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Barni S, Aschele C, Blasi L, Giordano M, Ortega C, Pinotti G, Artioli F, Fioretto L, Daniele B, Aprile G, Silva RR, Montesarchio V. [What patients with cancer think about the dehospitalization. A survey of Cipomo.]. Recenti Prog Med 2024; 115:232-237. [PMID: 38708534 DOI: 10.1701/4262.42402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Ministerial Decrete 77 (DM 77) promotes dehospitalization for chronic patients and defines out-of-hospital health facilities at this purpose. It has never been investigated how much patients with cancer know and judge this decree law. MATERIAL AND METHODS The Collegio italiano dei primari oncologi medici ospedalieri (Cipomo) carried out a survey with a dedicated questionnaire on oncological patients attending public hospital to investigate the liking of DM 77. RESULTS Anonymous responses were obtained from 1.443 patients. Median age 64ys, 42% males, 21% live alone, 70% have a companion. 19% thinks that oral chemotherapy could be managed outside the hospital, 26.68% carried out follow-up (FU),19.15% parenteral therapy, 32.16% basic examinations. Home is preferred by 21.8%, a health facility close to home by 36.3%, hospital by 37.54%. 59.67% would like FU in hospital by their personal oncologist, 5.47% by GP, 35.41% by both together and 9.45% by oncologist outside the hospital. Asked what they might feel about being followed out of the hospital, 29.94% say of not being treated at its best, 12.68% of not being able to be visited in hospital anymore, 5.27% of being abandoned, 30.7% of being freer and 10.88% of feeling less sick. Regarding the use of new technical tools to favor dehospitalisation, 44.15% answered yes, 15.88% no and 30.07% did not know. About the distance or traveling time from home to the therapy administration side, 20.26% answered this should be no more than 15 km or 30 mins, 9.91% no more than 30 km or 45 mins, 5.47% no more than 50 km or 60 mins but 39.5% say that the distance does not matter to them but only the continuity of care. The question related to the inconveniences with going to hospital for therapy: 40.81% waiting time, 20.47% lack of parking, 17.02% rotation of doctors,12.76% travel time and 5.62% bureaucracy. CONCLUSIONS The patients' answers suggest that dehospitalization could improve their quality of life, but at the condition of being able to maintain a close relationship with the personal oncologist.
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Affiliation(s)
- Sandro Barni
- Primario Emerito di Oncologia medica, Asst BG Ovest, Ospedale di Treviglio (Bergamo)
| | - Carlo Aschele
- Dipartimento di Oncologia medica, Ospedale Sant'Andrea, La Spezia
| | - Livio Blasi
- UO Oncologia medica (Arnas), Civico Benfratelli, Palermo
| | - Monica Giordano
- Dipartimento di Oncologia, Ospedale Sant'Anna, Asst-Lariana (Como)
| | - Cinzia Ortega
- Dipartimento di Oncologia, Ospedale San Lazzaro, Azienda sanitaria locale CN2, Alba (Cuneo)
| | | | | | - Luisa Fioretto
- Dipartimento di Oncologia medica, Azienda Usl Toscana Centro, Firenze
| | - Bruno Daniele
- Dipartimento di Oncologia, Ospedale del Mare, Asl Napoli 1 Centro, Napoli
| | - Giuseppe Aprile
- Dipartimento di Oncologia clinica, Ospedale San Bortolo, Vicenza, Azienda Ulss8 Berica, Vicenza
| | - Rosa Rita Silva
- Dipartimento di Oncologia, Asur Marche, Area Vasta 2, Fabriano (Ancona)
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Bigi S, Borelli E, Potenza L, Gilioli F, Artioli F, Porzio G, Luppi M, Bandieri E. Early palliative care for solid and blood cancer patients and caregivers: Quantitative and qualitative results of a long-term experience as a case of value-based medicine. Front Public Health 2023; 11:1092145. [PMID: 36950093 PMCID: PMC10025337 DOI: 10.3389/fpubh.2023.1092145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Cancer patients and their caregivers have substantial unmet needs, that negatively impact the clinical outcome and quality of life. However, interventions aimed to address such needs are still suboptimal, failing to answer the recent healthcare call for the adoption of value-based models of care. In the case of incurable oncologic and hematologic cancers, a value-based model of care should plan advanced care on patients' needs and include the quality of death as an outcome. The integration of early palliative care into standard oncologic care for patients with advanced cancers represents a recent innovative model of assistance whose benefits for patients and caregivers are now widely recognized. The key elements underlying the reasons behind these benefits are the multidisciplinary collaboration (teamwork), an honest and empathetic communication between the early palliative care team, the patient, and the caregiver (rapport building), and the ability to detect changes in the physical/psychosocial wellbeing of the patient, along the whole disease trajectory (constant monitoring). Methods This community case study documents the quantitative and qualitative results of a long term clinical and research experience in delivering early palliative care service to address both solid and blood cancer patients' and their primary caregivers' needs. Results Data showed decreased use of chemotherapy, blood transfusions and referral to intensive care units near the end of life; increased life expectancy; improved symptom burden and mood; increased frequency of goals-of-care and advanced care planning conversations. Hope perception among bereaved caregivers was associated with resilience and realistic expectations raising from honest communication with the early palliative care team and appreciation toward the model. Patients and caregivers perceived the possibility of a good death as realistic and not as an unlikely event as it was for patients and caregivers on standard oncologic care only. Gratitude expressions toward the model and the team were frequently identified in their reports and positively associated with communication and spirituality. Conclusions These findings are discussed in the context of an updated literature review regarding value-based care and suggest that early palliative care integrated into standard oncology care may be considered as an effective model of value-based care.
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Affiliation(s)
- Sarah Bigi
- Department of Linguistic Sciences and Foreign Literatures, Università Cattolica del Sacro Cuore, Milan, Italy
- *Correspondence: Sarah Bigi
| | - Eleonora Borelli
- 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, Modena, Italy
| | - Fabio Gilioli
- Department of Internal Medicine and Rehabilitation, USL, Modena, Italy
| | - Fabrizio Artioli
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | | | - Mario Luppi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Borelli E, Bigi S, Potenza L, Gilioli F, Artioli F, Porzio G, Porro CA, Efficace F, Bruera E, Luppi M, Bandieri E. Gratitude among advanced cancer patients and their caregivers: The role of early palliative care. Front Oncol 2022; 12:991250. [PMID: 36353529 PMCID: PMC9639866 DOI: 10.3389/fonc.2022.991250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/20/2022] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE A cancer diagnosis represents a unique trauma, given its life-threatening, multidimensional, and uncertain nature. Gratitude is a construct representing the emotional state that arises when individuals recognize that a benefit has been received as a result of someone else's action or a spiritual entity's intervention. Based on the positive psychological wellbeing, gratitude has been associated with improved health outcomes even in the disease setting. Thus, the models of care that foster gratitude should be adopted in the clinical context. This study aims to explore whether and how gratitude may originate in patients with advanced cancer and their caregivers undergoing early palliative care (EPC). METHODS We analyzed 251 reports from 133 patients and 118 caregivers describing their clinical experience in two EPC units. The sources of gratitude were identified and ranked based on their frequencies. Words expressing gratitude and words referring to communication and spirituality were collected by means of the Linguistic Inquiry and Word Count software and correlated. RESULTS In total, 123 (92.5%) of 133 patients' and 97 (82.2%) of 118 caregivers' reports, respectively, included explicit or implicit expressions of gratitude. Gratitude was associated specifically with successful physical symptom management, emotional support, improved attitude toward death, better information, humanity, and the familiar environment. The use of words of gratitude in patients' reports was positively correlated with the use of words referring to communication (r = .215, p = .026) and spirituality (r = .612, p <.001). CONCLUSION Our results suggest that interventions within the EPC model based on doctor-patient-caregiver communication may allow patients and caregivers to experience a feeling of gratitude, and this may represent a resource to be exploited to improve their physical and psychosocial wellbeing.
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Affiliation(s)
- Eleonora Borelli
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sarah Bigi
- Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Milan, 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, Modena, Italy
| | - Fabio Gilioli
- Department of Internal Medicine and Rehabilitation, Unitá Sanitaria Locale (USL), Modena, Italy
| | - Fabrizio Artioli
- Oncology and Palliative Care Units, Civil Hospital Carpi, Unitá Sanitaria Locale (USL), Carpi, Italy
| | | | - Carlo Adolfo Porro
- 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
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Eduardo Bruera
- Palliative Care and Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Mario Luppi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, Unitá Sanitaria Locale (USL), Carpi, Italy
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Andrini E, Lamberti G, Mazzoni F, Riccardi F, Bonetti A, Follador A, Artioli F, Genova C, Barbieri F, Frassoldati A, Brighenti M, Colantonio I, Pasello G, Ficorella C, Cinieri S, Tiseo M, Gelsomino F, Tognetto M, Rihawi K, Ardizzoni A. A phase II, open-label, single-arm trial of carboplatin plus etoposide with bevacizumab and atezolizumab in patients with extended-stage small-cell lung cancer (CeLEBrATE study): background, design and rationale. Future Oncol 2022; 18:771-779. [PMID: 35068173 DOI: 10.2217/fon-2021-1027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Based on improved survival from the addition of PD-L1 inhibitors in phase III trials, the combination of immunotherapy and platinum-doublet chemotherapy has become the new standard treatment for extended-stage small-cell lung cancer (ES-SCLC). Furthermore, the antiangiogenetic agent bevacizumab showed a longer progression-free survival by targeting VEGF that has pleiotropic effects, including immunosuppressive ones. We, therefore, hypothesized that targeting angiogenesis would improve the efficacy of chemoimmunotherapy. The CeLEBrATE trial is an open-label, multicenter, phase II study designed to assess the efficacy and safety of the combination of carboplatin and etoposide plus bevacizumab and atezolizumab in treatment-naive patients with ES-SCLC. The primary end point is overall survival rate at 1 year, while secondary end points include overall response rate, progression-free survival and toxicity.
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Affiliation(s)
- Elisa Andrini
- Department of Experimental, Diagnostic & Specialty Medicine (DIMES), University of Bologna, Bologna 40138, Italy
| | - Giuseppe Lamberti
- Department of Experimental, Diagnostic & Specialty Medicine (DIMES), University of Bologna, Bologna 40138, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Francesca Mazzoni
- Medical Oncology Unit, University Hospital Careggi, Firenze 50134, Italy
| | | | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago 37045, Italy
| | - Alessandro Follador
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine 33100, Italy
| | - Fabrizio Artioli
- Oncology & Palliative Care Units, Civil Hospital Carpi, USL, Carpi 41012, Italy
| | - Carlo Genova
- Academic Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
- Department of Internal Medicine & Medical Specialties (DiMI), Università degli Studi di Genova, Genoa 16132, Italy
| | - Fausto Barbieri
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena 41125, Italy
| | - Antonio Frassoldati
- Department of Oncology, Azienda Ospedaliero Universitaria di Ferrara-Arcispedale Sant'Anna, Ferrara 44124, Italy
| | | | - Ida Colantonio
- Medical Oncology Unit, Hospital of Cuneo, Cuneo 12100, Italy
| | - Giulia Pasello
- Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova 35122, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova 35122, Italy
| | - Corrado Ficorella
- Department of Biotechnological & Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila 67100, Italy
| | - Saverio Cinieri
- Department of Oncology, Medical Oncology & Breast Unit, Antonio Perrino Hospital, Brindisi 72100, Italy
| | - Marcello Tiseo
- Department of Medicine & Surgery, University of Parma & Medical Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma 43126, Italy
| | - Francesco Gelsomino
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Michele Tognetto
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Karim Rihawi
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Andrea Ardizzoni
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
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Bigi S, Ganfi V, Borelli E, Potenza L, Artioli F, Eliardo S, Mucciarini C, Cottafavi L, Cruciani M, Cacciari C, Odejide O, Porro CA, Zimmermann C, Efficace F, Bruera E, Luppi M, Bandieri E. OUP accepted manuscript. Oncologist 2022; 27:e168-e175. [PMID: 35641207 PMCID: PMC8895751 DOI: 10.1093/oncolo/oyab027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/07/2021] [Indexed: 11/14/2022] Open
Abstract
Background Oncologists’ fear of taking away hope from patients when proposing early palliative care (EPC) is a barrier to the implementation of this model. This study explores hope perceptions among bereaved caregivers of onco-hematologic patients who received EPC. Materials and Methods Open-ended questionnaires were administered to 36 primary caregivers of patients who received EPC (26 solid and 10 hematologic cancer patients; mean age: 51.4 years, range age: 20-74), at 2 cancer centers, 2 months to 3 years after a patient death. Definitions of hope in the caregivers’ narratives were analyzed through a directed approach to content analysis. Results were complemented with automated lexicographic analysis. Results Caregivers perceived hope mainly as resilience and as expectations based on what they were told about the patients’ clinical conditions. Their hope was bolstered by trusting relationships with the healthcare teams. EPC interventions were recalled as the major support for hope, both during the illness and after the death of the patient. The automated quantitative lexical analysis provided deeper insights into the links between hope, truth, and trust. Conclusions Our findings suggest that telling the truth about an incurable onco-hematologic disease and beginning EPC might be the combination of factors triggering hope in the setting of incurable cancer.
