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Capetti B, Conti L, Marzorati C, Grasso R, Ferrucci R, Pravettoni G. The Application of tDCS to Treat Pain and Psychocognitive Symptoms in Cancer Patients: A Scoping Review. Neural Plast 2024; 2024:6344925. [PMID: 38645612 PMCID: PMC11032211 DOI: 10.1155/2024/6344925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Background The use of transcranial direct current stimulation (tDCS) to modulate pain, psychological aspects, and cognitive functions has increased in recent years. The present scoping review aims to investigate the use of tDCS in cancer patients and its significant impact on psychocognitive and pain related symptoms. Methods From the earliest available date to June 2023, a comprehensive search was conducted in three electronic scientific databases-PubMed, Scopus, and Embase-and other supplementary sources. Ten relevant studies were identified and included, comprising single case studies, randomized controlled trials, pilot studies, and one retrospective study. PRISMA guidelines for scoping reviews were followed. Results These studies investigated the use of tDCS to improve pain and psychocognitive aspects in patients with various types of cancer, including breast, oral, bladder, lung, pancreatic, head and neck cancer, hepatocellular carcinoma, and meningioma. Overall, the results suggest that tDCS has shown efficacy in relieving pain, reducing anxiety and depression, and improving cognitive function in cancer patients. Conclusion Due to the limited number and high heterogeneity of the existing literature in this field, more investigation and the establishment of standardized protocols would be required to obtain more conclusive evidence.
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Affiliation(s)
- Benedetta Capetti
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Conti
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberta Ferrucci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- I Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, Milan 20142, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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2
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Conti L, Pizzoli SFM, Marzorati C, Grasso R, Petralia G, Pravettoni G. Cognitive alterations and brain functional changes following chemotherapy treatment in breast cancer patients: A systematic review on resting-state fMRI studies. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-16. [PMID: 38261545 DOI: 10.1080/23279095.2024.2303362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Cognitive dysfunctions and functional brain modifications are among the side effects reported by breast cancer patients that persist beyond the chemotherapy. This paper aims at synthesizing the evidence on cognitive and functional brain changes and their associations in breast cancer patients treated with chemotherapy. A systematic literature search was performed using PubMed, Ovid MEDLINE, Scopus, and Embase up to July 2022. Eligible studies evaluated adult women with breast cancer treated with systemic chemotherapy, that performed cognitive assessment and resting-state functional MRI. Methodological quality was assessed. Sixteen studies were included, with a total of 1054 female participants. All studies reported alterations mainly concerned the fronto-parieto-temporal system and specifically involved the disruption of the DMN. Consistent with these findings, BCPs showed changes in cognitive performance reporting dysfunctions in executive ability, memory, and attention. However, not all the studies found a significant association between functional brain alterations and cognitive dysfunction. Some limitations including lack of sample homogeneity and different methodological approaches were reported. This work highlighted the presence of cognitive dysfunctions and functional brain alteration in breast cancer patients treated with chemotherapy. This allows a greater awareness of the side effects, promoting better clinical management. However, further research is needed to investigate the cause-effect relationship between cognitive and functional alterations.
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Affiliation(s)
- Lorenzo Conti
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Milan, Italy
| | | | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Milan, Italy
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Milan, Italy
- Department of Oncology and Haemato-Oncology, University of Milan, Milano, Italy
| | - Giuseppe Petralia
- Department of Oncology and Haemato-Oncology, University of Milan, Milano, Italy
- Division of Radiology, IRCCS European Institute of Oncology, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Milan, Italy
- Department of Oncology and Haemato-Oncology, University of Milan, Milano, Italy
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3
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Buyens G, van Balken M, Oliver K, Price R, Venegoni E, Lawler M, Battisti NML, Van Poppel H. Cancer literacy - Informing patients and implementing shared decision making. J Cancer Policy 2023; 35:100375. [PMID: 36462750 DOI: 10.1016/j.jcpo.2022.100375] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022]
Abstract
In order to tailor treatment to their needs, cancer patients are encouraged to be more active and engaged in their care decisions and to be autonomous yet collaborative with their healthcare professionals when it comes to aspects of their treatment in order to get better results. However, this can only happen after providing them with accurate information about cancer and the different treatment alternatives and their potential side effects. However, sharing robust data-based information is often hindered by exposure to misleading information through different media and online platform, where patients might come across unscientifically founded health practices. Increasing health literacy and cancer-specific literacy is essential to fight this negative trend. The idea is that more knowledgeable patients will be able to debunk more easily misinformation they encounter. This is also related to inequalities among cancer patients. Not only levels of cancer literacy within Europe are uneven across and within countries, but there are social groups that, due to specific social determinants, are systematically less informed and skilled regarding cancer care. In this paper an overview of gaps in addressing literacy issues, and the importance of health literacy to empower patients in their journey through treatment is delineated, concluding with some recommendations to improve cancer literacy in Europe.
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Affiliation(s)
| | - Michael van Balken
- European Association of Urology Patient Office (EAU-PO), NL; Rijnstate Hospital, Arnhem, NL
| | | | | | | | - Mark Lawler
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, UK
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4
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Buitelaar J, Bölte S, Brandeis D, Caye A, Christmann N, Cortese S, Coghill D, Faraone SV, Franke B, Gleitz M, Greven CU, Kooij S, Leffa DT, Rommelse N, Newcorn JH, Polanczyk GV, Rohde LA, Simonoff E, Stein M, Vitiello B, Yazgan Y, Roesler M, Doepfner M, Banaschewski T. Toward Precision Medicine in ADHD. Front Behav Neurosci 2022; 16:900981. [PMID: 35874653 PMCID: PMC9299434 DOI: 10.3389/fnbeh.2022.900981] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a complex and heterogeneous neurodevelopmental condition for which curative treatments are lacking. Whilst pharmacological treatments are generally effective and safe, there is considerable inter-individual variability among patients regarding treatment response, required dose, and tolerability. Many of the non-pharmacological treatments, which are preferred to drug-treatment by some patients, either lack efficacy for core symptoms or are associated with small effect sizes. No evidence-based decision tools are currently available to allocate pharmacological or psychosocial treatments based on the patient's clinical, environmental, cognitive, genetic, or biological characteristics. We systematically reviewed potential biomarkers that may help in diagnosing ADHD and/or stratifying ADHD into more homogeneous subgroups and/or predict clinical course, treatment response, and long-term outcome across the lifespan. Most work involved exploratory studies with cognitive, actigraphic and EEG diagnostic markers to predict ADHD, along with relatively few studies exploring markers to subtype ADHD and predict response to treatment. There is a critical need for multisite prospective carefully designed experimentally controlled or observational studies to identify biomarkers that index inter-individual variability and/or predict treatment response.
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Affiliation(s)
- Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden.,Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Arthur Caye
- Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Nina Christmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Samuele Cortese
- Centre for Innovation in Mental Health, Academic Unit of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom.,Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Solent National Health System Trust, Southampton, United Kingdom.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Royal Children's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen V Faraone
- Departments of Psychiatry, Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, NY, United States
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Markus Gleitz
- Medice Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Corina U Greven
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.,King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Sandra Kooij
- Amsterdam University Medical Center, Location VUMc, Amsterdam, Netherlands.,PsyQ, Expertise Center Adult ADHD, The Hague, Netherlands
| | - Douglas Teixeira Leffa
- Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Nanda Rommelse
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luis Augusto Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil.,ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Mark Stein
- Department of Psychiatry and Behavioral Sciences, Seattle, WA, United States
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy.,Department of Public Health, Johns Hopkins University, Baltimore, MA, United States
| | - Yanki Yazgan
- GuzelGunler Clinic, Istanbul, Turkey.,Yale Child Study Center, New Haven, CT, United States
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Neurocenter, Saarland, Germany
| | - Manfred Doepfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany.,School for Child and Adolescent Cognitive Behavioural Therapy, University Hospital of Cologne, Cologne, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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Crico C, Sanchini V, Casali PG, Pravettoni G. Ethical issues in oncology practice: a qualitative study of stakeholders' experiences and expectations. BMC Med Ethics 2022; 23:67. [PMID: 35773683 PMCID: PMC9248199 DOI: 10.1186/s12910-022-00803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Clinical Ethics Support Services (CESS) have been established to support healthcare professionals in addressing ethically sensitive issues in clinical practice and, in many countries, they are under development. In the context of growing CESS, exploring how healthcare professionals experience and address clinical ethics issues in their daily practice represents a fundamental step to understand their potential needs. This is even more relevant in the context of extremely sensitive diseases, such as cancer. On this basis, we carried out a qualitative study conducting in-depth semi-structured interviews with stakeholders of a major comprehensive cancer centre in Italy, with the twofold aim of investigating what ethical issues arise in the context of clinical oncology and how they are addressed, as well as stakeholders’ expectations about a potential CESS to be implemented within the Institution. Methods The study was conducted within the theoretical framework of Grounded Theory. Participants were healthcare professionals and other key stakeholders working within the cancer centre. The semi-structured interview aimed at exploring common ethical aspects of oncology, investigating stakeholders’ professional experience in dealing with clinical ethics issues, their expectations and requests regarding ethics support services. Transcripts of the interviews were coded and analysed according to the principles of Grounded Theory. Results Twenty-one stakeholders were interviewed. Our analysis showed a wide consensus on the identification of ethically relevant issues, above all those concerning communication, end-of-life, and resource allocation. The absence of institutional tools or strategies to address and manage ethical issues at the patient bedside emerged, and this is reflected in the widespread request for their development in the future. The ideal support service should be fast and flexible in order to adapt to different needs and clinical cases. Conclusions The interviewees showed a limited degree of ‘ethical awareness’: despite having reported many issues in clinical practice, they could hardly identify and describe the ethical aspects, while complaining about a lack of ethical resources in their management. To build a truly effective support service, it therefore seems appropriate to take such context into consideration and address the emerged needs. Ethical sensitivity seems to be key and it becomes even more relevant in critical clinical areas, such as the therapeutic pathways of terminally ill patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00803-x.
