaires en oncogériatrie, malgré leur rôle crucial dans le parcours de soins et l’impulsion donnée par les sociétés savantes. L’évolution des modes de financement et le développement de la coopération ville–hôpital pourrait permettre à l’avenir de favoriser cette intégration.

The role of hospital oncology pharmacists (HOP) in the care of cancer patients has evolved considerably. This evidence led the experts of the French Society for Oncology Pharmacy (SFPO) to write a position paper. The first part presents the key insights of oncology pharmacy services (technology aspects of anticancer drug preparation and clinical pharmacy services), training of HOPs and research activities (clinical trials, research in oncology pharmacy). The second part of this position paper refers to the challenges and perspectives of E-health and artificial intelligence, precision medicine, access to innovation, and environmental issues.

Introduction L’admission des patients porteurs d’un cancer bronchique en réanimation reste débattue, le décès survenant en moyenne dans 40 % des hospitalisations. Cependant, 16 % des cancers bronchiques sont découverts en réanimation. En raison de sa localisation médiastinale et de sa vitesse évolutive, le cancer bronchique à petites cellules (CBPC) peut entraîner une détresse respiratoire aiguë prise en charge en réanimation. Une fonte tumorale rapide après une 1ère chimiothérapie associant sels de platine et étoposide est possible. La survie des patients hospitalisés au diagnostic de CBPC en réanimation n’a pas été spécifiquement étudiée. Méthodes Cette étude rétrospective a inclus les patients ayant eu une 1ère chimiothérapie pour un CBPC au CHU de Dijon de janvier 2012 à juillet 2022. Deux groupes étaient analysés selon que le traitement était administré en soins intensifs respiratoires ou en réanimation (SIRR) vs en secteur conventionnel (SC). Les déterminants de la mortalité ont été analysés par régression logistique. Résultats La chimiothérapie a été administrée à 30 patients en SIRR et 117 en SC, dont 59 % étaient des hommes âgés de 63 [59–71] ans et 71 % étaient métastatiques (p=0,34). La mortalité intra-hospitalière était significativement supérieure en SIRR (12 vs 37 %, p<0,01). À 6 mois, la survie était de 74 % en SC vs 47 % en SIRR (p<0,001) (Fig. 1A). En analyse multivariée, les facteurs prédictifs de la mortalité étaient l’aplasie (p=0,04), le score IGS2 (p=0,001) et les complications iatrogènes (p=0,009). L’intubation était un facteur de mauvais pronostic (HR: 1,93 [1,3-12,9], p=0,006) (Fig. 1B). Conclusion La mortalité des patients CBPC bénéficiant d’une 1ère chimiothérapie en SIRR reste élevée. Le recours à la ventilation mécanique et la survenue de complications iatrogènes sont de mauvais pronostic. Toutefois, l’admission en SIRR au diagnostic de CBPC bénéficie à 63 % des patients et doit faire l’objet d’une concertation entre l’oncologue et le réanimateur, ainsi que le patient et sa famille.

Introduction: Older patients with cancer are particularly vulnerable to the risk of adverse drug events. Therefore, it is essential that pharmacists play an active role in their multidisciplinary management throughout the care pathway. The aim of this study is to provide an overview of clinical pharmacy activities integrated into multidisciplinary management in geriatric oncology in France. Method: An online survey involving pharmacists from the French societies of clinical pharmacy (SFPC) and oncology pharmacy (SFPO) was carried out between 1st May 2023 and 31 August 2023. The questionnaire focused on the description of clinical pharmacy activities associated with multidisciplinary geriatric oncology assessment developed in the institution. A single response per hospital was required. Results: Among the 70 respondents, 46 (65.7%) offer multidisciplinary geriatric oncology assessments. Clinical pharmacy activities have already been integrated to these assessments in 27 (38.6%) hospitals, and a further 10 (14.2%) are planning to implement them in the near future. These activities are carried out in parallel with medical activities, primarily after the initiation of cancer treatment and mainly on an outpatient basis. They mostly involve medication reconciliation and optimization of drug therapy. The main obstacles to their development are the lack of human resources and funding, particularly in hospitalization settings. Discussion/Conclusion: Pharmacists are still insufficiently integrated into multidisciplinary geriatric oncology teams, despite their crucial role in the care pathway and the advocacy of professional societies. Changes in funding methods and the development of digital tools for city-hospital cooperation could help to promote this integration in the future.

