Assessing Predictors of Tamoxifen Nonadherence in Patients with Early Breast Cancer

Adjuvant endocrine therapy (AET) is generally proposed to all patients with hormone receptor-positive breast cancer to reduce the risk of recurrence and death. Adherence to therapy is crucial. However, non-adherence to AET is common, with estimates of up to 50% of patients not successfully completing a five-year course of treatment, and it is significantly associated with lower survival rates and a higher risk of recurrence. Currently, no gold standard is available to assess adherence. Several studies, most of them retrospective in nature, have used both direct and indirect methods to monitor the adherence to therapy in breast cancer. The indirect method is more widely used, and it is based on pharmacy prescription refills and patient administered questionnaires. On the other hand, direct methods such as a measurement of the level of the drug or its metabolites in blood or urine are much more precise, but more expensive and not routinely implemented. In this review, we analyzed the results of the major studies focused on the adherence to tamoxifen in breast cancer patients. We identified several factors associated with poor adherence, such as the side effects of therapy, the lack of shared decision-making between the physician and patient, the context in which the discussion takes place, and whether the patients are enrolled in a clinical trial. Moreover, we discussed possible methods to improve adherence to adjuvant therapy in breast cancer.

Opportunities and Challenges of Web-Based and Remotely Administered Surveys for Patient Preference Studies in a Vulnerable Population

The application of web-based and remotely administered surveys is becoming increasingly popular due to the fact that it offers numerous advantages over traditional paper-based or computer-based surveys completed in the presence of the researcher. However, it is unclear whether complex preference elicitation tasks administered online in highly vulnerable patient populations are also feasible. This commentary discusses opportunities and challenges of conducting quantitative patient preference studies in lung cancer patients using web-based modes of data collection. We refer to our recent experience in the context of the Patient Preference in Benefit-Risk Assessments during the Drug Life Cycle (PREFER) project. Among the main advantages were the possibility of reaching a wider and geographically distant population in a shorter timeframe while reducing the financial costs of testing, the greater flexibility offered and the reduced burden on the patients. Some limitations were also identified and should be the object of further research, including the potential lack of inclusiveness of the research, the lack of control over who is completing the survey, a poor comprehension of the study material, and ultimately a lower level of engagement with the study. Despite these limitations, experience from the PREFER project suggests that online quantitative methods for data collection may provide a valuable method to explore preferences in vulnerable patient populations beyond the COVID-19 pandemic.

“Optimism Is a Strategy for Making a Better Future”

Abstract. Cancer is a deadly disease that can lead to psychological suffering and decreased quality of life (QoL). Personality has been proven to have an effect on QoL and, in particular, Dispositional Optimism (DO) has been studied in relation to overcoming health crisis. The aim of this systematic review is to deepen the state of art of the relationship between QoL and DO in cancer patients. PubMed and Embase databases were systematically searched. Fifteen studies were included with a total of 5,249 cancer patients. All of the studies consider the relationship between DO and QoL, some studies analyze the correlation between the two variables and found a positive association. The majority of the studies investigate the predictive power of DO over QoL and most of them found DO to be predictive of a higher QoL. Results confirmed the association between DO and QoL in a sample of cancer patients. These results could influence the clinical practice as DO has been proven to have a beneficial effect on mental and physical health.

COVID-19 impact in radiotherapy practice in an oncology hub: a screenshot from Lombardy, Italy

Objective:

During 2020, medical clinical activities were dramatically modified by the coronavirus disease 2019 (COVID-19) emergency. We aim to evaluate the impact of COVID-19 on radiotherapy (RT) practice in a hub cancer center.

Methods:

Retrospective data collection of patients with suspected COVID-19 infection, identified by pathognomonic symptoms feedback at triage realized at the entrance to RT division. Inclusion criteria were diagnosis of oncologic disease, COVID-19–related symptoms, and signed written informed consent.

Results:

Between 1 March and 30 June 2020, 1,006 patients accessed our RT division for RT simulation or treatment. Forty-four patients matched inclusion criteria (4.4% of all patients): 29 women and 15 men. Seventeen patients had metastatic disease. Twenty-one patients reported fever, 6 presented dyspnea, 4 complained of ageusia and anosmia, and 3 developed conjunctivitis. Thirty-six patients underwent nasal swab, with 7 positive results. From our cohort, 4 cases of pneumonia were diagnosed with computed tomography scan imaging: 3 were related to COVID-19 infection, while the fourth was evaluated as an RT adverse event. From the entire series, 4 patients died: 3 during hospitalization in intensive care unit of complications of COVID-19 and 1 of other causes neither COVID-19 nor cancer-related.