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Affiliation(s)
- Chiara Crico
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.,Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Virginia Sanchini
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. .,Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium.
| | - Paolo G Casali
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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6
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Goria S, Girgis A, Shaw J, Przezdziecki A, Levesque J, Bamgboje‐Ayodele A. A Delphi‐based approach to developing the contents of an online resource, Care Assist, for male caregivers of women with breast cancer. Psychooncology 2022; 31:1474-1482. [PMID: 35575006 PMCID: PMC9543824 DOI: 10.1002/pon.5962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/19/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
Objective Informal male caregivers of women with breast cancer (BC) have significant psychological, emotional, and social burdens that are inadequately addressed by current face‐to‐face interventions. Online interventions overcome barriers that limit engagement with face‐to‐face interventions. This study aimed to develop the contents of Care Assist, an online supportive care resource for male caregivers of BC patients, through expert consensus. Methods A Delphi study comprising two survey rounds and an expert consultation was conducted. In Round 1, experts in BC care rated the importance of 25 content items. In Round 2, they re‐rated content items that failed to reach consensus (i.e. 80% agreement) in Round 1 or were newly developed. Free‐text responses were also collected. During expert consultation, the resource was reviewed and revised for clarity. Iterative refinement followed all rounds. Quantitative data was analysed descriptively, and qualitative data was analysed using content analysis. Results Twenty‐two experts participated and reached consensus on 96% of items, with 217 comments provided on: (a) the perceived benefits of Care Assist to caregivers and care recipients, (b) recommendations of newly suggested content items, wording, and use of external links, and (c) concerns regarding information overload and need for tailoring. The expert consultation comments focused on clarifying scope, wording, and information tailoring. Conclusion The rigorous Delphi process resulted in the content for a comprehensive online supportive care intervention for male caregivers. Information overload can be minimised through self‐identification of needs and utilisation of eHealth to personalise the resource for the heterogeneous male caregiver population.
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Affiliation(s)
- Sandra Goria
- Ingham Institute for Applied Medical Research Sydney Australia
- South Western Sydney Clinical School Faculty of Medicine and Health University of New South Wales Liverpool Australia
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research Sydney Australia
- South Western Sydney Clinical School Faculty of Medicine and Health University of New South Wales Liverpool Australia
| | - Joanne Shaw
- Psycho‐oncology Co‐operative Research Group (PoCoG) University of Sydney Sydney Australia
| | - Astrid Przezdziecki
- South Western Sydney Clinical School Faculty of Medicine and Health University of New South Wales Liverpool Australia
- Liverpool Hospital South Western Sydney Local Health District Liverpool Australia
| | - Janelle Levesque
- School of Psychological Sciences Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia
| | - Adeola Bamgboje‐Ayodele
- Ingham Institute for Applied Medical Research Sydney Australia
- South Western Sydney Clinical School Faculty of Medicine and Health University of New South Wales Liverpool Australia
- School of Medical Sciences Biomedical Informatics and Digital Health Faculty of Medicine and Health University of Sydney Sydney Australia
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7
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Rao NC, Zwibel H, Berezanskaya J, Pena P, Jung MK. A comparative study of the effectiveness of an osteopathic primary care sports medicine led intervention on performance in men's collegiate lacrosse players. J Osteopath Med 2021; 122:71-77. [PMID: 34787383 DOI: 10.1515/jom-2021-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Comprehensive sports medicine care goes beyond the treatment of injuries resulting from athletic activities. Ultimately, it is a competence that includes knowledge in physical therapy, training, nutrition, coaching, motivation, competition, mentoring, psychology, and spirituality that allows the physician and patient to collaborate on promoting the patient's health goals. The current literature demonstrates a lack of knowledge in the Osteopathic Primary Care Sports Medicine Model's effectiveness in performance. OBJECTIVES To determine whether a comprehensive osteopathic primary care sports medicine approach can improve performance and health outcomes in collegiate athletes. METHODS A randomized controlled trial commenced just prior to the start of the lacrosse season and concluded at the end of the season. All the New York Institute of Technology (NYIT) collegiate lacrosse players were educated first in a 1-day seminar of the core competencies, and all participants had access to ask questions on their own volition. Then they were randomized into two groups, either the experimental group receiving the direct osteopathic primary care sports medicine intervention (n=18) or the control group not having active intervention (n=19). Also, the overall team winning percentage for that season was computed and compared to that for the previous years and the following year. Participants were assessed before and after the intervention with the Patient Health Questionnaire (PHQ-9), the 36-Item Short Form Survey (SF-36), custom Osteopathic Primary Care Sports Medicine questionnaire, and body fat composition, and their changes were compared between the experimental group and the control group. Collected data were analyzed using the repeated-measures analysis of variance. RESULTS Thirty-seven participants were enrolled in the study. After 14 participants were excluded due to being lost to follow-up, 23 athlete records were analyzed. The winning percentage of the team was highest during the year of the study period time than in the 3 previous years and the following year. The test group did not have any statistically significant change in the PHQ-9, SF-36, custom Osteopathic Primary Care Sports Medicine questionnaire, as well as in body fat composition. CONCLUSIONS When used during a collegiate lacrosse season, this Osteopathic Primary Care Sports Medicine intervention did not significantly improve health outcomes. This preliminary study, despite its limitations in compliance and study population size, did demonstrate improvement in overall team performance when comparing the intervention sport season to other seasons but was not statistically significantly. Therefore, further studies are warranted to improve the understanding in this approach to athlete health outcomes and performance.
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Affiliation(s)
| | - Hallie Zwibel
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Jenny Berezanskaya
- University of Miami Health System Primary Care Sports Medicine Fellowship, Miami, FL, USA
| | - Paul Pena
- HRHCare HRHCare Yonkers, the Valentine Lane Health Center, Yonkers, NY, USA
| | - Min-Kyung Jung
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
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8
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Mazzoni D, Monzani D, Riva P, Pravettoni G. Does being involved by doctors satisfy patients' fundamental psychological needs? A study on a large European sample. PSYCHOL HEALTH MED 2021; 27:1397-1409. [PMID: 34190661 DOI: 10.1080/13548506.2021.1946104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The present work was aimed at investigating whether the patients' involvement by their healthcare providers may satisfy patients' fundamental psychological needs (i.e. self-esteem, belonging, control, meaningful existence), which in turn, can impact their psychological well-being. Based on the European Quality of Life Survey data, the sample included 10,427 European adults who, in the last 12 months, visited GP/family doctors and hospital/medical specialists. Among them, 51.3% declared to have a chronic disease. Results showed that the experience of being involved by GP/family doctors and hospital/medical specialists had a positive effect on psychological well-being and that this effect was mediated by the satisfaction of all four needs. Moreover, the results of the moderated mediation model showed that the indirect effect of the involvement by GP/family doctors and hospital/medical specialists on psychological well-being through belonging was moderated by the presence or absence of a chronic condition. The study provides a novel contribution in investigating the positive effects of the patient's involvement, emphasizing its importance for patient's needs satisfaction, and its role appears particularly beneficial for the ones living with a chronic condition.
