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Ng IKS, Goh WGW, Lin NHY, Teo DB. 'Person-centred care': an overhyped cliché or a practicable health delivery model? Intern Med J 2024; 54:1053-1055. [PMID: 38655740 DOI: 10.1111/imj.16358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/14/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Isaac K S Ng
- Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wilson G W Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Norman H Y Lin
- Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Desmond B Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Fast and Chronic Programmes, Alexandra Hospital, Singapore
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore
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2
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Bragazzi NL, Garbarino S. Toward Clinical Generative AI: Conceptual Framework. JMIR AI 2024; 3:e55957. [PMID: 38875592 PMCID: PMC11193080 DOI: 10.2196/55957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/08/2024] [Accepted: 05/06/2024] [Indexed: 06/16/2024]
Abstract
Clinical decision-making is a crucial aspect of health care, involving the balanced integration of scientific evidence, clinical judgment, ethical considerations, and patient involvement. This process is dynamic and multifaceted, relying on clinicians' knowledge, experience, and intuitive understanding to achieve optimal patient outcomes through informed, evidence-based choices. The advent of generative artificial intelligence (AI) presents a revolutionary opportunity in clinical decision-making. AI's advanced data analysis and pattern recognition capabilities can significantly enhance the diagnosis and treatment of diseases, processing vast medical data to identify patterns, tailor treatments, predict disease progression, and aid in proactive patient management. However, the incorporation of AI into clinical decision-making raises concerns regarding the reliability and accuracy of AI-generated insights. To address these concerns, 11 "verification paradigms" are proposed in this paper, with each paradigm being a unique method to verify the evidence-based nature of AI in clinical decision-making. This paper also frames the concept of "clinically explainable, fair, and responsible, clinician-, expert-, and patient-in-the-loop AI." This model focuses on ensuring AI's comprehensibility, collaborative nature, and ethical grounding, advocating for AI to serve as an augmentative tool, with its decision-making processes being transparent and understandable to clinicians and patients. The integration of AI should enhance, not replace, the clinician's judgment and should involve continuous learning and adaptation based on real-world outcomes and ethical and legal compliance. In conclusion, while generative AI holds immense promise in enhancing clinical decision-making, it is essential to ensure that it produces evidence-based, reliable, and impactful knowledge. Using the outlined paradigms and approaches can help the medical and patient communities harness AI's potential while maintaining high patient care standards.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Human Nutrition Unit, Department of Food and Drugs, University of Parma, Parma, Italy
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genoa, Genoa, Italy
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3
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Garbarino S, Bragazzi NL. Revolutionizing Sleep Health: The Emergence and Impact of Personalized Sleep Medicine. J Pers Med 2024; 14:598. [PMID: 38929819 PMCID: PMC11204813 DOI: 10.3390/jpm14060598] [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: 02/23/2024] [Revised: 05/11/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Personalized sleep medicine represents a transformative shift in healthcare, emphasizing individualized approaches to optimizing sleep health, considering the bidirectional relationship between sleep and health. This field moves beyond conventional methods, tailoring care to the unique physiological and psychological needs of individuals to improve sleep quality and manage disorders. Key to this approach is the consideration of diverse factors like genetic predispositions, lifestyle habits, environmental factors, and underlying health conditions. This enables more accurate diagnoses, targeted treatments, and proactive management. Technological advancements play a pivotal role in this field: wearable devices, mobile health applications, and advanced diagnostic tools collect detailed sleep data for continuous monitoring and analysis. The integration of machine learning and artificial intelligence enhances data interpretation, offering personalized treatment plans based on individual sleep profiles. Moreover, research on circadian rhythms and sleep physiology is advancing our understanding of sleep's impact on overall health. The next generation of wearable technology will integrate more seamlessly with IoT and smart home systems, facilitating holistic sleep environment management. Telemedicine and virtual healthcare platforms will increase accessibility to specialized care, especially in remote areas. Advancements will also focus on integrating various data sources for comprehensive assessments and treatments. Genomic and molecular research could lead to breakthroughs in understanding individual sleep disorders, informing highly personalized treatment plans. Sophisticated methods for sleep stage estimation, including machine learning techniques, are improving diagnostic precision. Computational models, particularly for conditions like obstructive sleep apnea, are enabling patient-specific treatment strategies. The future of personalized sleep medicine will likely involve cross-disciplinary collaborations, integrating cognitive behavioral therapy and mental health interventions. Public awareness and education about personalized sleep approaches, alongside updated regulatory frameworks for data security and privacy, are essential. Longitudinal studies will provide insights into evolving sleep patterns, further refining treatment approaches. In conclusion, personalized sleep medicine is revolutionizing sleep disorder treatment, leveraging individual characteristics and advanced technologies for improved diagnosis, treatment, and management. This shift towards individualized care marks a significant advancement in healthcare, enhancing life quality for those with sleep disorders.
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Affiliation(s)
- Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy;
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
- Human Nutrition Unit (HNU), Department of Food and Drugs, University of Parma, 43125 Parma, Italy
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4
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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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Neagu AN, Whitham D, Bruno P, Arshad A, Seymour L, Morrissiey H, Hukovic AI, Darie CC. Onco-Breastomics: An Eco-Evo-Devo Holistic Approach. Int J Mol Sci 2024; 25:1628. [PMID: 38338903 PMCID: PMC10855488 DOI: 10.3390/ijms25031628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Known as a diverse collection of neoplastic diseases, breast cancer (BC) can be hyperbolically characterized as a dynamic pseudo-organ, a living organism able to build a complex, open, hierarchically organized, self-sustainable, and self-renewable tumor system, a population, a species, a local community, a biocenosis, or an evolving dynamical ecosystem (i.e., immune or metabolic ecosystem) that emphasizes both developmental continuity and spatio-temporal change. Moreover, a cancer cell community, also known as an oncobiota, has been described as non-sexually reproducing species, as well as a migratory or invasive species that expresses intelligent behavior, or an endangered or parasite species that fights to survive, to optimize its features inside the host's ecosystem, or that is able to exploit or to disrupt its host circadian cycle for improving the own proliferation and spreading. BC tumorigenesis has also been compared with the early embryo and placenta development that may suggest new strategies for research and therapy. Furthermore, BC has also been characterized as an environmental disease or as an ecological disorder. Many mechanisms of cancer progression have been explained by principles of ecology, developmental biology, and evolutionary paradigms. Many authors have discussed ecological, developmental, and evolutionary strategies for more successful anti-cancer therapies, or for understanding the ecological, developmental, and evolutionary bases of BC exploitable vulnerabilities. Herein, we used the integrated framework of three well known ecological theories: the Bronfenbrenner's theory of human development, the Vannote's River Continuum Concept (RCC), and the Ecological Evolutionary Developmental Biology (Eco-Evo-Devo) theory, to explain and understand several eco-evo-devo-based principles that govern BC progression. Multi-omics fields, taken together as onco-breastomics, offer better opportunities to integrate, analyze, and interpret large amounts of complex heterogeneous data, such as various and big-omics data obtained by multiple investigative modalities, for understanding the eco-evo-devo-based principles that drive BC progression and treatment. These integrative eco-evo-devo theories can help clinicians better diagnose and treat BC, for example, by using non-invasive biomarkers in liquid-biopsies that have emerged from integrated omics-based data that accurately reflect the biomolecular landscape of the primary tumor in order to avoid mutilating preventive surgery, like bilateral mastectomy. From the perspective of preventive, personalized, and participatory medicine, these hypotheses may help patients to think about this disease as a process governed by natural rules, to understand the possible causes of the disease, and to gain control on their own health.
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Affiliation(s)
- Anca-Narcisa Neagu
- Laboratory of Animal Histology, Faculty of Biology, “Alexandru Ioan Cuza” University of Iași, Carol I bvd. 20A, 700505 Iasi, Romania
| | - Danielle Whitham
- Biochemistry & Proteomics Laboratories, Department of Chemistry and Biomolecular Science, Clarkson University, Potsdam, NY 13699-5810, USA; (D.W.); (P.B.); (A.A.); (L.S.); (H.M.); (A.I.H.)
| | - Pathea Bruno
- Biochemistry & Proteomics Laboratories, Department of Chemistry and Biomolecular Science, Clarkson University, Potsdam, NY 13699-5810, USA; (D.W.); (P.B.); (A.A.); (L.S.); (H.M.); (A.I.H.)
| | - Aneeta Arshad
- Biochemistry & Proteomics Laboratories, Department of Chemistry and Biomolecular Science, Clarkson University, Potsdam, NY 13699-5810, USA; (D.W.); (P.B.); (A.A.); (L.S.); (H.M.); (A.I.H.)
| | - Logan Seymour
- Biochemistry & Proteomics Laboratories, Department of Chemistry and Biomolecular Science, Clarkson University, Potsdam, NY 13699-5810, USA; (D.W.); (P.B.); (A.A.); (L.S.); (H.M.); (A.I.H.)
| | - Hailey Morrissiey
- Biochemistry & Proteomics Laboratories, Department of Chemistry and Biomolecular Science, Clarkson University, Potsdam, NY 13699-5810, USA; (D.W.); (P.B.); (A.A.); (L.S.); (H.M.); (A.I.H.)
| | - Angiolina I. Hukovic
- Biochemistry & Proteomics Laboratories, Department of Chemistry and Biomolecular Science, Clarkson University, Potsdam, NY 13699-5810, USA; (D.W.); (P.B.); (A.A.); (L.S.); (H.M.); (A.I.H.)
| | - Costel C. Darie
- Biochemistry & Proteomics Laboratories, Department of Chemistry and Biomolecular Science, Clarkson University, Potsdam, NY 13699-5810, USA; (D.W.); (P.B.); (A.A.); (L.S.); (H.M.); (A.I.H.)
