After about 20 years of exciting improvements in treatment efficacy outcomes of advanced epidermal growth factor receptor(EGFR)mutant and anaplastic lymphoma kinase(ALK)rearranged non-small cell lung cancer(NSCLC),als...After about 20 years of exciting improvements in treatment efficacy outcomes of advanced epidermal growth factor receptor(EGFR)mutant and anaplastic lymphoma kinase(ALK)rearranged non-small cell lung cancer(NSCLC),also combined with a progressively better safety profile,from chemotherapy to new generation tyrosine kinase inhibitors(TKIs)(osimertinib,alectinib,brigatinib),the recent MARIPOSA and CROWN trials have changed this trend.For the first time in the history of EGFR and ALK treatments,we must face the issue of being a step behind in terms of toxicity profile.The combination of amivantamab plus lazertinib in EGFR mutant NSCLC,and lorlatinib in ALK rearranged NSCLC,has improved efficacy outcomes as never before.The story would be easy and totally positive if these two innovative,amazing treatments were not associated with new peculiar features in safety profiles that must be discussed with patients,because they potentially affect their quality of life.When treating these patient populations,the peculiar safety profiles of amivantamab plu lazertinib and lorlatinib require a well-structured shared decision making,“where and when”,both the high probability of a longer survival and the risk of worse quality of life must be well announced and explained to our patients before the shared final treatment choice.展开更多
Background:Information on the possibility of drawing up Advance Directives(AD)is a necessity,and represents a major medical,ethical,and legal challenge.The difficulties are numerous,both organizational and cultural,an...Background:Information on the possibility of drawing up Advance Directives(AD)is a necessity,and represents a major medical,ethical,and legal challenge.The difficulties are numerous,both organizational and cultural,and this is also true in the context of oncology,where ADs(and more broadly,advanced palliative care)are of critical importance.As an eminently sensitive subject,dealing with ADs(and therefore with end-of-life issues)requires both societal and medical/health-care acculturation.An institutional approach has therefore been developed,to deploy information tools,training professionals,and formalize the collection of AD.Such an approach cannot be implemented without an assessment not only of its objective results but also above all of its psychological effects,on both users(patients,family caregivers)and professionals.Methods:This longitudinal study,based on a mixed-method,interdisciplinary approach,will assess the impact of this information dissemination on AD,in terms of both potential positive and negative effects,using validated measurement methods.Thus,this study follows the 5 criteria of the RE-AIM model,designed to analyze the interest and impact of a device intended for users of the healthcare system;we will use a mixed methodology,relying on both a quantitative component(counting the number of people benefiting from the scheme,and those requesting support in drawing up their DA...,administering questionnaires),as well as a qualitative component(focus groups)which will enable us to study the subjective experiences of users,their relatives and the professionals involved in the scheme.Results:The results of this study will make it possible to determine the effects of this system of assistance in the drafting of ADs,which is currently being promoted by the legislator,but which is struggling to be implemented.展开更多
文摘After about 20 years of exciting improvements in treatment efficacy outcomes of advanced epidermal growth factor receptor(EGFR)mutant and anaplastic lymphoma kinase(ALK)rearranged non-small cell lung cancer(NSCLC),also combined with a progressively better safety profile,from chemotherapy to new generation tyrosine kinase inhibitors(TKIs)(osimertinib,alectinib,brigatinib),the recent MARIPOSA and CROWN trials have changed this trend.For the first time in the history of EGFR and ALK treatments,we must face the issue of being a step behind in terms of toxicity profile.The combination of amivantamab plus lazertinib in EGFR mutant NSCLC,and lorlatinib in ALK rearranged NSCLC,has improved efficacy outcomes as never before.The story would be easy and totally positive if these two innovative,amazing treatments were not associated with new peculiar features in safety profiles that must be discussed with patients,because they potentially affect their quality of life.When treating these patient populations,the peculiar safety profiles of amivantamab plu lazertinib and lorlatinib require a well-structured shared decision making,“where and when”,both the high probability of a longer survival and the risk of worse quality of life must be well announced and explained to our patients before the shared final treatment choice.
文摘Background:Information on the possibility of drawing up Advance Directives(AD)is a necessity,and represents a major medical,ethical,and legal challenge.The difficulties are numerous,both organizational and cultural,and this is also true in the context of oncology,where ADs(and more broadly,advanced palliative care)are of critical importance.As an eminently sensitive subject,dealing with ADs(and therefore with end-of-life issues)requires both societal and medical/health-care acculturation.An institutional approach has therefore been developed,to deploy information tools,training professionals,and formalize the collection of AD.Such an approach cannot be implemented without an assessment not only of its objective results but also above all of its psychological effects,on both users(patients,family caregivers)and professionals.Methods:This longitudinal study,based on a mixed-method,interdisciplinary approach,will assess the impact of this information dissemination on AD,in terms of both potential positive and negative effects,using validated measurement methods.Thus,this study follows the 5 criteria of the RE-AIM model,designed to analyze the interest and impact of a device intended for users of the healthcare system;we will use a mixed methodology,relying on both a quantitative component(counting the number of people benefiting from the scheme,and those requesting support in drawing up their DA...,administering questionnaires),as well as a qualitative component(focus groups)which will enable us to study the subjective experiences of users,their relatives and the professionals involved in the scheme.Results:The results of this study will make it possible to determine the effects of this system of assistance in the drafting of ADs,which is currently being promoted by the legislator,but which is struggling to be implemented.