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Affiliation(s)
- Sarah Bigi
- Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Milan, Italy
- 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;
| | - Vittorio Ganfi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Eleonora Borelli
- 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, 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
| | | | - 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
| | - Oreofe Odejide
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Carlo Adolfo Porro
- 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
| | - Camilla Zimmermann
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Eduardo Bruera
- Palliative Care and Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Mario Luppi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
- 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 (office) - 5570 (free-set);
| | - Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
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Artioli F, Razzini G, Barbieri D, Secchi C. Relationship Dynamics Underlying Cancer Overtreatment in Advanced Cancer Patients From an Oncologist Point of View. Front Psychol 2021; 12:754432. [PMID: 34867648 PMCID: PMC8637613 DOI: 10.3389/fpsyg.2021.754432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Fabrizio Artioli
- Unit of Medical Oncology, Civil Hospital "B. Ramazzini", Azienda USL Modena, Carpi, Italy
| | - Giorgia Razzini
- Unit of Medical Oncology, Civil Hospital "B. Ramazzini", Azienda USL Modena, Carpi, Italy
| | - Dania Barbieri
- Unit of Psychology, Civil Hospital "B. Ramazzini", Azienda USL Modena, Carpi, Italy
| | - Cesare Secchi
- International Psychoanalytical Association, Reggio Emilia, Italy
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Bongiovanni A, Foca F, Menis J, Stucci SL, Artioli F, Guadalupi V, Forcignanò MR, Fantini M, Recine F, Mercatali L, Spadazzi C, Burgio MA, Fausti V, Miserocchi A, Ibrahim T. Immune Checkpoint Inhibitors With or Without Bone-Targeted Therapy in NSCLC Patients With Bone Metastases and Prognostic Significance of Neutrophil-to-Lymphocyte Ratio. Front Immunol 2021; 12:697298. [PMID: 34858389 PMCID: PMC8631508 DOI: 10.3389/fimmu.2021.697298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/08/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Bone metastases (BMs) are a negative prognostic factor in patients with non-small cell lung cancer (NSCLC). Although immune-checkpoint inhibitors (ICIs) have dramatically changed the therapeutic landscape of NSCLC, little information is available on BMs from NSCLC treated with ICIs alone or in association with bone-targeted therapy (BTT) such as zoledronate or denosumab. Methods From 2014 to 2020, 111 of the 142 patients with BMs secondary to NSCLC extrapolated from the prospective multicenter Italian BM Database were eligible for analysis. Information on blood count, comorbidities, and toxicity was retrospectively collected. The neutrophil-to-lymphocyte ratio (NLR) pre- and post-treatment was calculated. Survival was analyzed using the Kaplan-Meier method, with statistical significance of survival differences assessed using the log-rank test. Results Median age was 66 (range, 42-84) years. Performance status (PS) Eastern Cooperative Oncology Group (ECOG) was 0-1 in 79/111 patients. The majority of patients (89.2%) had adenocarcinoma histology. At a median follow-up of 47.4 months, median progression-free (mPFS) and overall survival (mOS) was 4.9 (95%CI, 2.8-10.0) and 11.9 (95%CI, 8.2-14.4) months, respectively. Forty-six (43.4%) patients with BM NSCLC underwent first- or further-line therapy with ICIs: 28 (60.8%) received nivolumab, 9 (19.6%) pembrolizumab, and 9 (19.6%) atezolizumab. Of the 46 patients treated with ICIs, 30 (65.2%) underwent BTT: 24 (80.0%) with zoledronate and 6 (20.0%) with denosumab. The ICI-alone group had an mOS of 15.8 months [95%CI, 8.2-not evaluable (NE)] vs. 21.8 months (95%CI, 14.5-not evaluable) for the ICI plus BTT group and 7.5 (95%CI, 6.1-10.9) months for the group receiving other treatments (p < 0.001). NLR ≤5 had a positive impact on OS. Conclusion BTT appears to have a synergistic effect when used in combination with ICIs, improving patient survival.
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Affiliation(s)
- Alberto Bongiovanni
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Jessica Menis
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy.,Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Stefania Luigia Stucci
- Medical Oncology Unit, Policlinico Hospital of Bari Department of Biomedical Sciences and Human Oncology University of Bari "A. Moro", Bari, Italy
| | | | | | | | | | | | - Laura Mercatali
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Chiara Spadazzi
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Marco Angelo Burgio
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Valentina Fausti
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Anna Miserocchi
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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9
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Cavanna L, Citterio C, Di Nunzio C, Zaffignani E, Cremona G, Vecchia S, De Ponzio M, Riva A, Proietto M, Mordenti P, Bosi C, Vallisa D, Andena AM, Zanlari L, Palermo E, Iofrida M, Groppi L, Civardi G, Artioli F. [Territorial-based management of patients with cancer on active treatment following the Piacenza (north Italy) Model. Results of 4 consecutive years.]. Recenti Prog Med 2021; 112:785-791. [PMID: 34924573 DOI: 10.1701/3710.37001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The natural history of cancer has radically changed in the last decade. The burden of travel from patient's residence to health care providers is an important issue that can influence access to diagnosis and treatment of cancer; however this issue is quite neglect by the medical community and by the national health system. In addition, community care in the oncology field is actually debated. METHODS In the district of Piacenza an innovative model to deliver onco-hematologic treatment near the residence of patients was initiated some years ago. The oncologic and hematologic treatments are delivered by specialized nurses under supervision of medical oncologists or hematologists at the 3 community hospital and at 1 house of health in the district of Piacenza. We conducted a retrospective study involving 1,339 cancer patients (CPs) managed and treated near their residence, CPs were on active medical treatment at the oncology and hematology department Azienda sanitaria (ASL) of Piacenza (North Italy). The electronic data base of the antiblastic drug unit (UFA) of the ASL Piacenza, provided: the number of patients treated each year, number of treatments and the accesses to the territorial medical structure each year. The kms saved to reach the nearest territorial structures instead of the oncologic unit of the city hospital, were registered and recorded. RESULTS During a 4 years period, from January 2017 to December 2020, 1,339 CPs were treated near their residence, 278 in the year 2017, 347 in 2018, 354 in 2019 and 360 in 2020. The total accesses for treatment in 4 years were 10,003: 2,214 in the year 2017, 2,652 in 2018, 2,524 in 2019 and 2,613 in 2020. The mean distance saved for each patient was 937 kms in the year 2017, 891 in 2018, 879 in 2019, 920 in 2020, totally a mean of 3,627 kms in the 4 years. DISCUSSION AND CONCLUSION We believe that the results of our retrospective study highlight the possibility of treating cancer patients in territorial structures near their residence, with advantages for patients themselves, their caregivers and for the entire community.
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Affiliation(s)
- Luigi Cavanna
- Dipartimento di Oncologia-Ematologia, Azienda USL Ospedale di Piacenza
| | - Chiara Citterio
- Dipartimento di Oncologia-Ematologia, Azienda USL Ospedale di Piacenza
| | - Camilla Di Nunzio
- Dipartimento di Oncologia-Ematologia, Azienda USL Ospedale di Piacenza
| | - Elena Zaffignani
- Dipartimento di Oncologia-Ematologia, Azienda USL Ospedale di Piacenza
| | - Gabriele Cremona
- Dipartimento di Oncologia-Ematologia, Azienda USL Ospedale di Piacenza
| | - Stefano Vecchia
- Dipartimento di Farmacia, Azienda USL Ospedale di Piacenza - Unità di Farmaci Antiblastici (UFA), Azienda USL Ospedale di Piacenza
| | | | - Alessandra Riva
- Dipartimento di Farmacia, Azienda USL Ospedale di Piacenza - Unità di Farmaci Antiblastici (UFA), Azienda USL Ospedale di Piacenza
| | - Manuela Proietto
- Dipartimento di Oncologia-Ematologia, Azienda USL Ospedale di Piacenza - Dipartimento delle Cure Primarie, Casa della Salute, Bettola (Piacenza)
| | - Patrizia Mordenti
- Dipartimento di Oncologia-Ematologia, Azienda USL Ospedale di Piacenza
| | - Costanza Bosi
- Dipartimento di Oncologia-Ematologia, Azienda USL Ospedale di Piacenza
| | - Daniele Vallisa
- Dipartimento di Oncologia-Ematologia, Azienda USL Ospedale di Piacenza
| | - Anna Maria Andena
- Dipartimento delle Cure Primarie, Casa della Salute, Bettola (Piacenza)
| | - Luca Zanlari
- Dipartimento di Medicina Interna, Ospedale di Fiorenzuola (Piacenza)
| | - Eliana Palermo
- Dipartimento di Medicina Interna, Ospedale di Castel San Giovanni (Piacenza)
| | - Mariana Iofrida
- Dipartimento di Medicina Interna, Ospedale di Bobbio (Piacenza)
| | - Lisa Groppi
- Dipartimento di Oncologia-Ematologia, Azienda USL Ospedale di Piacenza - Dipartimento delle Cure Primarie, Casa della Salute, Bettola (Piacenza)
| | | | - Fabrizio Artioli
- Unità Operativa di Oncologia, Ospedale di Carpi e Mirandola (Modena)
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10
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Borelli E, Bigi S, Potenza L, Eliardo S, Artioli F, Mucciarini C, Cottafavi L, Cagossi K, Razzini G, Cruciani M, Pietramaggiori A, Fantuzzi V, Lombardo L, Ferrari U, Ganfi V, Lui F, Odejide O, Cacciari C, Porro CA, Zimmermann C, Efficace F, Bruera E, Luppi M, Bandieri E. Changes in Cancer Patients' and Caregivers' Disease Perceptions While Receiving Early Palliative Care: A Qualitative and Quantitative Analysis. Oncologist 2021; 26:e2274-e2287. [PMID: 34510624 PMCID: PMC8649024 DOI: 10.1002/onco.13974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/18/2021] [Indexed: 12/17/2022] Open
Abstract
Background Little is known about the underlying mechanisms through which early palliative care (EPC) improves multiple outcomes in patients with cancer and their caregivers. The aim of this study was to qualitatively and quantitatively analyze patients’ and caregivers’ thoughts and emotional and cognitive perceptions about the disease prior to and during the EPC intervention, and in the end of life, following the exposure to EPC. Materials and Methods Seventy‐seven patients with advanced cancer and 48 caregivers from two cancer centers participated in semistructured interviews. Their reports were qualitatively and quantitatively analyzed by the means of the grounded theory and a text‐analysis program. Results Participants reported their past as overwhelmed by unmanaged symptoms, with detrimental physical and psychosocial consequences. The EPC intervention allowed a prompt resolution of symptoms and of their consequences and empowerment, an appreciation of its multidimensional approach, its focus on the person and its environment, and the need for EPC for oncologic populations. Patients reported that conversations with the EPC team increased their acceptance of end of life and their expectation of a painless future. Quantitative analysis revealed higher use of Negative Affects (p < .001) and Biological Processes words (p < .001) when discussing the past; Agency words when discussing the present (p < .001); Positive Affects (p < .001), Optimism (p = .002), and Insight Thinking words (p < .001) when discussing the present and the future; and Anxiety (p = .002) and Sadness words (p = .003) when discussing the future. Conclusion Overall, participants perceived EPC to be beneficial. Our findings suggest that emotional and cognitive processes centered on communication underlie the benefits experienced by participants on EPC. Implications for Practice By qualitative and quantitative analyses of the emotional and cognitive perceptions of cancer patients and their caregivers about their experiences before and during EPC interventions, this study may help physicians/nurses to focus on the disease perception by patients/caregivers and the benefits of EPC, as a standard practice. The analysis of words used by patients/caregivers provides a proxy for their psychological condition and support in tailoring an EPC intervention, based on individual needs. This study highlights that the relationship of the triad EPC team/patients/caregivers may rise as a therapeutic tool, allowing increasing awareness and progressive acceptance of the idea of death. Early palliative care can improve experiences and outcomes for patients with advanced cancer. This article analyzes disease perceptions of cancer patients and their caregivers before and after early palliative care intervention.
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Affiliation(s)
- Eleonora Borelli
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sarah Bigi
- Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Milan, 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, Modena, Italy
| | - Sonia Eliardo
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Fabrizio Artioli
- 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
| | - Katia Cagossi
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Giorgia Razzini
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | | | | | - Valeria Fantuzzi
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Laura Lombardo
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Umberto Ferrari
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Vittorio Ganfi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fausta Lui
- 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
| | - Oreofe Odejide
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - 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
| | - Carlo Adolfo Porro
- 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
| | - Camilla Zimmermann
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Eduardo Bruera
- Palliative Care & Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Mario Luppi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
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11
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Bongiovanni A, Foca F, Menis J, Stucci L, Artioli F, Guadalupi V, Forcignanò M, Fantini M, Recine F, Mercatali L, Spadazzi C, De Vita A, Casadei R, Falasconi M, Fausti V, Pallotti M, Bertoni M, Vanni S, Ibrahim T. 1296P Immune checkpoint inhibitors with or without bone targeted therapy in NSCLC patients with bone metastases and prognostic significance of neutrophil-to-lymphocyte ratio. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Borelli E, Bigi S, Potenza L, Artioli F, Eliardo S, Mucciarini C, Cagossi K, Razzini G, Pasqualini A, Lui F, Ferlazzo F, Cruciani M, Bruera E, Efficace F, Luppi M, Cacciari C, Porro CA, Bandieri E. Different semantic and affective meaning of the words associated to physical and social pain in cancer patients on early palliative/supportive care and in healthy, pain-free individuals. PLoS One 2021; 16:e0248755. [PMID: 33788893 PMCID: PMC8011738 DOI: 10.1371/journal.pone.0248755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/04/2021] [Indexed: 12/25/2022] Open
Abstract
Early palliative/supportive care (ePSC) is a medical intervention focused on patient's needs, that integrates standard oncological treatment, shortly after a diagnosis of advanced/metastatic cancer. ePSC improves the appropriate management of cancer pain. Understanding the semantic and emotional impact of the words used by patients to describe their pain may further improve its assessment in the ePSC setting. Psycholinguistics assumes that the semantic and affective properties of words affect the ease by which they are processed and comprehended. Therefore, in this cross-sectional survey study we collected normative data about the semantic and affective properties of words associated to physical and social pain, in order to investigate how patients with cancer pain on ePSC process them compared to healthy, pain-free individuals. One hundred ninety patients and 124 matched controls rated the Familiarity, Valence, Arousal, Pain-relatedness, Intensity, and Unpleasantness of 94 words expressing physical and social pain. Descriptive and inferential statistics were performed on ratings in order to unveil patients' semantic and affective representation of pain and compare it with those from controls. Possible effects of variables associated to the illness experience were also tested. Both groups perceived the words conveying social pain as more negative and pain-related than those expressing physical pain, confirming previous evidence of social pain described as worse than physical pain. Patients rated pain words as less negative, less pain-related, and conveying a lower intense and unpleasant pain than controls, suggesting either an adaptation to the pain experience or the role played by ePSC in improving patients' ability to cope with it. This exploratory study suggests that a chronic pain experience as the one experienced by cancer patients on ePSC affects the semantic and affective representation of pain words.