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Özdemir V. Taking Political Determinants of Planetary Health Seriously: Expanding from P4 to P5 Medicine. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2024; 28:2-4. [PMID: 38150521 DOI: 10.1089/omi.2023.0276] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Predictive, Personalized, Preventive, and Participatory (P4) Medicine is embedded in the precision medicine conceptual framework to achieve the overarching goal of "the right drug, for the right patient, at the right dose, and at the right time." Science cultures and political determinants of health have normative and instrumental impacts on P4 medicine. Yet, since the age of Enlightenment in the 17th century, science and economics have been disarticulated from politics along the lines of classical liberalism, and with an ahistorical approach that continues into the 21st century. The consequence of this liberal disarticulation is that science is falsely and narrowly understood as an invariably technocratic and objective field. In the aftermath of the Covid-19 pandemic, it is clearer that political determinants of health are the causes-of-causes for disease and health. I propose that we need P5 medicine with a fifth P, political determinants of planetary health. The new "P" can engage not only with instrumental aspects of P4 medicine research and clinical implementation but also with the structural factors that are an integral part of the politics of the P4 medicine. For example, the living legacies of colonialism contribute to the unequal relationships in trade, labor, provision, and production of materials among nation-states and between the Global South and the Global North and shape the class struggles in contemporary society, science, and medicine. A decolonial politics of care in which the political determinants of planetary health are taken seriously is therefore crucial and relevant to building a robust, ethical, responsible, and just P5 medicine in the 21st century.
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Affiliation(s)
- Vural Özdemir
- OMICS: A Journal of Integrative Biology, New Rochelle, New York, USA
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Cobo M, Menéndez Fernández-Miranda P, Bastarrika G, Lloret Iglesias L. Enhancing radiomics and Deep Learning systems through the standardization of medical imaging workflows. Sci Data 2023; 10:732. [PMID: 37865635 PMCID: PMC10590396 DOI: 10.1038/s41597-023-02641-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023] Open
Affiliation(s)
- Miriam Cobo
- Advanced Computing and e-Science Group, Institute of Physics of Cantabria (IFCA), CSIC - UC, Santander, Spain.
| | | | - Gorka Bastarrika
- Clínica Universidad de Navarra, Department of Radiology, Pamplona, Spain
| | - Lara Lloret Iglesias
- Advanced Computing and e-Science Group, Institute of Physics of Cantabria (IFCA), CSIC - UC, Santander, Spain
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8
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Noordegraaf MA, van den Berg SW, Bloem BR. Hopamine as Personalized Medicine for Persons with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:271-277. [PMID: 36806516 PMCID: PMC10041418 DOI: 10.3233/jpd-230012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Prescribing dopamine replacement therapy remains the most common approach used by physicians who strive to support persons with Parkinson's disease. In this viewpoint, we argue that instead of merely prescribing dopamine, healthcare professionals should particularly encourage and enable persons with Parkinson's disease to draft their own personalized prescription of "hopamine". The term hopamine is a self-invented neologism representing the uniquely personal set of hopes, desires, experiences, and skills of each individual with a dopamine deficit. As such, the concept of hopamine-as a reflection of the unique personal characteristics of each person with Parkinson's disease-really supplements that of dopamine-as a reflection of each person's unique physical characteristics. Whereas a prescription of dopamine replacement medication necessitates the diagnosed individual to lay his or her fate in the hands of medical professionals, adding a personalized dose of hopamine to the therapeutic mix empowers persons to self-manage daily life with Parkinson's disease. In this viewpoint, we argue that hopamine is a prerequisite for personalized medicine and offer several practical recommendations for how medical professionals can introduce the concept of hopamine in daily clinical practice.
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Affiliation(s)
- Marina A Noordegraaf
- Patient Advocate and Patient Researcher at the Dutch Parkinson's Association, The Netherlands
| | - Sanne W van den Berg
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology; Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology; Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
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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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Chieffo DPR, Lafuenti L, Mastrilli L, De Paola R, Vannuccini S, Morra M, Salvi F, Boškoski I, Salutari V, Ferrandina G, Scambia G. Medi-Cinema: A Pilot Study on Cinematherapy and Cancer as A New Psychological Approach on 30 Gynecological Oncological Patients. Cancers (Basel) 2022; 14:cancers14133067. [PMID: 35804839 PMCID: PMC9265104 DOI: 10.3390/cancers14133067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Several subjects affected by cancer experience a significant level of multidimensional disease. This longitudinal study aims to evaluate the effectiveness of psycho-oncological support using Cinema as an emotional mediator and to promote perceived well-being by personalized psychological treatment. Methods: Thirty women diagnosed with gynecological cancer watched 12 movies and participated in a psychotherapy group co-conducted by two psychotherapists. Patients completed nine questionnaires at T0 (baseline), T1 (3 months) and T2 (6 months). Results: Patients observed significant improvements (CORE-OM: p < 0.001) in psychological well-being. The results showed statistically significant differences, even in several other dimensions, such as Anxiety (STAY-Y1-2: p < 0.001), Empathy (BEES, p < 0.001), Coping (COPE: p < 0.001), QoL (QLQ-C30, p: 0.026), couple relationship (DAS, Satisfaction: p: 0.013; Cohesion: p: 0.004) and alexithymia (TAS-20, Difficulty Identifying Feeling: p: 0.002; Externally-Oriented Thinking: p: 0.003). Conclusions: The data show that cinema, as an innovative psychological approach, could be a valid instrument to support patients in oncological pathways as well as facilitating the process of recognizing themselves in other patients and communicating about their own feelings.
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Affiliation(s)
- Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.P.R.C.); (L.M.); (R.D.P.); (S.V.)
- Medicine and Surgery Faculty, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Letizia Lafuenti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.P.R.C.); (L.M.); (R.D.P.); (S.V.)
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.S.); (G.F.)
- Correspondence: ; Tel.: +39-3489003122
| | - Ludovica Mastrilli
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.P.R.C.); (L.M.); (R.D.P.); (S.V.)
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.S.); (G.F.)
| | - Rebecca De Paola
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.P.R.C.); (L.M.); (R.D.P.); (S.V.)
| | - Sofia Vannuccini
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.P.R.C.); (L.M.); (R.D.P.); (S.V.)
| | - Marina Morra
- Medicinema Italia Onlus, 20122 Milan, Italy; (M.M.); (F.S.)
| | - Fulvia Salvi
- Medicinema Italia Onlus, 20122 Milan, Italy; (M.M.); (F.S.)
| | - Ivo Boškoski
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Vanda Salutari
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.S.); (G.F.)
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.S.); (G.F.)
| | - Giovanni Scambia
- Medicine and Surgery Faculty, Catholic University of the Sacred Heart, 00168 Rome, Italy;
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.S.); (G.F.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Amram D, Cignoni A, Banfi T, Ciuti G. From P4 medicine to P5 medicine: transitional times for a more human-centric approach to AI-based tools for hospitals of tomorrow. OPEN RESEARCH EUROPE 2022; 2:33. [PMID: 37645333 PMCID: PMC10445924 DOI: 10.12688/openreseurope.14524.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 08/31/2023]
Abstract
Within the debate on shaping future clinical services, where different robotics and artificial intelligence (AI) based technologies are integrated to perform tasks, the authors take the chance to provide an interdisciplinary analysis required to validate a tool aiming at supporting the melanoma cancer diagnosis. In particular, they focus on the ethical-legal and technical requirements needed to address the Assessment List on Trustworthy AI (ALTAI), highlighting some pros and cons of the adopted self-assessment checklist. The dialogue stimulates additionally remarks on the EU regulatory initiatives on AI in the healthcare systems.
