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Di Lorenzo S, Mozzi L, Salmaso F, Silvagni C, Soffientini S, Valenti V, Zagonel V. A multicentre survey on the perception of palliative care among health professionals working in haematology. Support Care Cancer 2024; 32:253. [PMID: 38536470 PMCID: PMC10973048 DOI: 10.1007/s00520-024-08452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/20/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Patients with haematologic malignancies have less access to palliative care and are referred later than patients with solid tumours. We developed a survey to investigate this phenomenon, with the intention of analysing palliative care perceptions among health professionals who treat haematology patients and identifying barriers and facilitators to referrals to palliative care services. METHODS This was a multicentre exploratory descriptive web-based survey. A questionnaire was administered to 320 medical and nursing staff members from five Italian haematological units and San Marino's hospital to investigate their perception of palliative care. Quantitative and qualitative analyses were performed. RESULTS A total of 142/320 healthcare professionals completed the survey, achieving a 44% response rate. Most of the respondents supported the integration of haematology and palliative care and were aware of the role of palliative care. Despite this, only half had an in-hospital palliative care team, and only a few had previously attended a specific training course. The majority agreed with palliative care referral when the prognosis was less than 3 months or when the symptoms were incoercible and with blood transfusions even in the last stages of the disease. Many considered the presence of an in-hospital palliative care team or a case manager, as well as structured palliative care training, as fundamental facilitators of palliative care referrals. CONCLUSION These results showed that healthcare professionals in haematology generally hold a favourable attitude and a high interest in integrating palliative care into their patients' care. The low referral rate could depend on clinical, cultural, and organisational issues.
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Affiliation(s)
- Sara Di Lorenzo
- Clinical Hematology and Bone Marrow Transplant and Cellular Therapies Center, Carlo Melzi", Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Lisa Mozzi
- Clinical Hematology, Azienda Ospedaliera Ulss 8 Berica, "St. Bortolo" Hospital, Vicenza, Italy
| | - Flavia Salmaso
- Palliative Care Unit, IRCCS Istituto Oncologico Veneto IOV, Padua, Italy
| | - Claudia Silvagni
- Continuity of Care Center, Istituto Per La Sicurezza Sociale, Cailungo, Republic of San Marino
| | - Silvia Soffientini
- Integrated Home Care Unit, AULLS 6 Euganea - Terme Colli District, Padua, Italy
| | - Vanessa Valenti
- Palliative Care Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST), "Dino Amadori", Via P. Maroncelli 40, Meldola, FC, 47014, Italy.
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, IRCCS Istituto Oncologico Veneto IOV, Padua, Italy
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Bigi S, Ganfi V, Borelli E, Potenza L, Artioli F, Eliardo S, Mucciarini C, Cottafavi L, Ferrari U, Lombardo L, Cagossi K, Pietramaggiori A, Fantuzzi V, Bernardini I, Cruciani M, Cacciari C, Odejide O, Adolfo Porro C, Zimmermann C, Efficace F, Bruera E, Luppi M, Bandieri E. Perceptions of Death Among Patients with Advanced Cancer Receiving Early Palliative Care and Their Caregivers: Results from a Mixed-Method Analysis. Oncologist 2022; 28:e54-e62. [PMID: 36320128 PMCID: PMC9847550 DOI: 10.1093/oncolo/oyac227] [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: 05/04/2022] [Accepted: 09/30/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Oncologists are often concerned that talking about death with patients may hinder their relationship. However, the views of death held by patients have not been thoroughly investigated. This study aimed to describe the perception of death among patients with advanced cancer receiving early palliative care (EPC) and their caregivers. MATERIAL AND METHODS Qualitative and quantitative analyses were performed on 2 databases: (a) transcripts of open-ended questionnaires administered to 130 cancer patients receiving EPC with a mean age of 68.4 years and to 115 primary caregivers of patients on EPC with a mean age of 56.8; (b) texts collected from an Italian forum, containing instances of web-mediated interactions between patients and their caregivers. RESULTS Quantitative analysis shows that: (a) patients and caregivers are not afraid of speaking about death; (b) patients and caregivers on EPC use the word "death" significantly more than patients on standard oncology care (SOC) and their caregivers (P < .0001). For both participants on EPC and SOC, the adjectives and verbs associated with the word "death" have positive connotations; however, these associations are significantly more frequent for participants on EPC (verbs, Ps < .0001; adjectives, Ps < .003). Qualitative analysis reveals that these positive connotations refer to an actual, positive experience of the end of life in the EPC group and a wish or a negated event in the SOC group. CONCLUSIONS EPC interventions, along with proper physician-patient communication, may be associated with an increased acceptance of death in patients with advanced cancer and their caregivers.