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Affiliation(s)
- Eleonora Borelli
- 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
| | - Sarah Bigi
- Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Milan, Italy
| | - Leonardo Potenza
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 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
| | - Katia Cagossi
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Giorgia Razzini
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | | | - Fausta Lui
- 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
| | - Fabio Ferlazzo
- Department of Psychology, Sapienza University, Rome, Italy
| | | | - Eduardo Bruera
- Palliative Care & Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Mario Luppi
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, 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
| | - Carlo Adolfo Porro
- 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
| | - Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
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13
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Indini A, Pinotti G, Artioli F, Aschele C, Bernardi D, Butera A, Defraia E, Fasola G, Gamucci T, Giordano M, Iaria A, Leo S, Ribecco AS, Rossetti R, Savastano C, Schena M, Silva RR, Grossi F, Blasi L. Management of patients with cancer during the COVID-19 pandemic: The Italian perspective on the second wave. Eur J Cancer 2021; 148:112-116. [PMID: 33743478 PMCID: PMC7904514 DOI: 10.1016/j.ejca.2021.01.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 01/08/2023]
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has been an overwhelming challenge for worldwide health systems. Since the beginning of year 2020, COVID-19 has represented a potential harm for cancer patients and has often hindered oncology care. The Collegio Italiano dei Primari Oncologi Medici (CIPOMO) is an Italian association of head physicians in oncology departments, which promotes working and research activities in oncology on a national basis. During the second wave of COVID-19 pandemic, the CIPOMO promoted a national survey aiming to evaluate the impact of COVID-19 on oncologists' clinical activity and what changes have been made compared with the Italian situation during the first wave of the pandemic. Overall, 138 heads of medical oncology departments participated in this survey: 75 (54%) from the North, 24 (17%) from the Centre and 39 (28%) from the South of Italy and islands. This survey provides an overview of Italian oncologists facing the second wave of COVID-19 pandemic. The lesson learned during the first wave of COVID-19 pandemic has led to a better organisation of clinical activities, and regular testing among healthcare practitioners, with better chances to grant patients' protection. However, the lack of standardised informatic platforms results in serious challenges in replacing frontal visits, often making a concrete reduction of patients' hospital accesses unfeasible. Oncologists need to keep preserving the continuum of care of patients. Standardisation of safety measures, together with the implementation of informatic platforms, can significantly improve oncology pathways during this second wave of COVID-19 pandemic.
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Affiliation(s)
- Alice Indini
- Medical Oncology Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Carlo Aschele
- Medical Oncology Department, Ospedale Sant'Andrea, La Spezia, Italy
| | | | - Alfredo Butera
- Medical Oncology Unit, Ospedale San Giovanni di Dio, Agrigento, Italy
| | | | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | | | - Antonino Iaria
- Oncology Unit, Azienda Sanitaria Provinciale, Presidio Ospedaliero Melito Porto Salvo, Reggio Calabria, Italy
| | - Silvana Leo
- Department of Medical Oncology, Vito Fazzi Hospital, Lecce, Italy
| | | | - Riccardo Rossetti
- Medical Oncology and Palliative Care Unit, Pantalla Hospital, Todi, Italy
| | | | - Marina Schena
- Medical Oncology, Azienda AUSL, Regional Hospital of Aosta, Aosta, Italy
| | - Rosa R Silva
- Medical Oncology, ASUR Marche, Area Vasta 2, Fabriano, Italy
| | - Francesco Grossi
- Medical Oncology Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Livio Blasi
- Medical Oncology Unit, ARNAS Civico, Palermo, Italy
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14
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Bongiovanni A, Foca F, Fantini M, Forcignanò MR, Artioli F, Berardi R, Campadelli E, Procopio G, Silvestris F, Riva N, Gurrieri L, Debonis SA, Di Menna G, Fausti V, Recine F, Vespignani R, Ibrahim T. First prospective data on breast cancer patients from the multicentre italian bone metastasis database. Sci Rep 2021; 11:4329. [PMID: 33619285 PMCID: PMC7900106 DOI: 10.1038/s41598-021-83749-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 02/05/2021] [Indexed: 01/28/2023] Open
Abstract
Bone metastases (BM) are still the main cause of morbidity in cancer patients because of skeletal-related events (SREs) that reduce quality of life. They have also led to increased social and healthcare costs. At present, data available on BM are insufficient. This was a multicentre prospective observational study of patients with BM from breast cancer (BC) with at least 6 months' follow-up. Information on patients at the first diagnosis of BM, including demographics and characteristics of the primary tumor and BM. Data were periodically updated by participating centres and reviewed by the coordinator centre. From October 2014 to July 2019, 618 patients with BM from solid tumors were enrolled and 220 were eligible for the present study. Median age was 62 years (range 26-86). Median follow-up was 34 months (range 6-149). At the time of enrolment, 109 (50%) had only BM (BOM) and 109 (50%) had concomitant visceral lesions and BM (BVM). Median time-to-first BM was 47 months (range 0-312) in BOM and 78.6 months in BVM patients. Disease-free interval differed on the basis of BC molecular subtype and stage. Ninety-eight BM patients had at least on SRE. Zoledronate was used in 69.1% of cases and denosumab in 28.3%. First-line treatment was hormone-based (50.7%), chemotherapy-based (38.7%) or chemotherapy- + hormone therapy-based (9.7%). Median progression-free and overall survival were 15.1 months (95% CI 12.6-18.4) and 66.8 months (95% CI 52.1-79.2), respectively. Our prospective study could substantially help to better understand the natural history of BM from BC.
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Affiliation(s)
- Alberto Bongiovanni
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, Italy.
| | | | | | | | | | | | | | - Francesco Silvestris
- Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Nada Riva
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Lorena Gurrieri
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Silvia Angela Debonis
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giandomenico Di Menna
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Valentina Fausti
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Federica Recine
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Roberto Vespignani
- IT Service, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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15
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Reni M, Bergamo F, Giommoni E, Milella M, Cavanna L, Di Marco M, Artioli F, Silvestris N, Spada M, Ghidini M, Maiello E, Cardellino G, Macchini M, Orsi G, Manai C, Valente M, Torri V, Porcu L, Giugliano V, Beretta G. 1562P Observational prospective study of Italian guidelines application for patients with pancreatic ductal adenocarcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Negru M, Tondini C, Pastorino A, Caccese M, Cariello A, Bertolini A, Buzzatti G, Cinieri S, Comandone A, Grossi F, Franchini M, Caffo O, Garrone O, Mambrini A, Leone F, Chini C, Agustoni F, Artioli F, Blasi L, Aschele C. 1705P SARS-CoV-2 infection among cancer patients receiving antitumor treatment in Italy: A nationwide observational study (CIPOMO ONCO COVID-19). Ann Oncol 2020. [PMCID: PMC7506478 DOI: 10.1016/j.annonc.2020.08.1769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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17
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Brandes AA, Ardizzoni A, Artioli F, Cappuzzo F, Cavanna L, Frassineti GL, Frassoldati A, Leonardi F, Longo G, Maestri A, Tassinari D, Franceschi E, Nunno VD, Pinto C. Fighting cancer in coronavirus disease era: organization of work in medical oncology departments in Emilia Romagna region of Italy. Future Oncol 2020; 16:1433-1439. [PMID: 32437242 PMCID: PMC7249540 DOI: 10.2217/fon-2020-0358] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess the measures applied to reduce the spread of coronavirus disease (COVID-19) and the timing of their application in medical oncology departments. Materials & methods: We surveyed all medical oncology departments from the Italian Emilia Romagna region via a multidomain questionnaire. The questions covered items on patients, healthcare workers, risk reduction measure and clinical trials. Results: A total of 12 centers involving 861 healthcare members joined the survey. The measures applied to patients and health workers partially converged in all the departments while major divergences were found in the clinical trials domain. High rate of COVID-19 infection occurred among medical doctors (21/208, 10.1%) and social care workers (13/110, 11.8%). Rate of infection among nurses was 5.7% (24/418). Conclusion: All measures able to reduce risk of COVID-19 infection must be applied in medical oncology departments. Early introduction of risk reduction measures may be a critical issue.
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Affiliation(s)
- Alba A Brandes
- Department of Medical Oncology, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Andrea Ardizzoni
- Department of Oncology, Policlinico S Orsola-Malpighi, University of Bologna, Bologna, Italy
| | | | | | - Luigi Cavanna
- Department of Onco-Haematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Antonio Frassoldati
- Department of Oncology, Azienda Ospedaliero Universitaria di Ferrara-Arcispedale Sant'Anna, Ferrara, Italy
| | - Francesco Leonardi
- Department of Oncology & Hematology, University Hospital of Parma, Parma, Italy
| | - Giuseppe Longo
- Oncology Division, University of Modena & Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Antonio Maestri
- Medical Oncology Department, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Davide Tassinari
- Department of Oncology, Infermi Rimini City Hospital, Rimini, Italy
| | - Enrico Franceschi
- Department of Medical Oncology, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Vincenzo Di Nunno
- Department of Medical Oncology, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Carmine Pinto
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS of Reggio Emilia, Italy
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18
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Bongiovanni A, Foca F, Fantini M, Forcignano R, Artioli F, Berardi R, Campadelli E, Procopio G, Silvestris F, Riva N, Gurrieri L, Di Menna G, Recine F, Fausti V, Debonis SA, Mercatali L, Spadazzi C, Menis J, Vespignani R, Ibrahim T. Multicenter Italian bone metastasis database: First prospective data on breast cancer patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e13072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13072 Background: Bone Metastases (BM) are still the main cause of morbidity and morbility in cancer patients because of their complications defined as skeletal-related events (SREs).SREs reduce pts quality of life and are associated with an increasing in social and health costs. At present, data concerning BM are mainly obtained retrospectively from monocentric experiences. Methods: We performed a multicentre prospective observational study of patients with BM from breast cancer (BC) with at least 6 month (m)'s follow-up who were registered in a prospective BM database (BMDB). Detailed information on patients at first diagnosis of BM was recorded in a custom-built software system, updated every 6 m by participating centres and reviewed by the coordinator centre.All pts have signed an informed consent. Results: Since October 2014,618 pts with BM from solid tumors were enrolled of whom 220 have BC as primitive site with a 6 m follow-up. Median age was 62 y (range 26-86). Median Follow up was 34 m (6-149). At enrolment 109 (50%) had only BM and 109 (50%) pts had concomitant visceral and BM. Median time to first BM was 47 m (range 0-312) in Bone only disease and 78.6 m in pts with visceral bone metastases. Disease Free interval (DFI) was different according to BC molecular subtypes and stage. The univariate hazard ratio (HR) for visceral or bone metastasis was higher in luminal B tumors (1.56, 95% confidence interval [CI]:1.1-2.3) (p = 0.002), basal-like (2.50, 95% CI:1.1-6.0) (p = 0.043), and HER2-enriched tumors (1.37, 95% CI:0.78-2.4) (p = 0.273). DFI for pts with stage I disease at diagnosis of primary BC was longer than that for stage III pts (median 67.2 m, 95%CI:53.1-96.1, vs. 58.1 m, 95%CI:41.9-73.4), with a HR of 1.84 (95% CI:1.1-3.0) (p = 0.015) for the stage III group, and 0.98 (95% C.I.:0.6-1.5) (p = 0.930) for the stage II group. During BM disease, 98 pts had at least 1 SREs . Zoledronate was used in 69.1% and Denosumab in 28.3% of cases. First line treatment was hormone-based (n = 105, 50.7%) chemo-based therapy (n = 80, 38.7%) and chemo+ormono based (n = 20, 9.7%). During follow up progression disease occurred in 167 pts. Median progression-free (mPFS) and overall survival calculated from metastatic disease diagnosis (mOS) were 15.1 m (95%CI 12.6-18.4) and 66.8 m (95%CI 52.1-79.2),respectively. Conclusions: This study presents prospective data about a cohort of BC pts enrolled at the first BM occurrence and followed over the time, extrapolated by the multicentric observational BMDB in order to better understed the clinical history of breast cancer and bone metastases.
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Affiliation(s)
- Alberto Bongiovanni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) Srl., IRCCS-Osteoncology and Rare Tumors Center, Meldola, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | | | | | | | | | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Nada Riva
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Lorena Gurrieri
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giandomenico Di Menna
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Federica Recine
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Valentina Fausti
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Silvia Angela Debonis
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Laura Mercatali
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Chiara Spadazzi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Jessica Menis
- Department of Surgery, Oncology and Gastroenterology, University of Padova;Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Roberto Vespignani
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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19
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Lorusso D, Bologna A, Cecere SC, De Matteis E, Scandurra G, Zamagni C, Arcangeli V, Artioli F, Bella M, Blanco G, Cardalesi C, Casartelli C, De Vivo R, Di Napoli M, Gisone EB, Lauria R, Lissoni AA, Loizzi V, Maccaroni E, Mangili G, Marchetti C, Martella F, Naglieri E, Parolin V, Ricciardi G, Ronzino G, Salutari V, Scarfone G, Secondino S, Spagnoletti I, Tasca G, Tognon G, Guarneri V. Sharing real-world experiences to optimize the management of olaparib toxicities: a practical guidance from an Italian expert panel. Support Care Cancer 2020; 28:2435-2442. [PMID: 32048043 DOI: 10.1007/s00520-020-05320-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/17/2020] [Indexed: 11/28/2022]
Abstract
Olaparib is the first poly(ADP-ribose) polymerase inhibitor approved as maintenance therapy of recurrent ovarian cancer (OC) patients with a BRCA mutation. To achieve the maximum clinical benefit, adherence to olaparib must be persistent. However, in clinical practice, this is challenged by the frequent suboptimal management of toxicities. In view of the expanding use of olaparib also in Italy, physicians must learn how to adequately and promptly manage drug toxicities not to unnecessarily interrupt or reduce the dose. The experts agreed that nausea,vomiting, anemia, and fatigue are the most frequent events experienced by OC patients on olaparib, and that these toxicities usually develop early during treatment, are mainly of grade 1-2 and transient and can be managed with simple non-pharmacological interventions. By sharing their real-world experiences, the panel prepared, for each toxicity, an algorithm organized by grade and besides the procedures indicated in the local label, included supportive care interventions based also on nutritional and lifestyle modifications and psycho-oncology consultation. Moreover, in view of the tablet entry into the Italian market, the full and reduced dosages of capsules and tablets were compared. This practical guidance is intended to be a tool to support especially less-experienced physicians in the management of these complex patients, with the aim to help preventing the worsening of patients' conditions and the unnecessary interruption/reduction of olaparib dosage, which may jeopardize treatment efficacy.