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Affiliation(s)
- Davide Mazzoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Riva
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
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9
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Karademas EC, Simos P, Pat-Horenczyk R, Roziner I, Mazzocco K, Sousa B, Oliveira-Maia AJ, Stamatakos G, Cardoso F, Frasquilho D, Kolokotroni E, Marzorati C, Mattson J, Pettini G, Poikonen-Saksela P. Cognitive, emotional, and behavioral mediators of the impact of coping self-efficacy on adaptation to breast cancer: An international prospective study. Psychooncology 2021; 30:1555-1562. [PMID: 33998100 DOI: 10.1002/pon.5730] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/14/2021] [Accepted: 05/10/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The main objective of this prospective multicenter study was to examine whether illness representations of control, affect, and coping behaviors mediate the effects of self-efficacy to cope with cancer on psychological symptoms and overall quality of life, in breast cancer patients. METHOD Data from 413 women (Mean age = 54.87; SD = 8.01), coming from four countries (i.e., Finland, Israel, Italy, Portugal), who received medical therapy for their early breast cancer, were analyzed. Coping self-efficacy was assessed at baseline. Potential mediators were assessed three months later, and outcomes after six months. RESULTS Coping self-efficacy was related to all mediators and outcomes. Illness representations of treatment control, positive and negative affect, and certain coping behaviors (mostly, anxiety preoccupation) mediated the effects of coping self-efficacy. Coping self-efficacy was related to each outcome through a different combination of mediators. CONCLUSIONS Coping self-efficacy is a major self-regulation factor which is linked to well-being through multiple cognitive, emotional, and behavioral pathways. Enhancement of coping self-efficacy should be a central intervention goal for patients with breast cancer, towards promotion of their well-being.
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Affiliation(s)
- Evangelos C Karademas
- Department of Psychology, University of Crete, and Foundation for Research and Technology-Hellas, Greece
| | - Panagiotis Simos
- Medical School, University of Crete, and Foundation for Research and Technology-Hellas, Greece
| | - Ruth Pat-Horenczyk
- School of Social Work and Social Welfare, Hebrew University of Jerusalem, Israel
| | - Ilan Roziner
- Department of Communication Disorders, Sackler Faculty of Medicine, University of Tel Aviv, Israel
| | - Ketti Mazzocco
- Department of Oncology and Hemato-oncology, University of Milan, & Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Berta Sousa
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Champalimaud Research, Lisboa, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, and NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Georgios Stamatakos
- School of Electrical and Computer Engineering, Institute of Communication and Computer Systems, National Technical University of Athens, Athens, Greece
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisboa, Portugal
| | - Diana Frasquilho
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisboa, Portugal
| | - Eleni Kolokotroni
- School of Electrical and Computer Engineering, Institute of Communication and Computer Systems, National Technical University of Athens, Athens, Greece
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Johanna Mattson
- Helsinki University Hospital Comprehensive Cancer Center, and Helsinki University, Helsinki, Finland
| | - Greta Pettini
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Paula Poikonen-Saksela
- Helsinki University Hospital Comprehensive Cancer Center, and Helsinki University, Helsinki, Finland
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10
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Durosini I, Janssens R, Arnou R, Veldwijk J, Smith MY, Monzani D, Smith I, Galli G, Garassino M, Katz EG, Bailo L, Louis E, Vandevelde M, Nackaerts K, de Wit GA, Pravettoni G, Huys I. Patient Preferences for Lung Cancer Treatment: A Qualitative Study Protocol Among Advanced Lung Cancer Patients. Front Public Health 2021; 9:622154. [PMID: 33634069 PMCID: PMC7900128 DOI: 10.3389/fpubh.2021.622154] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/08/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction: Lung cancer is the deadliest and most prevalent cancer worldwide. Lung cancer treatments have different characteristics and are associated with a range of benefits and side effects for patients. Such differences may raise uncertainty among drug developers, regulators, payers, and clinicians regarding the value of these treatment effects to patients. The value of conducting patient preference studies (using qualitative and/or quantitative methods) for benefits and side effects of different treatment options has been recognized by healthcare stakeholders, such as drug developers, regulators, health technology assessment bodies, and clinicians. However, evidence-based guidelines on how and when to conduct and use these studies in drug decision-making are lacking. As part of the Innovative Medicines Initiative PREFER project, we developed a protocol for a qualitative study that aims to understand which treatment characteristics are most important to lung cancer patients and to develop attributes and levels for inclusion in a subsequent quantitative preference survey. Methods: The study protocol specifies a four-phased approach: (i) a scoping literature review of published literature, (ii) four focus group discussions with stage III and IV Non-Small Cell Lung Cancer patients, (iii) two nominal group discussions with stage III and IV Non-Small Cell Lung Cancer patients, and (iv) multi-stakeholder discussions involving clinicians and preference experts. Discussion: This protocol outlines methodological and practical steps as to how qualitative research can be applied to identify and develop attributes and levels for inclusion in patient preference studies aiming to inform decisions across the drug life cycle. The results of this study are intended to inform a subsequent quantitative preference survey that assesses patient trade-offs regarding lung cancer treatment options. This protocol may assist researchers, drug developers, and decision-makers in designing qualitative studies to understand which treatment aspects are most valued by patients in drug development, regulation, and reimbursement.
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Affiliation(s)
- Ilaria Durosini
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Reinhard Arnou
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Jorien Veldwijk
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Meredith Y Smith
- Alexion Pharmaceuticals, Inc., University of Southern California School of Pharmacy, Los Angeles, CA, United States
| | - Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ian Smith
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Giulia Galli
- Unit of Thoracic Oncology, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina Garassino
- Unit of Thoracic Oncology, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Eva G Katz
- Janssen Research and Development, Raritan, NJ, United States
| | - Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Evelyne Louis
- Department of Pneumology/Respiratory Oncology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Marie Vandevelde
- Department of Pneumology/Respiratory Oncology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Kristiaan Nackaerts
- Department of Pneumology/Respiratory Oncology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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11
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Russo S, Monzani D, Pinto CA, Vergani L, Marton G, Falahee M, Simons G, Whichello C, Kihlbom U, Pravettoni G. Taking into Account Patient Preferences: A Consensus Study on the Assessment of Psychological Dimensions Within Patient Preference Studies. Patient Prefer Adherence 2021; 15:1331-1345. [PMID: 34177261 PMCID: PMC8219660 DOI: 10.2147/ppa.s261615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/23/2021] [Indexed: 11/23/2022] Open
Abstract
Patient preferences are gaining recognition among key stakeholders involved in benefit-risk decision-making along the medical product lifecycle. However, one of the main challenges of integrating patient preferences in benefit-risk decision-making is understanding differences in patient preference, which may be attributable to clinical characteristics (eg age, medical history) or psychosocial factors. Measuring the latter may provide valuable information to decision-makers but there is limited guidance regarding which psychological dimensions may influence patient preferences and which psychological instruments should be considered for inclusion in patient preference studies. This paper aims to provide such guidance by advancing evidence and consensus-based recommendations and considerations. Findings of a recent systematic review on psychological constructs having an impact on patients' preferences and health-related decisions were expanded with input from an expert group (n = 11). These data were then used as the basis for final recommendations developed through two rounds of formal evaluation via an online Delphi consensus process involving international experts in the field of psychology, medical decision-making, and risk communication (n = 27). Three classes of recommendations emerged. Eleven psychological constructs reached consensus to be recommended for inclusion with the strongest consensus existing for health literacy, numeracy, illness perception and treatment-related beliefs. We also proposed a set of descriptive and checklist criteria to appraise available psychological measures to assist researchers and other stakeholders in including psychological assessment when planning patient preference studies. These recommendations can guide researchers and other stakeholders when designing and interpreting patient preference studies with a potential high impact in clinical practice and medical product benefit-risk decision-making processes.
