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Monti M, Cortesi P, Vespignani R, Bronico I, Gallio C, Flospergher M, Matteucci L, Frassineti GL. Takotsubo Syndrome (TTS) in Onco-Hematologic Patients: Retrospective Analysis and Focus on the Correlation or Not With Anticancer Drugs. Case Reports and Review of the Literature. Front Oncol 2022; 12:875391. [PMID: 35692777 PMCID: PMC9179013 DOI: 10.3389/fonc.2022.875391] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/22/2022] [Indexed: 12/27/2022] Open
Abstract
Takotsubo syndrome (TTS) is an uncommon cardiovascular condition also known as stress-induced cardiomyopathy or broken heart disease. The syndrome, characterized by acute non-coronary segmental ventricular dysfunction, commonly occurs as a reaction to severe emotional or physical stress and can cause significant problems. Several classes of chemotherapeutic agents that are known to be cardiotoxic have been shown to be associated with TTS in cancer patients. Describing a case of TTS from chemotherapy and/or monoclonal antibody is important because these drugs are widely used and their temporary or permanent suspension could compromise the success of treatment. The detection and reporting of suspected adverse drug reactions in clinical practice are the foundations of postmarketing surveillance. We performed a retrospective analysis of a large number of patients followed at our cancer centre to identify drugs that could lead to the onset of TTS, focusing our attention on 2 monoclonal antibodies, bevacizumab and rituximab plus chemotherapy. A search was carried out for the word “Takotsubo” in database sources such as in PubMed, in medical oncology, radiology and cardiology electronic clinical records. From October 2007 to March 2021, of the 79,005 patients seen or treated for any kind of malignancy at our institute, 9 had a diagnosis of TTS (4 before and 5 after the diagnosis of malignancy). Only 2 patients had TTS after treatment with the anticancer drugs, bevacizumab and rituximab plus chemotherapy. These two patients were hospitalised, one for subocclusion while the other for pulmonary embolism (PE) with a life threatening condition and in need of intravenous catecholamines. For both patients, an ECG, echocardiography and coronary angiography were performed as well as blood tests with a subsequent diagnosis of TTS and both received cardiological treatment with resolution of the clinical picture. A reassessment of the two cases found that a subocclusion and intravenous catecholamines appeared to be the most likely triggers. In conclusion, TTS is rare in cancer patients. Identifying TTS triggers could be useful because it could induce therapeutic changes.
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Affiliation(s)
- Manlio Monti
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
- *Correspondence: Manlio Monti,
| | - Pietro Cortesi
- Cardio-Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Roberto Vespignani
- Information Technology (IT) Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Ilaria Bronico
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Chiara Gallio
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Michele Flospergher
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Laura Matteucci
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
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Passardi A, Foca F, Caffo O, Tondini CA, Zambelli A, Vespignani R, Bartolini G, Sullo FG, Andreis D, Dianti M, Eccher C, Piras EM, Forti S. A Remote Monitoring System to Optimize the Home Management of Oral Anticancer Therapies (ONCO-TreC): Prospective Training-Validation Trial. J Med Internet Res 2022; 24:e27349. [PMID: 35080505 PMCID: PMC8829690 DOI: 10.2196/27349] [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: 01/22/2021] [Revised: 06/10/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background A platform designed to support the home management of oral anticancer treatments and provide a secure web-based patient–health care professional communication modality, ONCO-TreC, was tested in 3 cancer centers in Italy. Objective The overall aims of the trial are to customize the platform; assess the system’s ability to facilitate the shared management of oral anticancer therapies by patients and health professionals; and evaluate system usability and acceptability by patients, caregivers, and health care professionals. Methods Patients aged ≥18 years who were candidates for oral anticancer treatment as monotherapy with an Eastern Cooperative Oncology Group performance status score of 0 to 1 and a sufficient level of familiarity with mobile devices were eligible. ONCO-TreC consisted of a mobile app for patients and a web-based dashboard for health care professionals. Adherence to treatment (pill count) and toxicities reported by patients through the app were compared with those reported by physicians in medical records. Usability and acceptability were evaluated using questionnaires. Results A total of 40 patients were enrolled, 38 (95%) of whom were evaluable for adherence to treatment. The ability of the system to measure adherence to treatment was high, with a concordance of 97.3% (95% CI 86.1%-99.9%) between the investigator and system pill count. Only 60% (3/5) of grade 3, 54% (13/24) of grade 2, and 19% (7/36) of grade 1 adverse events reported by physicians in the case report forms were also reported in the app directly by patients. In total, 94% (33/35) of patients had ≥1 app launch each week, and the median number of daily accesses per patient was 2. Approximately 71% (27/38) and 68% (26/38) of patients used the app for messages and vital sign entering, respectively, at least once during the study period. Conclusions ONCO-TreC is an important tool for measuring and monitoring adherence to oral anticancer drugs. System usability and acceptability were very high, whereas its reliability in registering toxicity could be improved. Trial Registration ClinicalTrials.gov NCT02921724; https://www.clinicaltrials.gov/ct2/show/NCT02921724
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Affiliation(s)
- Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Carlo Alberto Tondini
- Department of Medical Oncology, Azienda Socio-Sanitaria Territoriale "Papa Giovanni XXIII", Bergamo, Italy
| | - Alberto Zambelli
- Department of Medical Oncology, Azienda Socio-Sanitaria Territoriale "Papa Giovanni XXIII", Bergamo, Italy
| | - Roberto Vespignani
- IT Service, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Giulia Bartolini
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Francesco Giulio Sullo
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Daniele Andreis
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Marco Dianti
- Center for Information and Communication Technology, eHealth Unit, Fondazione "Bruno Kessler", Trento, Italy
| | - Claudio Eccher
- Center for Information and Communication Technology, eHealth Unit, Fondazione "Bruno Kessler", Trento, Italy
| | - Enrico Maria Piras
- Center for Information and Communication Technology, eHealth Unit, Fondazione "Bruno Kessler", Trento, Italy
| | - Stefano Forti
- Center for Information and Communication Technology, eHealth Unit, Fondazione "Bruno Kessler", Trento, Italy