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Affiliation(s)
- Denise Amram
- LIDER LAB - DIRPOLIS Institute EMbeDS Department of Excellence, Scuola Superiore Sant'Anna di Studi Universitari e di Perfezionamento, Pisa, Pisa, 56100, Italy
| | - Arianna Cignoni
- The BioRobotics Institute Department of Excellence in Robotics & AI,, Scuola Superiore Sant'Anna di Studi Universitari e di Perfezionamento, Pisa, Pisa, 56100, Italy
| | - Tommaso Banfi
- The BioRobotics Institute Department of Excellence in Robotics & AI,, Scuola Superiore Sant'Anna di Studi Universitari e di Perfezionamento, Pisa, Pisa, 56100, Italy
| | - Gastone Ciuti
- The BioRobotics Institute Department of Excellence in Robotics & AI,, Scuola Superiore Sant'Anna di Studi Universitari e di Perfezionamento, Pisa, Pisa, 56100, Italy
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12
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Chiurazzi M, Damone A, Finocchiaro M, Farnesi F, Secco GL, Forcignano E, Arezzo A, Ciuti G. Small bowel to closest human body surface distance calculation through a custom-made software using CT-based datasets. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:2903-2909. [PMID: 34891853 DOI: 10.1109/embc46164.2021.9630828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Screening of the gastrointestinal tract is imperative for the detection and treatment of physiological and pathological disorders in humans. Ingestible devices (e.g., magnetic capsule endoscopes) represent an alternative to conventional flexible endoscopy for reducing the invasiveness of the procedure and the related patient's discomforts. However, to properly design localization and navigation strategies for capsule endoscopes, the knowledge of anatomical features is paramount. Therefore, authors developed a semi-automatic software for measuring the distance between the small bowel and the closest human external body surface, using CT colonography images. In this study, volumetric datasets of 30 patients were processed by gastrointestinal endoscopists with the dedicated custom-made software and results showed an average distance of 79.29 ± 23.85 mm.
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13
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Monzani D, Petrocchi S, Oliveri S, Veldwijk J, Janssens R, Bailo L, Smith MY, Smith I, Schoefs E, Nackaerts K, Vandevelde M, Louis E, Decaluwé H, De Leyn P, Declerck H, Katz EG, Petrella F, Casiraghi M, Durosini I, Galli G, Garassino MC, de Wit GA, Pravettoni G, Huys I. Patient Preferences for Lung Cancer Treatments: A Study Protocol for a Preference Survey Using Discrete Choice Experiment and Swing Weighting. Front Med (Lausanne) 2021; 8:689114. [PMID: 34409049 PMCID: PMC8365300 DOI: 10.3389/fmed.2021.689114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Advanced treatment options for non-small cell lung cancer (NSCLC) consist of immunotherapy, chemotherapy, or a combination of both. Decisions surrounding NSCLC can be considered as preference-sensitive because multiple treatments exist that vary in terms of mode of administration, treatment schedules, and benefit–risk profiles. As part of the IMI PREFER project, we developed a protocol for an online preference survey for NSCLC patients exploring differences in preferences according to patient characteristics (preference heterogeneity). Moreover, this study will evaluate and compare the use of two different preference elicitation methods, the discrete choice experiment (DCE) and the swing weighting (SW) task. Finally, the study explores how demographic (i.e., age, gender, and educational level) and clinical (i.e., cancer stage and line of treatment) information, health literacy, health locus of control, and quality of life may influence or explain patient preferences and the usefulness of a digital interactive tool in providing information on preference elicitation tasks according to patients. Methods: An online survey will be implemented with the aim to recruit 510 NSCLC patients in Belgium and Italy. Participants will be randomized 50:50 to first receive either the DCE or the SW. The survey will also collect information on participants' disease-related status, health locus of control, health literacy, quality of life, and perception of the educational tool. Discussion: This protocol outlines methodological and practical steps to quantitatively elicit and study patient preferences for NSCLC treatment alternatives. Results from this study will increase the understanding of which treatment aspects are most valued by NSCLC patients to inform decision-making in drug development, regulatory approval, and reimbursement. Methodologically, the comparison between the DCE and the SW task will be valuable to gain information on how these preference methods perform against each other in eliciting patient preferences. Overall, this protocol may assist researchers, drug developers, and decision-makers in designing quantitative patient preferences into decision-making along the medical product life cycle.
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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, Milan, Italy
| | - Serena Petrocchi
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Serena Oliveri
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Jorien Veldwijk
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands.,Erasmus 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
| | - Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Meredith Y Smith
- Alexion Pharmaceuticals, Inc., Boston, MA, United States.,University of Southern California School of Pharmacy, Los Angeles, CA, United States
| | - Ian Smith
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Elise Schoefs
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Kristiaan Nackaerts
- Department of Respiratory Oncology, University Hospital Leuven, Leuven, Belgium
| | - Marie Vandevelde
- Department of Respiratory Oncology, University Hospital Leuven, Leuven, Belgium
| | - Evelyne Louis
- Department of Respiratory Oncology, University Hospital Leuven, Leuven, Belgium
| | | | - Paul De Leyn
- Department of Thoracic Surgery, KU Leuven, Leuven, Belgium
| | - Hanne Declerck
- Department of Thoracic Surgery, KU Leuven, Leuven, Belgium
| | - Eva G Katz
- Janssen Research and Development, LLC, Raritan, NJ, United States
| | - Francesco Petrella
- Thoracic Surgery Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Monica Casiraghi
- Thoracic Surgery Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ilaria Durosini
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Galli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina Chiara Garassino
- University of Chicago Department of Medicine Section Hematology/Oncology, Chicago, IL, United States
| | - 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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14
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Nardini C, Osmani V, Cormio PG, Frosini A, Turrini M, Lionis C, Neumuth T, Ballensiefen W, Borgonovi E, D'Errico G. The evolution of personalized healthcare and the pivotal role of European regions in its implementation. Per Med 2021; 18:283-294. [PMID: 33825526 DOI: 10.2217/pme-2020-0115] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Personalized medicine (PM) moves at the same pace of data and technology and calls for important changes in healthcare. New players are participating, providing impulse to PM. We review the conceptual foundations for PM and personalized healthcare and their evolution through scientific publications where a clear definition and the features of the different formulations are identifiable. We then examined PM policy documents of the International Consortium for Personalised Medicine and related initiatives to understand how PM stakeholders have been changing. Regional authorities and stakeholders have joined the race to deliver personalized care and are driving toward what could be termed as the next personalized healthcare. Their role as a key stakeholder in PM is expected to be pivotal.
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Affiliation(s)
| | - Venet Osmani
- Fondazione Bruno Kessler Research Institute, Trento 38123, Italy
| | - Paola G Cormio
- Sant'Anna School of Advanced Studies, Istituto di BioRobotica, Pisa 56127, Italy
| | | | - Mauro Turrini
- Institute of Public Goods & Policies - Consejo Superior de Investigaciones Científicas, Madrid 28037, Spain
| | - Christos Lionis
- School of Medicine, University of Crete, Clinic of Social & Family Medicine (CSFM), Crete 71003, Greece
| | - Thomas Neumuth
- University of Leipzig, Innovation Center Computer Assisted Surgery (ICCAS), Leipzig 04103, Germany
| | - Wolfgang Ballensiefen
- Deutsche Zentrum für Luft- und Raumfahrt Projektträger (DLR PT), Bonn 53227, Germany
| | - Elio Borgonovi
- Department of Social & Political Sciences, Bocconi University, Milan 20136, Italy
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15
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Longo UG, Carnevale A, Massaroni C, Lo Presti D, Berton A, Candela V, Schena E, Denaro V. Personalized, Predictive, Participatory, Precision, and Preventive (P5) Medicine in Rotator Cuff Tears. J Pers Med 2021; 11:255. [PMID: 33915689 PMCID: PMC8066336 DOI: 10.3390/jpm11040255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 12/28/2022] Open
Abstract
Rotator cuff (RC) disease is a common musculoskeletal disorder of the shoulder entailing pain, with reduced functionality and quality of life. The main objective of this study was to present a perspective of the current scientific evidence about personalized, predictive, participatory, precision, and preventive approaches in the management of RC diseases. The personalized, predictive, participatory, precision and preventive (P5) medicine model is an interdisciplinary and multidisciplinary approach that will provide researchers and clinicians with a comprehensive patrimony of knowledge in the management of RC diseases. The ability to define genetic predispositions in conjunction with the evaluation of lifestyle and environmental factors may boost the tailoring of diagnosis and therapy in patients suffering from RC diseases.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (A.C.); (A.B.); (V.C.); (V.D.)
| | - Arianna Carnevale
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (A.C.); (A.B.); (V.C.); (V.D.)
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (C.M.); (D.L.P.); (E.S.)
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (C.M.); (D.L.P.); (E.S.)
| | - Daniela Lo Presti
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (C.M.); (D.L.P.); (E.S.)