Conclusions:

Cancer hub allows for safe RT practice continuation while minimizing the spread of contagion in this frail patient population. A challenge for the future will be to understand pandemic consequences in cancer natural history and manage its clinical impact.

One-Year Quality of Life Trends in Early-Stage Lung Cancer Patients After Lobectomy

Objective: Quality of Life (QoL) is an important predictor of patient's recovery and survival in lung cancer patients. The aim of the present study is to identify 1-year trends of lung cancer patients' QoL after robot-assisted or traditional lobectomy and investigate whether clinical (e.g., pre-surgery QoL, type of surgery, and perioperative complications) and sociodemographic variables (e.g., age) may predict these trends.

Methods: An Italian sample of 176 lung cancer patients undergoing lobectomy completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire—Core 30 (QLQ-C30) at the pre-hospitalization (t0), 30 days (t1), 4 months (t2), 8 months (t3), and 12 months (t4) after surgery. Sociodemographic and clinical characteristics (age, gender, perioperative complications, and type of surgery) were also collected. The individual change over time of the 15 dimensions of the EORTC QLQ-C30 and the effects of pre-surgery scores of QoL dimensions, type of surgery, perioperative complications, and age on patients' QoL after surgery were studied with the individual growth curve (IGC) models.

Results: Patients had a good recovery after lobectomy: functioning subscales improved over time, while most of the symptoms became less severe over the care process. Perioperative complications, type of surgery, pre-surgery status, and age significantly affected these trends, thus becoming predictors of patients' QoL.

Conclusion: This study highlights different 1-year trends of lung cancer patients' QoL. The measurement of pre- and post-surgery QoL and its clinical and sociodemographic covariables would be necessary to better investigate patients' care process and implement personalized medicine in lung cancer hospital divisions.

Protect, promote and support: a warm chain of breastfeeding for oncological women-results from a survey of young Italian cancer mothers

The topic of lactation following cancer diagnosis will become increasingly more current. Although oncological research confirms that breastfeeding after cancer might be possible, there is a lack of guidelines and a good recommendation for oncological women. In the absence of specific recommendations, women with past cancer may be at higher risk for psychological distress related to breastfeeding.

The objective of this article was to analyse the experience of breastfeeding in new mothers with a history of cancer compared to women without a cancer diagnosis. First, we explored the impact of the cancer diagnosis on the breastfeeding choice. Second, we evaluated the relationship between different feeding methods and the mother’s mood states in women with and without a history of cancer.

The sample was composed of 74 mothers divided into two groups: 34 with a cancer history (clinical sample) and 40 without a cancer diagnosis (control group). Participants were requested to complete a questionnaire three months after childbirth which assessed: socio-demographic and clinical data, feeding modes (breastfeeding, formula and mixed feeding) and the profile of mood states (POMS).

Results showed that women in the clinical group breastfeed significantly less and use formula more than those in the control group. Moreover, in the clinical group, women who breastfeed feel reported higher levels of confusion (according to POMS) than mothers who bottle-feed or use a mixed feeding method. On the contrary, in the control sample, women who breastfeed feel significantly more vigorous than puerperae who bottle-feed or use mixed methods according to POMS.

Our findings suggest the need for a specific warm chain of support and the development of guidelines with clear and specific information for women with a cancer diagnosis in order to reduce their confusion around breastfeeding.

Web-Based Relaxation Intervention for Stress During Social Isolation: Randomized Controlled Trial

BACKGROUND

Relaxation practices might be helpful exercises for coping with anxiety and stressful sensations. They may be of particular utility when used in web-based interventions during periods of social isolation.

OBJECTIVE

This randomized study aimed to test whether web-based relaxation practices like natural sounds, deep respiration, and body scans can promote relaxation and a positive emotional state, and reduce psychomotor activation and preoccupation related to the COVID-19 pandemic.

METHODS

Participants were randomly assigned to one of three experimental conditions. Each condition was characterized by a single online session of a guided square breathing exercise, a guided body scan exercise, or natural sounds. The participants listened to one of the fully automated audio clips for 7 minutes and pre-post completed self-assessed scales on perceived relaxation, psychomotor activation, level of preoccupation associated with COVID-19, and emotional state. At the end of the session, qualitative reports on subjective experience were also collected.