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Passardi A, Serra P, Caffo O, Masini C, Brugugnoli E, Vespignani R, Giardino V, Petracci E, Bartolini G, Sullo F, Anesi C, Dianti M, Eccher C, Piras EM, Gios L, Campomori A, Oberosler V, Forti S. Use of the ONCO-TreC electronic diary compared with a standard paper diary to improve adherence to oral cancer therapy in patients with solid and haematological tumours: protocol for a randomised controlled trial. BMJ Open 2022; 12:e055814. [PMID: 35017254 PMCID: PMC8753414 DOI: 10.1136/bmjopen-2021-055814] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION ONCO-TreC platform consists of a mobile application delivered to patients as electronic diary and a web-based dashboard managed by healthcare professionals. We aim to compare the effectiveness of ONCO-TreC electronic diary with a standard paper diary, in improving adherence to oral cancer therapy in patients with solid and haematological tumours. METHODS AND ANALYSIS This is an open label, superiority, randomised controlled trial conducted in two Italian oncology units. Patients will be randomised with a 1:1 ratio to electronic or paper diary. For both groups a counsellor will be responsible for drug and diary delivery. The evaluation period will end after six cycles of therapy. The primary aim is to compare the proportion of non-adherent patients in the two arms. Adherence will be measured through pill count; anyone who takes less than 90% of the total prescribed drug dose will be considered non-adherent. Assuming a percentage of non-adherent patients to oral therapy of 40% in arm B, and a 60% reduction in this percentage in arm A, a sample of 124 patients will provide 80% power to identify an absolute difference greater than 24 percentage points using a bilateral Fisher's exact test with a significance level of 0.05. Considering a dropout rate of 10%, approximately 136 patients will have to be enrolled. The primary analysis will be performed on the intention-to-treat population. Secondary aims are to describe the reasons for non-adherence, the level of satisfaction of patients and healthcare professionals with the paper and electronic diary, and the impact of non-adherence in terms of healthcare costs. ETHICS AND DISSEMINATION Ethical approval was obtained from Romagna Ethics Committee (CEROM), study ID 2108, prot. n. IRST 100.28 of 10/04/2020. Informed consent will be obtained from all study participants. Findings will be disseminated through peer-reviewed journals, conferences and event presentations. PROTOCOL VERSION Version 2, 6 April 2021. TRIAL REGISTRATION NUMBER NCT04826458.
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Affiliation(s)
- Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Patrizia Serra
- Unit of Biostatistic and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Provincia autonoma di Trento Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Carla Masini
- Oncology Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Erika Brugugnoli
- Oncology Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Roberto Vespignani
- IT Service, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Valeria Giardino
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Elisabetta Petracci
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Giulia Bartolini
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Francesco Sullo
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Cecilia Anesi
- Department of Medical Oncology, Provincia autonoma di Trento Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Marco Dianti
- eHealth Unit, Bruno Kessler Foundation, Trento, Italy
| | | | | | - Lorenzo Gios
- Competence Center for Digital Health, TrentinoSalute 4.0, Trento, Italy
| | - Annalisa Campomori
- Hospital Pharmacy Unit, Presidio Ospedaliero Santa Chiara, Trento, Italy
| | | | - Stefano Forti
- eHealth Unit, Bruno Kessler Foundation, Trento, Italy
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Passardi A, Serra P, Donati C, Fiori F, Prati S, Vespignani R, Taglioni G, Farfaneti Ghetti P, Martinelli G, Nanni O, Altini M, Frassineti GL, Minguzzi MV. An Integrated Model to Improve Medication Reconciliation in Oncology: Prospective Interventional Study. J Med Internet Res 2021; 23:e31321. [PMID: 34932001 PMCID: PMC8726040 DOI: 10.2196/31321] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/21/2021] [Accepted: 10/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background Accurate medication reconciliation reduces the risk of drug incompatibilities and adverse events that can occur during transitions in care. Community pharmacies (CPs) are a crucial part of the health care system and could be involved in collecting essential information on conventional and supplementary drugs used at home. Objective The aim of this paper was to establish an alliance between our cancer institute, Istituto Romagnolo per lo Studio dei Tumori (IRST), and CPs, the latter entrusted with the completion of a pharmacological recognition survey. We also aimed to integrate the national information technology (IT) platform of CPs with the electronic medical records of IRST. Methods Cancer patients undergoing antiblastic treatments were invited to select a CP taking part in the study and to complete the pharmacological recognition step. The information collected by the pharmacist was sent to the electronic medical records of IRST through the new IT platform, after which the oncologist performed the reconciliation process. Results A total of 66 CPs completed surveys for 134 patients. An average of 5.9 drugs per patient was used at home, with 12 or more used in the most advanced age groups. Moreover, 60% (80/134) of the patients used nonconventional products or critical foods. Some potential interactions between nonconventional medications and cancer treatments were reported. Conclusions In the PROF-1 (Progetto di Rete in Oncologia con le Farmacie di comunità della Romagna) study, an alliance was created between our cancer center and CPs to improve medication reconciliation, and a new integrated IT platform was validated. Trial Registration ClinicalTrials.gov NCT04796142; https://clinicaltrials.gov/ct2/show/NCT04796142
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Affiliation(s)
- Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Patrizia Serra
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Caterina Donati
- Oncology Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Federica Fiori
- Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Sabrina Prati
- Oncology Unit, 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
| | | | | | - Giovanni Martinelli
- Hematology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Mattia Altini
- Healthcare Administration, Azienda Unità Sanitaria Locale (AUSL) Romagna, Ravenna, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Martina Vittoria Minguzzi
- Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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Lilli C, Biggeri A, Zingaretti C, Vertogen B, Frassineti V, Vespignani R, Grossi V, Florescu C, Matteucci L, Pazzi C, Bongiovanni A, Limarzi F, Fausti V, Bertoni L, Donati C, Galardi F, Gentili N, Mazza F, Martinelli G, Nanni O. Is it possible to conduct clinical trials during a pandemic? The example of a trial of hydroxychloroquine. Epidemiol Prev 2021; 45:28-36. [PMID: 33884840 DOI: 10.19191/ep21.1-2.p028.036] [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] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to examine the factors that, in the context of the current pandemic, have influenced the conduct of a randomized clinical trial on hydroxychloroquine in Italy. DESIGN the trend of enrolment in the PROTECT study, "A randomized study with Hydroxychloroquine versus observational support for prevention or early phase treatment of Coronavirus disease (COVID-19)" (Eudract number: 2020-001501-24, NCT04363827), conducted in the period from May to September 2020, was analysed to evaluate the possible association of the enrolment rate with the amount of information published in the national and local press on hydroxychloroquine. SETTING AND PARTICIPANTS the PROTECT clinical study is an Italian interventional superiority study, open label, with cluster randomization, aimed