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (A.C.); (A.B.); (V.C.); (V.D.)
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (A.C.); (A.B.); (V.C.); (V.D.)
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (C.M.); (D.L.P.); (E.S.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (A.C.); (A.B.); (V.C.); (V.D.)
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16
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Oliveri S, Lanzoni L, Petrocchi S, Janssens R, Schoefs E, Huys I, Smith MY, Smith IP, Veldwijk J, de Wit GA, Pravettoni G. Opportunities and Challenges of Web-Based and Remotely Administered Surveys for Patient Preference Studies in a Vulnerable Population. Patient Prefer Adherence 2021; 15:2509-2517. [PMID: 34848947 PMCID: PMC8613941 DOI: 10.2147/ppa.s327006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/16/2021] [Indexed: 01/09/2023] Open
Abstract
The application of web-based and remotely administered surveys is becoming increasingly popular due to the fact that it offers numerous advantages over traditional paper-based or computer-based surveys completed in the presence of the researcher. However, it is unclear whether complex preference elicitation tasks administered online in highly vulnerable patient populations are also feasible. This commentary discusses opportunities and challenges of conducting quantitative patient preference studies in lung cancer patients using web-based modes of data collection. We refer to our recent experience in the context of the Patient Preference in Benefit-Risk Assessments during the Drug Life Cycle (PREFER) project. Among the main advantages were the possibility of reaching a wider and geographically distant population in a shorter timeframe while reducing the financial costs of testing, the greater flexibility offered and the reduced burden on the patients. Some limitations were also identified and should be the object of further research, including the potential lack of inclusiveness of the research, the lack of control over who is completing the survey, a poor comprehension of the study material, and ultimately a lower level of engagement with the study. Despite these limitations, experience from the PREFER project suggests that online quantitative methods for data collection may provide a valuable method to explore preferences in vulnerable patient populations beyond the COVID-19 pandemic.
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Affiliation(s)
- Serena Oliveri
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lucilla Lanzoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Correspondence: Lucilla Lanzoni European Institute of Oncology IRCCS, Applied Research Division for Cognitive and Psychological Science, Via Giuseppe Ripamonti, 435, Milano, 20141, ItalyTel +39 294 372054 Email
| | - Serena Petrocchi
- 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
| | - Elise Schoefs
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Meredith Y Smith
- Alexion Pharmaceuticals, Inc., Boston, MA, USA
- University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | - Ian P Smith
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jorien Veldwijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
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17
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Gauld C, Dumas G, Darrason M, Salles N, Desvergnes P, Philip P, Micoulaud-Franchi JA. Médecine du sommeil personnalisée et syndrome d’apnées hypopnées obstructives du sommeil : entre précision et stratification, une proposition de clarification. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.msom.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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18
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Corso G, Montagna G, Figueiredo J, La Vecchia C, Fumagalli Romario U, Fernandes MS, Seixas S, Roviello F, Trovato C, Guerini-Rocco E, Fusco N, Pravettoni G, Petrocchi S, Rotili A, Massari G, Magnoni F, De Lorenzi F, Bottoni M, Galimberti V, Sanches JM, Calvello M, Seruca R, Bonanni B. Hereditary Gastric and Breast Cancer Syndromes Related to CDH1 Germline Mutation: A Multidisciplinary Clinical Review. Cancers (Basel) 2020; 12:E1598. [PMID: 32560361 PMCID: PMC7352390 DOI: 10.3390/cancers12061598] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023] Open
Abstract
E-cadherin (CDH1 gene) germline mutations are associated with the development of diffuse gastric cancer in the context of the so-called hereditary diffuse gastric syndrome, and with an inherited predisposition of lobular breast carcinoma. In 2019, the international gastric cancer linkage consortium revised the clinical criteria and established guidelines for the genetic screening of CDH1 germline syndromes. Nevertheless, the introduction of multigene panel testing in clinical practice has led to an increased identification of E-cadherin mutations in individuals without a positive family history of gastric or breast cancers. This observation motivated us to review and present a novel multidisciplinary clinical approach (nutritional, surgical, and image screening) for single subjects who present germline CDH1 mutations but do not fulfil the classic clinical criteria, namely those identified as-(1) incidental finding and (2) individuals with lobular breast cancer without family history of gastric cancer (GC).
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Affiliation(s)
- Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (G.M.); (F.M.); (V.G.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (E.G.-R.); (N.F.); (G.P.)
| | - Giacomo Montagna
- Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Joana Figueiredo
- i3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal; (J.F.); (M.S.F.); (S.S.); (R.S.)
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy;
| | - Uberto Fumagalli Romario
- Department of Digestive Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy;
| | - Maria Sofia Fernandes
- i3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal; (J.F.); (M.S.F.); (S.S.); (R.S.)
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal
| | - Susana Seixas
- i3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal; (J.F.); (M.S.F.); (S.S.); (R.S.)
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal
| | - Franco Roviello
- Departments of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy;
| | - Cristina Trovato
- Division of Endoscopy, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy;
| | - Elena Guerini-Rocco
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (E.G.-R.); (N.F.); (G.P.)
- Division of Pathology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (E.G.-R.); (N.F.); (G.P.)
- Division of Pathology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (E.G.-R.); (N.F.); (G.P.)
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy;
| | - Serena Petrocchi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy;
| | - Anna Rotili
- Division of Breast Imaging, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy;
| | - Giulia Massari
- Division of Breast Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (G.M.); (F.M.); (V.G.)
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (G.M.); (F.M.); (V.G.)
| | - Francesca De Lorenzi
- Division of Plastic Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (F.D.L.); (M.B.)
| | - Manuela Bottoni
- Division of Plastic Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (F.D.L.); (M.B.)
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (G.M.); (F.M.); (V.G.)
| | - João Miguel Sanches
- Institute for Systems and Robotics, Instituto Superior Técnico, 1049-001 Lisboa, Portugal;
| | - Mariarosaria Calvello
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (M.C.); (B.B.)
| | - Raquel Seruca
- i3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal; (J.F.); (M.S.F.); (S.S.); (R.S.)
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal
- Medical Faculty, University of Porto, 4099-002 Porto, Portugal
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (M.C.); (B.B.)
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19
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Arnaboldi P, Oliveri S, Vergani L, Marton G, Guiddi P, Busacchio D, Didier F, Pravettoni G. The clinical-care focused psychological interview (CLiC): a structured tool for the assessment of cancer patients' needs. Ecancermedicalscience 2020; 14:1000. [PMID: 32153655 PMCID: PMC7032941 DOI: 10.3332/ecancer.2020.1000] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Indexed: 12/12/2022] Open
Abstract
Integrating the psychosocial perspective in oncology is warranted. Here, we introduce a structured psychological intervention, the clinical-care focused psychological interview (CLiC), to address patients' needs in the relationship with health professionals, clinical pathway and decision-making process. The perceived utility and feasibility of the CLiC were evaluated in a preliminary sample of 30 patients who were candidates to undergo a radical cystectomy at the European Institute of Oncology, Milan, Italy. Patients reported a very high satisfaction with the interview, because it prepared them for their upcoming surgery by gathering more information about their clinical pathway and allowed them to discover the information they still needed. 30% stated that CLiC helped them to reorganise their thoughts and 36.7% understood the role of psychological intervention in the clinical pathway. Only 20% considered the CLiC useful in helping to build their relationship with the clinical staff. Before an invasive surgery such as radical cystectomy, patients' need for information regarding the upcoming surgery seems to prevail. Knowing the future consequences and adjusting toward the disease could be paramount for patients in facing uncertainty and they might feel that creating a relationship with physicians could be a secondary issue. However, our data show that a structured psychological intervention such as the CLiC interview can collect important information for patients and healthcare professionals to develop real patient-centred care.
