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Giusti R, Porzio G, Maltoni M, Filetti M, Cuomo A, Bandieri E, Trapani D, Bruera E. Association of opioid use with survival in patients with cancer treated with immune checkpoint inhibitors: it is time for evidence-based behaviors. Oncologist 2024:oyae081. [PMID: 38688456 DOI: 10.1093/oncolo/oyae081] [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: 01/24/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
Cancer is a leading cause of morbidity and mortality worldwide, with pain experienced by most patients undergoing cancer treatment. Opioids are the recommended treatment for cancer pain management, but recent studies suggest a negative association between opioid use and survival rates among patients undergoing immunotherapy. However, conclusions cannot be drawn regarding causality from these observational data. Immunotherapy, which boosts the body's immune system to fight cancer cells, has emerged as a promising treatment option for all types of cancer. Immune checkpoint inhibitors (ICIs) can activate the anticancer function of exhausted T cells and have shown remarkable survival benefits in patients with multiple malignancies. However, a recent systematic review and meta-analysis suggested that the use of opioids during ICI treatment has an adverse effect on patient prognosis, while the use of NSAIDs is not significantly associated with the prognosis in patients treated with ICIs. These reviews have major limitations due to the retrospective nature of the studies and the multiple factors that can influence the phenomenon. Therefore, caution is required when interpreting results from retrospective data on drug interactions. The findings of this study are alarming and potentially harmful to patients with cancer suffering from pain or other symptoms requiring opioid drugs.
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Affiliation(s)
- Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Sant'Andrea, Rome, Italy
| | | | - Marco Maltoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco Filetti
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Arturo Cuomo
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Naples, Italy
| | - Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | | | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Bimonte S, Nocerino D, Schiavo D, Crisci M, Cascella M, Cuomo A. Cannabinoids for Cancer-related Pain Management: An Update on Therapeutic Applications and Future Perspectives. Anticancer Res 2024; 44:895-900. [PMID: 38423660 DOI: 10.21873/anticanres.16883] [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] [Received: 11/24/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 03/02/2024]
Abstract
Pain is a debilitating phenomenon that dramatically impairs the quality of life of patients. Many chronic conditions, including cancer, are associated with chronic pain. Despite pharmacological efforts that have been conducted, many patients suffering from cancer pain remain without treatment. To date, opioids are considered the preferred therapeutic choice for cancer-related pain management. Unfortunately, opioid treatment causes side effects and inefficiently relieves patients from pain, therefore alternative therapies have been considered, including Cannabis Sativa and cannabinoids. Accumulating evidence has highlighted that an increasing number of patients are choosing to use cannabis and cannabinoids for the management of their soothing and non-palliative cancer pain and other cancer-related symptoms. However, their clinical application must be supported by convincing and reproducible clinical trials. In this review, we provide an update on cannabinoid use for cancer pain management. Moreover, we tried to turn a light on the potential use of cannabis as a possible therapeutic option for cancer-related pain relief.
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Affiliation(s)
- Sabrina Bimonte
- Department of Anesthesia and Critical Care-Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy;
| | - Davide Nocerino
- Department of Anesthesia and Critical Care-Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Daniela Schiavo
- Department of Anesthesia and Critical Care-Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Marco Crisci
- Department of Anesthesia and Critical Care-Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Marco Cascella
- Unit of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Department of Medicine, Surgery, and Dentistry, University of Salerno, Baronissi, Italy
| | - Arturo Cuomo
- Department of Anesthesia and Critical Care-Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
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Morano C, Dei Cas M, Casagni E, Pallavicini M, Bolchi C, Penati S, Cuomo A, Cascella M, Bimonte S, Spensiero A, Ferrari A, Lombardi A, Roda G. Medicinal Cannabis: Extended Stability of Cannabis Extracts Produced Using a New Ethanol-based Extraction Method. Planta Med 2024; 90:73-80. [PMID: 37963569 DOI: 10.1055/a-2189-8155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Cannabis as a therapeutic agent is increasing in popularity all around the globe, particularly in Western countries, and its potential is now well assessed. On the other hand, each country has its own regulation for the preparation of cannabis macerated oils; in Italy, there are only a few preparation methods allowed. With this work, we aim to perform a stability study of cannabis oils produced with a novel method for the extraction of cannabinoids from cannabis inflorescence. Three different varieties of cannabis were used, with and without the adding of tocopherol acetate as an antioxidant. Cannabinoids were extracted using ethanol at room temperature; then, the solvent was evaporated under reduced pressure and the preparations reconstituted with olive oil. In this work, we assessed the stability of both cannabinoids and terpenes in these formulas over 8 months. Cannabinoid stability was assessed by monitoring the concentrations of THC and CBD, while terpene stability was assessed by monitoring β-Caryophyllene and α-Humulene concentrations. Stability of the extracts was not influenced by the presence of tocopherol acetate, though refrigeration seems to be detrimental for a long storage of products, especially regarding THC concentrations. The improvements offered by this method reside in the flexibility in controlling the concentration of the extract and the ability to produce highly concentrated oils, alongside the possibility to produce standardized oils despite the variability of the starting plant material.