at evaluating whether treatment with hydroxychloroquine can reduce the percentage of symptomatic subjects compared to observation only in a population of subjects exposed to SARS-CoV-2 virus consisting of cohabitants/contacts of COVID-19 patients and asymptomatic or paucisymptomatic subjects diagnosed with COVID-19. MAIN OUTCOME MEASURES the number of asymptomatic or paucisymptomatic COVID-19 patients and the number of contacts/cohabitants of COVID-19 patients enrolled in the Protect study from May to September 2020. RESULTS from May to September 2020, the number of patients diagnosed with COVID-19 enrolled in the PROTECT clinical trial showed a decrease consistent with the number of news on hydroxychloroquine appearing in the national and local press, starting from the time when the first criticisms of the efficacy of hydroxychloroquine were made known; the number of contacts/cohabitants of COVID-19 patients showed a more marked and more timely decrease. CONCLUSIONS in the context determined by the current COVID-19 pandemic, conducting a controlled clinical trial is strongly influenced by public opinion on scientific issues. Adherence to a clinical study can become highly problematic and invalidate the possibility of answering a scientific question and the validity of a project. In the current pandemic situation, randomized controlled trials may not always be the optimal tool to reach the expected scientific evidence, due to a number of problems. It is preferable to use a sequential or adaptive design. Furthermore, study protocols should implement innovative approaches that also include the involvement of participants in the decision-making process. In any case, the influence of public information on scientific issues is an extremely important factor to consider in the design of clinical trials in exceptional situations such as a pandemic.
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Affiliation(s)
- Claudia Lilli
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Annibale Biggeri
- Dipartimento di statistica, informatica, applicazioni "G. Parenti", Università degli Studi di Firenze, Florence (Italy);
| | - Chiara Zingaretti
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Bernadette Vertogen
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | | | - Roberto Vespignani
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Veruska Grossi
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Caterina Florescu
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Laura Matteucci
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Chiara Pazzi
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Alberto Bongiovanni
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | | | - Valentina Fausti
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Lucia Bertoni
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Caterina Donati
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Francesca Galardi
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Nicola Gentili
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Francesco Mazza
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Giovanni Martinelli
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
| | - Oriana Nanni
- IRCCS Istituto romagnolo per lo studio dei tumori "Dino Amadori" srl, Meldola (FC) (Italy)
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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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Nanni O, Viale P, Vertogen B, Lilli C, Zingaretti C, Donati C, Masini C, Monti M, Serra P, Vespignani R, Grossi V, Biggeri A, Scarpi E, Galardi F, Bertoni L, Colamartini A, Falcini F, Altini M, Massa I, Gaggeri R, Martinelli G. PROTECT Trial: A cluster-randomized study with hydroxychloroquine versus observational support for prevention or early-phase treatment of Coronavirus disease (COVID-19): A structured summary of a study protocol for a randomized controlled trial. Trials 2020; 21:689. [PMID: 32736597 PMCID: PMC7393246 DOI: 10.1186/s13063-020-04527-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Hydroxychloroquine has shown to have antiviral activity in vitro against coronaviruses, specifically SARS-CoV-2. It is believed to block virus infection by increasing endosomal pH required for virus cell fusion and glycosylation of viral surface proteins. In addition to its antiviral activity, hydroxychloroquine has an immune-modulating activity that may synergistically enhance its antiviral effect in vivo, making it a potentially promising drug for the prevention and the cure of SARS-CoV-19. However, randomized controlled trials are needed to assess whether it can be used safely to treat COVID-19 patients or to prevent infection. The main objective of the present study is to evaluate the efficacy of hydroxychloroquine for (I) the prevention of COVID-19 or related symptoms in SARS-CoV-2-exposed subjects, such as as household members/contacts of COVID-19 patients and (II) the treatment of early-phase asymptomatic or paucisymptomatic COVID-19 patients. TRIAL DESIGN This is a controlled, open label, cluster-randomized, superiority trial with parallel group design. Subjects will be randomized either to receive hydroxychloroquine or to observation (2:1). PARTICIPANTS SARS-CoV-2-exposed subjects, including household members and/or contacts of COVID-19 patients and healthcare professionals (Group 1) or patients with COVID-19 (positive PCR test on a rhinopharyngeal or oropharyngeal swab for SARS-CoV-2), asymptomatic or paucisymptomatic in home situations who are not undergoing treatment with any anti COVID-19 medication (Group 2), will be enrolled. Paucisymptomatic patients are defined as patients with a low number of mild symptoms. All subjects must be aged ≥18 years, male or female, must be willing and able to give informed consent and must not have any contraindications to take hydroxychloroquine (intolerance or previous toxicity for hydroxychloroquine/chloroquine, bradycardia or reduction in heart rhythm with arrhythmia, ischemic heart disease, retinopathy, congestive heart failure with use of diuretics, favism or glucose-6-phosphate dehydrogenase (G6PD) deficiency, diabetes type 1, major comorbidities such as advanced chronic kidney disease or dialysis therapy, known history of ventricular arrhythmia, any oncologic/hematologic malignancy, severe neurological and mental illness, current use of medications with known significant drug-drug interactions, and known prolonged QT syndrome or current use of drugs with known QT prolongation). The study is monocentric and will be conducted at Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS. Subjects will be enrolled from a large epidemic region (North-Central Italy). The Public Health Departments of several Italian regions will collaborate by identifying potentially eligible subjects. INTERVENTION AND COMPARATOR The participants will be randomized (2:1 randomization) to receive either hydroxychloroquine (Arm A) or to Observation (Arm B). Hydroxychloroquine will be administered with the following schedule: Group1: A loading dose hydroxychloroquine 400 mg twice daily on day 1, followed by a weekly dose of hydroxychloroquine 200 mg twice daily on days 8, 15 and 22, for a total of one month of treatment. Group 2: A loading dose hydroxychloroquine 400 mg twice daily on day 1 followed by 200 mg twice daily for a total of 5-7 days. The comparator in this trial is observation given that currently neither treatment is administered to asymptomatic or paucisymptomatic subjects, nor prophylaxis is available for contacts. Hydroxychloroquine will be shipped to subjects within 24 hours of randomization. Given the extraordinary nature of the COVID-19 pandemic, only telephonic interviews will be carried out and