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2
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Chan RJ, Milch VE, Crawford-Williams F, Agbejule OA, Joseph R, Johal J, Dick N, Wallen MP, Ratcliffe J, Agarwal A, Nekhlyudov L, Tieu M, Al-Momani M, Turnbull S, Sathiaraj R, Keefe D, Hart NH. Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature. CA Cancer J Clin 2023; 73:565-589. [PMID: 37358040 DOI: 10.3322/caac.21788] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 06/27/2023] Open
Abstract
Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The aim of this umbrella review was to identify, critically appraise, synthesize, and present the best available evidence to inform policy and planning regarding patient navigation across the cancer continuum. Systematic reviews examining navigation in cancer care were identified in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), Epistemonikos, and Prospective Register of Systematic Reviews (PROSPERO) databases and in the gray literature from January 1, 2012, to April 19, 2022. Data were screened, extracted, and appraised independently by two authors. The JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used for quality appraisal. Emerging literature up to May 25, 2022, was also explored to capture primary research published beyond the coverage of included systematic reviews. Of the 2062 unique records identified, 61 systematic reviews were included. Fifty-four reviews were quantitative or mixed-methods reviews, reporting on the effectiveness of cancer patient navigation, including 12 reviews reporting costs or cost-effectiveness outcomes. Seven qualitative reviews explored navigation needs, barriers, and experiences. In addition, 53 primary studies published since 2021 were included. Patient navigation is effective in improving participation in cancer screening and reducing the time from screening to diagnosis and from diagnosis to treatment initiation. Emerging evidence suggests that patient navigation improves quality of life and patient satisfaction with care in the survivorship phase and reduces hospital readmission in the active treatment and survivorship care phases. Palliative care data were extremely limited. Economic evaluations from the United States suggest the potential cost-effectiveness of navigation in screening programs.
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Affiliation(s)
- Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vivienne E Milch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Cancer Australia, Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Oluwaseyifunmi Andi Agbejule
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ria Joseph
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Jolyn Johal
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Narayanee Dick
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Matthew P Wallen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Victoria, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Anupriya Agarwal
- Cancer Australia, Sydney, New South Wales, Australia
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Larissa Nekhlyudov
- Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Tieu
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | | | | | - Dorothy Keefe
- Cancer Australia, Sydney, New South Wales, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute for Health Research, The University of Notre Dame Australia, Perth, Western Australia, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- Human Performance Research Centre, Innovative Solutions for Well-being and Health (INSIGHT) Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, New South Wales, Australia
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Fusetti V, Angi M, Caraceni AT, Di Guardo L, Regalia E, Bosisio M, Lo Dico S, Pigni A, Brunelli C, Lusignani M. Palliative Care Nursing Case Management in Young Adults With Advanced Rare Cancer: Case Discussion of a Multidisciplinary Approach. Prof Case Manag 2023; 28:280-287. [PMID: 37787706 DOI: 10.1097/ncm.0000000000000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Purpose/Objectives:
This case aims to identify the elements of care continuity that are lacking in young adult patients with advanced rare cancer, suggesting ways to enhance continuity of care through nurse case manager/management (NCM) interventions and describing their impact on the emotional burden of patients and their families.
Primary Practice Setting(s):
Comprehensive cancer center.
Findings/Conclusions:
The dyadic care alliance with the NCM can alleviate disease burden, fostering trust in the team and adherence to care advice, thus reducing the patient's distress. The NCM can be an efficient option to advocate for patient needs on the multidisciplinary team, addressing practical issues and the unmet needs of patients and their caregivers, and facilitating referrals to other professionals. The study also shows that caring for young adults with advanced rare cancers should include mindful evaluation of their significant others.
Implications for Case Management Practice:
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Affiliation(s)
- Viviana Fusetti
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Angi
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Augusto T Caraceni
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenza Di Guardo
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Enrico Regalia
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Bosisio
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Lo Dico
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandra Pigni
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Cinzia Brunelli
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maura Lusignani
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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