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Affiliation(s)
- Paola Arnaboldi
- Psychiatry and Medical Psychology Service (SPPM), Cantonal Socio-Psychiatric Organisation (OSC), Via Tesserete 67, 6942 Savosa, Switzerland.,Ticino League against Cancer, Piazza Nosetto, 3, 6500 Bellinzona, Switzerland
| | - Serena Oliveri
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy.,Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
| | - Laura Vergani
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy.,Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
| | - Giulia Marton
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy.,Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
| | - Paolo Guiddi
- Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
| | - Derna Busacchio
- Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
| | - Florence Didier
- Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via 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 Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
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20
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Mauri G, Orsi F, Carriero S, Della Vigna P, De Fiori E, Monzani D, Pravettoni G, Grosso E, Manzoni MF, Ansarin M, Giugliano G. Image-Guided Thermal Ablation as an Alternative to Surgery for Papillary Thyroid Microcarcinoma: Preliminary Results of an Italian Experience. Front Endocrinol (Lausanne) 2020; 11:575152. [PMID: 33488514 PMCID: PMC7820745 DOI: 10.3389/fendo.2020.575152] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/06/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To report the results of our preliminary experience in treating patients with papillary thyroid microcarcinoma (PTMC) with image-guided thermal ablation, in particular estimating the feasibility, safety and short-term efficacy. MATERIALS AND METHODS From 2018 patients with cytologically proven PTMC < 10 mm were discussed in a multidisciplinary team and evaluated for feasibility of image-guided thermal ablation. In case of technical feasibility, the three possible alternatives (i.e., image-guided thermal ablation, surgery, and active surveillance) were discussed with patients. Patients who agreed to be treated with image guided thermal ablation underwent radiofrequency (RFA) or laser ablation under local anesthesia and conscious sedation. Treatment feasibility, technical success, technique efficacy, change in thyroid function tests, side effects, minor and major complications, patients satisfaction and pain/discomfort perception during and after treatment, and disease recurrence during follow-up were recorded. RESULTS A total of 13 patients were evaluated, and 11/13 (84.6%) patients (9 female, 2 male, mean age 49.3 ± 8.7 years) resulted suitable for image-guided thermal ablation. All 11 patients agreed to be treated with image-guided thermal ablation. In addition, 3/11 (27.3%) were treated with laser ablation and 8/11 (72.7%) with RFA. All procedures were completed as preoperatively planned (technical success 100%). Technique efficacy was achieved in all 11/11 (100%) cases. Ablated volume significantly reduced from 0.87 ± 0.67 ml at first follow-up to 0.17 ± 0.36 at last follow-up (p = 0.003). No change in thyroid function tests occurred. No minor or major complications occurred. All patients graded 10 the satisfaction for the treatment, and mean pain after the procedure was reported as 1.4 ± 1.7, and mean pain after the procedure as 1.2 ± 1.1 At a median follow-up of 10.2 months (range 1.5-12 months), no local recurrence or distant metastases were found. CONCLUSIONS Image guided thermal ablations appear to be feasible and safe in the treatment of PTMC. These techniques hold the potential to offer patients a minimally invasive curative alternative to surgical resection or active surveillance. These techniques appear to be largely preferred by patients.
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Affiliation(s)
- Giovanni Mauri
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
- Divisione di Radiologia interventistica, Istituto Europeo di Oncologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Franco Orsi
- Divisione di Radiologia interventistica, Istituto Europeo di Oncologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Serena Carriero
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
- *Correspondence: Serena Carriero,
| | - Paolo Della Vigna
- Divisione di Radiologia interventistica, Istituto Europeo di Oncologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Elvio De Fiori
- Unità di Radiologia Clinico Diagnostica, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Dario Monzani
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
- Divisione di Psiconcologia, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
- Divisione di Psiconcologia, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Enrica Grosso
- Divisione di Otorinolaringoiatria e Chirurgia Cervico Facciale, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Marco F. Manzoni
- Divisione di Otorinolaringoiatria e Chirurgia Cervico Facciale, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Mohssen Ansarin
- Divisione di Otorinolaringoiatria e Chirurgia Cervico Facciale, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Gioacchino Giugliano
- Divisione di Otorinolaringoiatria e Chirurgia Cervico Facciale, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
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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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Abstract
PURPOSE OF REVIEW In this review, we herein describe the progress in management of severe asthma, evolving from a 'blockbuster approach' to a more personalized approach targeted to the utilization of endotype-driven therapies. RECENT FINDINGS Severe asthma characterization in phenotypes and endotypes, by means of specific biomarkers, have led to the dichotomization of the concepts of 'personalized medicine' and 'precision medicine', which are often used as synonyms, but actually have conceptual differences in meaning. The recent contribute of the omic sciences (i.e. proteomics, transcriptomics, metabolomics, genomics, …) has brought this initially theoretic evolution into a more concrete level. SUMMARY This step-by-step transition would bring to a better approach to severe asthmatic patients as the personalization of their therapeutic strategy would bring to a better patient selection, a more precise endotype-driven treatment, and hopefully to better results in terms of reduction of exacerbation rates, symptoms, pulmonary function and quality of life.
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Horgan D, Codacci Pisanelli G, Esposito G, Moch H. The Pros and Comms of Gene Sequencing. Biomed Hub 2017; 2:32-36. [PMID: 31988929 PMCID: PMC6945937 DOI: 10.1159/000481299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/04/2017] [Indexed: 11/22/2022] Open
Abstract
Full-gene sequencing undoubtedly comes with its pluses and its minuses. In this article, the authors aim to weigh up the pros and cons not only from the point of view of the patient but also in view of the doctor's possible perspective. Either party may be for or against it for a variety of reasons - for example, a fear of knowing too much on the part of the patient, and concerns about possible over-treatment on the part of the healthcare professional. One thing is certain: the possibility of full-gene sequencing is here and here to stay. At the very least, doctors need to make patients aware of their options, while offering balanced advice.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
| | | | | | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
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24
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Pogue RE, Cavalcanti DP, Shanker S, Andrade RV, Aguiar LR, de Carvalho JL, Costa FF. Rare genetic diseases: update on diagnosis, treatment and online resources. Drug Discov Today 2017; 23:187-195. [PMID: 29129805 DOI: 10.1016/j.drudis.2017.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/28/2017] [Accepted: 11/02/2017] [Indexed: 12/23/2022]
Abstract
Rare genetic diseases collectively impact a significant portion of the world's population. For many diseases there is limited information available, and clinicians can find difficulty in differentiating between clinically similar conditions. This leads to problems in genetic counseling and patient treatment. The biomedical market is affected because pharmaceutical and biotechnology industries do not see advantages in addressing rare disease treatments, or because the cost of the treatments is too high. By contrast, technological advances including DNA sequencing and analysis, together with computer-aided tools and online resources, are allowing a more thorough understanding of rare disorders. Here, we discuss how the collection of various types of information together with the use of new technologies is facilitating diagnosis and, consequently, treatment of rare diseases.
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Affiliation(s)
- Robert E Pogue
- Genomic Sciences and Biotechnology Program, Catholic University of Brasília, Distrito Federal, Brazil.
| | | | - Shreya Shanker
- Illinois Mathematics and Science Academy (IMSA), IL, USA
| | - Rosangela V Andrade
- Genomic Sciences and Biotechnology Program, Catholic University of Brasília, Distrito Federal, Brazil
| | - Lana R Aguiar
- Genomic Sciences and Biotechnology Program, Catholic University of Brasília, Distrito Federal, Brazil
| | - Juliana L de Carvalho
- Genomic Sciences and Biotechnology Program, Catholic University of Brasília, Distrito Federal, Brazil; OneSkin Technologies, San Francisco, CA, USA
| | - Fabrício F Costa
- Genomic Sciences and Biotechnology Program, Catholic University of Brasília, Distrito Federal, Brazil; MATTER, Chicago, IL, USA; The Founder Institute, San Francisco, CA, USA.
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25
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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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26
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Schleidgen S, Thiersch S, Wuerstlein R, Marckmann G. How Do Patients Experience Individualized Medicine? A Qualitative Interview-based Study of Gene Expression Analyses in the Treatment of Breast Cancer. Geburtshilfe Frauenheilkd 2017; 77:984-992. [PMID: 28959062 PMCID: PMC5612773 DOI: 10.1055/s-0043-115396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/27/2017] [Accepted: 06/30/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION In recent years, the hopes and expectations associated with so-called individualized medicine have been the subject of intense debate as has the medical potential of this approach. Questions about the uses of gene expression analyses for decisions on adjuvant systemic treatment options for patients with breast cancer have played a prominent role in this debate. There are a number of empirical studies on the effect of gene expression tests on the therapy decisions of physicians and the potentially conflicted decisions for patients. Very little attention has been paid to how patients perceive such approaches, the extent to which they feel included in the therapy decision, and the expectations they associate with such an approach. MATERIAL AND METHODS Using qualitative explorative interviews, the study looked at how well patients with breast cancer understood the individualized treatment approaches and examined patients' experiences and expectations with regard to gene expression analyses. The sample consisted of 8 patients who were diagnosed with primary hormone receptor-positive, HER2-negative breast cancer between 2013 and 2014 and who underwent gene expression analyses as part of their adjuvant therapy planning. RESULTS Patients were found to have a quite realistic view of the benefits of gene expression analyses, although it also became clear that the treatment could also raise false hopes. The statements by the interviewed women also illustrated the necessity of continuing to explore the possibilities and limits to joint decision-making in such complex medical contexts as individualized molecular genomic medicine. And finally, the interviews reflected the hope for individualized treatment in the broadest sense of the word. CONCLUSION The results of the study highlight the challenge of taking psychosocial aspects of medical treatment sufficiently into consideration, given the ever increasing options for molecular genomic individualization.