electronic Patient Reported Outcomes (ePRO) completed. During treatment, each subject will be contacted every other day for the first week and weekly thereafter (Group 2) or weekly (Group 1) by a study physician to assess early onset of any COVID-19 symptom or any adverse reaction to hydroxychloroquine and to check subject compliance. Furthermore, all subjects will receive periodic ePROs which may be completed through smartphone or tablets to record drug self-administration and onset of any symptom or adverse event. All subjects will be followed up for a total of 6 months by periodic telephonic interviews and ePROs. MAIN OUTCOMES The primary endpoint/outcome measure for this trial is: for Group 1, the proportion of subjects who become symptomatic and/or swab-positive in each arm within one month of randomization; for Group 2, the proportion of subjects who become swab-negative in each arm within 14 days of randomization. RANDOMIZATION All household members and/or contacts of each COVID-19 index case, and the COVID-19 patient himself/herself, fulfilling all inclusion criteria will be grouped into a single cluster and this cluster will be randomized (2:1) to either arm A or arm B. Information on each subject will be recorded in specific data records. Randomization lists will be stratified according to the following factors regarding COVID-19 index cases: 1. COVID-19 risk level on the basis of province of residence (high vs. low/intermediate); 2. Index case is a healthcare professional (yes vs.no) 3. Index case with COVID-19 treatment (yes vs. no) An independent statistician not otherwise involved in the trial will generate the allocation sequence, and COVID-19 response teams will be unaware of the allocation of clusters. Randomization will be performed through an interactive web-based electronic data-capturing database. An Independent Data Monitoring Committee has been established. BLINDING (MASKING) This study is open label. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE) For Group 1, a sample size of about 2000 SARS-CoV-2-exposed subjects such as household members and/or contacts of COVID-19 patients will take part in the study. Assuming around 1.5-2.0 asymptomatic household members and/or contacts for each COVID-19 patient, we expect to identify approximately 1000-1300 COVID-19 index cases to be randomized. An interim analysis on efficacy is planned using standard alpha-spending function. For Group 2, sufficient power for primary objective (negative swab within 14 days of randomization) will be reached given a sample size of 300 asymptomatic or paucisymptomatic COVID-19 subjects in home situations not treated for COVID-19 (25%-30% of about 1000-1300 expected index cases). Since up to date reduced evidence about COVID-19 infection epidemiology, the continuous update of diagnostic and therapeutic approaches, the sample size estimation could be updated after a one third of population will be recruited and eventually modified according to a substantial protocol amendment. An interim analysis at 100 enrolled COVID-19 patients is planned. We have planned a Generalized Estimating Equation analysis, which is more efficient than a cluster level analysis, to take advantage of subject-specific covariates. The above reported sample size analysis is therefore to be considered conservative. TRIAL STATUS The current version of the PROTECT trial protocol is 'Final version, 15 April 2020'. The study started on 9th May 2020. The first patient was enrolled on 14th May 2020. Recruitment is expected to last through September 2020. TRIAL REGISTRATION The PROTECT trial is registered in the EudraCT database (no. 2020-001501-24) and in ClinicalTrials.gov ( NCT04363827 ), date of registration 24 April 2020. FULL PROTOCOL The full PROTECT protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interests of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol (Protocol final version, 15th April 2020). The study protocol has been reported in accordance with Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
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Affiliation(s)
- Oriana Nanni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Pierluigi Viale
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Bernadette Vertogen
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Claudia Lilli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Chiara Zingaretti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Caterina Donati
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Carla Masini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Manuela Monti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Patrizia Serra
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Roberto Vespignani
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Veruska Grossi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Annibale Biggeri
- Dipartimento di Statistica, Informatica, Applicazioni “G. Parenti” (DISIA), Università degli studi Firenze, Florence, Italy
| | - Emanuela Scarpi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Francesca Galardi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Lucia Bertoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Americo Colamartini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Fabio Falcini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Mattia Altini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ilaria Massa
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Raffaella Gaggeri
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giovanni Martinelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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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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9
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Recine F, Bongiovanni A, Foca F, Mercatali L, Fausti V, Calpona S, Riva N, De Vita A, Liverani C, Spadazzi C, Miserocchi G, Di Menna G, Gurrieri L, Cocchi C, Debonis SA, Vespignani R, Ibrahim T. BOne HEalth ManagEment in Patients with Early Breast Cancer: A Retrospective Italian Osteoncology Center "Real-Life" Experience (BOHEME Study). J Clin Med 2019; 8:jcm8111894. [PMID: 31698876 PMCID: PMC6912302 DOI: 10.3390/jcm8111894] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/16/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background: We assessed the real-life clinical impact of bone health management in patients with breast cancer (BC) receiving adjuvant endocrine therapy at an Italian Osteoncology Center. Methods: Pre- and post-menopausal women undergoing adjuvant endocrine therapy for early-stage BC who came to our institute for their first bone health evaluation from January 2011 to June 2016 were considered in this retrospective observational study. Results: 1125 pre- and post-menopausal early-stage BC patients (209 and 916, respectively) were evaluated. Median age was 61 years (range 26–88). In the pre-menopausal group, spinal x-ray revealed that 10 patients (4.7%) had a morphometric vertebral fracture. Higher age (OR: 1.14; 95% CI: 1.01–1.29) and bone mineral density (BMD) ≤ −2.5 (OR: 14.45; 95% CI: 1.70–122.67) were associated with a higher risk of bone fracture. The overall frequency of bone fracture was 17.6% (n = 161) in post-menopausal patients and a lower risk for bone fractures was associated with tamoxifen or other treatments (OR: 0.25; 95% CI: 0.12–0.53), presence of back pain (OR: 1.65; 95% CI: 1.16–2.36), lower BMD (OR: 2.09 in patients with T-score ≤ 2.5; 95% CI: 1.21–3.59) and lower vitamin D levels (OR: 1.57 in patients with ≤ 10 ng/mL; 95% CI: 1.05–2.34) in univariate analysis. Conclusion: Our findings confirm that bone health management should be an integral part of long-term cancer care.
