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Cerbone L, Delfanti S, Crivellari S, De Angelis AM, Mazzeo L, Proto C, Occhipinti M, Lo Russo G, Dellepiane C, Biello F, Alabiso I, Verderame F, Gauna R, De Simone I, Cuppone F, Petraglia S, Pasello G, Ceresoli GL, Garassino MC, Torri V, Grosso F. Nivolumab in pretreated pleural mesothelioma: Results from an observational real-world study of patients treated within the AIFA 5% Fund. Tumori 2024:3008916241229287. [PMID: 38372045 DOI: 10.1177/03008916241229287] [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] [Indexed: 02/20/2024]
Abstract
BACKGROUND Pleural mesothelioma is a rare cancer with a dismal prognosis and few therapeutic options, especially in the pretreated setting. Immunotherapy with checkpoint inhibitors as single agents yielded interesting results in refractory pleural mesothelioma, achieving a response rate between 10-20%, median progression-free survival of 2-5 months and median overall survival of 7-13 months. PATIENTS AND METHODS A retrospective, multi-institutional study of pleural mesothelioma patients treated with nivolumab in second and further line was performed. The endpoints of the study are response rate, disease control rate, progression free survival and overall survival. RESULTS Sixty-five patients with pleural mesothelioma treated with nivolumab in second and further line were enrolled at seven Italian institutions. The response rate was 8%, disease control rate was 37%, median progression free survival was 5.7 months (95% CI: 2.9-9.0) and median overall survival was 11.1 (95% CI 6.2-19.9) months. A higher neutrophils and neutrophils to lymphocytes ratio at baseline were associated with worse prognosis. CONCLUSION Nivolumab as a single agent is fairly active in a cohort of unselected pretreated pleural mesothelioma patients. Further investigations on clinical and translational factors are needed to define which patient might benefit most from nivolumab treatment in pleural mesothelioma.
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Affiliation(s)
- Luigi Cerbone
- Mesothelioma Unit AO SS, Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Sara Delfanti
- Mesothelioma Unit AO SS, Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Stefania Crivellari
- Mesothelioma Unit AO SS, Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Projects, Investigation and Innovation Unit, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | | | - Laura Mazzeo
- Medical Oncology Department 1, Fondazione IRCCS - Istituto Nazionale Dei Tumori, Milano, Italy
| | - Claudia Proto
- Medical Oncology Department 1, Fondazione IRCCS - Istituto Nazionale Dei Tumori, Milano, Italy
| | - Mario Occhipinti
- Medical Oncology Department 1, Fondazione IRCCS - Istituto Nazionale Dei Tumori, Milano, Italy
| | - Giuseppe Lo Russo
- Medical Oncology Department 1, Fondazione IRCCS - Istituto Nazionale Dei Tumori, Milano, Italy
| | - Chiara Dellepiane
- Lung Cancer Unit, Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federica Biello
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Irene Alabiso
- Oncology Unit 2, Presidio Ospedaliero S. Giovanni Bosco, Azienda Sanitaria Locale Città Di Torino, Torino, Italy
| | - Francesco Verderame
- Medical Oncology Unit, Azienda Ospedaliera Ospedali Riuniti PO Vincenzo Cervello, Palermo, Italy
| | - Roberta Gauna
- Oncology Unit, Ospedale Degli Infermi, Ponderano, Italy
| | - Irene De Simone
- Clinical Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Federica Cuppone
- Pre-Authorisation Department, Italian Medicines Agency, Rome, Italy
| | - Sandra Petraglia
- Pre-Authorisation Department, Italian Medicines Agency, Rome, Italy
| | - Giulia Pasello
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy 12Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy
| | | | - Marina Chiara Garassino
- Department of Medicine, University of Chicago Comprehensive Cancer Center, University of Chicago, Illinois, USA
| | - Valter Torri
- Clinical Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Federica Grosso
- Mesothelioma Unit AO SS, Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Bolgeo T, Di Matteo R, Crivellari S, Gatti D, Cassinari A, Riccio C, De Angelis A, Delfanti S, Ferrero E, Gnani C, Riili G, Maconi A. Quality of life in patients with PICC diagnosed with mesothelioma: Results of a multicenter epidemiological survey (LifePICC). J Vasc Access 2023:11297298231202046. [PMID: 37873988 DOI: 10.1177/11297298231202046] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Pleural mesothelioma (PM) is a rare and aggressive cancer. PICC devices are widely used in cancer patients. The aim of the study is to evaluate the quality of life of patients with PICC diagnosed with PM treated at the Hospital of Casale Monferrato and Alessandria (Italy), an area with a high incidence of asbestos-related diseases. STUDY DESIGN AND METHODS Longitudinal prospective observational study with data collection at PICC insertion (T0), after 3 months (T1), 6 months (T2), and 9 months (T3). Participants were aged >18 years, diagnosed with PM, eligible for PICC insertion. Questionnaires used: EORTC QLQ-C30, EORTC QLQ-LC13, and HADS rating scale. RESULTS Twenty-eight patients were enrolled. The mean age was 68.93 years (SD 9.13), mostly male (57.1%). The most frequent cancer stage at diagnosis was III (39.3%), then I (32.1%), and IV (21.4%). 85.7% were treated with chemotherapy, 14.3% also with immunotherapy. 96.4% of patients reported no complications during PICC implantation. The perception of health status and quality of life, measured on a scale of 1-7, was in line with an average score of 5 during the evaluation period. The total anxiety and depression score remained normal for most patients (0-7). CONCLUSIONS The PICC management involved a multidisciplinary team with different skills: study findings revealed the key role that dedicated nurses play in PICC placement and ensuring patient problems are promptly addressed. From our study results, PICC placement does not seem to negatively impact the patient's quality of life.