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Affiliation(s)
- Sebastian Schleidgen
- Pflegewissenschaftliche Fakultät, Philosophisch-Theologische Hochschule Vallendar, Vallendar, Germany
| | - Sandra Thiersch
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Germany
| | - Rachel Wuerstlein
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Brustzentrum der Universität München, München, Germany
- Comprehensive Cancer Center LMU München, München, Germany
| | - Georg Marckmann
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Germany
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Abstract
Chronotherapeutics aim at treating illnesses according to the endogenous biologic rhythms, which moderate xenobiotic metabolism and cellular drug response. The molecular clocks present in individual cells involve approximately fifteen clock genes interconnected in regulatory feedback loops. They are coordinated by the suprachiasmatic nuclei, a hypothalamic pacemaker, which also adjusts the circadian rhythms to environmental cycles. As a result, many mechanisms of diseases and drug effects are controlled by the circadian timing system. Thus, the tolerability of nearly 500 medications varies by up to fivefold according to circadian scheduling, both in experimental models and/or patients. Moreover, treatment itself disrupted, maintained, or improved the circadian timing system as a function of drug timing. Improved patient outcomes on circadian-based treatments (chronotherapy) have been demonstrated in randomized clinical trials, especially for cancer and inflammatory diseases. However, recent technological advances have highlighted large interpatient differences in circadian functions resulting in significant variability in chronotherapy response. Such findings advocate for the advancement of personalized chronotherapeutics through interdisciplinary systems approaches. Thus, the combination of mathematical, statistical, technological, experimental, and clinical expertise is now shaping the development of dedicated devices and diagnostic and delivery algorithms enabling treatment individualization. In particular, multiscale systems chronopharmacology approaches currently combine mathematical modeling based on cellular and whole-body physiology to preclinical and clinical investigations toward the design of patient-tailored chronotherapies. We review recent systems research works aiming to the individualization of disease treatment, with emphasis on both cancer management and circadian timing system–resetting strategies for improving chronic disease control and patient outcomes.
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Affiliation(s)
- Annabelle Ballesta
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
| | - Pasquale F Innominato
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
| | - Robert Dallmann
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
| | - David A Rand
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
| | - Francis A Lévi
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
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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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29
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Gorini A, Mazzocco K, Kondylakis H, McVie G, Pravettoni G. A web-based interactive tool to improve breast cancer patient centredness. Ecancermedicalscience 2016; 10:659. [PMID: 27563354 PMCID: PMC4970622 DOI: 10.3332/ecancer.2016.659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Indexed: 11/06/2022] Open
Abstract
The uniqueness of a patient as determined by the integration of clinical data and psychological aspects should be the aspired aim of a personalized medicine approach. Nevertheless, given the time constraints usually imposed by the clinical setting, it is not easy for physicians to collect information about the patient’s unique mental dimensions and needs related to her illness. Such information may be useful in tailoring patient–physician communication, improving the patient’s understanding of provided information, her involvement in the treatment process, and in general her empowerment during and after the therapeutic journey. The primary objective of this study is to evaluate the effect of an interactive empowerment tool (IEm) on enhancing the breast cancer patient–physician experience, in terms of increasing empowerment, i.e. by providing physicians with a personalised patient’s profile, accompanied by specific recommendations to advise them how to interact with each individual patient on the basis of her personal profile. The study will be implemented as a two-arm randomised controlled trial with 100 adult breast cancer patients who fill in the ALGA-BC questionnaire, a computerised validated instrument to evaluate the patient’s physical and psychological characteristics following a breast cancer diagnosis. The IEm tool will collect and analyse the patient’s answers in real time and send them, together with specific recommendations to the physician’s computer immediately before physician’s first encounter with the patient. Patients will be randomised to either the intervention group using the IEm tool or to a control group who will only fill in the questionnaire without taking advantage of the tool (physicians will not receive the patient’s profile). The proposed approach is supposed to improve the patient–physician communication leading to increased patient participation in the therapeutic process as a consequence leading to improvement in patient empowerment and personalisation of care.
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Affiliation(s)
- Alessandra Gorini
- Department of Oncology and Haemato-Oncology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy; European Institute of Oncology, Via G. Ripamonti 435, 20100 Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Haemato-Oncology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy; European Institute of Oncology, Via G. Ripamonti 435, 20100 Milan, Italy
| | - Haridimos Kondylakis
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, N. Plastira 100, Vassilika Vouton, GR-700 13 Heraklion, Crete, GR-700 13, Greece
| | - Gordon McVie
- European Institute of Oncology, Via G. Ripamonti 435, 20100 Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Haemato-Oncology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy; European Institute of Oncology, Via G. Ripamonti 435, 20100 Milan, Italy
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30
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De Grandis G, Halgunset V. Conceptual and terminological confusion around personalised medicine: a coping strategy. BMC Med Ethics 2016; 17:43. [PMID: 27431285 PMCID: PMC4950113 DOI: 10.1186/s12910-016-0122-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/07/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The idea of personalised medicine (PM) has gathered momentum recently, attracting funding and generating hopes as well as scepticism. As PM gives rise to differing interpretations, there have been several attempts to clarify the concept. In an influential paper published in this journal, Schleidgen and colleagues have proposed a precise and narrow definition of PM on the basis of a systematic literature review. Given that their conclusion is at odds with those of other recent attempts to understand PM, we consider whether their systematic review gives them an edge over competing interpretations. DISCUSSION We have found some methodological weaknesses and questionable assumptions in Schleidgen and colleagues' attempt to provide a more specific definition of PM. Our perplexities concern the lack of criteria for assessing the epistemic strength of the definitions that they consider, as well as the logical principles used to extract a more precise definition, the narrowness of the pool from which they have drawn their empirical data, and finally their overlooking the fact that definitions depend on the context of use. We are also worried that their ethical assumption that only patients' interests are legitimate is too simplistic and drives all other stakeholders' interests-including those that are justifiable-underground, thus compromising any hope of a transparent and fair negotiation among a plurality of actors and interests. CONCLUSION As an alternative to the shortcomings of attempting a semantic disciplining of the concept we propose a pragmatic approach. Rather than considering PM to be a scientific concept in need of precise demarcation, we look at it as an open and negotiable concept used in a variety of contexts including at the level of orienting research goals and policy objectives. We believe that since PM is still more an ideal than an achieved reality, a plurality of visions is to be expected and we need to pay attention to the people, reasons and interests behind these alternative conceptions. In other words, the logic and politics of PM cannot be disentangled and disagreements need to be tackled addressing the normative and strategic conflicts behind them.
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Affiliation(s)
- Giovanni De Grandis
- Department of Philosophy and Religious Studies, Norwegian University of Science and Technology, NTNU Dragvoll, 7491, Trondheim, Norway.
| | - Vidar Halgunset
- Department of Philosophy and Religious Studies, Norwegian University of Science and Technology, NTNU Dragvoll, 7491, Trondheim, Norway
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Truccolo I, Cipolat Mis C, Cervo S, Dal Maso L, Bongiovanni M, Bearz A, Sartor I, Baldo P, Ferrarin E, Fratino L, Mascarin M, Roncadin M, Annunziata MA, Muzzatti B, De Paoli P. Patient-Centered Cancer Care Programs in Italy: Benchmarking Global Patient Education Initiatives. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:405-412. [PMID: 25773134 PMCID: PMC4831987 DOI: 10.1007/s13187-015-0805-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In Italy, educational programs for cancer patients are currently provided by the national government, scientific societies, and patient advocate organizations. Several gaps limit their effectiveness, including the lack of coordinated efforts, poor involvement of patient feedback in the planning of programs, as well as a lack of resources on innovative cancer-related topics. This process is parallel to a strong shift in the attitude of patients towards health in general and taking charge of their own health conditions in particular. The National Cancer Institute in the USA and the Organization of European Cancer Institutes encourage comprehensive cancer centers in providing educational programs conceived to overcome these gaps. The goal of this paper is to identify and describe the key elements necessary to develop a global patient education program and provide recommendations for strategies with practical examples for implementation in the daily activities of cancer institutes. A multidisciplinary committee was established for patient education, including patient representatives as equal partners, to define, implement, verify, and evaluate the fundamental steps for establishing a comprehensive education program. Six essential topics were identified for the program: appropriate communication of cancer epidemiology, clinical trial information, new therapeutic technologies, support in the use of medicines, psycho-oncological interventions, age-personalized approaches, and training programs for healthcare providers. Integration of these topics along with patient feedback is the key to a successful model for educational programs. An integrated educational program can transform a comprehensive cancer center to an institution that provides research and care for and with patients.
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Affiliation(s)
- Ivana Truccolo
- Scientific Directorate, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Chiara Cipolat Mis
- Scientific Directorate, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Silvia Cervo
- CRO-Biobank, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy.