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Affiliation(s)
- Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Alessandra Bologna
- Oncologia Medica, IRCCS Arcispedale S. Maria Nuova, Viale Risorgimento, 80, 42123, Reggio Emilia, Italy
| | - Sabrina Chiara Cecere
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | | | - Giusy Scandurra
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina, 829, 95126, Catania, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, S.Orsola-Malpighi Hospital, Viale Ercolani 4/2, Bologna, Italy
| | - Valentina Arcangeli
- U.O. Oncologia, Ospedale Infermi Rimini, AUSL Romagna, viale Settembrini 2, 47923, Rimini, Italy
| | - Fabrizio Artioli
- Oncology Dept., Carpi and Mirandola Hospitals, Via G. Molinari 2, 41012, Carpi, Italy
| | - Mariangela Bella
- Medical Oncology Unit, University Hospital of Parma, Viale Antonio Gramsci, 14, 43126, Parma, Italy
| | - Giusi Blanco
- Oncology Unit, Ist. Oncologico del Mediterraneo, Via Penninazzo, 7, Viagrande, 95029, Catania, Italy
| | - Cinzia Cardalesi
- Dept. of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Clelia Casartelli
- Medical Oncology Unit, Ospedale Valduce, Via Dante Alighieri, 11, 22100, Como, Italy
| | - Rocco De Vivo
- Medical Oncology Unit, AULSS 8 Vicenza, viale Rodolfi, 37, 36100, Vicenza, Italy
| | - Marilena Di Napoli
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Emanuele Baldo Gisone
- Dept of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Via del Ponte, 19, 21100, Varese, Italy
| | - Rossella Lauria
- Dept. of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Alberto Andrea Lissoni
- Dept of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.,Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Vera Loizzi
- Dept of Biomedical Sciences and Medical Oncology, University of Bari "Aldo Moro", Piazza Umberto I 1, 70124, Bari, Italy
| | - Elena Maccaroni
- Clinica Oncologica, AOU Ospedali Riuniti Ancona, via Conca 71, , 60020, Ancona, AN, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology, San Raffaele Hospital, Via Olgettina Milano, 60, 20132, Milan, Italy
| | - Claudia Marchetti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesca Martella
- Breast Unit, Ospedale S.M. Annunziata, USL Toscana Centro, Via dell'Antella, 58, Bagno a Ripoli, 50012, Florence, Italy
| | - Emanuele Naglieri
- Division of Medical Oncology, IRCCS Istituto Oncologico Giovanni Paolo II, Viale Orazio Flacco, 65, 70124, Bari, Italy
| | - Veronica Parolin
- Breast Uni, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Giusy Ricciardi
- Medical Oncology, AO Papardo, Contrada Papardo, 98158, Messina, Italy
| | - Graziana Ronzino
- Dept. of Oncology, Vito Fazzi Hospital, Piazzetta Muratore, 73100, Lecce, Italy
| | - Vanda Salutari
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Giovanna Scarfone
- Dept of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, via F. Sforza 28, Milan, Italy
| | - Simona Secondino
- Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Ilaria Spagnoletti
- Medical Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Viale Principe di Napoli, 14/A, 82100, Benevento, Italy
| | - Giulia Tasca
- Division of Medical Oncology 2, Istituto Oncologico Veneto, Via Gattamelata, 64, 35128, Padua, Italy
| | - Germana Tognon
- UO Ostetricia e Ginecologia-ASST degli Spedali Civili di Brescia, Università degli Studi, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Valentina Guarneri
- Division of Medical Oncology 2, Istituto Oncologico Veneto, Via Gattamelata, 64, 35128, Padua, Italy
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20
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Barni S, Rosati G, Lonardi S, Pella N, Banzi M, Zampino MG, Dotti KF, Rimassa L, Marchetti P, Maiello E, Artioli F, Ferrari D, Labianca R, Bidoli P, Zaniboni A, Sobrero A, Iaffaioli V, De Placido S, Frassineti GL, Ciarlo A, Buonadonna A, Silvestris N, Piazza E, Pavesi L, Moroni M, Clerico M, Aglietta M, Giordani P, Galli F, Galli F, Petrelli F. Khorana score and thromboembolic risk in stage II-III colorectal cancer patients: a post hoc analysis from the adjuvant TOSCA trial. Ther Adv Med Oncol 2020; 12:1758835919899850. [PMID: 32010236 PMCID: PMC6974756 DOI: 10.1177/1758835919899850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 12/09/2019] [Indexed: 11/16/2022] Open
Abstract
Background: The risk of venous thromboembolic events (VTE) during adjuvant chemotherapy
for colorectal cancer (CRC) is unknown. We aim to evaluate if the Khorana
score (KS) can predict this risk, and if it represents a prognostic factor
for overall survival (OS) through a post hoc analysis of
the phase III TOSCA trial of different durations (3- versus
6-months) of adjuvant chemotherapy. Methods: A logistic regression model was used to test the associations between the
risk of VTE and the KS. The results are expressed as odds ratios (OR) with
95% confidence intervals (95% CI). To assess the effect of the KS on OS,
multivariable analyses using Cox regression models were performed. The
results are expressed as hazard ratios (HR) with 95% CI. Results: Among 1380 CRC patients with available data, the VTE risk
(n = 72 events: 5.2%) was similar in the two duration arms
(5.5% versus 4.9%), with 0.2% of patients belonging to the
high-risk KS group. Rates of VTE were similar in the low- and
intermediate-risk groups (4.8% versus 6.4%). KS did not
represent an independent predictive factor for VTE occurrence. Chemotherapy
duration was not associated with VTE risk. In addition, KS was not
prognostic for OS in multivariate analysis (HR: 0.92, 95% CI, 0.63–1.36;
p = 0.6835). Conclusions: The use of the KS did not predict VTEs in a low–moderate thromboembolic risk
population as CRC. These data did not support the use of KS to predict VTE
during adjuvant chemotherapy, and suggest that other risk assessment models
should be researched.
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Affiliation(s)
- Sandro Barni
- Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Treviglio (BG), Italy
| | - Gerardo Rosati
- Medical Oncology Unit, Ospedale San Carlo, Potenza, Italy
| | - Sara Lonardi
- Medical Oncology Unit 1, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Nicoletta Pella
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Maria Banzi
- Medical Oncology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Maria G Zampino
- Gastrointestinal Medical Oncology Unit and Neuroendocrine Tumors, Istituto Europeo di Oncologia-IRCCS, Milano, Italy
| | - Katia F Dotti
- Medical Oncology Unit, Fondazione Istituto Nazionale Tumori-IRCCS, Milano, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Paolo Marchetti
- Medical Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome and IDI-IRCCS, Roma, Italy
| | - Evaristo Maiello
- Medical Oncology Unit, Hospital Casa Sollievo della Sofferenza-IRCCS, San Giovanni Rotondo, Italy
| | | | - Daris Ferrari
- Medical Oncology Unit, Azienda Ospedaliera San Paolo, Milano, Italy
| | | | - Paolo Bidoli
- Medical Oncology Unit San Gerardo dei Tintori Hospital, Monza, Italy
| | | | | | - Vincenzo Iaffaioli
- Abdominal Medical Oncology, National Cancer Institute, IRCCS Foundation Pascale, Napoli, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - Gian Luca Frassineti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST, IRCCS, Meldola, Italy
| | | | - Angela Buonadonna
- Medical Oncology Unit Centro di Riferimento Oncologico Aviano-IRCCS, Aviano, Italy
| | - Nicola Silvestris
- Medical Oncology Unit Ospedale Oncologico 'Giovanni Paolo II' and Scientific Directorate-IRCCS, Bari, Italy
| | - Elena Piazza
- Medical Oncology Unit AOU Sacco Hospital, Milano, Italy
| | - Lorenzo Pavesi
- Medical Oncology Unit Fondazione Maugeri-IRCCS, Pavia, Italy
| | - Mauro Moroni
- Medical Oncology Unit AO San Carlo Borromeo, Milano, Italy
| | - Mario Clerico
- Medical Oncology Department ASL Biella, Biella, Italy
| | - Massimo Aglietta
- Candiolo Cancer Institute FPO-IRCCS, Candiolo, Italy, Department of Oncology, University of Torino, Torino, Italy
| | - Paolo Giordani
- Medical Oncology Unit AO Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Francesca Galli
- Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio Galli
- Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fausto Petrelli
- Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Piazzale Ospedale 1, Treviglio (BG), 24047, Italy
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21
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Rosati G, Galli F, Cantore M, Bergamo F, Banzi M, Zampino MG, Mattioli R, Cardellino GG, Ronzoni M, Di Bartolomeo M, Tamberi S, Marchetti P, Rimassa L, Corsi D, Bochicchio AM, Artioli F, Labianca R, Galli F, Rulli E, Bilancia D, Bregni G. Predictive Impact of Mucinous Tumors on the Clinical Outcome in Patients with Poorly Differentiated, Stage II Colon Cancer: A TOSCA Subgroup Analysis. Oncologist 2020; 25:e928-e935. [PMID: 31943506 DOI: 10.1634/theoncologist.2019-0736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/19/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although American Society of Clinical Oncology and European Society for Medical Oncology guidelines have identified the negative prognostic factors that clinicians have to consider when treating their patients with stage II colon cancer (CC), the role of histological subtype is controversial. SUBJECTS, MATERIALS, AND METHODS The randomized, multicenter, phase III TOSCA trial compared 3 versus 6 months of fluoropyrimidine-oxaliplatin adjuvant chemotherapy in 3,759 patients with high-risk stage II or stage III CC. The objective of this substudy was to evaluate the influence of histological subtypes on the impact of the treatment duration of adjuvant chemotherapy in terms of relapse-free survival (RFS) and overall survival (OS) in 85 mucinous adenocarcinoma (MUC) and 389 nonmucinous adenocarcinoma (NMUC) patients with high-risk stage II, grade 3 CC. RESULTS A significant interaction between treatment duration and histology was observed in both RFS (p = .027) and OS (p = .017). In the subgroup of patients with MUC, worse RFS (adjusted hazard ratio [HR], 3.95; 95% confidence interval [CI], 1.03-15.17; p = .045) and OS (HR, 9.56; 95% CI, 1.14-79.98; p = .037) were detected for patients treated in the 3-month arm. No statistically significant differences were found in the subgroup of patients with NMUC. CONCLUSION Patients with MUC, grade 3, stage II CC require special attention and may need 6 months of oxaliplatin-based chemotherapy. Larger studies are required to assess the combined use of histology and other prognostic/predictive factors to define the administration of chemotherapy in patients with stage II CC and to improve their prognosis. IMPLICATIONS FOR PRACTICE Although ASCO and ESMO guidelines define the prognostic factors for patients with stage II colon cancer to establish the use of adjuvant chemotherapy, the influence of histological subtypes is controversial in this population. This study underscores that patients with grade 3 mucinous adenocarcinomas may need adjuvant chemotherapy with oxaliplatin and fluoropyrimidines for a duration of 6 months rather than 3 months.
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Affiliation(s)
- Gerardo Rosati
- U.O. Oncologia Medica, Ospedale S. Carlo, Potenza, Italy
| | - Fabio Galli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio Cantore
- U.O. Oncologia Medica, Azienda USL 1 di Massa e Carrara, Carrara, Italy
| | - Francesca Bergamo
- U.O. Oncologia Medica 1, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Maria Banzi
- U.O. Oncologia Medica, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Maria Giulia Zampino
- Gastrointestinal Medical Oncology Unit and Neuroendocrine Tumors, IRCCS Istituto Europeo di Oncologia, Milan, Italy
| | - Rodolfo Mattioli
- U.O. Oncologia Medica, Azienda Ospedaliera Marche Nord, Pesaro/Fano, Italy
| | | | - Monica Ronzoni
- U.O. Oncologia Medica, Ospedale San Raffaele, Milan, Italy
| | | | - Stefano Tamberi
- U.O. Oncologia Medica, Ospedale degli Infermi, Faenza, Italy
| | - Paolo Marchetti
- U.O. Oncologia Medica, Ospedale Sant'Andrea, Università Sapienza, Roma e IRCCS Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Domenico Corsi
- U.O. Oncologia Medica, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Anna Maria Bochicchio
- U.O. Oncologia Medica, Ospedale Oncologico Regionale CROB, Rionero in Vulture, Italy
| | | | | | - Francesca Galli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Eliana Rulli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Giacomo Bregni
- U.O. Oncologia Medica, IRCCS San Martino-IST, Genova, Italy
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Poletti S, Razzini G, Ferrari R, Ricchieri MP, Spedicato GA, Pasqualini A, Buzzega C, Artioli F, Petropulacos K, Luppi M, Bandieri E. Mindfulness-Based stress reduction in early palliative care for people with metastatic cancer: A mixed-method study. Complement Ther Med 2019; 47:102218. [PMID: 31780005 DOI: 10.1016/j.ctim.2019.102218] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To explore the impact of a Mindfulness-Based Stress Reduction (MBSR) intervention for people with metastatic cancer integrated in Early Palliative Care (EPC). DESIGN Mixed-method study. SETTINGS/LOCATION EPC Service integrated with Oncology Unit, Carpi General Hospital, Italy from January to October 2017. The MBSR intervention took place inside the hospital. SUBJECTS Study participation was offered to 25 consecutive people referred to the EPC service. INCLUSION CRITERIA people with metastatic cancer between 18 and 75 years old; informed consent. EXCLUSION CRITERIA Performance Status <60% according to Karnofsky scale; active psychiatric disorder. 20 patients were included in the study. INTERVENTION The adapted program consists of 8 meetings for 2.5 h once a week, a 4.5 h session between the 6th and 7th weeks and 0.5 h home practice daily. The following mindfulness practices were included during the training: formal sitting meditation, body scan, light yoga, walking meditation, and Aikido exercises. Participants were provided with materials for home practice. A qualified MBSR instructor conducted the program. Sessions were attended by a clinical psychologist and a physician trained in meditation, together with the palliative nurse as facilitators. OUTCOME MEASURES Feasibility and acceptability were assessed on 16 participants. In addition, pre-post measures of cancer pain and mood state were collected. Semi-structured, in-depth interviews were conducted on a subset of 8 participants at the end of the study and analysed using the Interpretative-Phenomenological approach. RESULTS MBSR attendance to meetings and adherence to home practice were 75%. MBSR intervention helped participants to develop an accepting attitude in respect to metastatic cancer disease helping them to face anxiety and cancer pain. MBSR improves self-regulation of mood state engendering feelings of compassion MBSR program supports participants in questioning and reconnecting with their values and spiritual beliefs. CONCLUSIONS A Mindfulness intervention integrated into EPC setting is feasible, well accepted and could help metastatic cancer patients to control cancer pain together with an opportunity of emotional and spiritual relief.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mario Luppi
- Department of Medical and Surgical Sciences, AOU, UNIMORE, Italy.
| | - Elena Bandieri
- Unit of Early Palliative Care, Carpi Civil Hospital, Italy.