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Affiliation(s)
- Federica Recine
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
- Correspondence: ; Tel.: +39-0543-739140; Fax: +39-0543-739151
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Laura Mercatali
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Valentina Fausti
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Sebastiano Calpona
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Nada Riva
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Alessandro De Vita
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Chiara Liverani
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Chiara Spadazzi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Giacomo Miserocchi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Giandomenico Di Menna
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Lorena Gurrieri
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Claudia Cocchi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Silvia Angela Debonis
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
| | - Roberto Vespignani
- IT Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.B.); (L.M.); (V.F.); (S.C.); (N.R.); (A.D.V.); (C.L.); (C.S.); (G.M.); (G.D.M.); (L.G.); (C.C.); (S.A.D.); (T.I.)
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Casadei Gardini A, Scarpi E, Orlandi E, Tassinari D, Leo S, Bernardini I, Gelsomino F, Tamberi S, Ruscelli S, Vespignani R, Ronconi S, Frassineti GL, Amadori D, Passardi A. Prognostic role of aspartate aminotransferase-lymphocyte ratio index in patients with metastatic colorectal cancer: results from the randomized ITACa trial. Onco Targets Ther 2018; 11:5261-5268. [PMID: 30214231 PMCID: PMC6120511 DOI: 10.2147/ott.s166614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/31/2022] Open
Abstract
Background The aim of this study was to investigate the role of pre-treatment aspartate aminotransferase-lynphocyte ratio (ALRI) as a predictor of prognosis and treatment efficacy in patients with metastatic colorectal cancer (mCRC) enrolled in the prospective multicenter randomized ITACa (Italian Trial in Advanced Colorectal Cancer) trial to receive first-line chemotherapy (CT) + bevacizumab (B) or CT alone. Patients and methods Patients randomly received CT+B or CT alone as first-line therapy. CT consisted of either FOLFOX4 or FOLFIRI at the clinician’s discretion. Results Out of the 284 patients enrolled, increased ALRI levels were associated with shorter PFS and OS (p<0.0001). At baseline, median PFS was 10.3 months (95% CI 9.4–12.0) and 8.0 months (95 % CI 6.8–8.9), and median OS was 25.2 months (95 % CI 21.3–30.2) and 18.8 months (95 % CI 16.6–21.7) for patients with low (<14) and high (≥14) ALRI levels, respectively (HR 1.43, 95% CI 1.12–1.82, p=0.004; HR=1.51, 95% CI 1.17–1.96, p<0.001). Interaction tests on ALRI levels and treatment efficacy in the CT+B and the CT groups were statistically significant for PFS (p=0.0003), but not for OS (p=0.228). Conclusion Our results indicate that ALRI is a good prognostic and predictive marker for mCRC patients candidate for CT+B.
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Affiliation(s)
- Andrea Casadei Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Emanuela Scarpi
- Unit of Biostatistics and Clinical Trials, IRST IRCCS, Meldola, Italy,
| | - Elena Orlandi
- Medical Oncology Department, Piacenza Hospital, Piacenza, Italy
| | | | - Silvana Leo
- Medical Oncology Unit, Vito Fazzi Hospital, Lecce, Italy
| | | | - Fabio Gelsomino
- Department of Oncology and Hematology, Division of Oncology, University Hospital Modena, Italy
| | | | - Silvia Ruscelli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Sonia Ronconi
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Dino Amadori
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessandro Passardi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Passardi A, Scarpi E, Cavanna L, Dall'Agata M, Tassinari D, Leo S, Bernardini I, Gelsomino F, Tamberi S, Brandes AA, Tenti E, Vespignani R, Frassineti GL, Amadori D, De Giorgi U. Inflammatory indexes as predictors of prognosis and bevacizumab efficacy in patients with metastatic colorectal cancer. Oncotarget 2017; 7:33210-9. [PMID: 27120807 PMCID: PMC5078087 DOI: 10.18632/oncotarget.8901] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [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: 02/24/2016] [Accepted: 04/04/2016] [Indexed: 12/15/2022] Open
Abstract
Background To investigate the role of pre-treatment inflammatory indexes (II) as predictors of prognosis and treatment efficacy in patients with metastatic colorectal cancer mCRC randomized onto the prospective multicenter randomized ITACa (Italian Trial in Advanced Colorectal Cancer) trial to receive first-line chemotherapy (CT) with or without bevacizumab (Bev). Results In the overall population, PFS and OS were higher in patients with low SII (p = .015 and .002, respectively), low NLR (p = .0001 and <.0001, respectively) and low PLR (p = .004 and .008, respectively). Patients with low NLR in the CT plus Bev arm had a higher PFS than those treated with CT alone (HR = 0.69, p = .021). Patients and Methods Two hundred and eighty-nine patients were considered for this study, 141 receiving CT plus Bev and 148 receiving CT alone. The pre-treatment systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were evaluated to identify a potential correlation with progression-free (PFS) and overall survival (OS) in both the overall population and the 2 treatment arms. Conclusion Our results indicate that II, in particular NLR, are good prognostic and predictive markers for mCRC patients who are candidates for CT plus Bev.