RESULTS

Overall, 294 participants completed 75% of the survey and 240 completed the entire survey as well as one of three randomly assigned interventions. Perceived relaxation, psychomotor activation/stress, and preoccupation related to COVID-19 showed a positive improvement after participants listened to the audio clips. The same pattern was observed for the valence and perceived dominance of the emotional state. The square breathing and body scan exercises yielded superior results compared to natural sounds in lowering perceived stress.

CONCLUSIONS

This study provides a novel insight that can guide the development of future low-cost web-based interventions to reduce preoccupation and stress in the general population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/19236.

Patients' experience with MRI-guided in-bore biopsy versus TRUS-guided biopsy in prostate cancer: a pilot study

Background

Ultrasound-guided magnetic resonance imaging (MRI)-fusion biopsy and in-bore MRI-guided biopsy (MRGB) have improved the diagnostic pathway in patients with suspected prostate cancer compared to the traditional random sampling of the prostate gland under transrectal ultrasound guidance (TRUS-Bx). The aim of our study was to assess the psychological experiences of patients undergoing MRGB and TRUS-Bx.

Method

Participants completed an ad hoc set of 11 items to be rated from 0 (not at all) to 10 (very much) on visual analogue scales and one open question on the most worrisome aspect of the procedure. The set of items evaluated satisfaction with the information received and the possibility to ask questions to the staff; the tolerability of the irritation, duration and discomfort associated with the exam; their level of worry or calm before the exam; the perceived need to undergo the exam; their satisfaction with the exam and willingness to repeat it in the future; and acceptability of the exam.

Results

Between May 2018 and June 2019, 47 participants were enrolled on the day of their MRGB; 24 had previously undergone TRUS-Bx. The MRGB was rated with high positive scores on all 11 items. The lowest ratings regarded the duration of the exam (mean = 6.6) and feeling calm (mean = 6.6). Participants were significantly more satisfied with MRGB than TRUS-Bx, rating it as less painful and more comfortable, necessary and tolerable.

Conclusion

These preliminary results indicate that the MRGB is likely to be more tolerable and acceptable to patients than TRUS-Bx.

Short Bouts of Physical Activity Are Associated with Reduced Smoking Withdrawal Symptoms, but Perceptions of Intensity May Be the Key

The primary aim of this study was to assess the effectiveness of a short bout (10 min) of moderate-intensity exercise to reduce withdrawal symptomatology, craving and negative affect; while the secondary aim was to assess how the effectiveness of a short bout of moderate exercise can be modulated by the perception of intensity in physically active and low-activity smokers. Fifty low-activity and physically active smokers were recruited (24 male and 26 female) and randomized in three different conditions. Prescribed (objective) moderate intensity (OBJ) and perceived moderate intensity (PER), and passive waiting (PW). After the intervention (T3), smokers reported less desire to smoke in the PER (p < 0.001) and OBJ (p < 0.001) conditions, relative to the PW condition. At T3 smokers in the PER condition reported less negative affect than smokers in the PW condition relative to the baseline (T1) (p < 0.007). Further, smokers in the PER condition reported less negative affect than smokers in the PW condition (p < 0.048). Physically active (PA) smokers perceived less exertion than low-activity (LA) smokers, and the effects were stronger in the PER condition relative to OBJ. Generally, our results suggest that a short bout of moderate exercise helps both LA and PA smokers. These findings provided a novel insight into the psychological mechanisms that affect the efficacy of the exercise in smoking cessation and suggest that exercise should be tailored according to individual perception of intensity.

A Systematic Review and Provisional Metanalysis on Psychopathologic Burden on Health Care Workers of Coronavirus Outbreaks

BACKGROUND

The new coronavirus (SARS-CoV-2) shows several similarities with previous outbreaks of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). Aim of this systematic review and meta-analysis is to provide evidence of the psychopathologic burden on health care workers (HCWs) of the first two deadly coronavirus outbreaks to get lessons for managing the current burden of COVID-19 outbreak.

METHOD

According to Cochrane Collaboration guidelines and the PRISMA Statement, the study quantified the effects of frontline work on mental health of HCWs. Major databases - Pubmed, Scopus, Embase, Medline, and Web of Science - were searched for observational and case-control studies evaluating mental health indexes reported by front-line work. This study computed the percentage of sample that reported clinically significant levels of psychiatric symptoms. Cohen's d was used for comparing mental health outcomes of health care workers directly involved in addressing pandemic emergency with a control group that was not directly exposed to such conditions. Pooled effect sizes (dw ) were estimated whenever at least three independent studies yielded data. Heterogeneity of findings and bias of publication were estimated as well.