BACKGROUND:Only few information is available about the impact of concomitant medication (CM) and comorbidities on the outcome of cancer patients and the tolerability of chemotherapy. METHODS:Patients of the phase III randomized trial PETACC8 had resection with curative intent of a stage III colon cancer (CC) and were treated with standard adjuvant fluoropyrimidine and oxaliplatin + /- cetuximab over 6 months. Information on CM intake has been gathered by study visits at inclusion as well as during chemotherapy. We investigated the association between number of CM as well as the 5 most frequently applied CM categories according to the WHO ATC classification system (gastro-esophageal reflux disease (GERD) treatment, anticoagulants, platelet aggregation inhibitors, cardiovascular and antidiabetic drugs) with outcome and tolerability. RESULTS:Among 2559 patients, median number of CM intake was 8 (range 0-25), with only 22 patients (0.9 %) without any CM intake. Anticoagulation treatment was the only CM category being significantly and independently associated with a shorter disease-free survival (DFS) (HR 1.29, 95 %CI 1.06-1.56, p = 0.010) as well as overall survival (OS) (HR 1.28, 95 %CI 1.02-1.59, p = 0.032). No association of number of CM (<5,5-10,>10) has been observed neither with DFS (ref.;HR 0.98;HR 1.17) nor OS (ref.;HR 0.98;HR 1.15) (p > 0.05). Patients with anticoagulants experienced significantly more grade 3/4 adverse events (AEs) (75.9 % vs 64.8 %, p = 0.002) and treatment discontinuations due to toxicity (17.7 % vs 10.8 %, p = 0.005) compared to patients without anticoagulants. DISCUSSION:Early CC patients with polypharmacy do not generally exhibit an impaired outcome. Anticoagulation was the only CM category associated with a shorter DFS and OS which might be a consequence of enhanced toxicities necessitating treatment adaptations in these patients.

Background/Objectives: Despite advances in personalized medicine, diabetes classification and management have remained widely unchanged for decades. The aims of the present study were to determine profiles of patients with type 2 diabetes at the time of their myocardial infarction and to assess 1-year cardiovascular events. Methods: All type 2 diabetic patients admitted for myocardial infarction in our Coronary Intensive Care Unit between 1 April 2021 and 30 June 2023 were included in this retrospective study. To identify patient profiles, we performed a data-driven cluster analysis based on the k-means method according to six characteristics considered as the most relevant in the literature (age at diabetes diagnosis, body mass index, glycated hemoglobin, glutamate decarboxylase antibodies, insulin resistance and beta-cell function). Cox multivariate models were used to identify predictors of 1-year cardiovascular event- and major adverse cardiovascular event-free survivals. Results: This study included 250 patients with a median age of 71 years. Our cluster repartition was as follows: 46% patients presented a severe insulin-deficient diabetes, 3% a severe insulin-resistant diabetes, 16% a mild obesity-related diabetes, 33% a mild age-related diabetes, and 2% patients suffered from a severe autoimmune diabetes. In multivariate analyses, the only independent factor for both longer cardiovascular event- and major adverse cardiovascular event-free survival was a higher glomerular function rate (hazard ratio of 0.97 and 0.98 per 1 mL/mn/1.73 m2; p = 0.01 and p = 0.03, respectively). Conclusions: This study suggests that the severe insulin-deficient diabetes and mild age-related diabetes pathophysiological phenotypes, easily estimated using insulin resistance and beta-cell function as well as age at diabetes diagnosis, body mass index, and glycated hemoglobin, were more frequent among diabetic patients at the time of their myocardial infarction. In daily clinical practice, caution is needed for patients with a low glomerular function rate, as this was associated with shorter cardiovascular event- and major adverse cardiovascular event-free survival at 1-year.

