The Comfort Corner #2: Dialogue with Prof. Florian Scotté, hosted by Martin Harutyunyan

“The Comfort Corner” is a palliative care series that brings together medical professionals with the goal of providing insightful discussions on supportive and palliative care. Hosted by Dr. Martin Harutyunyan, the series features contributions from world-class experts like Prof. Florian Scotte. It explores practical approaches to enhance patient care and is a valuable resource for healthcare providers looking to deepen their understanding of supportive care in oncology.

Prof. Florian Scotté is a medical oncologist who heads Gustave Roussy’s Interdisciplinary Department for the Organization of Patient Pathways (DIOPP). Prof. Scotté is the new president-elect of MASCC. He is a national and international leader in supportive care and holds various positions of responsibility in this field.

Before joining Gustave Roussy, he established and developed the chemotherapy day hospital at the Georges Pompidou European Hospital (AP-HP) in 2000. In 2017, he became the head of the medical oncology and supportive care department at the Foch Hospital in Suresnes.

Prof. Scotté is the creator of the supportive care barometer and has led several research programs. He is the author of numerous publications, particularly on the use of cooling gloves to limit the toxicity of certain chemotherapies on the skin and nails and on the organization of the cancer treatment circuit in day hospitalization.

Dr. Martin Harutyunyan is a medical oncologist and palliative care specialist who currently serves as the Head of the Palliative Medicine Service at Yeolyan Hematology and Oncology Center in Yerevan, Armenia. He has been working as a medical oncologist at the same center since October 2021.

Dr. Harutyunyan has made significant contributions to research and patient care throughout his career. He has worked as a clinical researcher at the “City of Smile” Charitable Foundation and as a medical coordinator at the Union of Armenian Doctors.

Dr. Harutyunyan’s played a key role in the launch of a Palliative Medicine Service at Yeolyan Hematology and Oncology Center.

0:14 Introduction
1:38 Why Prof. Scotté decided to focus on supportive care?
6:23 How to be patient-centered in all aspects of palliative care?
10:13 How collaborations enhance supportive care?
12:40 Specific changes Prof. Scotté will introduce as the president-elect of MASCC (the Multinational Association for Supportive Care in Cancer).
15:04 How does MASCC advance supportive care science globally?
16:37 How to stay resilient and maintain empathy?

The Transcript of  “The Comfort Corner #2: Dialogue with Prof. Florian Scotté, hosted by Martin Harutyunyan”

Martin Harutyunyan: Greetings and the warm welcome to the Comfort Corner, a palliative care series on OncoDaily. We aim to raise awareness about the critical need for palliative and supportive care among cancer patients with the goal of improving their quality of life.

Our motto, “Navigating life twist with compassion,” encapsulates our mission.

My name is Martin Harutyunyan. I’m a medical oncologist and palliative care specialist from Yolian Hematology and Oncology Center in Yerevan, Armenia.

I am honored to introduce Professor Florian Scotté, a renowned medical oncologist and expert in supportive care. He leads Gustave Roussy’s Interdisciplinary Department for the Organization of Patient Pathways, established in March 2020.

Professor Scotte holds a Doctorate of Science in Medical Ethics, and his expertise extends beyond medical protocols.

As a national and international leader in supportive care, he actively shapes strategies to improve patients’ lives, and his legacy lies in patient-centered care research and ethical excellence.

Hello, Professor Scotte. We are delighted to have you with us today.

Florian Scotté: My pleasure.

Martin Harutyunyan: We have prepared some questions to ask you. First of all, we would like to learn about your path in supportive care.

How did you decide to focus on supportive care, and what key moments shaped your journey?

Florian Scotté: My journey in medicine began with a desire to support patients, like every physician, I suppose. My primary goal was to help patients as much as possible. When I started medical oncology, I recognized the importance of supportive care and cancer management. I quickly became knowledgeable about GCSF and antiemetic use, as well as the organization around patients and their carers to alleviate suffering from cancer and its treatments.

This evolution led me to be involved in establishing the first dedicated supportive care unit at George Pompidou European Hospital in Paris, France. Later, I moved to Opal F, where I became head of the Department of Medical Oncology and Supportive Care Unit. In that role, I developed various initiatives, such as a dedicated hospital unit.

In 2020, I joined Gustave Roussy to develop an innovative division that combined the ICU department with an ambulatory department and an emergency unit. I also established a specialized unit with Navigator nurses to manage patients at home and the supportive care department.

This large division consists of 350 professionals and provides a comprehensive approach to the patient journey. This includes managing nutrition and psychological disorders, handling emergency visits in case of complications, and ICU hospitalization when necessary. My focus remains on providing holistic care and support for patients throughout their cancer journey.

My pivotal moments during my journey included my first involvement in real supportive treatment, which was researching onycholysis and skin toxicity. We developed an innovative approach using frozen gloves and socks for patients undergoing docetaxel therapies for prostate and breast cancer in 2003. This was my first trial and was presented as a poster at the ASCO meeting in 2004, marking a significant moment in my life.

Another key moment was the creation of the French-speaking Association of Supportive Care and Cancer in 2008 with several colleagues and friends. This was a major step in my journey, and it has continued to influence my work in supportive care and cancer.

I also integrated the MASCC board and was elected as President-elect in 2022. I will assume the position of President in June 2024 in France during the MASCC meeting. I hope you will join us, and I look forward to welcoming everyone virtually or in person at the event in France.

Martin Harutyunyan: Supportive care is a complex field. How do you ensure that it remains patient-centered and addresses not only physical symptoms but also emotional and social needs?

Florian Scotté: This is a key question, Martin. Thank you for asking that.