FINDINGS

Fifteen studies have been selected for a total of 7,393 HCWs. From 9.6% to 51% of HCWs reported symptoms of Post-Traumatic Stress Disorder (PTSD) and from 20% to 75% reported psychiatric symptoms, with a prevalence of anxiety and depression. From one to the three years after outbreak, from 2% to 19% reported PTSD symptoms and from 5% to 90% psychiatric symptoms. Interestingly, HWCs who were directly involved in pandemic emergency showed significantly higher depressive and anxious symptoms (dw = .66 (.46-.85); p <.001) than ones who were not directly exposed. Similarly, the direct involvement significantly affected the severity of PTSD symptoms (dw = .30 (.21-.39); p <.001).

CONCLUSION

Health care professionals in general and most of all frontline workers showed an association with a likely risk of developing psychiatric disorders following outbreaks and for at least three years later. Mental health interventions for professionals exposed to COVID-19 need to be immediately implemented. Further studies are warranted to investigate long-term consequences carefully, and to look for mediating and buffering factors as well. The role of clinical psychologists and psychiatrists in delivering adequate interventions is critically important.

2020s Heroes Are Not Fearless: The Impact of the COVID-19 Pandemic on Wellbeing and Emotions of Italian Health Care Workers During Italy Phase 1

Objective

The study aimed to investigate the mental health and emotional reaction of physicians working during phase 1 of the COVID-19 pandemic in Italy.

Methods

A total of 458 Italian Health Care Workers (HCWs) working during phases 1 of the COVID-19 outbreak were voluntarily enlisted in the study and recruited with the snowball technique through an online survey. We examined our variables with the General Health Questionnaire – 12 and with Visual Analog Scales.

Results

The sample has a high level of psychological distress 21.26 (SD = 4.46), the emotional reaction was characterized by high level of fear for family members and cohabitants (M = 77.67, SD = 27.16) and patients (M = 67.16, SD = 27.71). Perceived control, fear for patients, and for family members and cohabitants, feeling alone and anger all contribute to a decreased mental health in Italian physicians (R² = 0.285, p < 0.001).

Conclusion

Italian HCWs’ mental health and emotional reaction have to be considered to prevent high risk of burnout and post-traumatic stress disorder (PTSD). It becomes pivotal in the next months to implement a tailored psychological intervention to take care of HCWs and to prevent costly consequences for them, patients, and the healthcare system.

Exploring public attitude toward biofeedback technologies: Knowledge, preferences and personality tendencies

Background: Biofeedback is increasingly used in the clinical area and in daily health monitoring through wearable devices (e.g. smart watches). Nevertheless, it remains rather unknown. This study aimed to assess, in a sample of Italian citizens, the level of knowledge, attitudes, perceived efficacy and personality tendencies which could affect the uptake of biofeedback technologies.

Design and Methods: Participants were recruited by advertising the survey on the social networks, from March to May 2019. 160 subjects filled in an ad hoc online questionnaire assessing socio-demographic variables, clinical status, physical activity, knowledge and attitude towards biofeedback, psychological tendencies toward health.

Results: Data showed a good level of interest in biofeedback training in spite of poor knowledge about such technologies. Sport and chronic diseases were not correlated to a greater use of biofeedback. People informed about biofeedback technologies were more interested in undergoing biofeedback training and had higher scores in the Health Locus of Control. Finally, people who showed a positive perception of their own health (Health Esteem) did not rely on these technologies.

Discussion: Despite the huge spread of biofeedback technologies, our results disconfirmed the expectation that people having an active lifestyle or a disease were more familiar with biofeedback systems. The attitude toward such technologies seems to depend on individual tendencies.

Conclusions: This study suggests the importance to improve general public literacy on biofeedback technologies, tailor tools on their needs and characteristics, empower people’s sense of internal health control for promoting a valid use and a proper knowledge of biofeedback.