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Rosati G, Galli F, Cantore M, Lonardi S, Banzi M, Zampino M, Mattioli R, Pella N, Ronzoni M, Bartolomeo MD, Tamberi S, Marchetti P, Bozzarelli S, Corsi D, Bochicchio A, Artioli F, Labianca R, Galli F, Bilancia D, Bregni G. Clinical impact of mucinous and poorly differentiated tumours on the outcome of patients with stage II colon cancer: A TOSCA subgroup analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gianotti E, Razzini G, righi A, bini M, crivellaro C, Artioli F. Mindfulness-based stress reduction in early palliative care for advanced cancer patients: An Italian single-centre study. MINDEEP. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz273.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Manfredini B, Morandi U, De Santis G, Catani F, Stefani A, Pinelli M, Baccarani A, Starnoni M, Artioli F, Aramini B. Can surgery relieve pain and act as first-line treatment for a large metastasis of the sternum? Int J Surg Case Rep 2019; 63:125-128. [PMID: 31585323 PMCID: PMC6796717 DOI: 10.1016/j.ijscr.2019.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/19/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There are few papers published on sternal metastasis from renal cell carcinoma. The unifying element is the operability of the sternal metastasis if it is the only site of metastasis, on the operability of the primary site of the tumor and on the patient's health conditions. PRESENTATION OF THE CASE We present a case of a 66-years-old man undergone sternal resection for a large painful metastasis. He was previously undergone left nephrectomy for clear cells carcinoma. En bloc resection of the sternal manubrium and right clavicle was performed, a Gore-Tex mesh was placed. Histology confirmed metastasis of kidney clear cells carcinoma. Patient was discharged with no complications and no pain. Chest CT at six months follow up was negative for recurrence. DISCUSSION AND CONCLUSION We highlighted the importance of surgery as possible first-line treatment in symptomatic large sternum metastasis. Therefore, prospective studies should be considered to confirm our strategy.
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Affiliation(s)
- Beatrice Manfredini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Uliano Morandi
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Giorgio De Santis
- Division of Plastic Surgery, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Fabio Catani
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Modena, Italy.
| | - Alessandro Stefani
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Massimo Pinelli
- Division of Plastic Surgery, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Alessio Baccarani
- Division of Plastic Surgery, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Marta Starnoni
- Division of Plastic Surgery, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Fabrizio Artioli
- Division of Medical Oncology, Ramazzini Hospital, Carpi, Modena, Italy.
| | - Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
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Reni M, Bergamo F, Cavanna L, Spada M, Ghidini M, Giommoni E, Maiello E, Artioli F, Cardellino G, Torri V, Cinquini M, Giugliano V, Pinto C. Real-world guideline application in the management of pancreatic cancer patients: the Italian GARIBALDI study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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27
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Morabito A, Piccirillo MC, Maione P, Luciani A, Cavanna L, Bonanno L, Filipazzi V, Leo S, Cinieri S, Morgillo F, Burgio MA, Ferrara D, Rosetti F, Bianco R, Artioli F, Cortinovis D, Gebbia V, Fregoni V, Mencoboni M, Sandomenico C, Rossi A, Montanino A, Manzo A, Rocco G, Arenare L, Daniele G, Signoriello S, Gallo C, Perrone F, Gridelli C. Effect on quality of life of cisplatin added to single-agent chemotherapy as first-line treatment for elderly patients with advanced non-small cell lung cancer: Joint analysis of MILES-3 and MILES-4 randomised phase 3 trials. Lung Cancer 2019; 133:62-68. [PMID: 31200830 DOI: 10.1016/j.lungcan.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate the effect on quality of life (QOL) of the addition of cisplatin to single-agent chemotherapy in the treatment of elderly patients with advanced non-small cell lung cancer (NSCLC) enrolled in two parallel phase 3 trials, MILES-3 and MILES-4. PATIENTS AND METHODS Advanced NSCLC pts, >70 years old, performance status (PS) 0-1, were eligible. Patients were randomly assigned to chemotherapy without or with cisplatin. EORTC QLQ C30 and LC13 questionnaires were planned at baseline, end of cycle 1 and end of cycle 2 in both trials and were used for joint QOL analysis. Trial-specific data including questionnaires at non-shared time-points were used for additional analyses. Intention-to-treat strategy was applied. Analyses were adjusted for baseline QOL, stage, performance status, gender, age, size of centre, trial, histotype and non-platinum companion drug. RESULTS Overall, 458/531 pts (86%) answered baseline questionnaire and missing rates over treatment were slightly higher among patients receiving cisplatin. Mean change in sore mouth after cycle 2 was worse with cisplatin (P = 0.02). The size of differences between arms was in the small-medium range for peripheral neuropathy and alopecia (0.25 and 0.31 after one and 0.28 and 0.36 after two cycles, respectively) and for nausea/vomiting, sore mouth and dysphagia after two cycles (0.26, 0.38 and 0.25, respectively) always in the direction of worsening with cisplatin. Using a 10% change from baseline as clinically relevant threshold to categorize response, there was no significant difference between the arms. Time to deterioration of sore mouth and alopecia, with progression/death as competitive risk, was shorter with cisplatin (HR 1.72 95%CI 1.02-2.89, P = 0.04 and HR 1.84 95%CI 1.09-3.10, P = 0.02, respectively). CONCLUSION The addition of cisplatin to single agent chemotherapy worsens sore mouth and alopecia and does not improve any QOL items in elderly patients with advanced NSCLC.
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Affiliation(s)
- Alessandro Morabito
- Thoracic Department, Istituto Nazionale Tumori, IRCCS - Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy.
| | - Maria Carmela Piccirillo
- Clinical Trials Unit, Istituto Nazionale Tumori, IRCCS - Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy.
| | - Paolo Maione
- Medical Oncology, A.O. San Giuseppe Moscati, Contrada Amoretta,Città Ospedaliera, 83100, Avellino, Italy.
| | - Andrea Luciani
- Medical Oncology, Ospedale S. Paolo, Via A. di Rundinì, 20142, Milano, Italy; Gruppo Italiano di Oncologia Geriatrica (GIOGER), Italy.
| | - Luigi Cavanna
- Department of Oncology/Hematology, Ospedale Guglielmo da Saliceto, Via Taverna Giuseppe, 29121, Piacenza, Italy.
| | - Laura Bonanno
- Medical Oncology II, Istituto Oncologico Veneto, IRCCS, Via Gattamelata, 35128, Padova, Italy.
| | - Virginio Filipazzi
- Medical Oncology, Ospedale L. Sacco, Polo Universitario, Via G.B. Grassi, 20157, Milano, Italy.
| | - Silvana Leo
- Gruppo Italiano di Oncologia Geriatrica (GIOGER), Italy; Medical Oncology, AO Vito Fazzi, Piazza F. Muratore, 73100, Lecce, Italy.
| | - Saverio Cinieri
- Medical Oncology, Ospedale Senatore Antonio Perrino, S.S.7 per Mesagne, 72100, Brindisi, Italy.
| | - Floriana Morgillo
- Medical Oncology and Hematology, Dipartimento di Medicina di Precisione, Università degli Studi della Campania Luigi Vanvitelli, Via Pansini 5, 80131, Napoli, Italy.
| | - Marco Angelo Burgio
- Medical Oncology, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Via Piero Maroncelli, 47014, Meldola, FC, Italy.
| | - Domenica Ferrara
- Medical Oncology, AO San Carlo, Via Potito Petrone, 85100, Potenza, Italy.
| | - Francesco Rosetti
- Medical Oncology and Hematology, Mirano ULSS 3, Serenissima Regione Veneto, Via Sartor 4, 30174, Mirano, VE, Italy.
| | - Roberto Bianco
- Medical Oncology, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131, Napoli, Italy.
| | - Fabrizio Artioli
- Medical Oncology, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Via G. Molinari, 41012, Carpi, MO, Italy.
| | - Daniele Cortinovis
- Medical Oncology, Ospedale San Gerardo, Via G.B. Pergolesi, 20900, Monza, Italy.
| | - Vittorio Gebbia
- Medical Oncology, Casa di Cura La Maddalena Università di Palermo, Via S. Lorenzo, 90146, Palermo, Italy.
| | - Vittorio Fregoni
- Medical Oncology, Istituti Clinici Scientifici Maugeri, Via S. Maugeri, 27100, Pavia, Italy.
| | - Manlio Mencoboni
- Medical Oncology, Ospedale Villa Scassi, ASL 3 Genovese, Corso O. Scassi, 16121, Genova Sampierdarena, Italy.
| | - Claudia Sandomenico
- Thoracic Department, Istituto Nazionale Tumori, IRCCS - Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy.
| | - Antonio Rossi
- Medical Oncology, A.O. San Giuseppe Moscati, Contrada Amoretta,Città Ospedaliera, 83100, Avellino, Italy.
| | - Agnese Montanino
- Thoracic Department, Istituto Nazionale Tumori, IRCCS - Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy.
| | - Anna Manzo
- Thoracic Department, Istituto Nazionale Tumori, IRCCS - Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy.
| | - Gaetano Rocco
- Thoracic Department, Istituto Nazionale Tumori, IRCCS - Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy.
| | - Laura Arenare
- Clinical Trials Unit, Istituto Nazionale Tumori, IRCCS - Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy.
| | - Gennaro Daniele
- Clinical Trials Unit, Istituto Nazionale Tumori, IRCCS - Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy.
| | - Simona Signoriello
- Medical Statistics, Università degli Studi della Campania Luigi Vanvitelli, Via L. Armanni, 80128, Napoli, Italy.
| | - Ciro Gallo
- Medical Statistics, Università degli Studi della Campania Luigi Vanvitelli, Via L. Armanni, 80128, Napoli, Italy.
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori, IRCCS - Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy.
| | - Cesare Gridelli
- Medical Oncology, A.O. San Giuseppe Moscati, Contrada Amoretta,Città Ospedaliera, 83100, Avellino, Italy.
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Bandieri E, Banchelli F, Artioli F, Mucciarini C, Razzini G, Cruciani M, Potenza L, D'Amico R, Efficace F, Bruera E, Luppi M. Early versus delayed palliative/supportive care in advanced cancer: an observational study. BMJ Support Palliat Care 2019; 10:e32. [PMID: 31201152 DOI: 10.1136/bmjspcare-2019-001794] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/09/2019] [Accepted: 05/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The positive impact of early palliative care interventions in advanced cancer patients has so far been largely evaluated in randomised controlled trials. This study aimed at providing information on the value of early palliative/supportive care, integrated with standard oncologic care, in a real-life setting. METHODS This was a retrospective observational study of 292 advanced cancer patients consecutively admitted at Carpi Hospital in Modena, Italy, between 2014 and 2017. For the purpose of this analysis, patients were classified into two groups (early and delayed palliative/supportive care patients), and analysed for different clinical indicators. Early and delayed palliative/supportive care were classified according to the time elapsed from advanced cancer diagnosis until palliative/supportive care start. RESULTS A total of 200 patients (68%), with at least three visits, were included in the analyses. The frequency of chemotherapy use in the last 60 days of life was 3.4% and 24.6% in the early and delayed groups, respectively (adjusted OR=0.1; 95% CI 0.0 to 0.4; p=0.002). The estimated survival probability at 1 year was 74.5% (95% CI 65.0% to 85.4%) and 45.5% (95% CI 37.6% to 55.0%), in the early and delayed groups, respectively. Performance status, pain and all the Edmonton Symptom Assessment Scale items, assessed at baseline and at 1 to 12 weeks after the intervention, showed significant improvement over time. However, no between-group differences were found with regard to symptom outcomes. CONCLUSIONS An earlier palliative/supportive care intervention was associated with reduced aggressiveness of therapy, in patients receiving community oncology care. Symptom burden was improved by early palliative/supportive care, independently of the timing of patient referral.
