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Master Thesis

Mélanome uvéal métastatique : étude descriptive d'un modèle d'intégration précoce des soins palliatifs

Abstract : Background: uveal melanoma is a rare cancer. Up to 50% of patients develop metastasis, mainly hepatic. Prognosis is poor: median survival after metastasis is 12 months, in contrast with no significant symptom burden and a preserved overall condition until death. To assess the possibility of integrating early palliative care, we conducted the first pilot study to describe palliative care team activities and patient outcomes. Material and methods: from June 2016 to June 2018, 47 MUM patients began early, concomitant follow up by the oncologic and palliative teams at Institut Curie. Alongside clinical and biological features, data collection focused on symptoms and interventions of the palliative care team. Results: median age was 62 years (19-78), and median time to metastasis was 20 months (0-267). Median follow-up by the palliative team was 5 months (0-28). The first palliative care consultation occurred after a median time of 3 months (0-83) from the diagnosis of metastasis: 48,9% of patients were PS 0-1, and 78,7% were receiving systemic treatment for MUM. The main reason was the onset of symptoms for 42,6% (pain, malnutrition or anxiety), liver function tests impairment in 23,4% and stop of anti-cancer therapy in 4,3% of patients. It was a systematic joint consultation in 29,8%. At this first visit, we included social workers (8.5%) and nutritionists (4,3%). Antalgic and psychotrop prescriptions were needed for 36,2% and 27,7% of patients respectively. Over time, between 23 and 50% of patients experienced pain, but the most prevalent symptoms are anxiety and depression, experienced by 40 to 68% of the patients. At 9 months, antalgic prescriptions were needed for 53,8% and psychotrops for 61,5%,. Anti-cancer treatments were stopped in 93.6% of patients, mainly due to disease progression. 85,1%% of patients died of MUM, due to hepatic metastases, after a median time from metastasis of 14.5 months (1-107). A third of the patients died at home. Conclusions: despite few symptoms in comparison to other cancers, MUM patients could benefit from early palliative care to support needs and establish a life project. These issues will be investigated in a prospective study to assess the benefits of joint early oncological and palliative care in this rare melanoma.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03199526
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Submitted on : Thursday, April 15, 2021 - 4:48:50 PM
Last modification on : Saturday, September 4, 2021 - 3:26:07 AM

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Lorraine Waechter. Mélanome uvéal métastatique : étude descriptive d'un modèle d'intégration précoce des soins palliatifs. Médecine humaine et pathologie. 2019. ⟨dumas-03199526⟩

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