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Affiliation(s)
- Sarah Bigi
- Corresponding author: Sarah Bigi, PhD, Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Largo Gemelli 1—20123 Milan, Italy. Tel: +39 02 7234 3042; Fax: +39 02 7234 3667; ; or, Mario Luppi, MD, PhD, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Via del Pozzo, 71—41124 Modena, Italy. Tel: +39 059 4224641 (studio)—5570 (free-set); Fax: +39 059 4224429l;
| | - Vittorio Ganfi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Leonardo Potenza
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy,Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Italy
| | - Fabrizio Artioli
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Sonia Eliardo
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Claudia Mucciarini
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Luca Cottafavi
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Umberto Ferrari
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Laura Lombardo
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Katia Cagossi
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | | | - Valeria Fantuzzi
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Ilaria Bernardini
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | | | - Cristina Cacciari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy,Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | | | | | - Mario Luppi
- Corresponding author: Sarah Bigi, PhD, Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Largo Gemelli 1—20123 Milan, Italy. Tel: +39 02 7234 3042; Fax: +39 02 7234 3667; ; or, Mario Luppi, MD, PhD, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Via del Pozzo, 71—41124 Modena, Italy. Tel: +39 059 4224641 (studio)—5570 (free-set); Fax: +39 059 4224429l;
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Zurlo IV, Pozzo C, Strippoli A, Mignogna S, Basso M, Vivolo R, Trovato G, Ciaburri M, Morelli F, Bria E, Leo S, Tortora G. Safety and Efficacy of a First-Line Chemotherapy Tailored by G8 Score in Elderly Metastatic or Locally Advanced Gastric and Gastro-Esophageal Cancer Patients: A Real-World Analysis. Geriatrics (Basel) 2022; 7:geriatrics7050107. [PMID: 36286210 PMCID: PMC9601931 DOI: 10.3390/geriatrics7050107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/12/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Gastric (GC) and gastro-esophageal cancer (GEC) are common neoplasms in the elderly. However, in clinical practice, the correct strategy for elderly patients who might benefit from chemotherapy (CT) is unknown. Prospective data are still poor. In this context, we performed a retrospective analysis of GC patients aged ≥75 years and treated at our institutions. Material and Methods: We retrospectively analyzed 90 patients with confirmed metastatic GC or GEC, treated with an upfront CT. Inclusion criteria were patients aged ≥75 years, PS 0−2, normal bone marrow/liver/renal function and no major comorbidities. All patients received a G8 score, and some patients with G8 ≤14 received a comprehensive geriatric assessment (CGA). The primary goal was to perform a safety evaluation based on the incidence of adverse events (AE), and the secondary goal was to determine the efficacy (PFS and OS). The chi-square test and the Kaplan−Meier method were used to estimate the outcomes. The statistical significance level was set at p < 0.05. Results: Toxicity rates were quite low: G1/G2 (51.1%) and G3/G4 (25.5%). No toxic deaths were reported. The median PFS was 6.21 months and the median OS 11 months. The G8 score and PS ECOG significantly influenced both PFS and OS. A statistically significant correlation among G8, weight loss, hypoalbuminemia and risk of G3/G4 adverse events was also found. Conclusion: Our research on selected elderly patients did not detect broad differences of efficacy and tolerability compared to a young population. Our study, although retrospective and small-sized, showed that G8 score might be an accurate tool to identify elderly GC/GEC patients who could be safely treated with CT, further recognizing patients who could receive a doublet CT and who may require a single agent chemotherapy or a baseline dose reduction.