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Affiliation(s)
- Alessandro Passardi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Emanuela Scarpi
- Unit of Biostatistics and Clinical Trials, IRST IRCCS, Meldola, Italy
| | - Luigi Cavanna
- Medical Oncology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Monia Dall'Agata
- Unit of Biostatistics and Clinical Trials, IRST IRCCS, Meldola, Italy
| | | | - Silvana Leo
- Medical Oncology Unit, Vito Fazzi Hospital, Lecce, Italy
| | | | | | | | - Alba A Brandes
- Department of Medical Oncology, Azienda USL, Bellaria Hospital - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Elena Tenti
- Oncology Pharmacy Laboratory, IRST IRCCS, Meldola, Italy
| | | | - Giovanni L Frassineti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Dino Amadori
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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12
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Recine F, Bongiovanni A, Fausti V, Mercatali L, Riva N, Calpona S, Faedi M, De Vita A, Liverani C, Spadazzi C, Miserocchi G, Foca F, Vespignani R, Rocca A, Amadori D, Ibrahim T. Bone health management in early breast cancer patients: an Italian Osteoncology Center experience. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.003] [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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13
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Liberati EG, Ruggiero F, Galuppo L, Gorli M, González-Lorenzo M, Maraldi M, Ruggieri P, Friz HP, Scaratti G, Kwag KH, Vespignani R, Moja L. What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation. Implement Sci 2017; 12:113. [PMID: 28915822 PMCID: PMC5602839 DOI: 10.1186/s13012-017-0644-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/04/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. METHODS Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors (n = 30). We used a constant comparative approach to develop a framework for guiding implementation. RESULTS We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as "positions." The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians' perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians' reasoning and fostering organizational learning. CONCLUSIONS Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians' attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships, and an organizational ethos of transparency and accountability need to be considered when exploring the readiness of a hospital to adopt CDSSs.
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Affiliation(s)
- Elisa G. Liberati
- Cambridge Centre for Health Services Research (CCHSR), Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
| | - Francesca Ruggiero
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal 36, 20133 Milan, Italy
| | - Laura Galuppo
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 20123 Milan, Italy
| | - Mara Gorli
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 20123 Milan, Italy
| | - Marien González-Lorenzo
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal 36, 20133 Milan, Italy
| | - Marco Maraldi
- Clinica Ortopedica, Università degli Studi di Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Pietro Ruggieri
- Clinica Ortopedica, Università degli Studi di Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Hernan Polo Friz
- Dipartimento Internistico, Ospedale di Vimercate, Via Santi Cosma e Damiano 10, 20871 Vimercate, Italy
| | - Giuseppe Scaratti
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 20123 Milan, Italy
| | - Koren H. Kwag
- Medical School of International Health, Ben Gurion University of the Negev, P.O. Box 653, 84105 Beersheva, Israel
| | - Roberto Vespignani
- IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy
| | - Lorenzo Moja
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal 36, 20133 Milan, Italy
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Passardi A, Rizzo M, Maines F, Tondini C, Zambelli A, Vespignani R, Andreis D, Massa I, Dianti M, Forti S, Piras EM, Eccher C. Optimisation and validation of a remote monitoring system (Onco-TreC) for home-based management of oral anticancer therapies: an Italian multicentre feasibility study. BMJ Open 2017; 7:e014617. [PMID: 28554917 PMCID: PMC5729988 DOI: 10.1136/bmjopen-2016-014617] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Despite the growing number of oral agents available for cancer treatment, their efficacy may be reduced due to the lack of adherence, inappropriate adverse event self-management and arbitrary dose adjustment. The management of anticancer therapies could exponentially benefit from the introduction of mobile health technologies in a highly integrated electronic oncology system. METHODS AND ANALYSIS We plan to customise and fine-tune an existing monitoring TreC platform used in different chronic diseases in the oncology setting. This project follows a multistep approach with two major purposes: 1. participatory design techniques driven by Health Literacy and Patient Reported Outcomes principles in order to adapt the system to the oncology setting involving patients and healthcare providers; 2. a prospective training-validation, interventional, non-pharmacological, multicentre study on a series of consecutive patients with cancer (20 and 60 patients in the training and validation steps, respectively) in order to assess system capability, usability and acceptability. The novel Onco-TreC 2.0 is expected to contribute to improving the adherence and safety of cancer care, promoting patient empowerment and patient-doctor communication. ETHICS AND DISSEMINATION Ethical approval was obtained from the Independent Ethics Committees of the participating institutions (CEIIAV protocol Number 2549/2015; reference Number 1315-PU). Informed consent will be obtained from all study participants. Findings will be disseminated through peer-reviewed journals, conferences and event presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT02921724); (Pre-results). Other study ID Number: IRST100.18.
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Affiliation(s)
- Alessandro Passardi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Mimma Rizzo
- Department of Medical Oncology, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Francesca Maines
- Department of Medical Oncology, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Carlo Tondini
- Department of Medical Oncology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Alberto Zambelli
- Department of Medical Oncology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Roberto Vespignani
- IT Service, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Daniele Andreis
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ilaria Massa
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Marco Dianti
- Center for Information and Communication Technology, eHealth Unit, Fondazione Bruno Kessler, Trento, Italy
| | - Stefano Forti
- Center for Information and Communication Technology, eHealth Unit, Fondazione Bruno Kessler, Trento, Italy
| | - Enrico Maria Piras
- Center for Information and Communication Technology, eHealth Unit, Fondazione Bruno Kessler, Trento, Italy
| | - Claudio Eccher
- Center for Information and Communication Technology, eHealth Unit, Fondazione Bruno Kessler, Trento, Italy
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Recine F, Bongiovanni A, Fausti V, Mercatali L, Riva N, Calpona S, Faedi M, De Vita A, Liverani C, Spadazzi C, Miserocchi G, Foca F, Vespignani R, Rocca A, Amadori D, Ibrahim T. Bone health management in early breast cancer patients: An Italian osteoncology center experience. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e12055] [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
e12055 Background: Bone health evaluation is important for the optimal management of early stage breast cancer (BC) both in post and pre-menopausal setting. Adjuvant endocrine therapy (ET), including luteinizing hormone-releasing hormone (LHRH) analogues with tamoxifen (TAM) and aromatase inhibitors (AI), may affect bone health resulting in a reduction of the bone mineral density (BMD), leading to an increased risk of bone fractures. The objective of this observational study performed at an Italian Osteoncology Center was to evaluate the prevalence of vertebral fractures in pre and post women with BC treated with adjuvant ET. Methods: Data on patients (pts) with early BC were collected from 2011 to 2016 in a single Institution. We investigated the prevalence of vertebral fractures in pre and post pts treated with ET and other potential independent risk factors associated to bone fractures. To evaluate association with bone fractures and clinical factors, univariate logistic models were carried out. P-value of less than 0.05 was considered significant. Results: A total of 1,165 women with early pre and post-menopausal BC were evaluated; for 702 (60.2%) pts treated with ET was available a X-Ray of the spine and they were included in the analysis. The median age was 61 year-old (31-86 y). A total of 124 were pre-menopausal and 578 were post-menopausal pts. Frequency of bone fractures was 17.6% in post-menopausal and, among them, the major risk of bone fractures was associated with AI treatment (OR:4.37, p:0.005); in pre-menopausal pts bone fractures incidence was 6.4% and the major risk was associated to LHRH+AI treatment (OR:2.18, p:0.307). Higher risk of bone fractures was associated with presence of back-pain (OR:1.81, p:0.006), a lower BMD (OR:2.91, p: < 0.001 for pts with BMD≤2.5) and lower level of Vitamin D (OR:2.06, p:0.030 for pts with ≤10) in univariate analysis. Further analysis are ongoing. Conclusions: This Italian experience confirms the importance of bone health evaluation in order to prevent bone fractures in the management of pre and post-menopausal early BC treated with ET.