ContexteFin 2022, l’oncologie thoracique était le seul service d’oncologie de notre hôpital ne bénéficiant pas de la présence de pharmaciens cliniciens réalisant des entretiens pharmaceutiques. Dans une volonté d’amélioration de la qualité des soins, le programme collaboration assistance chimiothérapie (COACH) a été développé en janvier 2023 au sein de ce service. Il a débuté pour les patients atteints de cancer traités par thérapies orales (COACH Oral) avec la création d’un parcours patient permettant une valorisation financière de l’activité grâce à la nouvelle circulaire frontière de mars 2020. Il a ensuite été étendu, en juin 2023, aux patients traités par chimio/immunothérapie intraveineuse (COACH IV).ObjectifsL’objectif principal est de décrire la mise en place des programmes COACH en oncologie thoracique. L’objectif secondaire est de réaliser le bilan de ces programmes et d’évaluer l’impact clinique des interventions pharmaceutiques réalisées.MéthodeUn nouveau parcours patient pour les patients atteints de cancer traités par thérapies orales a été défini après plusieurs réunions multidisciplinaires (médecins, pharmaciens, infirmiers, département d’informations médicales) afin de valoriser financièrement le programme en transformant les consultations habituelles en hospitalisation de jour. L’ensemble de l’activité pharmaceutique (types d’entretiens, durée, intervention pharmaceutique (IP), impact clinique) est recueilli quotidiennement dans un tableur Excel par les pharmaciens cliniciens. L’impact clinique des interventions a été décrit selon l’échelle CLEO de la SFPC.RésultatsPour les thérapies orales, le jour de la consultation d’annonce, un rendez-vous pour une hospitalisation de jour est programmé avec la réalisation d’une imagerie, de consultations médicale et pharmaceutique (± un autre intervenant). Depuis le 1er janvier, 14 patients ont bénéficié de COACH’ORAL. 27 entretiens pharmaceutiques ont été réalisés. 13 consultations initiales ont donc été transformés en HJ intermédiaire et 14 en HJ pleine, soit une valorisation d’environ 14 300 euros. Depuis le 1er juin, 61 patients ont bénéficié de COACH IV. Au total, 74 entretiens ont été réalisés. 145 IPs ont été réalisés pour l’ensemble des deux programmes dont 42 (29%) avec un impact clinique moyen et 10 (7%) avec un impact clinique majeur.Discussion - ConclusionBien que l’activité de COACH’ORAL ait diminuée nettement depuis août (en cause, notamment, le refus de renouvellement d’un accès précoce), l’activité COACH’IV ne cesse d’accroître et va nécessiter des moyens supplémentaires. La valorisation financière de l’acte pharmaceutique fonctionne parfaitement si chaque intervenant trace son intervention le jour même dans le dossier patient informatisé. Une étude de satisfaction auprès des patients et de l’équipe médicale va être réalisée.

Abstract Background Type 2 diabetes mellitus (T2DM) is a highly heterogeneous entity, with multiple subgroups differing by clinic presentation, disease progression and risk of complications such as myocardial infarction (MI). A new T2DM phenotyping classification has been recently proposed to help to improve treatment tailoring and target early treatments, and we aimed to identify the prevalence and characteristics of the new phenotypes. Methods All consecutive adults with a history T2DM hospitalized in a french Coronary Intensive Care Unit for an acute MI between February 1st, 2021 and January 31st, 2023 were included. Clusters were based on six variables (glutamate decarboxylase antibodies, age at diagnosis, BMI, HbA1c, and homoeostatic model assessment 2 estimates of β-cell function and insulin resistance). We stratified patients into five subgroups : 1/ SAID=severe autoimmune diabetes; 2/ SIDD=severe insulin-deficient diabetes; 3/ SIRD=severe insulin-resistant diabetes; 4/ MOD=mild obesity-related diabetes; and 5/ MARD=mild age-related diabetes. Results Among the 266 patients included, characteristics according to diabetes phenotypes are summarized in the Table. Conclusions Our prospective study showed that in real-world T2DM patients with acute MI, unclassical phenotypes, i.e. hyperinsulinaemic and insulinopaenic were common. Given the large discrepancies in characteristics, our findings suggest the relevance of the new substratification. However, its clinical utlity and translation in tailored treatment strategies and prognosis remains to be determined.Table.