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Affiliation(s)
- Ina Valeria Zurlo
- Medical Oncology Unit, “Vito Fazzi” Hospital, 73100 Lecce, Italy
- Correspondence:
| | - Carmelo Pozzo
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Antonia Strippoli
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | | | - Michele Basso
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Raffaella Vivolo
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Giovanni Trovato
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Michele Ciaburri
- Geriatric Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Franco Morelli
- Medical Oncology Unit, Gemelli Molise, 86100 Campobasso, Italy
| | - Emilio Bria
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Silvana Leo
- Medical Oncology Unit, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | - Giampaolo Tortora
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
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Brunello A, Galiano A, Schiavon S, Nardi M, Feltrin A, Pambuku A, De Toni C, Dal Col A, Lamberti E, Pittarello C, Bergamo F, Basso U, Maruzzo M, Finotto S, Bolshinsky M, Stragliotto S, Procaccio L, Rizzato MD, Formaglio F, Lombardi G, Lonardi S, Zagonel V. Simultaneous Care in Oncology: A 7-Year Experience at ESMO Designated Centre at Veneto Institute of Oncology, Italy. Cancers (Basel) 2022; 14:cancers14102568. [PMID: 35626172 PMCID: PMC9139444 DOI: 10.3390/cancers14102568] [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: 04/08/2022] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 12/12/2022] Open
Abstract
Benefits of early palliative care referral in oncology are well-validated. At the Veneto Institute of Oncology-IRCCS, a simultaneous-care outpatient clinic (SCOC) has been active since 2014, where patients with advanced cancer are evaluated by an oncologist together with a palliative care team. We prospectively assessed SCOC patients’ characteristics and SCOC outcomes through internal procedure indicators. Data were retrieved from the SCOC prospectively maintained database. There were 753 eligible patients. The median age was 68 years; primary tumor sites were gastrointestinal (75.2%), genitourinary (15.0%) and other sites (9.8%). Predominant symptoms were psychological issues (69.4%), appetite loss (67.5%) and pain (65.9%). Dyspnea was reported in 53 patients (7%) in the referral form, while it was detected in 226 patients (34.2%) during SCOC visits (p < 0.0001). Median survival of patients after the SCOC visit was 7.3 months. Survival estimates by the referring oncologist were significantly different from the actual survival. Psychological intervention was deemed necessary and undertaken in 34.6% of patients, and nutritional support was undertaken in 37.9% of patients. Activation of palliative care services was prompted for 77.7% of patients. Out of 357 patients whose place of death is known, 69.2% died at home, in hospice or residential care. With regard to indicators’ assessment, the threshold was reached for 9 out of 11 parameters (81.8%) requested by the procedure. This study confirmed the importance of close collaboration between oncologists and palliative care teams in responding properly to cancer patients’ needs. The introduction of a procedure with indicators allowed punctual assessment of a team’s performance.
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Affiliation(s)
- Antonella Brunello
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Antonella Galiano
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Stefania Schiavon
- Pain Therapy and Palliative Care Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (S.S.); (A.P.); (A.D.C.); (F.F.)
| | - Mariateresa Nardi
- Clinical Nutrition Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy;
| | - Alessandra Feltrin
- Hospital Psychology, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy;
| | - Ardi Pambuku
- Pain Therapy and Palliative Care Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (S.S.); (A.P.); (A.D.C.); (F.F.)
| | - Chiara De Toni
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Alice Dal Col
- Pain Therapy and Palliative Care Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (S.S.); (A.P.); (A.D.C.); (F.F.)
| | - Evelina Lamberti
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Chiara Pittarello
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Francesca Bergamo
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Umberto Basso
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Marco Maruzzo
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Silvia Finotto
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Maital Bolshinsky
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Silvia Stragliotto
- Department of Oncology, Medical Oncology 3, Veneto Institute of Oncology IOV-IRCCS, 31033 Castelfranco Veneto, Italy; (S.S.); (S.L.)
| | - Letizia Procaccio
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Mario Domenico Rizzato
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Fabio Formaglio
- Pain Therapy and Palliative Care Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (S.S.); (A.P.); (A.D.C.); (F.F.)
| | - Giuseppe Lombardi
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
| | - Sara Lonardi
- Department of Oncology, Medical Oncology 3, Veneto Institute of Oncology IOV-IRCCS, 31033 Castelfranco Veneto, Italy; (S.S.); (S.L.)
| | - Vittorina Zagonel
- Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy; (A.B.); (A.G.); (C.D.T.); (E.L.); (C.P.); (F.B.); (U.B.); (M.M.); (S.F.); (M.B.); (L.P.); (M.D.R.); (G.L.)