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Affiliation(s)
- Selena Russo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Discipline of Paediatrics, School of Women’s and Children’s Health, The University of New South Wales, Kensington, NSW, Australia
- Correspondence: Selena Russo Department of Medicine and Surgery, University of Milano, Bicocca, via Cadore 48, Monza (MB), 20052, Italy Email
| | - Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Cathy Anne Pinto
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giulia Marton
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing (IIA), University of Birmingham, Birmingham, UK
| | - Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing (IIA), University of Birmingham, Birmingham, UK
| | - Chiara Whichello
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ulrik Kihlbom
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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12
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Aschieri F, Barello S, Durosini I. "Invisible Voices": A Critical Incident Study of Family Caregivers' Experience of Nursing Homes After Their Elder Relative's Death. J Nurs Scholarsh 2020; 53:65-74. [PMID: 33206459 DOI: 10.1111/jnu.12610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The literature provides few examples of family caregivers' retrospective evaluation of nursing home services. This study aimed at analyzing narratives of Italian family caregivers of elders who experienced nursing home placement. DESIGN AND METHODS Data were gathered through in-depth interviews with family members after their relatives' death. The interviews were based on the Critical Incident Technique, which allowed the categorization of the most memorable positive and negative events from the perspective of family members of elders deceased in nursing homes. Interviews were interpreted with a phenomenologically inspired thematic analysis approach. Participants were screened for complicated grief disorder as a confounding variable in relatives' accounts of the treatment. RESULTS Results suggested that positive long-term recollection of the nursing home was associated with different themes emerging from the interviews: medical reliability and expertise, active demonstrations of care that extend beyond the contract with the facility, individualized attention, responsiveness, openness to dialog with family members about routines, management of the first impression, and family engagement. Lack of professionals' expertise and medical failures, lack of care for patients' personal goods, lack of family involvement, lack of individualized attention, lack of responsiveness, poor patient surveillance, and structural limits of the facilities were the themes that were more frequently negatively associated with the nursing home experience. IMPLICATIONS FOR PRACTICE Focusing on the key dimensions connected to the quality of the experience of family members can enrich the quality of existing nursing home services and allow healthcare policymakers and managers to design better facilities for the patients.
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Affiliation(s)
- Filippo Aschieri
- Associate Professor, European Center for Therapeutic Assessment; Department of Psychology, Università Cattolica del Sacro Cuore, Milano, Lombardia, Italy
| | - Serena Barello
- Assistant Professor, EngageMinds Hub, Consumer, Food & Health Engagement Research Center; Department of Psychology, Università Cattolica del Sacro Cuore, Milano, Lombardia, Italy
| | - Ilaria Durosini
- Research fellow, Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
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13
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Galli F, Pravettoni G. Burning Mouth Syndrome-Opening the Door to a Psychosomatic Approach in the Era of Patient-Centered Medicine. JAMA Otolaryngol Head Neck Surg 2020; 146:569-570. [PMID: 32352502 DOI: 10.1001/jamaoto.2020.0524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Federica Galli
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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14
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Marton G, Pizzoli SFM, Vergani L, Mazzocco K, Monzani D, Bailo L, Pancani L, Pravettoni G. Patients' health locus of control and preferences about the role that they want to play in the medical decision-making process. PSYCHOL HEALTH MED 2020; 26:260-266. [PMID: 32323553 DOI: 10.1080/13548506.2020.1748211] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Health locus of control (HLOC) may influence people's behavior regarding their health as well as their desires to be involved in the medical decision-making. Our study aimed to examine HLOC's relations with people's control preferences about the medical decision-making. A total of 153 people filled out the self-administered version of the Control Preference Scale and the Multidimensional Health Locus of Control Scale - form C. The most preferred role is the collaborative one. However, HLOC explained heterogeneity in people's control preferences: lower scores in external HLOC were related to a greater preference for the active and the collaborative role. From the personalized medicine perspective, an accurate evaluation of the patient's HLOC could help tailoring the decision-making process within the clinical context.
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Affiliation(s)
- Giulia Marton
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan, Italy
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan, Italy
| | - Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan, Italy
| | - Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy
| | - Luca Pancani
- Department of Psychology, University of Milan - Bicocca , Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan, Italy
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15
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Monzani D, Vergani L, Pizzoli SFM, Marton G, Mazzocco K, Bailo L, Messori C, Pancani L, Cattelan M, Pravettoni G. Sexism Interacts with Patient-Physician Gender Concordance in Influencing Patient Control Preferences: Findings from a Vignette Experimental Design. Appl Psychol Health Well Being 2020; 12:471-492. [PMID: 31985173 PMCID: PMC7384069 DOI: 10.1111/aphw.12193] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient preferences regarding their involvement in shared treatments decisions is fundamental in clinical practice. Previous evidences demonstrated a large heterogeneity in these preferences. However, only few studies have analysed the influence of patients' individual differences, contextual and situational qualities, and their complex interaction in explaining this variability. METHODS We assessed the role of the interaction of patient's sociodemographic and psychological factors with a physician's gender. Specifically, we focused on patient gender and attitudes toward male or female physicians. One hundred fifty-three people participated in this randomised controlled study and were randomly assigned to one of two experimental conditions in which they were asked to imagine discussing their treatment with a male and a female doctor. RESULTS Analyses showed an interplay between attitude towards women and the gender of patients and doctors, explaining interindividual variability in patient preferences. CONCLUSIONS In conclusion, patients' attitudes toward the physicians' gender constitutes a relevant characteristic that may influence the degree of control patients want to have and the overall patient-physician relationship.
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Affiliation(s)
- Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Giulia Marton
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Messori
- Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Luca Pancani
- Department of Psychology, University of Milan - Bicocca, Milan, Italy
| | - Manuela Cattelan
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
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16
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Marzorati C, Monzani D, Mazzocco K, Pavan F, Monturano M, Pravettoni G. Dimensionality and Measurement Invariance of the Italian Version of the EORTC QLQ-C30 in Postoperative Lung Cancer Patients. Front Psychol 2019; 10:2147. [PMID: 31649573 PMCID: PMC6792474 DOI: 10.3389/fpsyg.2019.02147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/05/2019] [Indexed: 12/20/2022] Open
Abstract
Background This study aims to validate and evaluate the psychometric properties and measurement invariance of the Italian version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30), which is a measure of quality of life (QoL) for lung cancer patients after surgery. Methods A total of 167 lung cancer patients completed the Italian version of the EORTC QLQ-C30 questionnaire at 30 days after they received a lobectomy. The factor structure of this scale was assessed by performing confirmatory factor analysis (CFA). Measurement invariance was evaluated by considering differential item functioning (DIF) due to age, gender, and type of surgery (i.e., robot- or not robot-assisted). Results The CFA demonstrated the validity of the factor structure of the EORTC QLQ-C30 in assessing overall health and eight distinct subscales of adverse events and functioning. Moreover, the results highlighted a minimal DIF with only trivial consequences on measurement invariance. Specifically, the DIF did not affect the mean differences of latent scores of QoL between patients undergoing robot-assisted surgery or traditional surgery. Conclusion These findings supported the validity and suitability of the EORTC QLQ-C30 for the assessment of QoL in lung cancer patients of diverse ages and genders undergoing lobectomy with or without robot-assisted surgery.
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Affiliation(s)
- Chiara Marzorati
- Department of Oncology and Hemato-Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca Pavan
- Patient Safety and Risk Management Service, European Institute of Oncology IRCCS, Milan, Italy
| | - Massimo Monturano
- Patient Safety and Risk Management Service, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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17
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Triberti S, Gorini A, Savioni L, Sebri V, Pravettoni G. Avatars and the Disease: Digital Customization as a Resource for Self-Perception Assessment in Breast Cancer Patients. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2019; 22:558-564. [PMID: 31194583 DOI: 10.1089/cyber.2018.0461] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Avatars, or users' renditions within digital environments, may change depending on modifications of users' self-conception. According to literature, chronic health conditions influence patients and survivors' identity, because living with a disease requires people to reconfigure their self-representation and their own daily life and future plans. This is especially true for breast cancer, whose treatment and surgery also affect patients' body image, sexual identity, and sense of womanhood. In this study, 22 breast cancer survivors were asked to create multiple avatars resembling their actual self (AS), their ideal self (IS), and their self connected to the disease experience; then, they were asked to rate their attitudes toward their three avatars. Results show that disease avatars are significantly different in patients' attitudes toward them from AS and IS avatars. In addition, attitudes toward one's own avatars appeared partially related to clinically relevant psychological states, such as anxiety and depression. Discussion explores suggestions for usage of avatars in interventions for assessment and quality-of-life promotion among chronic patients.