Transarterial chemoembolization (TACE) is recommended as a palliative treatment for patients of the B stage of the Barcelona Clinic Liver Cancer (BCLC) classification. To identify clinical, biological, and radiological predictors of survival in patients undergoing TACE and develop a pre-therapeutic prognostic score. 191 adult cirrhotic patients treated for HCC with TACE at the University Hospital (UH) of Clermont-Ferrand (France) from 2007–2017 were retrospectively included. We investigated the impact of baseline liver function, patient characteristics, and tumor burden on overall survival and developed a prognostic score. Patients had a median age of 66 years and 126 patients were Child A. The AFP-DIAM score distinguishes two groups with a significant difference in survival time (median OS 28.3 months in patients with a score = 0 versus 17.7 months in patients with a score > 0). AFP-DIAM was validated on an external cohort, is well calibrated, and has the best discrimination capacity (C-index) as compared to NIACE, HAP, STATE, and SIX TO TWELVE. AFP-DIAM and SIX TO TWELVE are the more easy-to-use scores. When AFP-DIAM and the SIX TO TWELVE scores were tested in the same statistical model, results confirmed a better AFP-DIAM performance. The AFP-DIAM is an easy-to-use score which allows to distinguish two groups with different prognosis before the first TACE session. Its use could provide further support to BCLC system to guide the therapeutic strategy of patients with HCC. An easy-to-use score allows to distinguish two groups with a different median survival. Patient with a high score could receive immunotherapy as first-line treatment.

ContexteDepuis fin 2019, notre centre hospitalier dispose des autorisations nécessaires pour l’utilisation des CAR-T Cells en hématologie. Ces traitements innovants imposent un parcours de soin spécifique, complexe et pluridisciplinaire. Un parcours spécifique pour ces patients a été créé : le parcours UMACOACH CAR-T CELLS. Dans ce dernier, un pharmacien habilité et formé réalise un 1er entretien pharmaceutique avant l’injection de CAR-T Cells au cours d’une hospitalisation de jour (HDJ). Un compte-rendu pharmaceutique et une synthèse des traitements médicamenteux sont réalisés et communiqués aux professionnels hospitaliers et de ville impliqués. Après l’injection, un entretien de suivi est réalisé lors du retour des patients en HDJ puis selon leurs besoins ou à la demande des médecins.ObjectifsL’objectif est de réaliser un bilan de ces entretiens pharmaceutiques à 3ans, d’identifier les limites et de mettre en place des axes d’amélioration.MéthodeUne étude rétrospective monocentrique a été réalisée entre janvier 2020 et octobre 2023. Le nombre d’entretiens réalisés, le temps nécessaire à leurs réalisations et à celle des activités hors-entretiens (rédaction des courriers, contact des pharmacies d’officine…) ont été recueillis quotidiennement dans un tableur Excel par les pharmaciens cliniciens. Les interventions pharmaceutiques (IPs) réalisées ont été décrites selon la classification de la Société française de pharmacie clinique et l’échelle CLEO.RésultatsAu total, 76 patients ont été traités depuis janvier 2020 par CAR-T Cells. 33 patients ont bénéficié du parcours UMACOACH CAR-T Cells. Soixante-quatre entretiens pharmaceutiques ont été réalisés (33 premiers et 31 suivis). Parmi eux, 29 (45 %) ont été réalisés en 2023. La durée moyenne d’un entretien était de 29minutes et de 45minutes pour les activités hors-entretiens. 109 IPs ont été réalisées. 18 % des problèmes détectés étaient une interaction et 13 % une indication non traitée. 11 % des IPs avaient un impact clinique majeur et 20 % un impact moyen selon l’échelle CLEO.Discussion - ConclusionCette étude démontre l’implication des pharmaciens dans le parcours de soin des patients CAR-T Cells et l’impact clinique de leurs IPs. Cette activité a fluctué ces dernières années mais ne cesse d’accroître depuis 2023. Elle reste chronophage et nécessite des ressources humaines supplémentaires, non disponible actuellement. À ce jour, la nouvelle circulaire frontière des HDJ de mars 2020 permet une réelle valorisation économique de l’intervention du pharmacien. Cependant, nous rencontrons des limites, comme les changements dans le prévisionnel du parcours de soin ou des hospitalisations précoces des patients bloquant la visite du pharmacien. Un autre point important est la rédaction en temps et en heure des courriers pour permettre une valorisation économique. Des analyses régulières avec notre département d’information médicale sont réalisées afin de vérifier nos pratiques et d’optimiser notre activité.