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Affiliation(s)
- Federica Recine
- IRCCS - IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), Meldola, Italy
| | - Alberto Bongiovanni
- IRCCS - IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), Meldola, Italy
| | - Valentina Fausti
- IRCCS - IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), Meldola, Italy
| | - Laura Mercatali
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Nada Riva
- IRCCS - IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), Meldola, Italy
| | - Sebastiano Calpona
- IRCCS - IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), Meldola, Italy
| | - Marina Faedi
- Department of Medical Oncology IRST, IRCCS, Meldola, Italy
| | - Alessandro De Vita
- IRCCS - IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), Meldola, Italy
| | - Chiara Liverani
- IRCCS - IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), Meldola, Italy
| | - Chiara Spadazzi
- Osteoncology and Rare Tumors Center IRCCS IRST, Meldola, Italy
| | - Giacomo Miserocchi
- Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”- IRCCS- Osteoncology and Rare Tumors Center, Meldola, Italy
| | - Flavia Foca
- IRCCS - IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), Meldola, Italy
| | - Roberto Vespignani
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Dino Amadori
- 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 (IRST) IRCCS, Meldola, Italy
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16
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Moja L, Passardi A, Capobussi M, Banzi R, Ruggiero F, Kwag K, Liberati EG, Mangia M, Kunnamo I, Cinquini M, Vespignani R, Colamartini A, Di Iorio V, Massa I, González-Lorenzo M, Bertizzolo L, Nyberg P, Grimshaw J, Bonovas S, Nanni O. Implementing an evidence-based computerized decision support system linked to electronic health records to improve care for cancer patients: the ONCO-CODES study protocol for a randomized controlled trial. Implement Sci 2016; 11:153. [PMID: 27884165 PMCID: PMC5123241 DOI: 10.1186/s13012-016-0514-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/24/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Computerized decision support systems (CDSSs) are computer programs that provide doctors with person-specific, actionable recommendations, or management options that are intelligently filtered or presented at appropriate times to enhance health care. CDSSs might be integrated with patient electronic health records (EHRs) and evidence-based knowledge. METHODS/DESIGN The Computerized DEcision Support in ONCOlogy (ONCO-CODES) trial is a pragmatic, parallel group, randomized controlled study with 1:1 allocation ratio. The trial is designed to evaluate the effectiveness on clinical practice and quality of care of a multi-specialty collection of patient-specific reminders generated by a CDSS in the IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) hospital. We hypothesize that the intervention can increase clinician adherence to guidelines and, eventually, improve the quality of care offered to cancer patients. The primary outcome is the rate at which the issues reported by the reminders are resolved, aggregating specialty and primary care reminders. We will include all the patients admitted to hospital services. All analyses will follow the intention-to-treat principle. DISCUSSION The results of our study will contribute to the current understanding of the effectiveness of CDSSs in cancer hospitals, thereby informing healthcare policy about the potential role of CDSS use. Furthermore, the study will inform whether CDSS may facilitate the integration of primary care in cancer settings, known to be usually limited. The increasing use of and familiarity with advanced technology among new generations of physicians may support integrated approaches to be tested in pragmatic studies determining the optimal interface between primary and oncology care. TRIAL REGISTRATION ClinicalTrials.gov, NCT02645357.
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Affiliation(s)
- Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, 20133 Milan, Italy
- Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
| | - Alessandro Passardi
- Medical Oncology Unit, IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Matteo Capobussi
- School of Specialization in Hygiene and Preventive Medicine, University of Milan, Milan, Italy
| | - Rita Banzi
- IRCCS Mario Negri Institute for Pharmacological Research, Via La Masa 19, 20156 Milan, Italy
| | - Francesca Ruggiero
- Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
| | - Koren Kwag
- Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
| | - Elisa Giulia Liberati
- Cambridge Centre for Health Services Research (CCHSR), Department of Public Health and Primary Care, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
| | | | - Ilkka Kunnamo
- Duodecim Medical Publications Ltd, Kaivokatu 10 A, 00101 Helsinki, Finland
| | - Michela Cinquini
- IRCCS Mario Negri Institute for Pharmacological Research, Via La Masa 19, 20156 Milan, Italy
| | - Roberto Vespignani
- Medical Oncology Unit, IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Americo Colamartini
- Medical Oncology Unit, IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Valentina Di Iorio
- Medical Oncology Unit, IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Ilaria Massa
- Medical Oncology Unit, IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Marien González-Lorenzo
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, 20133 Milan, Italy
- Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
| | - Lorenzo Bertizzolo
- School of Specialization in Hygiene and Preventive Medicine, University of Milan, Milan, Italy
| | - Peter Nyberg
- Duodecim Medical Publications Ltd, Kaivokatu 10 A, 00101 Helsinki, Finland
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8 L6 Canada
| | - Stefanos Bonovas
- Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Oriana Nanni
- Medical Oncology Unit, IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, 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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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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Ruzza A, Esmailian F, Vespignani R, Yanagida R, Awad M, Mirocha J, Ramzy D, Moriguchi J, Trento A, Czer L. Renal Dysfunction Does Not Contraindicate Ventricular Assist Device as Destination Therapy or as Bridge to Single Heart or Combined Heart and Kidney Transplantation. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.591] [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: 10/27/2022] Open