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Affiliation(s)
- Camillo Morano
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Michele Dei Cas
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Eleonora Casagni
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Marco Pallavicini
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Cristiano Bolchi
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Sara Penati
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Arturo Cuomo
- Istituto Nazionale Tumori IRCCS, Fondazione 'G. Pascale', Division of Anesthesia and Pain Medicine, Naples, Italy
| | - Marco Cascella
- Istituto Nazionale Tumori IRCCS, Fondazione 'G. Pascale', Division of Anesthesia and Pain Medicine, Naples, Italy
| | - Sabrina Bimonte
- Istituto Nazionale Tumori IRCCS, Fondazione 'G. Pascale', Division of Anesthesia and Pain Medicine, Naples, Italy
| | - Antonia Spensiero
- Compounding Laboratory, Farmacia Caputo, Nocera Superiore (SA), Italy
| | | | | | - Gabriella Roda
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milan, Italy
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Cuomo A. Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits. Drugs Context 2023; 12:2023-10-2. [PMID: 38148830 PMCID: PMC10751104 DOI: 10.7573/dic.2023-10-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/14/2023] [Indexed: 12/28/2023] Open
Abstract
Cancer pain is an important challenge in treatment and requires a rapid onset of action for its control. In particular, breakthrough cancer pain (BTcP) should be adequately controlled with a stable dose of a short-acting oral opioid. Fentanyl is a synthetic, highly selective opioid with many advantageous chemical properties, including high lipophilicity and distinct pharmacokinetic properties. It is recommended for pain management in a variety of settings, including acute pain, chronic pain and BTcP. To date, its variously designed formulations allow non-invasive administration; amongst others, sublingual fentanyl has proven useful in the management of BTcP and in improving the quality of life of patients with cancer. This review provides an update on the management of BTcP with fentanyl, with consideration of safety, as it remains an important tool in the treatment of cancer pain.
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Affiliation(s)
- Arturo Cuomo
- Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples,
Italy
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Cascella M, Schiavo D, Cuomo A, Ottaiano A, Perri F, Patrone R, Migliarelli S, Bignami EG, Vittori A, Cutugno F. Artificial Intelligence for Automatic Pain Assessment: Research Methods and Perspectives. Pain Res Manag 2023; 2023:6018736. [PMID: 37416623 PMCID: PMC10322534 DOI: 10.1155/2023/6018736] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/03/2023] [Accepted: 04/20/2023] [Indexed: 07/08/2023]
Abstract
Although proper pain evaluation is mandatory for establishing the appropriate therapy, self-reported pain level assessment has several limitations. Data-driven artificial intelligence (AI) methods can be employed for research on automatic pain assessment (APA). The goal is the development of objective, standardized, and generalizable instruments useful for pain assessment in different clinical contexts. The purpose of this article is to discuss the state of the art of research and perspectives on APA applications in both research and clinical scenarios. Principles of AI functioning will be addressed. For narrative purposes, AI-based methods are grouped into behavioral-based approaches and neurophysiology-based pain detection methods. Since pain is generally accompanied by spontaneous facial behaviors, several approaches for APA are based on image classification and feature extraction. Language features through natural language strategies, body postures, and respiratory-derived elements are other investigated behavioral-based approaches. Neurophysiology-based pain detection is obtained through electroencephalography, electromyography, electrodermal activity, and other biosignals. Recent approaches involve multimode strategies by combining behaviors with neurophysiological findings. Concerning methods, early studies were conducted by machine learning algorithms such as support vector machine, decision tree, and random forest classifiers. More recently, artificial neural networks such as convolutional and recurrent neural network algorithms are implemented, even in combination. Collaboration programs involving clinicians and computer scientists must be aimed at structuring and processing robust datasets that can be used in various settings, from acute to different chronic pain conditions. Finally, it is crucial to apply the concepts of explainability and ethics when examining AI applications for pain research and management.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples 80131, Italy
| | - Daniela Schiavo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples 80131, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples 80131, Italy
| | - Alessandro Ottaiano