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Affiliation(s)
- Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Federico Banchelli
- Statistic Unit, Department of Medical and Surgical Sciences, UNIMORE, Modena, Italy
| | - Fabrizio Artioli
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Claudia Mucciarini
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Giorgia Razzini
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | | | - Leonardo Potenza
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D'Amico
- Statistic Unit, Department of Medical and Surgical Sciences, UNIMORE, Modena, Italy
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Eduardo Bruera
- Palliative Care & Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Mario Luppi
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Gianotti E, Razzini G, Bini M, Crivellaro C, Righi A, Darecchio S, Lui S, Basiricò ML, Cocconi S, Cagossi K, Ferrari A, Artioli F. Scalp Cooling in Daily Clinical Practice for Breast Cancer Patients Undergoing Curative Chemotherapy: A Multicenter Interventional Study. Asia Pac J Oncol Nurs 2019; 6:277-282. [PMID: 31259224 PMCID: PMC6518988 DOI: 10.4103/apjon.apjon_4_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: Chemotherapy-induced alopecia is a common and distressful side effect, especially among breast cancer patients. Scalp cooling (SC) can reduce hair loss during anthracycline- and taxane-based chemotherapy. This study assessed the effectiveness of SC in daily clinical practice in three Italian oncology units. Methods: From 2014 to 2016, we prospectively included 220 female early-stage breast cancer patients undergoing curative chemotherapy in combination with SC using the Paxman device. Effectiveness was defined as the severity of hair loss according to the Common Terminology Criteria for Adverse Events Version 4.0 as follows: Grade 0, no hair loss; Grade 1, <50% hair loss not requiring a wig; and Grade 2, ≥50% hair loss at each cycle and at completion of chemotherapy. The tolerability and safety were also evaluated. Results: The overall success rate of SC (hair loss Grade 0–1) was 68%. Severe hair loss was avoided in 89% of women receiving taxane-based chemotherapy and in 78% of women receiving both anthracyclines and taxanes. Among women undergoing anthracycline-based chemotherapy, 47% experienced hair preservation. SC was well tolerated, as only 20 patients discontinued SC for reasons other than hair loss. Conclusions: Our study confirmed that SC provides a reliable chance for breast cancer patients to keep their hair during taxane- and/or anthracycline-based chemotherapy.
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Affiliation(s)
- Emilia Gianotti
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Giorgia Razzini
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Manuela Bini
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Caterina Crivellaro
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Angela Righi
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Simona Darecchio
- Oncology Unit, Guastalla Civil Hospital, Guastalla, Medicine Department Local Healt Unit, Reggio Emilia, Italy
| | - Stefania Lui
- Oncology Unit, Guastalla Civil Hospital, Guastalla, Medicine Department Local Healt Unit, Reggio Emilia, Italy
| | | | - Silvia Cocconi
- Oncology Unit, Parma Hospital, University of Parma, Parma, Italy
| | - Katia Cagossi
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Alessia Ferrari
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
| | - Fabrizio Artioli
- Unit of Medical Oncology, Carpi Civil Hospital, Carpi, Medicine Department, Local Health Unit, Modena, Italy
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Barni S, Rosati G, Zagonel V, Pella N, Banzi M, Zampino M, Di Bartolomeo M, Rimassa L, Marchetti P, Maiello E, Artioli F, Ferrari D, Labianca R, Bidoli P, Zaniboni A, Sobrero A, Iaffaioli V, de Placido S, Frassineti L, Galli F, Petrelli F. Thromboembolic risk and survival with Khorana score in resected colorectal cancer patients: Subgroup analysis from the adjuvant TOSCA trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Gridelli C, Morabito A, Cavanna L, Luciani A, Maione P, Bonanno L, Filipazzi V, Leo S, Cinieri S, Ciardiello F, Burgio MA, Bilancia D, Cortinovis D, Rosetti F, Bianco R, Gebbia V, Artioli F, Bordonaro R, Fregoni V, Mencoboni M, Nelli F, Riccardi F, di Isernia G, Costanzo R, Rocco G, Daniele G, Signoriello S, Piccirillo MC, Gallo C, Perrone F. Cisplatin-Based First-Line Treatment of Elderly Patients With Advanced Non-Small-Cell Lung Cancer: Joint Analysis of MILES-3 and MILES-4 Phase III Trials. J Clin Oncol 2018; 36:2585-2592. [PMID: 30028656 DOI: 10.1200/jco.2017.76.8390] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To test the efficacy of adding cisplatin to first-line treatment for elderly patients with advanced non-small-cell lung cancer (NSCLC) within a combined analysis of two parallel phase III trials, MILES-3 and MILES-4. Patients and Methods Patients with advanced NSCLC who were older than age 70 years with Eastern Cooperative Oncology Group performance status 0 to 1 were randomly assigned to gemcitabine or pemetrexed, without or with cisplatin. In each trial, 382 events were required to detect a hazard ratio (HR) of death of 0.75, with 80% power and two-tailed α of .05. Trials were closed prematurely because of slow accrual, but the joint database allowed us to analyze the efficacy of cisplatin on the basis of intention-to-treat and adjusted by trial, histotype, non-platinum companion drug, stage, performance status, sex, age, and size of the study center. Results From March 2011 to August 2016, 531 patients (MILES-3, 299; MILES-4, 232) were assigned to gemcitabine or pemetrexed without (n = 268) or with cisplatin (n = 263). Median age was 75 years, 79% were male, and 70% had nonsquamous histology. At a median 2-year follow-up, 384 deaths and 448 progression-free survival events were recorded. Overall survival was not significantly prolonged with cisplatin (HR, 0.86; 95% CI, 0.70 to 1.05; P = .14) and global health status score of quality of life was not improved, whereas progression-free survival (HR, 0.76; 95% CI, 0.63 to 0.92; P = .005) and objective response rate (15.5% v 8.5%; P = .02) were significantly better. Significantly more severe hematologic toxicity, fatigue, and anorexia were found with cisplatin. Conclusion The addition of cisplatin to single-agent chemotherapy does not significantly prolong overall survival, and it does not improve global health status score of quality of life in elderly patients with advanced NSCLC.
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Affiliation(s)
- Cesare Gridelli
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Alessandro Morabito
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Luigi Cavanna
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Andrea Luciani
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Paolo Maione
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Laura Bonanno
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Virginio Filipazzi
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Silvana Leo
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Saverio Cinieri
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Fortunato Ciardiello
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Marco Angelo Burgio
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Domenico Bilancia
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Diego Cortinovis
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Francesco Rosetti
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Roberto Bianco
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Vittorio Gebbia
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Fabrizio Artioli
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Roberto Bordonaro
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Vittorio Fregoni
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Manlio Mencoboni
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Fabrizio Nelli
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Ferdinando Riccardi
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Giuditta di Isernia
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Raffaele Costanzo
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Gaetano Rocco
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Gennaro Daniele
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Simona Signoriello
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Maria Carmela Piccirillo
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Ciro Gallo
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Francesco Perrone
- Cesare Gridelli and Paolo Maione, Azienda Ospedaliera (AO) San Giuseppe Moscati, Avellino; Alessandro Morabito, Raffaele Costanzo, Gaetano Rocco, Gennaro Daniele, Maria Carmela Piccirillo, and Francesco Perrone, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) -Fondazione G. Pascale; Fortunato Ciardiello, Simona Signoriello and Ciro Gallo, Università degli Studi della Campania Luigi Vanvitelli; Roberto Bianco, Università degli Studi di Napoli Federico II; Ferdinando Riccardi, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, Naples; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Andrea Luciani, Ospedale S. Paolo; Virginio Filipazzi, Ospedale L. Sacco, Polo Universitario, Milan; Andrea Luciani and Silvana Leo, Gruppo Italiano di Oncologia Geriatrica; Manlio Mencoboni, Ospedale Villa Scassi, Azienda Sanitaria Locale 3 Genovese, Genoa; Laura Bonanno, Istituto Oncologico Veneto, IRCCS, Padova; Silvana Leo, AO Vito Fazzi, Lecce; Saverio Cinieri, Ospedale Senatore Antonio Perrino, Brindisi; Marco Angelo Burgio, Istituto Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola; Domenico Bilancia, AO San Carlo, Potenza; Diego Cortinovis, Ospedale San Gerardo, Monza; Francesco Rosetti, Mirano Unità Locale Socio Sanitaria 3, Serenissima Regione Veneto, Mirano; Vittorio Gebbia, Casa di Cura La Maddalena Università di Palermo, Palermo; Fabrizio Artioli, Ospedale Ramazzini di Carpi e Ospedale di Mirandola, Carpi; Roberto Bordonaro, AO Garibaldi Nesima, Catania; Vittorio Fregoni, Istituti Clinici Scientifici Maugeri, Pavia; Fabrizio Nelli, Ospedale Belcolle, Viterbo; and Giuditta di Isernia, Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy
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DeCensi A, Numico G, Ballatori E, Artioli F, Clerico M, Fioretto L, Livellara V, Ruggeri B, Tomirotti M, Verusio C, Roila F. Conflict of interest among Italian medical oncologists: a national survey. BMJ Open 2018; 8:e020912. [PMID: 29961019 PMCID: PMC6042593 DOI: 10.1136/bmjopen-2017-020912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/03/2018] [Accepted: 05/04/2018] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To assess Italian medical oncologists' opinion on the implications of conflict of interest (COI) on medical education, care and research, and to evaluate their direct financial relationships. DESIGN National cross-sectional survey conducted between March and April 2017 among Italian oncologists. SETTING Online survey sponsored by the Italian College of Medical Oncology Chiefs through its website. PARTICIPANTS Italian oncologists who filled out an anonymous questionnaire including 19 items and individual and working characteristics. MAIN OUTCOME MEASURE The proportion of medical oncologists perceiving COI as an outstanding issue and those receiving direct payments from industry. RESULTS There were 321 respondents, representing 13% of Italian tenured medical oncologists. Overall, 62% declared direct payments from the pharmaceutical industry in the last 3 years. Sixty-eight per cent felt the majority of Italian oncologists have a COI with industry, but 59% suppose this is not greater than that of other specialties. Eighty-two per cent consider that most oncology education is supported by industry. More than 75% believe that current allocation of industry budget on marketing and promotion rather than research and development is unfair, but 75% consider it appropriate to receive travel and lodging hospitality from industry. A median net profit margin of €5000 per patient enrolled in an industry trial was considered appropriate for the employee institution. Sixty per cent agree to receive a personal fee for patients enrolled in industry trials, but 79% state this should be reported in the informed consent. Over 90% believe that scientific societies should publish a financial report of industry support. Finally, 79% disagree to being a coauthor of an article written by a medical writer when no substantial scientific contribution is made. CONCLUSIONS Among Italian oncologists COI is perceived as an important issue influencing costs, education, care and science. A more rigorous policy on COI should be implemented.
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Affiliation(s)
- Andrea DeCensi
- Division of Medical Oncology, Galliera Hospital, Genova, Italy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Gianmauro Numico
- Division of Medical Oncology, SS Antonio e Biagio Hospital, Alessandria, Italy
| | | | - Fabrizio Artioli
- Department of Oncology, Carpi and Mirandola Hospitals, Carpi e Mirandola, Italy
| | - Mario Clerico
- Department of Medical Oncology, Hospital of Biella, Biella, Italy
- CIPOMO, Milan, Italy
| | - Luisa Fioretto
- Department of Oncology, SM Annunziata Hospital, Florence, Italy
| | | | - Benedetta Ruggeri
- Clinical Governance, Area Vasta 5, ASUR Marche, Ascoli Piceno, Italy
| | | | - Claudio Verusio
- Division of Medical Oncology, ASST Valle Olona, Saronno, Italy
| | - Fausto Roila
- Division of Medical Oncology, Ospedale Santa Maria, Terni, Italy
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Cavanna L, Di Nunzio C, Seghini P, Anselmi E, Biasini C, Artioli F, Mordenti P. Elderly cancer patients’ preferences regarding the disclosure of cancer diagnosis. Experience of a single institution in Italy. Tumori 2018; 95:63-7. [DOI: 10.1177/030089160909500111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The disclosure of a diagnosis of cancer is complex, particularly in older patients for reasons related to the wishes of the family, fear of discouraging the patient, or the patient's inability to understand the information. So our insight into older people's perspectives regarding the disclosure of their cancer diagnosis is fragmentary and inadequate. To examine the views of older adults regarding this issue, we performed a prospective observational study in an inpatient oncology clinic. From January 2006 to June 2006, a sample of 132 consecutive cancer patients aged over 70 years with a variety of solid tumors, recently diagnosed and mainly at an advanced stage, agreed to take part in a survey about the disclosure of the diagnosis of their disease. Of the 132 patients who verbally agreed to participate and were given questionnaires, 106 returned data. The majority of patients (64.1%) in this study wanted to be informed about the diagnosis of their disease also if it was cancer, and 58.5% were in fact informed about the exact nature of their disease. Male patients were more keen to know the diagnosis than female patients (P = 0.002) and they were in fact more informed about their diagnosis than female patients (P = 0.005). Patients with more formal education were more informed than patients with less formal education (P = 0.035). This study demonstrates that the preferences of older patients regarding cancer diagnosis disclosure are highly similar to those of younger people. Male patients and patients with more formal education were more informed than female patients and patients with less formal education.