- Correspondence: ; Tel.: +39-049-8215953
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Basilicata P, Giugliano P, Vacchiano G, Simonelli A, Guadagni R, Silvestre A, Pieri M. Forensic Toxicological and Medico-Legal Evaluation in a Case of Incongruous Drug Administration in Terminal Cancer Patients. TOXICS 2021; 9:toxics9120356. [PMID: 34941790 PMCID: PMC8704381 DOI: 10.3390/toxics9120356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 11/28/2022]
Abstract
Background: In most cases, palliative care is prescribed to adults diagnosed with cancer. The definition of the most suitable therapy for an effective sedation in terminal cancer patients still represents one of the most challenging goals in medical practice. Due to their poor health, the correct dosing of drugs used for deep palliative sedation in terminal cancer patients, often already on polypharmacological therapy, can be extremely complicated, also considering possible drug-to-drug interactions that could lead to an increased risk of overdose and/or incongruous administration with fatal outcomes. The case of a terminal cancer patient is presented, focusing on the “adequacy” of administered therapy. Materials and Methods: A young male, affected by Ewing sarcoma, attending a palliative care at his own home, died soon after midazolam administration. Toxicological and histological analyses were performed on body fluids and organ fragments. Results and Discussion: Morphological reliefs evidenced a neoplastic mass, composed of lobulated tissue with a lardy, pinkish-gray consistency, extending from the pleural surface to the lung parenchyma, also present at the sacrum region (S1–S5), at the anterior mediastinum level, occupying the entire left pleural cavity, and infiltrating the ipsilateral lung. Metastatic lesions diffused to rachis and lumbar structures. The brain presented edema and congestion. Toxicological analyses evidenced blood midazolam concentrations in the range of 0.931–1.690 µg/mL, while morphine was between 0.266 and 0.909 µg/mL. Death was attributed to cardiorespiratory depression because of a synergic action between morphine and midazolam. The pharmacological interaction between midazolam and morphine is discussed considering the clinical situation of the patient. The opportunity to proceed with midazolam administration is discussed starting from guidelines recommendation. Finally, professional liability outlines are highlighted.
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Affiliation(s)
- Pascale Basilicata
- Legal Medicine Section, Department of Advanced Biomedical Science, University of Naples “Federico II”, 80131 Naples, Italy; (P.B.); (A.S.); (R.G.); (A.S.)
| | - Pasquale Giugliano
- Legal Medicine Section, AORN “Sant’Anna e San Sebastiano” Caserta, 81100 Caserta, Italy;
| | - Giuseppe Vacchiano
- Department of Law, Economics and Mathematical Methods, University of Sannio, 82100 Benevento, Italy;
| | - Angela Simonelli
- Legal Medicine Section, Department of Advanced Biomedical Science, University of Naples “Federico II”, 80131 Naples, Italy; (P.B.); (A.S.); (R.G.); (A.S.)
| | - Rossella Guadagni
- Legal Medicine Section, Department of Advanced Biomedical Science, University of Naples “Federico II”, 80131 Naples, Italy; (P.B.); (A.S.); (R.G.); (A.S.)
| | - Angela Silvestre
- Legal Medicine Section, Department of Advanced Biomedical Science, University of Naples “Federico II”, 80131 Naples, Italy; (P.B.); (A.S.); (R.G.); (A.S.)
| | - Maria Pieri
- Legal Medicine Section, Department of Advanced Biomedical Science, University of Naples “Federico II”, 80131 Naples, Italy; (P.B.); (A.S.); (R.G.); (A.S.)
- Correspondence: ; Tel.: +39-0817463474; Fax: +39-0817464726
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Evolving pancreatic cancer treatment: From diagnosis to healthcare management. Crit Rev Oncol Hematol 2021; 169:103571. [PMID: 34923121 DOI: 10.1016/j.critrevonc.2021.103571] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
The prognosis of pancreatic ductal adenocarcinoma is still the worst among solid tumors. In this review, a panel of experts addressed the main unanswered questions about the clinical management of this disease, with the aim of providing practical decision support for physicians. On the basis of the evidence available from the literature, the main topics concerning pancreatic cancer are discussed: the diagnosis, as the need for a pathological characterization and the role for germ-line and somatic molecular profiling; the therapeutic management of resectable disease, as the role of upfront surgery or neoadjuvant chemotherapy, the post-operative restaging and the optimal timing foradjuvant chemotherapy, the management of the borderline resectable and locally advanced disease; the metastatic disease and the role of surgery for the management of patients with isolated metastasis and the use of biomarkers of metastatic potential; the role of supportive care and the healthcare management of pancreatic ductal adenocarcinoma.