The major and unprecedented health crisis of Covid-19 has highlighted many points of rupture in the management of patients (lack of follow-up, no biological control or imaging, delay in treatment, delay in diagnosis, etc.). We have shown that use of digital health solutions like an application on smartphone, is not sufficient because a majority of patients are not able to use it. CHU Dijon, ARS-BFC and GRADEs, as promoters, are developing an innovative approach through an automated collection of health data to improve therapeutic monitoring. We aimed to develop an innovative approach so that any patient leaving the cardiology unit can benefit from improved therapeutic follow-up upon discharge after an acute coronary syndrome (ACS). We first focused on monitoring kidney function after coronary angiography and monitoring cholesterol levels of all patients hospitalized for ACS and consenting to follow-up. Their identity, biological results and the medical prescription at discharge are automatically retrieved from a data warehouse. The city results of the blood tests prescribed during hospitalization are automatically recovered as well as any dispensation of medicines issued after a city pharmacy. Pre-defined algorithms condition an alert message based on the biological results. This message may suggest a treatment change to the prescriber if necessary. Currently, the flow of medical information (biology, prescription) from the hospital is active. Medical data flows from urban laboratories and pharmacies are ongoing. The supply, enrichment and extraction of medical data are controlled. The queries will be an indispensable tool to validate the algorithms and the concept. The results will be presented at the congress. The deployment of this innovative approach could improve the medical monitoring of post-hospitalization patients and help the practitioner to optimize his time, by automatically retrieving the biological results of analytical laboratories and the drugs dispensed by pharmacies. Once fully validated, this original strategy could be generalized to other cardiac or non-cardiac pathologies, at the regional and/or national level.

Objective. - Cardiovascular risk is increased in patients with diabetes. Little is known about glycemic and lipid control in patients with diabetes. We aimed to assess glycemic and lipid controls in patients with diabetes at time of their myocardial infarction. Method. - All known patients with type 2 diabetes consecutively admitted for a myocardial infarction in our coronary care unit between March 1st and December 31st, 2021 were included in this retrospective study. Glycemic and lipid control was assessed through individualized target of glycated haemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-c), respectively. At admission, the comprehensive list of chronic medications was obtained through medication reconciliation. Results. - This study included 112 patients with a median age of 72 years. Most of patients had an individualized target of HbA1c and LDL-c of 7.0% (67%) and 0.55 g/L (96%), respectively. The rate of uncontrolled patients for HbA1c and LDL-c and both was 46%, 90%, and 42% respectively. The rate of patients with non-optimal glucose- and lipid-lowering medications in uncontrolled patients was 63% and 87%, respectively. The rate of inappropriate glucose- and lipid-lowering medications was 73% and 91%, respectively. Conclusion. - We highlighted the poor glycemic and lipid control in high-risk CV patients. There is an urgent need to develop multidisciplinary approaches to optimize CV risk factors control to reduce myocardial infarction and strokes. (c) 2024 Published by Elsevier Masson SAS on behalf of Academie Nationale de Pharmacie.