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Affiliation(s)
- Tatiana Bolgeo
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliera "SS. Antonio e Biagio e Cesare Arrigo," Alessandria, Italy
| | - Roberta Di Matteo
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliera "SS. Antonio e Biagio e Cesare Arrigo," Alessandria, Italy
| | - Stefania Crivellari
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliera "SS. Antonio e Biagio e Cesare Arrigo," Alessandria, Italy
- SS Progetti, Ricerca e Innovazione, Ospedale Michele and Pietro Ferrero, ASL CN2, Verduno (CN), Italy
| | - Denise Gatti
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliera "SS. Antonio e Biagio e Cesare Arrigo," Alessandria, Italy
| | - Antonella Cassinari
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliera "SS. Antonio e Biagio e Cesare Arrigo," Alessandria, Italy
| | - Carmela Riccio
- Oncology Unit, Azienda Ospedaliera "SS. Antonio e Biagio e Cesare Arrigo," Alessandria, Italy
| | - Antonina De Angelis
- Mesothelioma and Rare Tumors Unit, Azienda Ospedaliera "SS. Antonio e Biagio e Cesare Arrigo," Alessandria, Italy
| | - Sara Delfanti
- Mesothelioma and Rare Tumors Unit, Azienda Ospedaliera "SS. Antonio e Biagio e Cesare Arrigo," Alessandria, Italy
| | - Elisabetta Ferrero
- Oncology and Hematology Day Hospital, Azienda Ospedaliera "SS. Antonio e Biagio e Cesare Arrigo," Alessandria, Italy
| | - Claudia Gnani
- SC General Medicine, Ospedale S. Spirito, ASL AL, Casale Monferrato, Italy
| | - Giuseppe Riili
- SC Oncology, Ospedale S. Spirito, ASL AL, Casale Monferrato, Italy
| | - Antonio Maconi
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliera "SS. Antonio e Biagio e Cesare Arrigo," Alessandria, Italy
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Bolgeo T, Gardalini M, Libener R, Bonvicini P, Crivellari S, Simonelli N, Vettore L, Lika O, Casaccia G, Gatti D, Maconi A, Timmins F. Nursing and distraction techniques during needle-related interventions on children: Identification of strategies for optimal care. J Clin Nurs 2023; 32:6755-6756. [PMID: 37179528 DOI: 10.1111/jocn.16744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Tatiana Bolgeo
- Health Professions Research Unit - Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI) - SS. Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Menada Gardalini
- Health Professions Research Unit - Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI) - SS. Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Roberta Libener
- Biobank - Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI) - SS Antonio e Biagio e Cesare Arrigo, Public Hospital Alessandria, Alessandria, Italy
| | - Paolo Bonvicini
- Biobank - Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI) - SS Antonio e Biagio e Cesare Arrigo, Public Hospital Alessandria, Alessandria, Italy
| | - Stefania Crivellari
- Environmental Diseases - Research Training Innovation Infrastructure - Department of Research and Innovation (DAIRI) - SS Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Niccolò Simonelli
- SC Cardiology - SS Antonio e Biagio e Cesare Arrigo Public Hospital, Alessandria, Italy
| | - Luca Vettore
- SC Neurorehabilitation - Borsalino - SS Antonio e Biagio e Cesare Arrigo Public Hospital, Alessandria, Italy
| | - Orjada Lika
- SC Pediatric Accident & Emergency - SS Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Germana Casaccia
- SC Pediatric Surgery - SS Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Denise Gatti
- Health Professions Research Unit - Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI) - SS. Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Antonio Maconi
- Director - Research and Innovation Department (DAIRI) - SS. Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Fiona Timmins
- Full Professor of Nursing, Dean, Head of School - School of Nursing and Midwifery, UCD School of Nursing, Midwifery & Health Systems, Trinity College Dublin, Dublin, Ireland