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Silvestris N, Brunetti O, Bittoni A, Cataldo I, Corsi D, Crippa S, D’Onofrio M, Fiore M, Giommoni E, Milella M, Pezzilli R, Vasile E, Reni M. Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up of Exocrine Pancreatic Ductal Adenocarcinoma: Evidence Evaluation and Recommendations by the Italian Association of Medical Oncology (AIOM). Cancers (Basel) 2020; 12:E1681. [PMID: 32599886 PMCID: PMC7352458 DOI: 10.3390/cancers12061681] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related death in women (7%) and the sixth in men (5%) in Italy, with a life expectancy of around 5% at 5 years. From 2010, the Italian Association of Medical Oncology (AIOM) developed national guidelines for several cancers. In this report, we report a summary of clinical recommendations of diagnosis, treatment and follow-up of PDAC, which may guide physicians in their current practice. A panel of AIOM experts in upper gastrointestinal cancer malignancies discussed the available scientific evidence supporting the clinical recommendations.
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Affiliation(s)
- Nicola Silvestris
- Medical Oncology Unit–IRCCS IstitutoTumori “Giovanni Paolo II” of Bari, 70124 Bari, Italy; (N.S.); (O.B.)
- Department of Biomedical Sciences and Human Oncology-University of Bari Medical School, 70124 Bari, Italy
| | - Oronzo Brunetti
- Medical Oncology Unit–IRCCS IstitutoTumori “Giovanni Paolo II” of Bari, 70124 Bari, Italy; (N.S.); (O.B.)
| | - Alessandro Bittoni
- Oncology Clinic, AOU Ospedali Riuniti, Polytechnic University of Marche, 60121 Ancona, Italy;
| | - Ivana Cataldo
- Department of Pathology, Hospital Cà Foncello of Treviso, 31100 Treviso, Italy;
| | - Domenico Corsi
- Medical Oncology Unit Azienda Ospedaliera San Giovanni Calibita Fatebene fratelli Roma, 00186 Roma, Italy;
| | - Stefano Crippa
- Division of Pancreatic Surgery, Vita-Salute University, San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Mirko D’Onofrio
- Department of Radiology, G. B. Rossi University Hospital, University of Verona, 37129 Verona, Italy;
| | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Elisa Giommoni
- Medical Oncology Unit, Department of Oncology and Robotic Surgery, AOU Careggi, 50139 Florence, Italy;
| | - Michele Milella
- Section of Medical Oncology, Department of Medicine, University of Verona and University Hospital Trust, 37129 Verona, Italy;
| | - Raffaele Pezzilli
- Department of Gastroenterology, San Carlo Hospital, 85100 Potenza, Italy;
| | - Enrico Vasile
- Division of Medical Oncology, Pisa University Hospital, 56124 Pisa, Italy;
| | - Michele Reni
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
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Pallotti MC, Ricci M, Rossi R, Cecconetto L, Barone D, Maltoni M. Palliative care: not only for treating symptoms: a case report. TUMORI JOURNAL 2020; 106:NP1-NP4. [PMID: 32008478 DOI: 10.1177/0300891620901771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Palliative care (PC) aims to treat symptoms independently of the disease. In many medical disciplines, including oncology, there is an emphasis on personalizing treatment, identifying the most effective therapeutic option by studying the genetic heritage of the patient and the molecular characteristics of the disease. PC, on the other hand, encompasses the overall (physical and spiritual) well-being of the patient and his or her caregivers. The increasing use of early PC and its integration with oncology could represent a fruitful collaboration among specialists. CASE DESCRIPTION We present the case of a 79-year-old woman with advanced breast cancer attending our institute who was referred to our PC Unit because of continuous ear pain, paresthesia around the mouth, strabismus, and facial dysesthesia. The patient was in good clinical condition (Eastern Cooperative Oncology Group 1) and was undergoing chemotherapy at the time. For these reasons, the PC physician carefully assessed the pain characteristics and differential diagnosis and discussed them with the oncologist, radiologist, and neurologist. Joint consultation led to a specific study of Meckel cave by MRI, revealing an extrameningeal gasserian ganglion metastasis, a very rare localization of breast cancer. CONCLUSION We present a case that underlines the importance of specialized PC assessment not limited to the control of symptoms. The search for the etiopathogenesis of a patient's symptoms and the evaluation of overall clinical conditions may be necessary to plan appropriate diagnostic evaluations, target palliative therapies, and achieve effective symptom control.
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Affiliation(s)
- Maria Caterina Pallotti
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Marianna Ricci
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Romina Rossi
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Lorenzo Cecconetto
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Domenico Barone
- Radiology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Pedrazzoli P, Pinto C, Rosti G, Caccialanza R. Nutritional support in cancer patients: reply to Scarpi et al. Support Care Cancer 2019; 28:1549-1550. [PMID: 31853700 DOI: 10.1007/s00520-019-05223-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/28/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. .,Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy.
| | - Carmine Pinto
- Medical Oncology, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Rosti
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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