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Affiliation(s)
- Stefano Triberti
- 1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Alessandra Gorini
- 1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Lucrezia Savioni
- 1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Sebri
- 1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- 1Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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18
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Marzorati C, Monzani D, Mazzocco K, Pavan F, Cozzi G, De Cobelli O, Monturano M, Pravettoni G. Predicting trajectories of recovery in prostate cancer patients undergone Robot-Assisted Radical Prostatectomy (RARP). PLoS One 2019; 14:e0214682. [PMID: 30946773 PMCID: PMC6448842 DOI: 10.1371/journal.pone.0214682] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/18/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To identify trends of patients' urinary and sexual dysfunctions from a clinical and psychological perspective and understand whether sociodemographic and medical predictors could differentiate among patients following different one-year longitudinal trajectories. METHODS An Italian sample of 478 prostate cancer patients undergone Robot-Assisted Radical Prostatectomy completed the EPIC-26 survey between July 2015 and July 2016 at the pre-hospitalization (T0), 45 days (T1) and 3 (T2), 6 (T3), 9 (T4), and 12 months (T5) after surgery. Sociodemographic and clinical characteristics (age, BMI, diabetes, nerve-sparing procedure) were also collected. Latent Class Growth Analysis was conducted separately for sexual dysfunction and urinary incontinence EPIC-26 subscales. The association between membership in the two longitudinal trajectories of urinary and sexual dysfunctions was assessed by considering Chi-square test and its related contingency table. RESULTS People who have a high level of urinary incontinence at T1 are likely to have a worse recovery. Age, BMI and pre-surgical continence may affect the level of incontinence at T1 and the recovery trajectories. Patients with low and moderate sexual problems at T1 can face a moderate linear recovery, while people with high level of impotence immediately after surgery may take a longer period to solve sexual dysfunctions. Age and the pre-surgical sexual condition may impact the recovery. Finally, a great proportion of patients reported both steady problems in sexual function and constant high levels of urinary incontinence over time. CONCLUSIONS This study highlights different categories of patients at risk who may be important to know in order to develop personalized medical pathways and predictive models in a value-based healthcare.
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Affiliation(s)
- Chiara Marzorati
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca Pavan
- Patient Safety & Risk Management Service, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriele Cozzi
- Division of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | - Massimo Monturano
- Patient Safety & Risk Management Service, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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19
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Turner K, Cutica I, Riva S, Zambrelli E, Canevini MP, Pravettoni G. Level of empowerment and decision-making style of women with epilepsy in childbirth age. Epilepsy Behav 2019; 93:32-37. [PMID: 30831399 DOI: 10.1016/j.yebeh.2019.01.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This research investigates level of empowerment, decisional skills, and the perceived relationship with the clinician, of women in childbirth age, also in relationship with clinical variables such as epilepsy type, seizure frequency, therapy, and pregnancy status. In particular, as concerning therapy, we were interested in women who take valproic acid (VPA), for its specific balance of risks and benefits, especially in pregnant women. METHODS The sample is composed of 60 women with epilepsy (6 were excluded), who underwent a standardized clinical protocol for assessment of level of empowerment, decisional skills, and of their judgment about how they feel to be involved by their clinician in medical decision making. RESULTS Overall, the sample does not show signs of low empowerment level nor of abnormal decision-making patterns. The type of epilepsy, the frequency of seizures, and the treatment type (VPA versus no VPA) do not impact on empowerment, on decision styles, nor on medical relationship, with the only exception of a specific decision style, the avoidant style, that is more frequent in women treated with VPA with respect to those taking other therapies. Interestingly, regarding VPA dosage, we found that women taking equal or more than 700 mg/day of VPA have lower scores on empowerment in all dimensions compared with women with a VPA dosage lower than 700 mg/day. CONCLUSIONS Shared decision making including improved decision quality, more informed choices and better treatment concordance, should be a central part of epilepsy care. In addition, for clinicians it would be useful to have specific tools to know if the patient has really understood the risks and benefits of antiepileptic drugs (AEDs), particularly VPA, and all treatment alternatives.
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Affiliation(s)
- Katherine Turner
- Epilepsy Center-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy.
| | - Ilaria Cutica
- Department of Psychoncology, University of Milan, Italy
| | - Silvia Riva
- University of Wolverhampton, West Midlands, UK
| | - Elena Zambrelli
- Epilepsy Center-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy
| | - Maria Paola Canevini
- Epilepsy Center-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy; Department of Health Sciences, University of Milan, Italy
| | - Gabriella Pravettoni
- European Institute of Oncology, Department of Psychoncology, University of Milan, Italy
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Bailo L, Guiddi P, Vergani L, Marton G, Pravettoni G. The patient perspective: investigating patient empowerment enablers and barriers within the oncological care process. Ecancermedicalscience 2019; 13:912. [PMID: 31123495 PMCID: PMC6467453 DOI: 10.3332/ecancer.2019.912] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Indexed: 12/13/2022] Open
Abstract
Patient empowerment is a multi-factorial concept and its relevance has led to a growing body of literature; despite this attention, there is still no agreement regarding the elements that define its expression. While several studies have already investigated the positive effect of empowerment interventions on the care process outcome, the aim of this study is to investigate which factors can foster an empowered management of the cancer condition from the patient's perspective. To examine patients' perception of empowerment enablers, we asked for participants' input on the role of three factors frequently cited as positively affected by empowerment: care quality, perception of direct control and relationships within the care context, during the care process. Three focus groups were conducted with 34 cancer patients. The results highlight the perception of direct control on their treatment as the least valued element (2.87, SD 0.566) when compared with care quality (3.75, SD 0.649) and relational support in the care context (3.91, SD 0.274). Unlike traditional approaches to empowerment, patient's expression of empowerment does not mainly reside in the direct control of their condition as much as in an active role within the relationship with caretakers, such as the ability to choose the doctor, the care team or the health organisation in charge of their healthcare. Emerging aspects from this analysis of patient's perspective are central in order to adequately consider empowerment in the care process and to provide more effective care strategies.
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Affiliation(s)
- Luca Bailo
- Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, 20141 Milan, Italy
| | - Paolo Guiddi
- Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, 20141 Milan, Italy
| | - Laura Vergani
- Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giulia Marton
- Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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Triberti S, Savioni L, Sebri V, Pravettoni G. eHealth for improving quality of life in breast cancer patients: A systematic review. Cancer Treat Rev 2019; 74:1-14. [PMID: 30658289 DOI: 10.1016/j.ctrv.2019.01.003] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 12/21/2022]
Abstract
Breast cancer patients (and survivors) use to deal with important challenges daily, such as coping with stress and depression, and adopting healthy lifestyles in order to improve treatment effectiveness; moreover, some experiential issues are quite specific of this disease, such as sexuality and fertility disfunctions after hormonal therapy, and distortions in body image after breast surgery. Recent literature highlighted the utility of eHealth or the use of new technologies to promote health management and quality of life in chronic diseases generally. The present contribution aims at (1) exploring usage and effectiveness of eHealth resources to improve breast cancer patients/survivors' quality of life, and (2) describing whether existing eHealth interventions addressed specific characteristics of breast cancer, or employed a generic approach only. A systematic literature search according to PRISMA guidelines was performed. Twenty-four studies met inclusion criteria and were included. Discussion highlights a majority of encouraging results about eHealth in breast cancer patients' health management, especially in those interventions featuring eHealth tools for improving patients' abilities (e.g., coping) and complex eHealth systems with multiple resources. However, generic use of eHealth is still predominant over disease-focused solutions. Guidelines for future eHealth research and development are listed in order to promote technology design centered on the lived experience of specific illness.
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Affiliation(s)
- Stefano Triberti
- Department of Oncology and Hemato-Oncology, University of Milan, via Festa del Perdono 7, 20122 Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, via Giuseppe Ripamonti 435, 20141 Milan, Italy.
| | - Lucrezia Savioni
- Department of Oncology and Hemato-Oncology, University of Milan, via Festa del Perdono 7, 20122 Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, via Giuseppe Ripamonti 435, 20141 Milan, Italy
| | - Valeria Sebri
- Department of Oncology and Hemato-Oncology, University of Milan, via Festa del Perdono 7, 20122 Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, via Giuseppe Ripamonti 435, 20141 Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, via Festa del Perdono 7, 20122 Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, via Giuseppe Ripamonti 435, 20141 Milan, Italy
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Marzorati C, Bailo L, Mazzocco K, Pravettoni G. Empowerment from patient's and caregiver's perspective in cancer care. Health Psychol Open 2018; 5:2055102918815318. [PMID: 30619617 PMCID: PMC6299910 DOI: 10.1177/2055102918815318] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The caregivers’ perceptions of the patients’ health condition may be biased and induce them to perceive higher needs than patients actually disclose. Our aim was to assess if the level of knowledge and awareness about cancer disease and treatment, and patient participation and assistance differs between caregivers and patients. A descriptive, cross-sectional study was conducted across five countries (Italy, United Kingdom, Spain, France and Germany) on a total of 510 participants who directly (patient) or indirectly (caregiver) faced a cancer diagnosis. Investigating this divergence could help to identify possible difficulties in patient–caregiver relationship, eventually improving patient empowerment.