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Grasso C, Giacchero F, Crivellari S, Bertolotti M, Maconi A. A Review on The Role of Environmental Exposures in IgG4-Related Diseases. Curr Environ Health Rep 2023; 10:303-311. [PMID: 37314670 DOI: 10.1007/s40572-023-00401-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW Immunoglobulin G4-related diseases (IgG4-RDs) are immune-mediated fibroinflammatory multisystemic conditions identified by the presence of tumefactive lesions with a rich infiltrate of IgG4-positive plasma cells, and often by a high IgG4 serum concentration. IgG-RDs have a prevalence of at least 1 case every 100,000 persons, and they are mostly diagnosed after age 50, with a male to female ratio of about 3:1. IgG4-RD pathophysiology is still uncertain: it has been proposed that both genetic predisposition and chronic environmental exposures may play a role by triggering abnormal immune activation that perpetuates the disease. The purpose of this review is to summarize the evidences supporting the hypothesis that certain environmental/occupational exposures can trigger IgG4-RDs, focusing on the possible role of asbestos in an emerging IgG4-RD called idiopathic retroperitoneal fibrosis (IRF). RECENT FINDINGS Although some studies suggested a relationship between tobacco smoking and IgG4-RD risk, occupational exposures seem to have the most interesting effects. Positive history of blue-collar work increases the risk of developing an IgG4-RD, and mineral dusts and asbestos were the most strongly associated industrial compounds. Asbestos has been found to be a risk factor for IRF years before its classification as IgG4-RD, and later in two large case-control studies. In the most recent one, conducted on 90 patients and 270 controls, asbestos exposure conferred an increased IRF risk, quantified by odds ratios from 2.46 to 7.07. Further structured studies including serum IgG4 evaluation should be conducted to clarify the effect of asbestos on patients with confirmed diagnosis of IgG4-related IRF. Environmental exposures, especially of occupational origin, appear to play a role in the development of different types of IgG-RDs. In particular, although first suggested very recently, the relationship between asbestos and IRF deserves to be explored in more structured studies, especially because of the biological plausibility of the role of asbestos in IRF pathogenesis.
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Affiliation(s)
- Chiara Grasso
- SC Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera "SS. Antonio E Biagio E Cesare Arrigo", Alessandria, Italy
| | - Fabio Giacchero
- SC Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Sanitaria Locale Alessandria, Alessandria, Italy
| | - Stefania Crivellari
- SC Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera "SS. Antonio E Biagio E Cesare Arrigo", Alessandria, Italy
| | - Marinella Bertolotti
- SC Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera "SS. Antonio E Biagio E Cesare Arrigo", Alessandria, Italy.
| | - Antonio Maconi
- SC Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera "SS. Antonio E Biagio E Cesare Arrigo", Alessandria, Italy
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Crivellari S, Pasquali M, Aiosa G, Daniele A, Bertolotti M, Salerno C, Pacileo G, Marchisio S, Maconi A, Gnerre P. Outcomes of patients with COVID-19 hospitalized during the fourth pandemic wave in relation to their clinical features and vaccination status. Ital J Med 2023. [DOI: 10.4081/itjm.2022.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
This study aims to observe the clinical characteristics and outcomes of recovered patients from Coronavirus Disease (COVID-19) related to the vaccination status. We examined results of 205 COVID-19-recovered patients from 15 December 2021 to 1 March 2022 in two hospitals of Local Health Authority of Alessandria (Italy) during the fourth pandemic wave. 77% of patients were hospitalized for acute respiratory failure (ARF) with radiological pneumonia pattern (recovered for COVID), 23% for other causes with occasional positivity finding (recovered with COVID). 32% of patients were not vaccinated for Sars-COV-2, 37% had three doses, 25% two doses, 5% only one dose. All patients without vaccination were hospitalized for ARF and they had a 7 times higher risk of hospitalization than the vaccinated. 60% of all patients had >3 comorbidities, of these 50% was vaccinated with three doses. In the fourth pandemic wave compared to the other not all patients were hospitalized for ARF and pneumonia and the presence of comorbidities >3 is a risk factor for hospitalization regardless of vaccination status. This justifies the administration of the fourth dose to frail patients.