- SSD-Innovative Therapies for Abdominal Metastases, Istituto Nazionale Tumori di Napoli IRCCS “G. Pascale”, Via M. Semmola, Naples 80131, Italy
| | - Francesco Perri
- Head and Neck Oncology Unit, Istituto Nazionale Tumori IRCCS-Fondazione “G. Pascale”, Naples 80131, Italy
| | - Renato Patrone
- Dieti Department, University of Naples, Naples, Italy
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS, Fondazione Pascale-IRCCS di Napoli, Naples, Italy
| | - Sara Migliarelli
- Department of Pharmacology, Faculty of Medicine and Psychology, University Sapienza of Rome, Rome, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Rome 00165, Italy
| | - Francesco Cutugno
- Department of Electrical Engineering and Information Technologies, University of Naples “Federico II”, Naples 80100, Italy
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Cascella M, Scarpati G, Bignami EG, Cuomo A, Vittori A, Di Gennaro P, Crispo A, Coluccia S. Utilizing an artificial intelligence framework (conditional generative adversarial network) to enhance telemedicine strategies for cancer pain management. J Anesth Analg Crit Care 2023; 3:19. [PMID: 37386680 DOI: 10.1186/s44158-023-00104-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The utilization of artificial intelligence (AI) in healthcare has significant potential to revolutionize the delivery of medical services, particularly in the field of telemedicine. In this article, we investigate the capabilities of a specific deep learning model, a generative adversarial network (GAN), and explore its potential for enhancing the telemedicine approach to cancer pain management. MATERIALS AND METHODS We implemented a structured dataset comprising demographic and clinical variables from 226 patients and 489 telemedicine visits for cancer pain management. The deep learning model, specifically a conditional GAN, was employed to generate synthetic samples that closely resemble real individuals in terms of their characteristics. Subsequently, four machine learning (ML) algorithms were used to assess the variables associated with a higher number of remote visits. RESULTS The generated dataset exhibits a distribution comparable to the reference dataset for all considered variables, including age, number of visits, tumor type, performance status, characteristics of metastasis, opioid dosage, and type of pain. Among the algorithms tested, random forest demonstrated the highest performance in predicting a higher number of remote visits, achieving an accuracy of 0.8 on the test data. The simulations based on ML indicated that individuals who are younger than 45 years old, and those experiencing breakthrough cancer pain, may require an increased number of telemedicine-based clinical evaluations. CONCLUSION As the advancement of healthcare processes relies on scientific evidence, AI techniques such as GANs can play a vital role in bridging knowledge gaps and accelerating the integration of telemedicine into clinical practice. Nonetheless, it is crucial to carefully address the limitations of these approaches.
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Affiliation(s)
- Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy.
| | - Giuliana Scarpati
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana, " University of Salerno, 84084, Baronissi, SA, Italy
| | - Elena Giovanna Bignami
- Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Arturo Cuomo
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy
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Cuomo A, Marinangeli F, Magni A, Petrucci E, Vittori A, Cascella M. Investigating Functional Impairment in Chronic Low Back Pain: A Qualitative Study from the Patients and Specialists' Perspectives. J Pers Med 2023; 13:1012. [PMID: 37374001 DOI: 10.3390/jpm13061012] [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: 06/04/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Prompt and appropriate treatment of chronic low back pain (cLBP) is of the utmost importance for preventing relevant disability, high burden of disease, and increasing costs for the healthcare system. Recently, the concept of functional impairment has been associated with any type of chronic pain, and mounting attention has been paid to extending the aims of treatment beyond mere pain remission, including restoration of working capacity, everyday functioning, mobility, and quality of life. Nevertheless, a shared definition of functionality is still lacking. Notably, different specialists involved in the treatment of cLBP such as general practitioners, orthopedists, pain therapists, and physiatrists, and patients themselves have different opinions on what "functional impairment" actually means. On these premises, a qualitative interview study was performed to investigate how the concept of "functionality" is interpreted by different specialists involved in the management of cLBP, and by patients. Overall, all different specialists agreed that functionality should be assessed in clinical practice. However, in spite of several instruments available for evaluating functionality, no homogeneity of behavior is observable.