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Affiliation(s)
- Chiara Marzorati
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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Martínez-García E, Buendía-Eisman A. The Hidden Agenda. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Martínez-García E, Buendía-Eisman A. La agenda oculta. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:855-857. [DOI: 10.1016/j.ad.2018.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/25/2018] [Indexed: 11/26/2022] Open
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Paz-Ares L, Luft A, Vicente D, Tafreshi A, Gümüş M, Mazières J, Hermes B, Çay Şenler F, Csőszi T, Fülöp A, Rodríguez-Cid J, Wilson J, Sugawara S, Kato T, Lee KH, Cheng Y, Novello S, Halmos B, Li X, Lubiniecki GM, Piperdi B, Kowalski DM. Pembrolizumab plus Chemotherapy for Squamous Non-Small-Cell Lung Cancer. N Engl J Med 2018; 379:2040-2051. [PMID: 30280635 DOI: 10.1056/nejmoa1810865] [Citation(s) in RCA: 2332] [Impact Index Per Article: 388.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Standard first-line therapy for metastatic, squamous non-small-cell lung cancer (NSCLC) is platinum-based chemotherapy or pembrolizumab (for patients with programmed death ligand 1 [PD-L1] expression on ≥50% of tumor cells). More recently, pembrolizumab plus chemotherapy was shown to significantly prolong overall survival among patients with nonsquamous NSCLC. METHODS In this double-blind, phase 3 trial, we randomly assigned, in a 1:1 ratio, 559 patients with untreated metastatic, squamous NSCLC to receive 200 mg of pembrolizumab or saline placebo for up to 35 cycles; all the patients also received carboplatin and either paclitaxel or nanoparticle albumin-bound [nab]-paclitaxel for the first 4 cycles. Primary end points were overall survival and progression-free survival. RESULTS After a median follow-up of 7.8 months, the median overall survival was 15.9 months (95% confidence interval [CI], 13.2 to not reached) in the pembrolizumab-combination group and 11.3 months (95% CI, 9.5 to 14.8) in the placebo-combination group (hazard ratio for death, 0.64; 95% CI, 0.49 to 0.85; P<0.001). The overall survival benefit was consistent regardless of the level of PD-L1 expression. The median progression-free survival was 6.4 months (95% CI, 6.2 to 8.3) in the pembrolizumab-combination group and 4.8 months (95% CI, 4.3 to 5.7) in the placebo-combination group (hazard ratio for disease progression or death, 0.56; 95% CI, 0.45 to 0.70; P<0.001). Adverse events of grade 3 or higher occurred in 69.8% of the patients in the pembrolizumab-combination group and in 68.2% of the patients in the placebo-combination group. Discontinuation of treatment because of adverse events was more frequent in the pembrolizumab-combination group than in the placebo-combination group (13.3% vs. 6.4%). CONCLUSIONS In patients with previously untreated metastatic, squamous NSCLC, the addition of pembrolizumab to chemotherapy with carboplatin plus paclitaxel or nab-paclitaxel resulted in significantly longer overall survival and progression-free survival than chemotherapy alone. (Funded by Merck Sharp & Dohme; KEYNOTE-407 ClinicalTrials.gov number, NCT02775435 .).
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Affiliation(s)
- Luis Paz-Ares
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Alexander Luft
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - David Vicente
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Ali Tafreshi
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Mahmut Gümüş
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Julien Mazières
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Barbara Hermes
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Filiz Çay Şenler
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Tibor Csőszi
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Andrea Fülöp
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Jerónimo Rodríguez-Cid
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Jonathan Wilson
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Shunichi Sugawara
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Terufumi Kato
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Ki Hyeong Lee
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Ying Cheng
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Silvia Novello
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Balazs Halmos
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Xiaodong Li
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Gregory M Lubiniecki
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Bilal Piperdi
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Dariusz M Kowalski
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
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Gorini A, Mazzocco K, Triberti S, Sebri V, Savioni L, Pravettoni G. A P5 Approach to m-Health: Design Suggestions for Advanced Mobile Health Technology. Front Psychol 2018; 9:2066. [PMID: 30429810 PMCID: PMC6220651 DOI: 10.3389/fpsyg.2018.02066] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
In recent years, technology has been developed as an important resource for health care management, especially in regard to chronic conditions. In the broad field of eHealth, mobile technology (mHealth) is increasingly used to empower patients not only in disease management but also in the achievement of positive experiences and experiential growth. mHealth tools are considered powerful because, unlike more traditional Internet-based tools, they allow patients to be continuously monitored and followed by their own mobile devices and to have continual access to resources (e.g., mobile apps or functions) supporting health care management activities. However, the literature has shown that, in many cases, such technology not accepted and/or adopted in the long term by its users. To address this issue, this article reviews the main factors influencing mHealth technology acceptance/adoption in health care. Finally, based on the main aspects emerging from the review, we propose an innovative approach to mHealth design and implementation, namely P5 mHealth. Relying on the P5 approach to medicine and health care, this approach provides design suggestions to address mHealth adoption issues already at the initial stages of development of the technologies.
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Affiliation(s)
- Alessandra Gorini
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Stefano Triberti
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Valeria Sebri
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Lucrezia Savioni
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
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Callus E, Bertoldo EG, Beretta M, Boveri S, Cardani R, Fossati B, Brigonzi E, Meola G. Neuropsychological and Psychological Functioning Aspects in Myotonic Dystrophy Type 1 Patients in Italy. Front Neurol 2018; 9:751. [PMID: 30298045 PMCID: PMC6160752 DOI: 10.3389/fneur.2018.00751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/17/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction: Myotonic Dystrophy Type 1 (DM1) is an autosomal dominant genetic illness, characterized by a progressive loss of strength. Important deficits in cognitive functioning and a significant prevalence of psychiatric disorders have been previously reported. Methods:A neuropsychological and psychological assessment was carried out in 31 DM1 patients (61% males) in order to measure the cognitive functioning and explore their personality profiles. The MMSE Mini-Mental State Examination, Frontal Assessment Battery (FAB), ENB-2 Battery assessing memory (short term, long term and working memory), integration capacities, visual-spatial ability, attention (selective, divided, shifting/switching) executive functions, praxis, discrimination and logic capabilities and psychopathology Symptom Check List 90-R (SCL-90-R) were administered. The neuropsychological and psychological evaluation of DM1 patients was carried out taking into consideration the clinical parameters (CTG repeat, age at onset, disease duration, Muscular Impairment Rate Scale (MIRS), Medical Research Council Scale (MRC) and the Epworth Sleepiness Scales (EPS)). Results: Regarding psychopathology 19.4% of patients scored a moderate or high level of symptoms intensity index (GSI), 12.9% reported a high number of symptoms (PST) and 16.1% reported a high intensity level of the perceived symptoms (PSDI). Fatigue and daytime sleepiness resulted as being associated with higher levels of psychoticism (PSY). Only 1 patient reported a severe impairment in the spatial and temporal orientation, memory, language, praxis, attention and calculation. Longer disease duration was also associated with cognitive impairment evaluated through ENB-2 (p < 0.05). Discussions and Conclusions:There are indications of the utility of neuropsychological and psychological screening and support for these patients and their families due to the link between disease duration and cognitive performances. A proposal of a clinical protocol, with an illustration of a clinical case report of a family is presented.