Genetic Testing Consumers in Italy: A Preliminary Investigation of the Socio-Demographic Profile, Health-Related Habits, and Decision Purposes

Aim of the study: Genetic testing is becoming increasingly common in clinical practice and health management; nonetheless, little is known about how the population approaches genetic services through private companies. Our study aims to describe socio-demographic aspects, health-related habits, and overall beliefs and knowledge about genetic risk and testing in a population of Italian citizens who decided to undergo a genetic examination through a private genetic company.

Study design: A sample of 152 clients from an Italian private genetic company completed an ad-hoc survey from September 2016 to February 2018, addressing socio-demographic data, health habits, psycho-physic condition, perceived utility of genetic results, decision purposes about data sharing, and behavioral changes after results.

Results: Participants (mean age 42.4) were predominantly female (82.2%) and were overall well-educated. Their main source of information were physicians (77%), and 41.1% entrusted the management of results to the same. Thirty-eight percentage underwent genetic analysis for cancer predisposition, 31.3% for fertility problems, 24% for dietary or intolerance issues in the period of enrolment. More than half of them (62.7%) reported a family history of the disease, and overall 69% had a current or past experience with a disease. Clients perceived the genetic screening as useful to adopt behaviors that may prevent disease onset (37.7%), to know their “real health status” (27.4%), and to adopt health-related behaviors (23.3%). 62.8% claimed they were motivated to change behaviors after results (healthier diet, practice exercise, medical checks), and they wanted to share results with their physician and family members.

Discussion/Conclusion: The overview of consumers' profiles in Italy and other European countries can contribute to tailoring and regulating genetic services in a way that could be efficient in terms of healthy choices, behaviors, and health resource expenditures for the general public.

From Individual To Social Trauma: Sources Of Everyday Trauma In Italy, The US And UK During The Covid-19 Pandemic

The heterogeneity of COVID-19 experience and response for each individual is irrefutable; nevertheless, similarities can be observed between countries with respect to people's psychological responses. The main aim of this Commentary is to provide a cultural perspective of the sources of trauma, at the individual and social level, in three different countries: Italy, US and UK. The evidence from previous outbreaks, such as SARS, H1N1 flu, Ebola, and the ongoing Italian, the US, and the UK experience of COVID-19 shows that COVID-19 has introduced not only an individual trauma but also a collective trauma, that researchers should attend to now and in future global emergencies. Future clinical interventions should aim to reconnect dissociated parts both in the individual and in society. This commentary discusses four potential sources of trauma: high-stakes decision fatigue in healthcare professionals, traumatic grief, and bereavement in people who have lost loved ones, loss of roles and identity, and social divisions related to economic shutdown.

Validation of the Italian Version of the Brief Emotional Intelligence Scale (BEIS-10)

Based on Salovey and Mayer's conceptualization of emotional intelligence, Davies and colleagues developed the BEIS-10 scale, a 10-items self-report questionnaire that explores individual dispositions that people have about exploring one's own and others' emotions. To date, no studies assess the validity of the BEIS-10 scale in the Italian context. This article aims to fill this gap, exploring the validity, reliability, and construct validity of the Italian version of this scale. 244 Italian adults participated in the study and 67 respondents completed a second administration of the scale after two-weeks. The recommended statistical procedures were followed to validate the Italian version of the BEIS-10 scale and, after a back-translation process and a pilot testing, the five-factor structure of the scale was tested through a confirmatory factor analysis. Results highlighted that the five-factor model of emotional intelligence proposed by Davies and colleagues (2010) is confirmed in the Italian population. Data showed good reliability, good stability over time, and evidence of construct validity of the BEIS-10 scale. The BEIS-10 scale could be completed in a couple of minutes and it is particularly useful for collecting data in contexts in which time is an issue.

Evaluation of endocrine therapy and patients preferences in early breast cancer: results of Elena study

PURPOSE

The development of the adjuvant therapy requires that clinicians and patients should discuss the magnitude of benefit of treatment for individual patient, estimating the pros and cons and the personal preferences. The aim of the present study was to determine the preferences of women treated with adjuvant hormonal therapy (HT) for breast cancer.

METHODS

The analyses were conducted into three different groups of early breast cancer patients to evaluate the survival benefit needed to make treatment worthwhile before starting HT (A), after a few months from the beginning (B) and after several years of HT (C). The questionnaires, showing hypothetical scenarios based on potential survival times and rates without HT, were used to determine the lowest gains women judged necessary to make the treatment worthwhile.