- Clinical Cancer Pathology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy.
| | - Luigino Dal Maso
- Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Marilena Bongiovanni
- Associazione Nazionale Guariti Lungoviventi Oncologici (ANGOLO), CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Alessandra Bearz
- Medical Oncology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Ivana Sartor
- Scientific Directorate, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Paolo Baldo
- Pharmacy, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Emanuela Ferrarin
- Pharmacy, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Lucia Fratino
- Medical Oncology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Maurizio Mascarin
- Radiotherapy, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Mario Roncadin
- Radiotherapy, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | | | - Barbara Muzzatti
- Psychooncology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Paolo De Paoli
- Scientific Directorate, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
- CRO-Biobank, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
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Emmert-Streib F, Tuomisto L, Yli-Harja O. The Need for Formally Defining "Modern Medicine" by Means of Experimental Design. Front Genet 2016; 7:60. [PMID: 27148357 PMCID: PMC4837140 DOI: 10.3389/fgene.2016.00060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/01/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frank Emmert-Streib
- Predictive Medicine and Analytics Lab, Department of Signal Processing, Tampere University of Technology Tampere, Finland
| | - Lauri Tuomisto
- Predictive Medicine and Analytics Lab, Department of Signal Processing, Tampere University of TechnologyTampere, Finland; Computational Systems Biology, Department of Signal Processing, Tampere University of TechnologyTampere, Finland
| | - Olli Yli-Harja
- Computational Systems Biology, Department of Signal Processing, Tampere University of Technology Tampere, Finland
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Pravettoni G, Mazzocco K, Gorini A, Curigliano G. Understanding cognitive processes behind acceptance or refusal of phase I trials. Crit Rev Oncol Hematol 2016; 100:69-73. [DOI: 10.1016/j.critrevonc.2016.01.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 12/09/2015] [Accepted: 01/20/2016] [Indexed: 11/29/2022] Open
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Gorini A, Masiero M, Pravettoni G. Patient decision aids for prevention and treatment of cancer diseases: are they really personalised tools? Eur J Cancer Care (Engl) 2016; 25:936-960. [DOI: 10.1111/ecc.12451] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/27/2022]
Affiliation(s)
- A. Gorini
- Department of Oncology and Hemato-Oncology; University of Milan; Milano Italy
- European Institute of Oncology; Milan Italy
| | - M. Masiero
- Department of Oncology and Hemato-Oncology; University of Milan; Milano Italy
- European Institute of Oncology; Milan Italy
| | - G. Pravettoni
- Department of Oncology and Hemato-Oncology; University of Milan; Milano Italy
- European Institute of Oncology; Milan Italy
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35
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Donzelli G, McGreevy KS. Perinatal care at the confluence of narrative medicine and personalized medicine: what lies downstream? J Matern Fetal Neonatal Med 2016; 29:2807-9. [PMID: 26794262 DOI: 10.3109/14767058.2015.1105210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Gianpaolo Donzelli
- a Fetal-Neonatal Department , Meyer Children's Hospital, University of Florence , Florence , Italy and
| | - Kathleen S McGreevy
- b Research, Innovation and International Relations Office, Meyer Children's Hospital , Florence , Italy
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Gorini A, Mazzocco K, Pravettoni G. Decision-Making Process Related to Participation in Phase I Clinical Trials: A Nonsystematic Review of the Existing Evidence. Public Health Genomics 2015; 18:359-65. [PMID: 26529420 DOI: 10.1159/000441559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Due to the lack of other treatment options, patient candidates for participation in phase I clinical trials are considered the most vulnerable, and many ethical concerns have emerged regarding the informed consent process used in the experimental design of such trials. Starting with these considerations, this nonsystematic review is aimed at analyzing the decision-making processes underlying patients' decision about whether to participate (or not) in phase I trials in order to clarify the cognitive and emotional aspects most strongly implicated in this decision. Considering that there is no uniform decision calculus and that many different variables other than the patient-physician relationship (including demographic, clinical, and personal characteristics) may influence patients' preferences for and processing of information, we conclude that patients' informed decision-making can be facilitated by creating a rigorously developed, calibrated, and validated computer tool modeled on each single patient's knowledge, values, and emotional and cognitive decisional skills. Such a tool will also help oncologists to provide tailored medical information that is useful to improve the shared decision-making process, thereby possibly increasing patient participation in clinical trials.
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Affiliation(s)
- Alessandra Gorini
- Department of Health Science, University of Milan, and European Institute of Oncology, Milan, Italy
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37
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Gorini A, Mazzocco K, Gandini S, Munzone E, McVie G, Pravettoni G. Development and psychometric testing of a breast cancer patient-profiling questionnaire. BREAST CANCER-TARGETS AND THERAPY 2015; 7:133-46. [PMID: 26064067 PMCID: PMC4457218 DOI: 10.2147/bctt.s80014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction The advent of “personalized medicine” has been driven by technological advances in genomics. Concentration at the subcellular level of a patient’s cancer cells has meant inevitably that the “person” has been overlooked. For this reason, we think there is an urgent need to develop a truly personalized approach focusing on each patient as an individual, assessing his/her unique mental dimensions and tailoring interventions to his/her individual needs and preferences. The aim of this study was to develop and test the psychometric properties of the ALGA-Breast Cancer (ALGA-BC), a new multidimensional questionnaire that assesses the breast cancer patient’s physical and mental characteristics in order to provide physicians, prior to the consultation, with a patient’s profile that is supposed to facilitate subsequent communication, interaction, and information delivery between the doctor and the patient. Methods The specific validation processes used were: content and face validity, construct validity using factor analysis, reliability and internal consistency using test–retest reliability, and Cronbach’s alpha correlation coefficient. The exploratory analysis included 100 primary breast cancer patients and 730 healthy subjects. Results The exploratory factor analysis revealed eight key factors: global self-rated health, perceived physical health, anxiety, self-efficacy, cognitive closure, memory, body image, and sexual life. Test–retest reliability and internal consistency were good. Comparing patients with a sample of healthy subjects, we also observed a general ability of the ALGA-BC questionnaire to discriminate between the two. Conclusion The ALGA-BC questionnaire with 29 items is a valid instrument with which to obtain a patient’s profile that is supposed to help physicians achieve meaningful personalized care which supplements biological and genetic analyses.
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Affiliation(s)
- Alessandra Gorini
- Department of Health Science, University of Milan, Milan, Italy ; European Institute of Oncology, Milan, Italy
| | - Ketti Mazzocco
- Department of Health Science, University of Milan, Milan, Italy ; European Institute of Oncology, Milan, Italy
| | | | | | | | - Gabriella Pravettoni
- Department of Health Science, University of Milan, Milan, Italy ; European Institute of Oncology, Milan, Italy
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Cutica I, Vie GM, Pravettoni G. Personalised medicine: the cognitive side of patients. Eur J Intern Med 2014; 25:685-8. [PMID: 25060407 DOI: 10.1016/j.ejim.2014.07.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/04/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although the fashion for the "personalised" or "stratified" approach to medicine is valuable in exploiting the omic signatures of the individual patient, too little attention has been paid to the influence of psychological and cognitive factors in the care process. The aim of this paper is to highlight the importance of those individual psycho-cognitive components in affecting how people act to prevent, cope and react to illness, decide about different therapeutic options, interact with health care providers, and adhere to treatment. METHODS We reviewed the medical and psychological literature about the effect of cognitive and psychological dimensions on treatment efficacy, on patients' global satisfaction, and on treatment compliance. RESULTS Psychological dimensions have been proved to impact on treatment efficacy, on patients' global satisfaction, and on compliance to treatment. However, there are substantial individual differences among patients; therefore, it is important that physicians recognise how to apply these general recommendations to each individual patient, alongside the omic information emerging from the molecular diagnostic laboratory. CONCLUSION The exam of the current literature allows one to derive several strategies which can help health professionals to improve the patients' understanding of their disease and involvement in the whole care process.