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Affiliation(s)
- Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Enrico G Bertoldo
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Maria Beretta
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Rosanna Cardani
- Laboratory of Muscle Histopathology and Molecular Biology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Barbara Fossati
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Elisa Brigonzi
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Meola
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Recupero A, Triberti S, Modesti C, Talamo A. Mixed Reality for Cross-Cultural Integration: Using Positive Technology to Share Experiences and Promote Communication. Front Psychol 2018; 9:1223. [PMID: 30065690 PMCID: PMC6056812 DOI: 10.3389/fpsyg.2018.01223] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/27/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Annamaria Recupero
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Stefano Triberti
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Camilla Modesti
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Alessandra Talamo
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
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Marzorati C, Renzi C, Russell-Edu SW, Pravettoni G. Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review. J Med Internet Res 2018; 20:e223. [PMID: 29914858 PMCID: PMC6028768 DOI: 10.2196/jmir.9812] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The number of published studies and systematic reviews examining different telehealth interventions targeting patients and their effects on patients' well-being and quality of life have grown in recent decades. However, the use of telemedicine tools aimed at the family members and caregivers of adult cancer patients is less defined. OBJECTIVE We aimed to conduct a systematic review to provide a more complete picture regarding telemedicine tools for informal caregivers (usually family members or close friends) implemented in all phases of cancer care. More specifically, the review aimed to better describe the study samples' characteristics, to analyze measured outcomes and the specific questionnaires used to assess them, and to describe in depth the implemented interventions and their formats. Finally, we examined the role of telehealth, and usability and feasibility trends in supporting patients' caregivers. METHODS We systematically searched the literature in the following databases: Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, MEDLINE, EMBASE, Google Scholar, and PsycINFO. Inclusion criteria were being written in English, published in peer-reviewed journals, describing a telehealth-implemented intervention, and focusing on caregivers of adult cancer patients at any stage of the disease. We selected studies published up to November 2017. We critically appraised included articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and graded the quality of evidence by outcome using the Centre for Evidence-Based Medicine framework. RESULTS We included 24 studies in the final selection. In 21 of the 24 studies, the patient-caregiver dyad was analyzed, and the study population dealt with different types of cancer at different stages. Included studies considered the caregiver's condition from both an individual and a relational point of view. Along with psychosocial variables, some studies monitored engagement and user satisfaction regarding Web-based platforms or telehealth interventions. All studies reported significant improvements in some of the investigated areas, but they often showed small effect sizes. Two types of telehealth intervention formats were used: Web-based platforms and telephone calls. Some of the included studies referred to the same project, but on study samples with different cancer diagnoses or with new versions of previously developed interventions. CONCLUSIONS Reported outcomes seem to suggest that we are in an exploratory phase. More detailed and targeted research hypotheses are still needed. Clarifying caregivers' needs related to telehealth tools and better defining outcome measures may yield more significant results.
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Affiliation(s)
- Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | | | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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30
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Lambert K, Mullan J, Mansfield K, Lonergan M. Comparison of the extent and pattern of cognitive impairment among predialysis, dialysis and transplant patients: A cross-sectional study from Australia. Nephrology (Carlton) 2018; 22:899-906. [PMID: 27505310 DOI: 10.1111/nep.12892] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/21/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023]
Abstract
AIM The aim of this study was to compare the extent of cogntive impairment and the types of cognitive deficits in an Australian cohort of four patient groups with end stage kidney disease. Characteristics predicting the presence of cognitive impairment were also evaluated. METHODS Observational cross-sectional study of 155 patients with end stage kidney disease are recruited from a regional Australian renal unit. Eligible participants included those whose estimated Glomerular Filtration Rate was < 30 ml/min per 1.73 m2 , were undertaking peritoneal or haemodialysis, or had received a kidney transplant. The Montreal Cognitive Assessment tool was used to screen the study participants for cognitive impairment and evaluate cognitive deficits. Cognitive impairment was defined as a total Montreal Cognitive Assessment tool score ≤24/30. RESULTS The extent of cognitive impairment varied between the four groups with end stage kidney disease. Factors predicting the presence of cognitive impairment included undertaking dialysis, age ≥65, male gender and the presence of diabetes or cerebrovascular disease. Deficits in executive function, attention, language, visuospatial skills, memory and orientation were common among the study participants, and the extent of these deficits varied between groups. Limitations to the study included the cross-sectional design, and that the presence of confounders like depression were not recorded. CONCLUSION The impact of disparities in the cognitive capabilities identified in this study are likely to be far reaching. Tailoring of education and self-management programmes to the cognitive deficits of individuals is required.
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Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Judy Mullan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kylie Mansfield
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Maureen Lonergan
- Service Director Renal Medicine, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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31
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Gandhi L, Rodríguez-Abreu D, Gadgeel S, Esteban E, Felip E, De Angelis F, Domine M, Clingan P, Hochmair MJ, Powell SF, Cheng SYS, Bischoff HG, Peled N, Grossi F, Jennens RR, Reck M, Hui R, Garon EB, Boyer M, Rubio-Viqueira B, Novello S, Kurata T, Gray JE, Vida J, Wei Z, Yang J, Raftopoulos H, Pietanza MC, Garassino MC. Pembrolizumab plus Chemotherapy in Metastatic Non-Small-Cell Lung Cancer. N Engl J Med 2018; 378:2078-2092. [PMID: 29658856 DOI: 10.1056/nejmoa1801005] [Citation(s) in RCA: 4173] [Impact Index Per Article: 695.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND First-line therapy for advanced non-small-cell lung cancer (NSCLC) that lacks targetable mutations is platinum-based chemotherapy. Among patients with a tumor proportion score for programmed death ligand 1 (PD-L1) of 50% or greater, pembrolizumab has replaced cytotoxic chemotherapy as the first-line treatment of choice. The addition of pembrolizumab to chemotherapy resulted in significantly higher rates of response and longer progression-free survival than chemotherapy alone in a phase 2 trial. METHODS In this double-blind, phase 3 trial, we randomly assigned (in a 2:1 ratio) 616 patients with metastatic nonsquamous NSCLC without sensitizing EGFR or ALK mutations who had received no previous treatment for metastatic disease to receive pemetrexed and a platinum-based drug plus either 200 mg of pembrolizumab or placebo every 3 weeks for 4 cycles, followed by pembrolizumab or placebo for up to a total of 35 cycles plus pemetrexed maintenance therapy. Crossover to pembrolizumab monotherapy was permitted among the patients in the placebo-combination group who had verified disease progression. The primary end points were overall survival and progression-free survival, as assessed by blinded, independent central radiologic review. RESULTS After a median follow-up of 10.5 months, the estimated rate of overall survival at 12 months was 69.2% (95% confidence interval [CI], 64.1 to 73.8) in the pembrolizumab-combination group versus 49.4% (95% CI, 42.1 to 56.2) in the placebo-combination group (hazard ratio for death, 0.49; 95% CI, 0.38 to 0.64; P<0.001). Improvement in overall survival was seen across all PD-L1 categories that were evaluated. Median progression-free survival was 8.8 months (95% CI, 7.6 to 9.2) in the pembrolizumab-combination group and 4.9 months (95% CI, 4.7 to 5.5) in the placebo-combination group (hazard ratio for disease progression or death, 0.52; 95% CI, 0.43 to 0.64; P<0.001). Adverse events of grade 3 or higher occurred in 67.2% of the patients in the pembrolizumab-combination group and in 65.8% of those in the placebo-combination group. CONCLUSIONS In patients with previously untreated metastatic nonsquamous NSCLC without EGFR or ALK mutations, the addition of pembrolizumab to standard chemotherapy of pemetrexed and a platinum-based drug resulted in significantly longer overall survival and progression-free survival than chemotherapy alone. (Funded by Merck; KEYNOTE-189 ClinicalTrials.gov number, NCT02578680 .).
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/secondary
- Disease-Free Survival
- Double-Blind Method
- Female
- Follow-Up Studies
- Humans
- Kaplan-Meier Estimate
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Male
- Middle Aged
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Affiliation(s)
- Leena Gandhi
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Delvys Rodríguez-Abreu
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Shirish Gadgeel
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Emilio Esteban
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Enriqueta Felip
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Flávia De Angelis
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Manuel Domine
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Philip Clingan
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Maximilian J Hochmair
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Steven F Powell
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Susanna Y-S Cheng
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Helge G Bischoff
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Nir Peled
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Francesco Grossi
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Ross R Jennens
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Martin Reck
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Rina Hui
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Edward B Garon
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Michael Boyer
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Belén Rubio-Viqueira
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Silvia Novello
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Takayasu Kurata
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Jhanelle E Gray
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - John Vida
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Ziwen Wei
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Jing Yang
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Harry Raftopoulos
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - M Catherine Pietanza
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Marina C Garassino
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
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Renzi C, Perinel G, Arnaboldi P, Gandini S, Vadilonga V, Rotmensz N, Tagini A, Didier F, Pravettoni G. Memories of paternal relations are associated with coping and defense mechanisms in breast cancer patients: an observational study. BMC Psychol 2017; 5:37. [PMID: 29122005 PMCID: PMC5679357 DOI: 10.1186/s40359-017-0206-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 10/30/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Breast cancer diagnosis and treatment represent stressful events that demand emotional adjustment, thus recruiting coping strategies and defense mechanisms. As parental relations were shown to influence emotion regulation patterns and adaptive processes in adulthood, the present study investigated whether they are specifically associated to coping and defense mechanisms in patients with breast cancer. METHODS One hundred and ten women hospitalized for breast cancer surgery were administered questionnaires assessing coping with cancer, defense mechanisms, and memories of parental bonding in childhood. RESULTS High levels of paternal overprotection were associated with less mature defenses, withdrawal and fantasy and less adaptive coping mechanisms, such as hopelessness/helplessness. Low levels of paternal care were associated with a greater use of repression. No association was found between maternal care, overprotection, coping and defense mechanisms. Immature defenses correlated positively with less adaptive coping styles, while mature defenses were positively associated to a fighting spirit and to fatalism, and inversely related to less adaptive coping styles. CONCLUSIONS These data suggest that paternal relations in childhood are associated with emotional, cognitive, and behavioral regulation in adjusting to cancer immediately after surgery. Early experiences of bonding may constitute a relevant index for adaptation to cancer, indicating which patients are at risk and should be considered for psychological interventions.