RESULTS

A total of 452 patients were included in the study: 149 in group A, 150 in group B and 153 in group C. In group C, 65% of patients were receiving HT with aromatase inhibitors (with or without a LHRH analogue). In the groups A, B, C 8%, 20% and 26%, respectively, received adjuvant chemotherapy. Overall, 355 women (79%) had children. The responses were quite similar between the three groups. A median gain of 10 years was judged necessary to make adjuvant HT worthwhile based on the hypothetical scenario of untreated mean survival time of 5 and 15 years. Median gain of 20% more women surviving was judged necessary to make adjuvant HT worthwhile based on an untreated 5-year survival rate expectation of 60%. Cognitive dysfunction was considered the side effect least compatible with the continuation of treatment in all three groups.

CONCLUSIONS

This is a large study of patient preferences on HT. Compared with other studies with similar design, the patients included in the present study required larger benefits to make adjuvant therapy worthwhile.

Abstract IA16: COVID-19 pandemic and its effect on the psychological status of cancer patients and oncologists

On the 11th of March, the Word Health Organization declared COVID-19 a pandemic. This unprecedented emergency caused some unexpected effects on the health care system. During the pandemic, the attention focused on keeping cancer patients safe from COVID-19. This infection could have a detrimental effect on the physical and mental health of cancer patients; patients who have a suspension of cancer care suffer more from anxiety and/or depression. One of the worst side effects of COVID-19 is the fact that family members could not visit patients; social support in cancer patients is an important factor for a healthy mental condition. With no social support, their normal coping strategies have to adapt and the feeling of helplessness is overwhelming. These aspects are highlighted by a case report of a European Institute of Oncology patient. After a surgical intervention due to oral tongue cancer, he was diagnosed with COVID-19 infection and this caused anxiety and depression symptoms. During the pandemic, health care professionals’ (HCP) role has been pivotal: HCP had to cope with a stressful working environment, facing physical and psychological challenges. Oncologists, in particular, in their daily practice are at risk of developing burnout symptoms and post-traumatic stress disorder symptoms and this could be exacerbated by the pandemic. During pandemic phase 1, we evaluated emotional distress and mental health of oncologists all over the world. Our results showed a low mental health status and distress regarding emotional status; oncologists revealed that fear is one of the most diffuse emotions during pandemic. They are afraid for their patients during the hospital hours, and, when they leave the hospital ward, they feel fear for their family members and cohabitants, in a never-ending feeling of dread. This condition, if prolonged, could be a stressor that could lead to burnout syndrome and post-traumatic stress disorder. For these reasons, it is important to care for the oncologists who had cared for their patients, often prioritizing it over their own well-being. In these particular times, new technologies can help both patients and oncologists. In this complex scenario, the role of the oncologists becomes more and more important; new technologies’ output must be interpreted and technologies have to be at the service of humans, not vice versa. This should help oncologists to perform the integration of a big amount of diverse data otherwise impossible to put together meaningfully.

Citation Format: Gabriella Pravettoni. COVID-19 pandemic and its effect on the psychological status of cancer patients and oncologists [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr IA16.

Management of Cardiac Toxicity Induced by Chemotherapy

Cardiotoxicity encompasses a spectrum of adverse cardiological effects experienced by cancer patients during and after receiving antineoplastic treatments. The intersection of cancer care with the management of the multiple comorbid non-communicable diseases carried by patients or related to cancer treatments motivates the need for an integrated and multidisciplinary approach to therapeutic clinical decision-making. This present review aimed to provide a perspective and an update of the current pharmacotherapy approaches for the prevention and management of cardiotoxicity from antiblastic chemotherapy; as such, it addresses myocardial, vascular, and arrhythmic disorders associated to chemotherapy, by navigating the current knowledge and clinical indications in support of the medical interventions. Clinical scenarios of pharmacological interventions take place with patients receiving anthracycline and, by extrapolation, other agents with cardiotoxic potentials and non-chemotherapy agents, including various small molecules and immunotherapy agents. Analysis of these scenarios aims to provide practical evidence-based guidance for the management of drug-induced cardiac dysfunctions. The possible role of new biomarkers for the early recognition of cardiotoxicity is mentioned across the clinical studies, with reference to the pharmacological biomarker-driven interventions delivered. To best inform survivorship care, the management and context of cardio-oncology services are discussed within the broader network of providers and settings of care.