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Cerbone L, Delfanti S, De Angelis AM, Crivellari S, Boccuzzi F, Cimorelli A, Bertolotti M, Righi L, Bertino P, Grosso F. Unprecedented long-term survival in a patient with malignant pleural mesothelioma treated with subsequent systemic chemo- and immunotherapeutic regimens. Thorac Cancer 2023; 14:524-527. [PMID: 36599413 PMCID: PMC9925339 DOI: 10.1111/1759-7714.14789] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 01/06/2023] Open
Abstract
Pleural mesothelioma is a rare disease with a dismal prognosis and few therapeutic options. Until recently the median overall survival for a pleural mesothelioma patient was up to 2 years, with few exceptional cases of patients achieving a longer survival. Here, we report the clinical case of a patient whose survival spanned over 10 years. The patient underwent several systemic treatments, including three different chemotherapy lines (cisplatin-pemetrexed, vinorelbine and platinum rechallenge) and two immunotherapy regimens using immune checkpoint inhibitors (anti CTLA-4 tremelimumab and anti PD-1 nivolumab). At the time this report was written, the patient was off-treatment, asymptomatic and with a stable radiological disease. Our case demonstrates that a prolonged survival with a preserved quality of life may be reached in selected patients through the exploitation of the available treatments in an expertise setting.
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Affiliation(s)
- Luigi Cerbone
- SSD Mesotelioma, Tumori Rari e MelanomaAO SS Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | - Sara Delfanti
- SSD Mesotelioma, Tumori Rari e MelanomaAO SS Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | - Antonina M. De Angelis
- SSD Mesotelioma, Tumori Rari e MelanomaAO SS Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | - Stefania Crivellari
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI)AO SS Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | - Francesco Boccuzzi
- Department of RadiologyAO SS Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | - Angela Cimorelli
- SSD Mesotelioma, Tumori Rari e MelanomaAO SS Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | - Marinella Bertolotti
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI)AO SS Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | | | - Pietro Bertino
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI)AO SS Antonio e Biagio e Cesare ArrigoAlessandriaItaly,Department of Cell and Molecular BiologyUniversity of Hawai’i, Honolulu, HI, USAHonoluluHawai'iUSA
| | - Federica Grosso
- SSD Mesotelioma, Tumori Rari e MelanomaAO SS Antonio e Biagio e Cesare ArrigoAlessandriaItaly
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Gnerre P, Pasquali M, Aiosa G, Daniele A, Crivellari S, Bertolotti M, Salerno C, Di Dio A, Pacileo G, Maconi A, Marchisio S. Esiti dei pazienti COVID-19 positivi ricoverati durante la quarta ondata pandemica in relazione alle caratteristiche cliniche e allo stato vaccinale. Ital J Med 2022. [DOI: 10.4081/itjm.q.2022.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Non disponibile
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Grosso F, Crivellari S, Bertolotti M, Lia M, De Angelis A, Cassinari A, Riccio C, Piovano PL, Cappelletti M, Maconi A. A feasibility exploratory study of a novel modality of using patient-reported outcomes (PROsEXPLOR) in the real world. Tumori 2020; 106:464-470. [DOI: 10.1177/0300891620923745] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction: Patient-reported outcomes (PROs) can help clinicians better evaluate chemotherapy and immunotherapy toxicity based on patient perspectives. In this exploratory study, we tested a simplified PRO questionnaire (sPQ) in routine clinical practice and patient satisfaction with this tool. Methods: We included 16 items related to the main toxicities of chemotherapy and immunotherapy to be filled in by patients. A baseline sPQ was completed by patients before starting treatment and then in the interval between courses for a total of 4 sPQs. Patients communicated the results to a data manager, who alerted the referral oncologist in case of replies differing from the basal or previous sPQ. According to the severity of symptoms, the patient was then referred to the team nurse, the general practitioner, or another specialist. A satisfaction survey was also completed. Results: In a 3-month interval, 27 patients were enrolled. Fatigue and nausea were the most frequent symptoms reported as worsening during treatment. The oncologist was involved in the management of adverse events in 4 cases, home therapy variations were recommended by the dedicated nurse in 14 cases, additional visits were performed in 6 patients, and 1 patient was admitted to the oncology ward. None of the patients had unplanned visits to the emergency department or to the hospital. The sPQ was judged to be simple, useful, and satisfactory. Conclusions: Using sPQs in routine clinical practice was feasible and well-accepted by patients. PROs allowed us to recognize and promptly manage adverse events, reducing unplanned emergency department or hospital visits to zero.
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Affiliation(s)
- Federica Grosso
- SSD Mesotelioma and Rare Cancer, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Stefania Crivellari
- Infrastruttura Ricerca Formazione Innovazione, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marinella Bertolotti
- Infrastruttura Ricerca Formazione Innovazione, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Michela Lia
- SSD Mesotelioma and Rare Cancer, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonina De Angelis
- Infrastruttura Ricerca Formazione Innovazione, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonella Cassinari
- Infrastruttura Ricerca Formazione Innovazione, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Carmela Riccio
- Department of Oncology, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Pier Luigi Piovano
- Department of Oncology, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Antonio Maconi
- Infrastruttura Ricerca Formazione Innovazione, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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