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Affiliation(s)
- Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
| | - Giada Perinel
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Paola Arnaboldi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Sara Gandini
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Valeria Vadilonga
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Nicole Rotmensz
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Angela Tagini
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, Italy
| | - Florence Didier
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Onco-Hematology, University of Milano, Via Festa del Perdono 7, Milan, Italy
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Renzi C, Fioretti C, Oliveri S, Mazzocco K, Zerini D, Alessandro O, Rojas DP, Jereczek-Fossa BA, Pravettoni G. A Qualitative Investigation on Patient Empowerment in Prostate Cancer. Front Psychol 2017; 8:1215. [PMID: 28798701 PMCID: PMC5526923 DOI: 10.3389/fpsyg.2017.01215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/03/2017] [Indexed: 12/04/2022] Open
Abstract
Purpose: Men with prostate cancer often describe low levels of empowerment. eHealth interventions may represent useful tools to deliver care and education and to meet patients' needs within an empowerment framework. In order to design a platform for cancer patients' empowerment within the H2020 iManageCancer project, the perspective of the target population for the platform was assessed. The present study aims to assess the qualitative experience of prostate cancer patients during treatment in order to provide insights for clinical practice with a particular focus on the design of a web platform to promote cancer patients' empowerment. Methods: Ten patients undergoing radiation therapy treatment took part in a semi-structured interview to explore different aspects of patient empowerment. Four main thematic areas were addressed: patient-healthcare providers' communication, decision-making, needs, and resources. A qualitative approach using thematic analysis was followed. Results: Half of the patients reported little to no possibility to share information and questions with healthcare providers. With regards to decision-making, the role of healthcare providers was perceived as directive/informative, but half of the patients perceived to assume an active role in at least one interaction. Difficulties and needs included the choice of the specialist or of the structure after diagnosis, clinicians' support in self-management, surgical consequences, and side effects, preparation for radiation therapy. Resources included family and social support both from a practical and from an emotional perspective, coping style, and work schedule management. Conclusions: These results suggest that relations with healthcare providers should be supported, especially immediately after diagnosis and after surgery. Support to self-management after surgery and at the beginning of radiation therapy treatment also constitutes a priority. The adoption of a personalized approach from the beginning of prostate cancer care flow may promote patient empowerment, overcoming the aforementioned needs and mobilizing resources. The social network represents an important resource that could be integrated in interventions. These considerations will be taken into account in the design of a cancer self-management platform aiming to increase patients' empowerment.
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Affiliation(s)
- Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy
| | - Chiara Fioretti
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy
| | - Serena Oliveri
- Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy.,Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Dario Zerini
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy
| | - Ombretta Alessandro
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Damaris P Rojas
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Barbara A Jereczek-Fossa
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy.,Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
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Fioretti C, Mazzocco K, Pravettoni G. Psychological Support in Breast Cancer Patients: A Personalized Approach. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_73] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Personalized Medicine: What’s in it for Rare Diseases? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1031:387-404. [DOI: 10.1007/978-3-319-67144-4_22] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Schee genannt Halfmann S, Evangelatos N, Schröder-Bäck P, Brand A. European healthcare systems readiness to shift from ‘one-size fits all’ to personalized medicine. Per Med 2017; 14:63-74. [DOI: 10.2217/pme-2016-0061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Personalized medicine (PM) is no longer an abstract healthcare approach. It has become a reality over the last years and is already successfully applied in the various medical fields. Although there are success stories of implementing PM, there are still many more opportunities to further implement and make full use of the potential of PM. We assessed the system readiness of healthcare systems in Europe to shift from the predominant ‘one size fits all’ healthcare approach to PM. We conclude that European healthcare systems are only partially ready for PM. Key challenges such as integration of big data, health literacy, reimbursement and regulatory issues need to be overcome in order to strengthen the implementation and uptake of PM.
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Affiliation(s)
- Sebastian Schee genannt Halfmann
- Maastricht Economic & Social Research Institute on Innovation & Technology (MERIT), Maastricht University, Boschstraat 24, 6211AX Maastricht, The Netherlands
| | - Nikolaos Evangelatos
- Maastricht Economic & Social Research Institute on Innovation & Technology (MERIT), Maastricht University, Boschstraat 24, 6211AX Maastricht, The Netherlands
- University Clinic for Emergency & Intensive Care Medicine, Paracelsus Medical University (PMU), Prof. Ernst-Nathan-Strasse 1, 90419 Nuremberg, Germany
| | - Peter Schröder-Bäck
- Department of International Health, School CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands
- Faculty for Health & Human Sciences, University of Bremen, Grazer Strasse 2, 28359 Bremen, Germany
| | - Angela Brand
- Maastricht Economic & Social Research Institute on Innovation & Technology (MERIT), Maastricht University, Boschstraat 24, 6211AX Maastricht, The Netherlands
- Faculty of Health, Medicine & Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Pravettoni G, Cutica I, Righetti S, Mazzocco K. Decisions and the involvement of cancer patient survivors: a moral imperative. J Healthc Leadersh 2016; 8:121-125. [PMID: 29355188 PMCID: PMC5741003 DOI: 10.2147/jhl.s115434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose The aim of this study was to review the experiences of direct involvement in patient survivorship for treatment and research. Methods This is a narrative-focused review of the following two recent experiences of patient involvement: the Chordoma Foundation and the Triple Negative Breast Cancer Foundation. Results These two examples represent concrete experiences that patients have built to favor a real involvement in the care and treatment of tumors. These experiences are profoundly modifying how cancer research is conducted and draw attention to the psychosocial dimensions of health care. Conclusion These examples represent the new scenario in which modern medicine faces completely new challenges, copes with new needs, and cooperates with new health care professionals. Implications Involving patients in a new perspective raises practical and ethical challenges for organizations to work together, for health providers to be professionally skilled and for the government to promote safeguarding policies.
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Affiliation(s)
- Gabriella Pravettoni
- Department of Oncology and Hematology, University of Milan.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - Ilaria Cutica
- Department of Oncology and Hematology, University of Milan.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | | | - Ketti Mazzocco
- Department of Oncology and Hematology, University of Milan.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
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Masiero M, Riva S, Fioretti C, Pravettoni G. Pediatric Blood Cancer Survivors and Tobacco Use across Adolescence and Emerging Adulthood: A Narrative Review. Front Psychol 2016; 7:392. [PMID: 27047419 PMCID: PMC4800409 DOI: 10.3389/fpsyg.2016.00392] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/04/2016] [Indexed: 01/27/2023] Open
Abstract
Scholars underline the pivotal role of tobacco cigarette smoking in carcinogenesis process for blood tumors. A controversial debate is represented by the diffusion of tobacco use in young cancer survivors that had a previous diagnosis of blood tumor during the childhood. Compared with their peers, scientific evidence highlights that pediatric survivors have more difficult to give-up cigarette smoking. Furthermore, tobacco-smoking is frequently linked with others risk behaviors as drinking or substance abuse. In reviewing the main knowledge on this topic, authors affirm the need for increasing research on blood cancer survivors in order to depict psychological characteristics of pediatric blood cancer survivors. Improving health decision-making skills in young survivors could reduce the risk to adopt un-healthy behaviors and increase psychological wellbeing. Furthermore, authors propose tailored antismoking interventions based on the knowledge of the psychological and cognitive factors that support smoking during the transition toward emerging-adulthood.
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Affiliation(s)
- Marianna Masiero
- Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilano, Italy
| | - Silvia Riva
- Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilano, Italy
| | - Chiara Fioretti
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology Milano, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilano, Italy
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