Brief report - "Every little thing gonna be all right" (at least for me): Dispositional optimists display higher optimistic bias for infection during the Italian COVID-19 outbreak

Dispositional optimism (DO) and optimistic bias (OB) in risk perception are two distinct phenomena and previous studies about their reciprocal relationship report contrasting results. In the present study, we focused on the relationship between DO and OB when reporting the personal and the other persons' risk about COVID-19. We hypothesized that, when facing a largely uncontrollable risky situation (like the recent pandemic), dispositional optimists would defensively increase their OB about the current risks. A convenience sample of 414 Italian participants aged 18 or older were recruited. They completed a questionnaire investigating past protective behaviors, DO, perceived personal and other persons' COVID-19-related risk. Results of the mixed regression model showed that more optimistic people were more likely to underestimate their COVID-19 personal risk over the other's person risk. These results shed light on the relationship between different forms of optimism and provide useful insight about the potential implications of risk communication approaches to face the current pandemic.

An Internet-Based Intervention to Alleviate Stress During Social Isolation With Guided Relaxation and Meditation: Protocol for a Randomized Controlled Trial

Background

Psychophysiological stress and decreased well-being are relevant issues during prolonged social isolation periods. Relaxation practices may represent helpful exercises to cope with anxiety and stressful sensations.

Objective

The aim of this research protocol is to test whether remote relaxation practices such as natural sounds, deep respiration, and body scan meditation promote relaxation and improved emotional state and reduce psychomotor activation and the preoccupation related to the coronavirus disease (COVID-19) pandemic.

Methods

The study population will consist of 3 experimental groups that will randomly receive one of 3 internet-based audio clips containing a single session of guided breathing exercise, guided body scan exercise, or natural sounds. The participants will listen to the fully automated audio clip for 7 minutes and complete pre-post self-assessment scales on their perceived relaxation, psychomotor activation, level of worry associated with COVID-19, and emotional state. At the end of the session, the participants will also be asked to provide qualitative reports on their subjective experiences.

Results

Analyses will be performed to test the differences in the efficacy of the different audio clips in an internet-based intervention on 252 participants (84 per group), investigating whether natural sounds or remote guided practices such as deep respiration and body scan meditation positively enhance the participants’ perceived psychological state.

Conclusions

The study will provide information on if and to what extent guided practices can help in reducing psychological side effects related to social isolation during the COVID-19 pandemic.

International Registered Report Identifier (IRRID)

PRR1-10.2196/19236

Hereditary Gastric and Breast Cancer Syndromes Related to CDH1 Germline Mutation: A Multidisciplinary Clinical Review

E-cadherin (CDH1 gene) germline mutations are associated with the development of diffuse gastric cancer in the context of the so-called hereditary diffuse gastric syndrome, and with an inherited predisposition of lobular breast carcinoma. In 2019, the international gastric cancer linkage consortium revised the clinical criteria and established guidelines for the genetic screening of CDH1 germline syndromes. Nevertheless, the introduction of multigene panel testing in clinical practice has led to an increased identification of E-cadherin mutations in individuals without a positive family history of gastric or breast cancers. This observation motivated us to review and present a novel multidisciplinary clinical approach (nutritional, surgical, and image screening) for single subjects who present germline CDH1 mutations but do not fulfil the classic clinical criteria, namely those identified as-(1) incidental finding and (2) individuals with lobular breast cancer without family history of gastric cancer (GC).

Health orientation and individual tendencies of a sample of Italian genetic testing consumers

Background

Over the last decade, genetic testing (GT) had markedly spread in European countries and struggled the debate concerning the psychological effects on the population. The aim of this study was to investigate the individual tendencies of GT consumers in a sample of Italian citizens.

Methods

A total of 152 Italian clients from GenomaLab, a private genetic company, were enrolled from February 2016 to September 2018 and completed an ad hoc survey.

Results

Results showed that GT consumers were motivated to preserve their well‐being, they felt responsible for their health, they were neither pessimistic nor optimistic toward negative occurrences, and poorly inclined to take high risks in their lives. Participants who had suffered from a disease in the past appear to be less tolerant to the uncertainty for future negative events.

Conclusion

Our results depict Italian GT consumers as health‐oriented, focused on prevention, who do not have a pessimistic perception of their condition but do not like to “bet” on their health, and probably their intention (and belief) is to acquire genetic information in order to reduce uncertainty and increase their decision‐making “power” related to their health. Taken together, all these results contribute to describe the population of GT users in European countries, to regulate the provision of GT results and to entail the communication of genetic risk information based on a consumers’ personal profile.