The main objective, the main purpose of supportive care, is to be patient-centered care. So, it has been developed during several meetings, and I remember the meeting in, I think it was in 2014, combining the ASCO Palliative Care and the ASCO Association. The MASCC Association and the Palliative Care from America Association.

And it was really interesting to ask to stop separating curative intent, palliative intent, supportive intent, blah, blah, blah, and then moving to the patient-centered care approach. So, this is the main objective that we have to keep in mind. We never have to forget that the goal of our daily living is supporting patients, helping patients that we have in front of us, patients and their caregivers.

The second part of your question is about the disparity between physical, psychological, emotional, social disorders. I think that supportive care is a very global approach. And if we focus on physical symptoms, it can be the door to enter the area of psychology and social problems.

What we try to do with patients at Gustave Roussy in my division is to assess the entireness of the patients. We send him a questionnaire, a self-questionnaire, before starting the treatment, before the first meeting with the oncologist, the care provider. They self-answer the questions with different domains: psychological, physical, with the MD operation, autonomy treatments, history, psychological situation, etc.

We have nine domains of interest, and we can assign a score depending on the different alerts on the domains. Then, based on this score, we propose a day hospital to assess the patients because it appears the patient seems to be in a complex situation that needs to be globally assessed.

So, we have a nurse, a physician, and two other professionals, often a dietitian and an educator in physical activity. And then, we propose at the end of the day hospital, a personalized patient pathway with several appointments scheduled to support them.

So, to conclude, it’s a global approach with the association of physical, social, and psychological management.

Martin Harutyunyan: Your international involvement in supportive care is remarkable. How can collaborations enhance the quality of supportive care worldwide, especially across different healthcare systems?

Florian Scotté: MASCC’s core interest is being a global association that brings together different cultural perspectives on supportive care.

Jean Klastri founded the association in 1990 with the aim of approaching supportive care with a culturally diverse perspective, acknowledging the differences in healthcare systems and practices worldwide.

The association values learning from others, emphasizing the need to embrace diverse approaches from around the world. Patients come from Africa, Asia, America, and Europe, and while their circumstances and healthcare needs vary, they are all patients requiring quality care.

By collaborating with professionals from different regions, such as Africa and Canada, MASCC enriches daily practice by sharing varied experiences and approaches. This broad perspective helps improve supportive care and ensures that all patients receive the best possible treatment.

So, we have affiliates, many from Europe, many from Asia, and also one from Africa, in Morocco. We have centers of excellence, and obviously many thousands of members with MASCC, with study groups.

And we are all able to discuss around the patients and propose different approaches depending on the reimbursement of drugs, access to care, and specificities of the different countries.

So, it’s a very global approach, and it’s so rich to learn from, again, from the others. I think that’s in a worldwide involvement.

Martin Harutyunyan: Congratulations on your role as MASCC President-elect. What specific changes or initiatives do you plan to introduce during your leadership to enhance supportive care globally?

Florian Scotté: Thank you for your congratulations. I won’t answer the question directly because I want to wait until the MASCC meeting in June, where I will deliver my message. My main focus will be to influence MASCC in the areas of toxicity and safety management of anti-cancer treatment.

This is crucial because the field of cancer treatment is rapidly evolving. We’re transitioning from chemotherapy and hormone therapy to targeted treatments and personalized medicine, with many other developments on the horizon. While we know a lot, there is still much to learn.

It’s important to understand and disseminate knowledge about managing patients with new drugs and treatments. In my opinion, the study group focused on emerging drugs and toxicities is essential. My other goals include increasing new members and ensuring a global approach to cancer care and patient management.

So, I really want each member to become an ambassador of MASCC and each member to be able to enrich the number of new members to join this movement. So, the message of MASCC is supportive care makes excellent cancer care possible. I think this is what we have to keep in mind every day in front of every patient. And I want to really promote this message worldwide.

Martin Harutyunyan: Thank you very much. MASCC reach extends worldwide. How will you advance the science of supportive care and foster partnerships and collaborations globally?

Florian Scotté: It’s about expanding to new affiliates and supporting the development of supportive care in new countries. This includes establishing centers of excellence with new members and exploring different approaches, as you mentioned previously, in terms of healthcare systems, reimbursement, and access to care.

Collaborating with people from countries such as Serbia and Armenia, as well as from America and Africa, allows us to better address patients’ needs. This diversity of perspectives helps us provide comprehensive care and support.

Regardless of whether you are in America or Paris, some individuals may lack resources and access to proper supportive care or cancer management. By working with different regions, we can better understand and tackle these disparities in patient care.

So, learning from what are able to do the other countries is really, really helpful. What we can do in developed countries can be of interest for low-income countries, and we are a family with MASCC. We have to all work and live together.

Martin Harutyunyan: Thank you very much. Dealing with emotionally demanding situations can be challenging. How do you stay resilient and maintain empathy?

Florian Scotté: The question is hard to answer because I live for patients like every professional in healthcare. I think if we keep in mind this objective to support our patients and their caregivers, I think that we can never lose our legs, that we will keep our way in front of us. And this is my first answer.

The second answer is that supportive care is so rich because we are dealing with a team, it’s a multidisciplinary approach. And it’s because we are daily working, living with physicians, nurses, pharmacists, dieticians, so many other professionals.

It’s because of that that we are able to discuss and to alleviate the pain when we lose a patient and when we are in front of different difficulties related to the cancer.

Martin Harutyunyan: Thank you very much, Professor Scotti, for your insights today. And thanks to our listeners for joining us. Keep exploring palliative care and join us next time for more discussions at the Comfort Corner. Take care.

Florian Scotté: Thank you so much.

Previous episodes of The Comfort Corner

Episode 1: Matti Aapro