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Affiliation(s)
- Luigi Cavanna
- Department of Medical Oncology and Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Camilla Di Nunzio
- Department of Medical Oncology and Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Pietro Seghini
- Department of Medical Oncology and Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Elisa Anselmi
- Department of Medical Oncology and Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Claudia Biasini
- Department of Medical Oncology and Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Fabrizio Artioli
- Department of Medical Oncology and Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Patrizia Mordenti
- Department of Medical Oncology and Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
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Artioli F, Gelmini G, Pedrazzoni M, Dall’Asta D, Ferretti P. Erythrocyte filtration: Analysis of different methods by scanning electron microscopy. Clin Hemorheol Microcirc 2016. [DOI: 10.3233/ch-1984-4405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- F. Artioli
- Department of Geriatrics, University of Parma, Italy
| | - G. Gelmini
- Department of Geriatrics, University of Parma, Italy
| | - M. Pedrazzoni
- Department of Geriatrics, University of Parma, Italy
| | - D. Dall’Asta
- Department of Geriatrics, University of Parma, Italy
| | - P.G. Ferretti
- Department of Geriatrics, University of Parma, Italy
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Ferretti P, Gelmini G, Artioli F, Marchini L, Palummeri E, Butturini L, Passeri M. Morphological study of erythrocytes changes induced by calcium and calcitonin. Clin Hemorheol Microcirc 2016. [DOI: 10.3233/ch-1988-8202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P.G. Ferretti
- Department of Geriatrics, University of Parma, Italy
| | - G. Gelmini
- Department of Geriatrics, University of Parma, Italy
| | - F. Artioli
- Department of Geriatrics, University of Parma, Italy
| | - L. Marchini
- Department of Geriatrics, University of Parma, Italy
| | - E. Palummeri
- Department of Geriatrics, University of Parma, Italy
| | - L. Butturini
- Department of Geriatrics, University of Parma, Italy
| | - M. Passeri
- Department of Geriatrics, University of Parma, Italy
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Bandieri E, Romero M, Ripamonti CI, Artioli F, Fanizza C, Cascinu S, Bruera E, Luppi M. Reply to O. Corli et al and M. Lucchesi et al. J Clin Oncol 2016; 34:3580-3581. [PMID: 27458301 DOI: 10.1200/jco.2016.67.7526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Marilena Romero
- Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy
| | - Carla Ida Ripamonti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale Tumori, Milan, Italy
| | | | | | - Stefano Cascinu
- Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Eduardo Bruera
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mario Luppi
- Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
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Bongiovanni A, Foca F, Fantini M, Forcignano R, Silvestris F, Artioli F, Campadelli E, Daniele B, Ciotti F, Marcantognini G, Recine F, Fausti V, Vespignani R, Amadori D, Ibrahim T. Italian perspective bone metastases (BM) database: The first one-year experience. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alberto Bongiovanni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) s.r.l., IRCCS - Osteoncology and Rare Tumors Center, Meldola, Italy
| | - Flavia Foca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | | | | | | | | | | | - Francesca Ciotti
- Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori - IRST, Meldola, Italy
| | - Giulia Marcantognini
- Osteoncology and Rare Tumors Center IRCCS Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori - IRST, Meldola, Italy
| | - Federica Recine
- Istituto Scientifico per lo Studio e la Cura dei Tumori (IRST) s.r.l., IRCCS - Osteoncology and Rare Tumors Center, Meldola, Italy
| | - Valentina Fausti
- 1Osteoncology and Rare tumors Center IRCCS Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori - IRST, Meldola, Italy
| | - Roberto Vespignani
- Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori - IRST, Meldola, Italy
| | - Dino Amadori
- Medical Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Toni Ibrahim
- Istituto Scientifico Romagnolo per Lo Studio e La Cura Dei Tumori, Meldola, Italy
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Lesi G, Razzini G, Musti MA, Stivanello E, Petrucci C, Benedetti B, Rondini E, Ligabue MB, Scaltriti L, Botti A, Artioli F, Mancuso P, Cardini F, Pandolfi P. Acupuncture As an Integrative Approach for the Treatment of Hot Flashes in Women With Breast Cancer: A Prospective Multicenter Randomized Controlled Trial (AcCliMaT). J Clin Oncol 2016; 34:1795-802. [PMID: 27022113 DOI: 10.1200/jco.2015.63.2893] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the effectiveness of acupuncture for the management of hot flashes in women with breast cancer. PATIENTS AND METHODS We conducted a pragmatic, randomized controlled trial comparing acupuncture plus enhanced self-care versus enhanced self-care alone. A total of 190 women with breast cancer were randomly assigned. Random assignment was performed with stratification for hormonal therapy; the allocation ratio was 1:1. Both groups received a booklet with information about climacteric syndrome and its management to be followed for at least 12 weeks. In addition, the acupuncture group received 10 traditional acupuncture treatment sessions involving needling of predefined acupoints. The primary outcome was hot flash score at the end of treatment (week 12), calculated as the frequency multiplied by the average severity of hot flashes. The secondary outcomes were climacteric symptoms and quality of life, measured by the Greene Climacteric and Menopause Quality of Life scales. Health outcomes were measured for up to 6 months after treatment. Expectation and satisfaction of treatment effect and safety were also evaluated. We used intention-to-treat analyses. RESULTS Of the participants, 105 were randomly assigned to enhanced self-care and 85 to acupuncture plus enhanced self-care. Acupuncture plus enhanced self-care was associated with a significantly lower hot flash score than enhanced self-care at the end of treatment (P < .001) and at 3- and 6-month post-treatment follow-up visits (P = .0028 and .001, respectively). Acupuncture was also associated with fewer climacteric symptoms and higher quality of life in the vasomotor, physical, and psychosocial dimensions (P < .05). CONCLUSION Acupuncture in association with enhanced self-care is an effective integrative intervention for managing hot flashes and improving quality of life in women with breast cancer.
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Affiliation(s)
- Grazia Lesi
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Giorgia Razzini
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy.
| | - Muriel Assunta Musti
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Elisa Stivanello
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Chiara Petrucci
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Benedetta Benedetti
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Ermanno Rondini
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Maria Bernadette Ligabue
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Laura Scaltriti
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Alberto Botti
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Fabrizio Artioli
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Pamela Mancuso
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Francesco Cardini
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Paolo Pandolfi
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
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Bandieri E, Romero M, Ripamonti CI, Artioli F, Sichetti D, Fanizza C, Santini D, Cavanna L, Melotti B, Conte PF, Roila F, Cascinu S, Bruera E, Tognoni G, Luppi M. Randomized Trial of Low-Dose Morphine Versus Weak Opioids in Moderate Cancer Pain. J Clin Oncol 2015; 34:436-42. [PMID: 26644526 DOI: 10.1200/jco.2015.61.0733] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The WHO guidelines on cancer pain management recommend a sequential three-step analgesic ladder. However, conclusive data are lacking as to whether moderate pain should be treated with either step II weak opioids or low-dose step III strong opioids. PATIENTS AND METHODS In a multicenter, 28-day, open-label randomized controlled study, adults with moderate cancer pain were assigned to receive either a weak opioid or low-dose morphine. The primary outcome was the number of responder patients, defined as patients with a 20% reduction in pain intensity on the numerical rating scale. RESULTS A total of 240 patients with cancer (118 in the low-dose morphine and 122 in the weak-opioid group) were included in the study. The primary outcome occurred in 88.2% of the low-dose morphine and in 57.7% of the weak-opioid group (odds risk, 6.18; 95% CI, 3.12 to 12.24; P < .001). The percentage of responder patients was higher in the low-dose morphine group, as early as at 1 week. Clinically meaningful (≥ 30%) and highly meaningful (≥ 50%) pain reduction from baseline was significantly higher in the low-dose morphine group (P < .001). A change in the assigned treatment occurred more frequently in the weak-opioid group, because of inadequate analgesia. The general condition of patients, which was based on the Edmonton Symptom Assessment System overall symptom score, was better in the morphine group. Adverse effects were similar in both groups. CONCLUSION In patients with cancer and moderate pain, low-dose morphine reduced pain intensity significantly compared with weak opioids, with a similarly good tolerability and an earlier effect.
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Affiliation(s)
- Elena Bandieri
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Marilena Romero
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Carla Ida Ripamonti
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Fabrizio Artioli
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Daniela Sichetti
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Caterina Fanizza
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Daniele Santini
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Luigi Cavanna
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Barbara Melotti
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Pier Franco Conte
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Fausto Roila
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Stefano Cascinu
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Gianni Tognoni
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Mario Luppi
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX.
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Passalacqua R, Caminiti C, Buti S, Porta C, Camisa R, Braglia L, Tomasello G, Vaglio A, Labianca R, Rondini E, Sabbatini R, Nastasi G, Artioli F, Prati A, Potenzoni M, Pezzuolo D, Oliva E, Alberici F, Buzio C. Adjuvant low-dose interleukin-2 (IL-2) plus interferon-α (IFN-α) in operable renal cell carcinoma (RCC): a phase III, randomized, multicentre trial of the Italian Oncology Group for Clinical Research (GOIRC). J Immunother 2015; 37:440-7. [PMID: 25304727 DOI: 10.1097/cji.0000000000000055] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is currently no standard therapy to reduce the recurrence rate after surgery for renal cell carcinoma (RCC). The aim of this study was to assess efficacy and safety of adjuvant treatment with low doses of interleukin-2 (IL-2)+interferon-α (IFN-α) in operable RCC. The patients were randomized 1:1 to receive a 4-week cycle of low-dose IL-2+IFN-α or observation after primary surgery for RCC. Treatment cycles were repeated every 4 months for the first 2 years and every 6 months for the subsequent 3 years. The primary endpoint was recurrence-free survival (RFS); safety; and overall survival (OS) were secondary endpoints. ClinicalTrials.gov registration number was NCT00502034. 303/310 randomized patients (156 in the immunotherapy arm and 154 in the observation group) were evaluable at the intention-to-treat analyses. The 2 arms were well balanced. At a median follow-up of 52 months (range, 12-151 mo), RFS, and OS were similar, with an estimated hazard ratio (HR) of 0.84 [95% confidence interval (CI), 0.54-1.31; P=0.44] and of 1.07 (95% CI, 0.64-1.79; P=0.79), respectively in the 2 groups. Unplanned, subgroup analysis showed a positive effect of the treatment for patients with age 60 years and younger, pN0, tumor grades 1-2, and pT3a stage. Among patients with the combined presence of ≥ 2 of these factors, immunotherapy had a positive effect on RFS (HR=0.44; 95% CI, 0.24-0.82; P ≤ 0.01), whereas patients with <2 factors in the treatment arm exhibited a significant poorer OS (HR=2.27; 95% CI, 1.03-5.03 P=0.037). Toxicity of immunotherapy was mild and limited to World Health Organization grade 1-2 in most cases. Adjuvant immunotherapy with IL-2+IFN-α showed no RFS or OS improvement in RCC patients who underwent radical surgery. The results of subset analysis here presented are only hypothesis generating.
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Affiliation(s)
- Rodolfo Passalacqua
- *Oncology Unit, Istituti Ospitalieri di Cremona, Cremona †Research and Innovation Unit ‡Medical Oncology Unit ¶Department of Clinical Medicine, Nephrology and Health Sciences, University Hospital of Parma, Parma §Medical Oncology Unit, IRCCS San Matteo University Hospital Foundation, Pavia ∥"Infrastructure Research and Statistics" Department, IRCCS-Arcispedale Santa Maria Nuova of Reggio Emilia, Reggio Emilia #Department of Oncology, Ospedali Riuniti di Bergamo, Bergamo **Oncology Unit, Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia ††Department of Oncology, University Hospital of Modena ‡‡Department of Oncology, Bolognini Hospital of Seriate, Alzano Lombardo §§Institute of Clinical Oncology, Carpi Hospital, Modena ∥∥Urology Unit, Vaio Hospital, Fidenza ¶¶Medical Oncology Unit, Hospital of Guastalla, Guastalla, Italy
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Viola M, Mazzeo E, Bruni A, Ferrari F, Brausi M, Verrini G, Artioli F, Prandini N, Bertoni F, Razzini G, Mucciarini C. Prostate cancer unit : a single institution two years experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv341.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gianotti E, Baraldi S, Bini M, Borriello A, Crivellaro C, Greco G, Razzini G, Righi A, Rossi S, Artioli F. Scalp cooling to prevent chemotherapy-induced hair loss. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv345.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bongiovanni A, Ricci M, Foca F, Vespignani R, Ciotti F, Fantini M, Forcignano R, Campedelli E, Silvestris F, Artioli F, Amadori D, Ibrahim T. First Prospective Bone Metastases (BM) Data Base: One-Year experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv348.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mucciarini C, Giardina D, Viola M, Brausi M, Razzini G, Artioli F. Hypophosphatemia in Prostate Cancer Patients Treated with Abiraterone. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv341.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bernardini I, Ferrari A, Giardina D, Longo L, Cagossi K, Artioli F, Pasqualini A, Razzini G, Guerzoni R, Gasparro D, Mucciarini C. A prospective observational study on quality of life (qol) questionnaire reliability in oncology (x-life study). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv346.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Brandes AA, Franceschi E, Ermani M, Tosoni A, Albani F, Depenni R, Faedi M, Pisanello A, Crisi G, Urbini B, Dazzi C, Cavanna L, Mucciarini C, Pasini G, Bartolini S, Marucci G, Morandi L, Zunarelli E, Cerasoli S, Gardini G, Lanza G, Silini EM, Cavuto S, Baruzzi A, Baruzzi A, Albani F, Calbucci F, D'Alessandro R, Michelucci R, Brandes A, Eusebi V, Ceruti S, Fainardi E, Tamarozzi R, Emiliani E, Cavallo M, Franceschi E, Tosoni A, Cavallo M, Fiorica F, Valentini A, Depenni R, Mucciarini C, Crisi G, Sasso E, Biasini C, Cavanna L, Guidetti D, Marcello N, Pisanello A, Cremonini AM, Guiducci G, de Pasqua S, Testoni S, Agati R, Ambrosetto G, Bacci A, Baldin E, Baldrati A, Barbieri E, Bartolini S, Bellavista E, Bisulli F, Bonora E, Bunkheila F, Carelli V, Crisci M, Dall'Occa P, de Biase D, Ferro S, Franceschi C, Frezza G, Grasso V, Leonardi M, Marucci G, Mazzocchi V, Morandi L, Mostacci B, Palandri G, Pasini E, Pastore Trossello M, Pession A, Ragazzi M, Riguzzi P, Rinaldi R, Rizzi S, Romeo G, Spagnolli F, Tinuper P, Trocino C, Cerasoli S, Dall'Agata M, Faedi M, Frattarelli M, Gentili G, Giovannini A, Iorio P, Pasquini U, Galletti G, Guidi C, Neri W, Patuelli A, Strumia S, Casmiro M, Gamboni A, Rasi F, Cruciani G, Cenni P, Dazzi C, Guidi A, Zumaglini F, Amadori A, Pasini G, Pasquinelli M, Pasquini E, Polselli A, Ravasio A, Viti B, Sintini M, Ariatti A, Bertolini F, Bigliardi G, Carpeggiani P, Cavalleri F, Meletti S, Nichelli P, Pettorelli E, Pinna G, Zunarelli E, Artioli F, Bernardini I, Costa M, Greco G, Guerzoni R, Stucchi C, Iaccarino C, Rizzi R, Zuccoli G, Api P, Cartei F, Fallica E, Granieri E, Latini F, Lelli G, Monetti C, Ramponi V, Saletti A, Schivalocchi R, Seraceni S, Tola MR, Urbini B, Giorgi C, Montanari E, Cerasti D, Crafa P, Dascola I, Florindo I, Mazza S, Servadei F, Silini E, Torelli P, Immovilli P, Morelli N, Vanzo C. Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center? Neurooncol Pract 2014; 1:166-171. [PMID: 26034628 PMCID: PMC4369716 DOI: 10.1093/nop/npu021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years. METHODS Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients. RESULTS Two hundred sixty-seven GBM patients (median age, 64 y; range, 29-84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2-12.4). The 139 patients ≤aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0-18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248-0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388-0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328-0.986; P = .0446). CONCLUSIONS The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged ≤70 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor.