Introduction > The evolution of pharmacotherapeutic management of cancer patients makes essential the role of the community pharmacist through its management conducted in community pharmacy as well as its relationships with the hospital and primary care professionals. The objective of this work is to study this pharmacotherapeutic management, for all routes of administration considered. Methods > This observational study is based on a questionnaire and semi -structured interviews conducted with community pharmacists in contact with the Unite medicale ambulatoire de cancerologie (UMAC) of the University Hospital of Dijon. Results > The main objective of community pharmacists is to ensure that patients understand and comply with their treatment. Twenty-one percent of them have already implemented oral anticancer drug interviews. Sixty-five percent have partial information about the injectable treatments administered to their patients while only 3 % have complete knowledge. Sixty-nine percent of community pharmacists are satisfied with the documents sent by the UMAC (summary of drug treatments, pharmaceutical report, individualized pharmaceutical plan). However, the lack of information from hospital structures generally represents one of the main difficulties in the management of cancer patients by community pharmacists and coordination with other professionals. Discussion > The information and training of community pharmacists represent possible improvements for a better care and coordination between healthcare professionals. Some emerging practices, such as the implementation of oral anticancer drug interviews in community pharmacies and the participation of community pharmacists in primary care coordination organizations, also represent opportunities to strengthen their role in the management of cancer patients.

Introduction The increasing number of oral anticancer medicines (OAMs) dispensed in community pharmacies and the associated challenges (misuse, management of side effects) give the community pharmacist (CP) a major role in the pharmacotherapeutic management of cancer patients. In France, as a response to these challenges, cancer outpatients can schedule a meeting with their CP to ensure the safe and effective use of OAMs. The objectives of this study were to evaluate the perspectives of these interventions regarding their implementation and the opinion of French CPs. Methods A declarative survey and semi-structured interviews were conducted with CPs that dispensed at least one OAM between January 2021 and March 2022. The study was conducted between April and August 2022. Results Eighty-five CPs completed the survey. Of these pharmacists, 21% ( n = 18) had already performed OAM interventions and 91% ( n = 61) wanted to implement them. Lack of time, knowledge and training were the main barriers to implementation. No correlations were identified between the characteristics of community pharmacies and the likelihood of implementing OAM interventions. Conclusions Considering that CPs seem willing to implement them and the favourable context in France, this observational study highlights the potential of OAM interventions to improve the management of cancer patients. Though further studies are required to better evaluate the implementation and the potential effects of these interventions, OAM interventions could be relevant strategies in other healthcare systems to secure the management of cancer patients through the involvement of the CP.

Background: There are few data assessing the risk of death and cardiovascular events in patients with lymphoma.Aim: Using a nationwide hospitalization database, we aimed to address cardiovascular outcomes in patients with lymphoma.Methods: From 01 January to 31 December 2013, 3,381,472 adults were hospitalized in French hospitals; 22,544 of these patients had a lymphoma. The outcome analysis (all-cause or cardiovascular death, myocardial infarction, ischaemic stroke, bleedings, new-onset heart failure and new-onset atrial fibrillation) was performed over a 5-year follow-up period. Each patient with lymphoma was matched with a patient without a lymphoma or other cancer (1:1). A competing risk analysis was also performed.Results: After adjustment on all risk factors, cardiovascular and non-cardiovascular co-morbidities, the subdistribution hazard ratios for all-cause death, major bleeding, intracranial bleeding, new-onset heart failure and new-onset atrial fibrillation were higher in patients with lymphoma; conversely, the subdistribution hazard ratios for cardiovascular death, myocardial infarction and ischaemic stroke were lower in patients with lymphoma. In the matched analysis, the risk of all-cause death (subdistribution hazard ratio 1.936, 95% confidence interval 1.881–1.992) and major bleeding (subdistribution hazard ratio 1.117, 95% confidence interval 1.049–1.188) remained higher in patients with lymphoma.Conclusion: In this large nationwide cohort study, patients with lymphoma had a higher incidence of all-cause death and major bleeding.