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Ruzza A, Vespignani R, Khoynezhad A, Berci G, De Robertis M, Trento A, Czer LSC. Concomitant dual intravascular and subcutaneous microsurgical implantation of xenograft tissue in a rodent model for evaluation of structural degeneration. Transplant Proc 2012; 45:735-40. [PMID: 23267809 DOI: 10.1016/j.transproceed.2012.06.061] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/26/2012] [Accepted: 06/19/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION An economical animal model to study xenograft tissue degeneration and calcification and the durability of biological vascular patch material and bioprosthetic valve leaflets is desirable. OBJECTIVE A cost-effective model to analyze xenograft degeneration, calcification, immunologic reaction, and anticalcification treatment was developed. Furthermore, a technique for implant into the vascular lumen of the abdominal aorta in rats is presented. METHODS Twelve Lewis rats were used as recipients. The microsurgical procedure was performed using a high-definition optical system. Anesthesia was induced and maintained with isoflurane inhalation. The suprarenal and infrarenal portion of the abdominal aorta was isolated, the abdominal aorta was cross-clamped, and a 4-mm square portion of the abdominal aorta was removed. Subsequently, a complementary-sized piece of porcine or bovine glutaraldehyde-fixed bioprosthetic valve leaflet tissue was sutured as a patch in the abdominal aorta. RESULTS The mean operating time was 45 ± 10 minutes and the mean ischemic time was 25 ± 5 minutes. Early and 3-month survivals were 100%. One rat had intraoperative bleeding. No paralysis or thrombosis was observed. CONCLUSION Feasibility and reproducibility of removing a portion of the abdominal aorta and replacing it with a patch of xenograft tissue was demonstrated in a rodent model with 100% survival at 3 months. Concomitant dual intravascular and subcutaneous microsurgical implantation of xenograft tissue in a small-animal (rat) model is a cost-effective approach for investigation of xenograft tissue degeneration.
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Affiliation(s)
- A Ruzza
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, the Comprehensive Transplant Center, Los Angeles, California 90048, USA
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Czer L, Ruzza A, Vespignani R, Jordan S, De Robertis M, Mirocha J, Gallagher S, Patel K, Schwarz E, Kass R, Trento A. Survival and Allograft Rejection Rates after Combined Heart and Kidney Transplantation in Comparison with Heart Transplantation Alone. Transplant Proc 2011; 43:3869-76. [DOI: 10.1016/j.transproceed.2011.08.095] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 08/04/2011] [Indexed: 02/07/2023]
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Czer LSC, Ruzza A, Vespignani R, Rafiei M, Pixton JR, Awad M, De Robertis M, Wong AV, Trento A. Prophylaxis of cytomegalovirus disease in mismatched patients after heart transplantation using combined antiviral and immunoglobulin therapy. Transplant Proc 2011; 43:1887-92. [PMID: 21693295 DOI: 10.1016/j.transproceed.2011.01.189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 01/18/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is a common cause of infection and morbidity after heart transplantation. Seronegative recipients (R-) of seropositive donor hearts (D+) are at high risk for CMV disease. We compared three different CMV prophylaxis regimens using combined antiviral and immunoglobulin therapy. METHODS In 99 patients who survived more than 30 days after heart transplant, all received induction with antilymphocytic therapy and triple-drug therapy. In group A, D+R- patients received one dose of intravenous immunoglobulin (IVIG) followed by one dose of CMV-specific immunoglobulin (CMV-IVIG), and intravenous ganciclovir (GCV) for 4 weeks followed by 11 months of oral acyclovir (ACV). In group B, D+R- patients received one dose IVIG followed by five doses of CMV-IVIG and intravenous GCV for 14 weeks followed by 9 months of oral ACV. In group C, D+R- patients were treated with the same regimen as for group B, except oral ACV was replaced with oral GCV. RESULTS The actuarial freedom from CMV disease for D+R- patients at 1 month, 1 year, and 2 years after transplantation in group A was 100%, 25% ± 15%, and 25% ± 15%, respectively; group B was 100%, 67% ± 27%, and 67% ± 27%; group C was 100%, 83% ± 15%, and 83% ± 15% (P < .01, groups B and C vs group A). By comparison, the actuarial freedom from CMV disease for seropositive recipients (D-R+ or D+R+) at 1 month, 1 year, and 2 years in group A was 100%, 87% ± 7%, and 82% ± 8%, respectively; group B was 100%, 88% ± 8%, and 75% ± 11%; group C was 100%, 72% ± 9%, and 72% ± 9% (P = NS among groups). Rejection rates did not differ among the three groups. CONCLUSIONS A longer course of intravenous GCV with multiple doses of CMV-IVIG was a more effective prophylaxis regimen against CMV disease for the high-risk group of seronegative recipients of seropositive donor hearts.
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Affiliation(s)
- L S C Czer
- Division of Cardiothoracic Surgery and Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California 90048, USA
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Yanagida R, Czer L, Ruzza A, Vespignani R, Simsir S, Schwarz E, De Robertis M, Mirocha J, Coleman B, Runyon C, Jocson R, Olay C, Kass R, Kobashigawa J, Trento A. 478 Ventricular Assist Device Implantation Provides Opportunity for Significant Weight Loss in Obese Patients with Advanced Heart Failure. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.488] [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: 11/27/2022] Open
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Phan A, Czer L, Rafiei M, Pixton J, Mirocha J, Schwarz E, De Robertis M, Coleman B, Luthringer D, Vespignani R, Ruzza A, Yanagida R, Kass R, Trento A. 416 Anti-Thymocyte Globulin Induction Therapy after Heart Transplantation: Impact on Rejection Rates, Survival, and CMV Infection. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.425] [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: 10/18/2022] Open
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Ruzza A, Vespignani R, Czer L, De Robertis M, Wu G, Trento A. Heterotopic Heart Transplantation in Rats: Improved Anesthetic and Surgical Technique. Transplant Proc 2010; 42:3828-32. [DOI: 10.1016/j.transproceed.2010.07.097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 07/14/2010] [Indexed: 11/29/2022]
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