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Affiliation(s)
- Alba A Brandes
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Enrico Franceschi
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Mario Ermani
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Alicia Tosoni
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Fiorenzo Albani
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Roberta Depenni
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Marina Faedi
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Anna Pisanello
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Girolamo Crisi
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Benedetta Urbini
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Claudio Dazzi
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Luigi Cavanna
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Claudia Mucciarini
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Giuseppe Pasini
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Stefania Bartolini
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Gianluca Marucci
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Luca Morandi
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Elena Zunarelli
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Serenella Cerasoli
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Giorgio Gardini
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Giovanni Lanza
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Enrico Maria Silini
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Silvio Cavuto
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
| | - Agostino Baruzzi
- Department of Medical Oncology , Bellaria - Maggiore Hospital, IRCCS Institute of Neurological Science , Bologna , Italy (A.A.B., E.F., A.T., S.B.); Department of Neurosciences, Statistics and Informatics Unit , Azienda Ospedale-Università , Padova , Italy (M.E.); IRCCS Institute of Neurological Sciences , Bologna , Italy (F.A., A.B.); Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy (F.A., A.B.); Department of Oncology, Hematology and Respiratory Diseases , University Hospital of Modena , Modena , Italy (R.D.); Department of Oncology and Hematology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS Cesena , Italy (M.F.); Neurology Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (A.P.); Department of Neuroradiology , University Hospital of Parma , Parma , Italy (G.C.); Clinical Oncology Unit , St Anna University Hospital , Ferrara , Italy (B.U.); Department of Oncology and Hematology , General Hospital , Ravenna , Italy (C.D.); Department of Oncology and Hematology, Oncology Unit , Azienda Ospedaliera Guglielmo da Saliceto , Piacenza , Italy (L.C.); Medical Oncology Unit , Ramazzini Hospital , Carpi , Italy (C.M.); Department of Medical Oncology , Infermi Hospital , Rimini , Italy (G.P.); Department of Biomedical and NeuroMotor Sciences (DiBiNeM) , University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital , Bologna , Italy (G.M., L.M.); Department of Pathology , Azienda Ospedaliero-Universitaria, Policlinico , Modena , Italy (E.Z.); Department of Human Pathology , AUSL Cesena Bufalini Hospital , Cesena , Italy (S.C.); Department of Pathology , IRCCS Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (G.G.); Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale , Sezione di Anatomia Patologica e Diagnostica Biomolecolare, Università di Ferrara , Ferrara , Italy (G.L.); Pathology Unit , Azienda Ospedaliero-Universitaria , Parma , Italy (E.M.S.); Department "Infrastructure Research and Statistics," IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy (S.C.)
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Cordioli M, Ranzi A, Freni Sterrantino A, Erspamer L, Razzini G, Ferrari U, Gatti MG, Bonora K, Artioli F, Goldoni CA, Lauriola P. A comparison between self-reported and GIS-based proxies of residential exposure to environmental pollution in a case-control study on lung cancer. Spat Spatiotemporal Epidemiol 2014; 9:37-45. [PMID: 24889992 DOI: 10.1016/j.sste.2014.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 03/03/2014] [Accepted: 04/25/2014] [Indexed: 01/09/2023]
Abstract
In epidemiological studies both questionnaire results and GIS modeling have been used to assess exposure to environmental risk factors. Nevertheless, few studies have used both these techniques to evaluate the degree of agreement between different exposure assessment methodologies. As part of a case-control study on lung cancer, we present a comparison between self-reported and GIS-derived proxies of residential exposure to environmental pollution. 649 subjects were asked to fill out a questionnaire and give information about residential history and perceived exposure. Using GIS, for each residence we evaluated land use patterns, proximity to major roads and exposure to industrial pollution. We then compared the GIS exposure-index values among groups created on the basis of questionnaire responses. Our results showed a relatively high agreement between the two methods. Although none of these methods is the "exposure gold standard", understanding similarities, weaknesses and strengths of each method is essential to strengthen epidemiological evidence.
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Affiliation(s)
- M Cordioli
- University of Parma, Department of Bio-Sciences, Parco Area delle Scienze 11/A, 43124 Parma, Italy; Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Via Begarelli 13, 41121 Modena, Italy.
| | - A Ranzi
- Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Via Begarelli 13, 41121 Modena, Italy.
| | - A Freni Sterrantino
- Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Via Begarelli 13, 41121 Modena, Italy; University of Bologna, Department of Statistical Sciences, Via Belle Arti 41, Bologna, Italy.
| | - L Erspamer
- Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Via Begarelli 13, 41121 Modena, Italy.
| | - G Razzini
- Clinical Trials Office, Cancer Unit of the Carpi General Hospital, Via Guido Molinari 2, Carpi, Modena, Italy.
| | - U Ferrari
- Clinical Trials Office, Cancer Unit of the Carpi General Hospital, Via Guido Molinari 2, Carpi, Modena, Italy.
| | - M G Gatti
- Department of Public Health, Unit of Epidemiology, Local Health Unit of Modena, Strada Martiniana 21, Baggiovara, 41126 Modena, Italy.
| | - K Bonora
- Department of Public Health, Unit of Epidemiology, Local Health Unit of Modena, Strada Martiniana 21, Baggiovara, 41126 Modena, Italy.
| | - F Artioli
- Clinical Trials Office, Cancer Unit of the Carpi General Hospital, Via Guido Molinari 2, Carpi, Modena, Italy.
| | - C A Goldoni
- Department of Public Health, Unit of Epidemiology, Local Health Unit of Modena, Strada Martiniana 21, Baggiovara, 41126 Modena, Italy.
| | - P Lauriola
- Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Via Begarelli 13, 41121 Modena, Italy.
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Bersanelli M, Tiseo M, Artioli F, Lucchi L, Ardizzoni A. Gefitinib and afatinib treatment in an advanced non-small cell lung cancer (NSCLC) patient undergoing hemodialysis. Anticancer Res 2014; 34:3185-3188. [PMID: 24922692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Renal failure in cancer patients is not a rare clinical condition and often contraindicates anticancer drug treatment; moreover, chemotherapeutic drugs are frequently identified as possible iatrogenic cause of renal failure. Molecular therapies, when appropriate, could represent a therapeutic option for cancer patients with severe renal disease, but the lack of knowledge in this field, at present, limits their use in patients undergoing dialysis. Herein we describe a case, at our knowledge the first reported, of a patient with advanced lung adenocarcinoma on maintenance hemodialysis treated with gefitinib and then with afatinib; we also reviewed the literature on epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitors (TKIs) used in NSCLC patients with concomitant renal impairment.
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Affiliation(s)
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Fabrizio Artioli
- Medical Oncology Unit, Hospitals of Carpi and Mirandola, Modena, Italy
| | - Leonardo Lucchi
- Nephrology and Dialysis Unit, University Hospital of Modena, Modena, Italy
| | - Andrea Ardizzoni
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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Guarneri V, Generali DG, Frassoldati A, Artioli F, Boni C, Cavanna L, Tagliafico E, Maiorana A, Bottini A, Cagossi K, Bisagni G, Piacentini F, Ficarra G, Bettelli S, Roncaglia E, Nuzzo S, Swaby R, Ellis C, Holford C, Conte P. Double-blind, placebo-controlled, multicenter, randomized, phase IIb neoadjuvant study of letrozole-lapatinib in postmenopausal hormone receptor-positive, human epidermal growth factor receptor 2-negative, operable breast cancer. J Clin Oncol 2014; 32:1050-7. [PMID: 24590635 DOI: 10.1200/jco.2013.51.4737] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This is a randomized, double-blind, placebo-controlled study aimed to evaluate the clinical and biologic effects of letrozole plus lapatinib or placebo as neoadjuvant therapy in hormone receptor (HR) -positive/human epidermal growth factor receptor 2 (HER2) -negative operable breast cancer. METHODS Ninety-two postmenopausal women with stage II to IIIA primary breast cancer were randomly assigned to preoperative therapy consisting of 6 months of letrozole 2.5 mg orally daily plus lapatinib 1,500 mg orally daily or placebo. Surgery was performed within 2 weeks from the last study medication. Clinical response was assessed by ultrasonography. Pre- and post-treatment samples were evaluated for selected biomarkers. Fresh-frozen tissue samples were collected for genomic analyses. RESULTS Numerically similar clinical response rates (partial + complete response) were observed (70% for letrozole-lapatinib and 63% for letrozole-placebo). Toxicities were generally mild and manageable. A significant decrease in Ki-67 and pAKT expression from baseline to surgery was observed in both arms. Overall, 34 patients (37%) had a mutation in PIK3CA exon 9 or 20. In the letrozole-lapatinib arm, the probability of achieving a clinical response was significantly higher in the presence of PIK3CA mutation (objective response rate, 93% v 63% in PIK3CA wild type; P = .040). CONCLUSION The combination of letrozole-lapatinib in early breast cancer was feasible, with expected and manageable toxicities. In unselected estrogen receptor-positive/HER2-negative patients, letrozole-lapatinib and letrozole-placebo resulted in a similar overall clinical response rate and similar effect on Ki-67 and pAKT. Our secondary end point findings of a significant correlation between PIK3CA mutation and response to letrozole-lapatinib in HR-positive/HER2-negative early breast cancer must now be independently confirmed.
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Affiliation(s)
- Valentina Guarneri
- Valentina Guarneri and PierFranco Conte, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Padova, Padova; Daniele Giulio Generali and Alberto Bottini, U.O. Multidisciplinare di Patologia Mammaria, Azienda Ospedaliera Istituti Ospitalieri di Cremona, Cremona; Antonio Frassoldati, University Hospital, Ferrara; Fabrizio Artioli and Katia Cagossi, Ramazzini Hospital, Carpi; Corrado Boni and Giancarlo Bisagni, Azienda Ospedaliera Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia; Luigi Cavanna, Hospital of Piacenza, Piacenza; Enrico Tagliafico, Enrica Roncaglia, and Simona Nuzzo, Center for Genome Research, University of Modena and Reggio Emilia; Antonino Maiorana, Federico Piacentini, Guido Ficarra, and Stefania Bettelli, Modena University Hospital, Modena, Italy; Ramona Swaby and Catherine Ellis, GlaxoSmithKline, Upper Providence, PA; and Clare Holford, GlaxoSmithKline, Stockley Park, United Kingdom
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Cagossi K, Razzini G, Ferrari A, Lazzaretti MG, Leporati M, Silvestri R, Iadanza M, Artioli F. Metronomic cyclophosphamide and capecitabine combined with lapatinib in heavily pretreated metastatic breast cancer (MBC) HER2-positive patients: 2-year update. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e11515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e11515 Background: Current therapeutic goals for MBC, as an incurable disease, are symptoms and prolonged disease control together with good quality of life. Metronomic chemotherapy has shown efficacy in patients with metastatic breast cancer. We evaluated the efficacy and tolerability of the combination of anti-angiogenetic activity of metronomic chemotherapy with a tyrosine kinase inhibitor such as lapatinib in heavily pre-treated MBC HER-2 positive patients. Methods: Metastatic breast cancer patients HER-2 positive with CEA or Ca15.3 elevated, prior systemic therapy for advanced disease, ECOG performance status < 1 and life expectancy longer than 3 months. MBC patients were treated with metronomic oral capecitabine (1500 mg daily) and cyclophosphamide (50 mg daily) plus lapatinib (1250 mg daily). The treatment was given until disease progression. Primary objective was time to progression (TTP) and safety. Results: Fifteenpatients were included. Median age was 52 years old (range 42-77). Median number of previous chemotherapy lines was 5 (range 2-10). Median time to tumor progression was 6 months (2-14). No complete response was observed. Eight out of fiftten patients (60%) with pre-existing only bone metastases achieved a stable disease and/or partial response and were still on treatment after 6 month of therapy. At the same time 100% of these patients exhibited significant reduction of serum marker concentrations. No grade 3-4 skin toxicity was reported. Hematological and gastro-intestinal toxicity was well tolerated (G1-2). No reduction of dose was needed. Conclusions: The combination of lapatinib with metronomic chemotherapy may lead to effective palliation despite extensive pretreatment at least in bone metastatic patients. The treatment appears to be less toxic than lapatinib and capecitabine at full dosage, especially in heavily pretreated MBC patients. The preliminary results suggest the need of a clinical trial to confirm a role of this combination to delay lapatinib resistance.
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Affiliation(s)
- Katia Cagossi
- Division of Medical Oncology, Ramazzini Hospital, Carpi, Italy
| | - Giorgia Razzini
- Division of Medical Oncology Ramazzini Hospital, Carpi, Italy
| | - Alessia Ferrari
- Division of Medical Oncology, Ramazzini Hospital, Carpi, Italy
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