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Affiliation(s)
- Ilaria Cutica
- University of Milan, Department of Health Science, Milan, Italy; Applied Research Unit for Psycho-oncology, European Institute of Oncology, Milan, Italy.
| | | | - Gabriella Pravettoni
- University of Milan, Department of Health Science, Milan, Italy; Applied Research Unit for Psycho-oncology, European Institute of Oncology, Milan, Italy
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39
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Carlsten C, Brauer M, Brinkman F, Brook J, Daley D, McNagny K, Pui M, Royce D, Takaro T, Denburg J. Genes, the environment and personalized medicine: We need to harness both environmental and genetic data to maximize personal and population health. EMBO Rep 2014; 15:736-9. [PMID: 24907240 DOI: 10.15252/embr.201438480] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Chris Carlsten
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michael Brauer
- School of Population and Public Health University of British Columbia, Vancouver, BC, Canada
| | - Fiona Brinkman
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | | | - Denise Daley
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kelly McNagny
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Mandy Pui
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Diana Royce
- AllerGen NCE: the Allergy, Genes, and Environment Network, a Canadian Network of Centres of Excellence, Hamilton, ON, Canada
| | - Tim Takaro
- Department of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Judah Denburg
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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40
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Li A, Meyre D. Jumping on the Train of Personalized Medicine: A Primer for Non- Geneticist Clinicians: Part 3. Clinical Applications in the Personalized Medicine Area. CURRENT PSYCHIATRY REVIEWS 2014; 10:118-132. [PMID: 25598768 PMCID: PMC4287884 DOI: 10.2174/1573400510666140630170549] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 12/17/2022]
Abstract
The rapid decline of sequencing costs brings hope that personal genome sequencing will become a common feature of medical practice. This series of three reviews aim to help non-geneticist clinicians to jump into the fast-moving field of personalized genetic medicine. In the first two articles, we covered the fundamental concepts of molecular genetics and the methodologies used in genetic epidemiology. In this third article, we discuss the evolution of personalized medicine and illustrate the most recent success in the fields of Mendelian and complex human diseases. We also address the challenges that currently limit the use of personalized medicine to its full potential.
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Affiliation(s)
| | - David Meyre
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON L8N 3Z5, Canada
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41
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Bragazzi NL. From P0 to P6 medicine, a model of highly participatory, narrative, interactive, and "augmented" medicine: some considerations on Salvatore Iaconesi's clinical story. Patient Prefer Adherence 2013; 7:353-9. [PMID: 23650443 PMCID: PMC3640773 DOI: 10.2147/ppa.s38578] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Salvatore Iaconesi was recently diagnosed with a brain tumor. He decided to share his clinical records not only with doctors but with everybody who wishes to find him a cure. "Because cure is not unique," he emphasizes "there are cures for the body and cures for the soul, and everyone, from a painter to a musician, can find me a cure. Please, feel free to take my clinical history for example and let it become a game, a video, a music, a picture, whatever you like." The emblematic hallmark of the changing times, Salvatore Iaconesi's case is an example of how many profound revolutions and steps medicine has undertaken during the past few centuries. Stemming from a form of remote medical paternalism and arriving at the concept of a therapeutic alliance, medicine nowadays faces challenges and opportunities at a level before unforeseeable and unimaginable. The new concept of P6 medicine (personalized, predictive, preventive, participatory, psychocognitive, and public) is discussed, together with its profound implications.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Correspondence: Nicola Luigi Bragazzi, School of Public Health, Department of Health Sciences (DISSAL), Via Antonio Pastore1, 16132, Genoa, Italy, Tel +39 010 353 7664, Fax +39 010 353 7669, Email ;
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42
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Smart Recommendation Services in Support of Patient Empowerment and Personalized Medicine. MULTIMEDIA SERVICES IN INTELLIGENT ENVIRONMENTS 2013. [DOI: 10.1007/978-3-319-00375-7_4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Rossi S, Di Narzo AF, Mestdagh P, Jacobs B, Bosman FT, Gustavsson B, Majoie B, Roth A, Vandesompele J, Rigoutsos I, Delorenzi M, Tejpar S. microRNAs in colon cancer: a roadmap for discovery. FEBS Lett 2012; 586:3000-7. [PMID: 23166923 DOI: 10.1016/j.febslet.2012.07.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cancer omics data are exponentially created and associated with clinical variables, and important findings can be extracted based on bioinformatics approaches which can then be experimentally validated. Many of these findings are related to a specific class of non-coding RNA molecules called microRNAs (miRNAs) (post-transcriptional regulators of mRNA expression). The related research field is quite heterogeneous and bioinformaticians, clinicians, statisticians and biologists, as well as data miners and engineers collaborate to cure stored data and on new impulses coming from the output of the latest Next Generation Sequencing technologies. Here we review the main research findings on miRNA of the first 10 years in colon cancer research with an emphasis on possible uses in clinical practice. This review intends to provide a road map in the jungle of publications of miRNA in colorectal cancer, focusing on data availability and new ways to generate biologically relevant information out of these huge amounts of data.
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Affiliation(s)
- Simona Rossi
- Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland.
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Lucchiari C, Masiero M, Pravettoni G. Methods for nutrition monitoring in cancer patients: a cognitive perspective. Ecancermedicalscience 2012; 6:259. [PMID: 22837764 PMCID: PMC3404545 DOI: 10.3332/ecancer.2012.259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Indexed: 01/06/2023] Open
Abstract
In the present medical context, the evaluation and the monitoring of factors other than mere physical symptoms are an urgent demand. In particular, the issue of quality of life (QoL) has become a relevant target in the treatment of cancer. However, the approach towards these aspects is not well standardized and the actual applications in a concrete setting are fragmented, left to personal or local initiative. If this is true for QoL in general, it is particularly relevant in the specific field of nutrition. Indeed, though the growing awareness of a correlation between chronic diseases and dietary habits has led to an increased interest in nutrition, both before and after cancer, very little is still known about the methods that measure this important variable of the QoL. Indeed, good nutrition may have a relevant impact on QoL, positively affecting both the physical and psychological well-being. Targeting this issue implies using proper instruments to both monitor and educate the patients. Hence, we argue that it is vital for oncologists to be able to individuate the best tool available in a specified context, so as to achieve an important goal with little effort, also adopting standardized strategies proved to be efficacious. In this framework, we briefly reviewed the tools more frequently reported in the scientific literature. We suggest that through a cognitive approach, it is possible to achieve important clinical targets, initially by understanding the patients' needs, values, and psychosocial factors involved in nutritional behaviour and food-related decisions, in order to develop a personalized approach. Hence, this is the only way to support concrete actions for promoting healthier diets, thus preventing recurrences, monitoring chronic conditions, and supporting a good QoL.
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Affiliation(s)
- C Lucchiari
- Università degli Studi di Milano, Milan, Italy
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45
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Rossi S, Christ-Neumann ML, Rüping S, Buffa FM, Wegener D, McVie G, Coveney PV, Graf N, Delorenzi M. p-Medicine: From data sharing and integration via VPH models to personalized medicine. Ecancermedicalscience 2011; 5:218. [PMID: 22276060 PMCID: PMC3223941 DOI: 10.3332/ecancer.2011.218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Indexed: 12/16/2022] Open
Abstract
The Worldwide innovative Networking in personalized cancer medicine (WIN) initiated by the Institute Gustave Roussy (France) and The University of Texas MD Anderson Cancer Center (USA) has dedicated its 3rd symposium (Paris, 6-8 July 2011) to discussion on gateways to increase the efficacy of cancer diagnostics and therapeutics (http://www.winconsortium.org/symposium.html).Speakers ranged from clinical oncologist to researchers, industrial partners, and tools developers; a famous patient was present: Janelle Hail, a 30-year breast cancer survivor, founder and CEO of the National Breast Cancer Foundation, Inc. (NBCF).The p-medicine consortium found this venue a perfect occasion to present a poster about its activities that are in accordance with the take home message of the symposium.In this communication, we summarize what we presented with particular attention to the interaction between the symposium's topic and content and our project.
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Affiliation(s)
- S Rossi
- Swiss Institute for Bioinformatics, Lausanne, Switzerland
| | | | - S Rüping
- Fraunhofer IAIS, Schloss Birlinghoven, Sankt Augustin, Germany
| | - FM Buffa
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - D Wegener
- Fraunhofer IAIS, Schloss Birlinghoven, Sankt Augustin, Germany
| | - G McVie
- Ecancermedicalscience, Gotthardstrasse 20, 6300 Zug, Switzerland
| | - PV Coveney
- Centre for Computational Science, University College London, London, UK
| | - N Graf
- Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany
| | - M Delorenzi
- Swiss Institute for Bioinformatics, Lausanne, Switzerland
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Abstract
A system approach termed P4 medicine has recently been proposed in the field of oncology. This approach has been advanced as an extension of what is usually called 'personalized' or 'genomic medicine'. P4 medicine creates effective predictive, personalized, preventive and participatory models to treat patients. In order to give more relevance to the behavioural component that impinges on the way individuals act to prevent, cope and react to illnesses, how they decide between different therapeutic options and interact with physicians and adhere to treatment, we propose that P4 medicine should be transformed into P5 medicine. The fifth P represents the psycho-cognitive aspects to be considered in order to empower the patient, increase his/her quality of life and transform him/her from a passive recipient into an active decision-maker in the treatment process.
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Affiliation(s)
- Gabriella Pravettoni
- Dipartimento di Studi Sociali e Politici, Università degli Studi di Milano, Milan, Italy.
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