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Affiliation(s)
- Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS, "Fondazione G. Pascale", 80131 Naples, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 Coppito, Italy
| | - Alberto Magni
- Italian College of General Practitioners and Primary Care (SIMG), Via del Sansovino 179, 50142 Firenze, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, 67100 L'Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS, "Fondazione G. Pascale", 80131 Naples, Italy
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Cuomo A, Cascella M, Vittori A, Baciarello M, Badino M, Bignami E. Comments on "Telemedicine for Managing Cancer Pain. A Great Opportunity to be Exploited for CLinical and Research Purposes". Pain Physician 2023; 26:E108-E110. [PMID: 36988375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Arturo Cuomo
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Marco Cascella
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesiology and Critical Care, ARCO, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Baciarello
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Badino
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Bimonte S, Palma G, Cascella M, Cuomo A. Phytocannabinoids in Triple Negative Breast Cancer Treatment: Current Knowledge and Future Insights. Anticancer Res 2023; 43:993-1000. [PMID: 36854495 DOI: 10.21873/anticanres.16243] [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: 09/08/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 03/02/2023]
Abstract
Triple negative breast cancer (TNBC) represents an aggressive subtype of breast cancer, which is deficient in estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression. Thus, TNBC cells are unable to respond to the conventional hormonal therapies, making chemotherapy the only therapeutic choice. Patients with TNBC develop metastasis and recurrence over time and have reduced survival compared to patients with other subtypes of breast cancer. Therefore, there is a need for innovative therapies. Data emerged from pre-clinical studies, highlighted various antitumor activities of plant-derived Cannabis sativa and synthetic cannabinoids (CBs), including delta-9-tetrahydrocannabinol (THC) and non-psychoactive cannabidiol (CBD). On the contrary, some studies indicated that CBs might also promote tumor progression. At present, clinical studies on the effects of CBs from Cannabis sativa in cancer patients are few. In the present study, we reviewed known and possible interactions between cannabinoids and TNBC therapies.
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Affiliation(s)
- Sabrina Bimonte
- Division of Anesthesia and Pain Medicine Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy;
| | - Giuseppe Palma
- SSD Sperimentazione Animale, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G. Pascale", IRCCS, Naples, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
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Mercadante S, Caraceni A, Cuomo A, Mammucari M, Marchetti P, Mediati RD, Natoli S, Tonini G. Breakthrough pain in patients with multiple myeloma: a secondary analysis of IOPS MS study. Eur Rev Med Pharmacol Sci 2023; 27:1134-1139. [PMID: 36808361 DOI: 10.26355/eurrev_202302_31219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE The aim of this study was to characterize breakthrough pain (BTcP) in patients with multiple myeloma (MM). PATIENTS AND METHODS This was a secondary analysis of a large multicenter study of patients with BTcP. Background pain intensity and opioid doses were recorded. The BTcP characteristics, including the number of BTcP episodes, intensity, onset, duration, predictability, and interference with daily activities were recorded. Opioids prescribed for BTcP, time to achieve a meaningful pain relief after taking a medication, adverse effects, and patients' satisfaction were assessed. RESULTS Fifty-four patients with MM were examined. In comparison with other tumors, in patients with MM BTcP was more predictable (p=0.04), with the predominant trigger being the physical activity (p<0.001). Other BTcP characteristics, pattern of opioids used for background pain and BTcP, satisfaction and adverse effects did not differ. CONCLUSIONS Patients with MM have their own peculiarities. Given the peculiar involvement of the skeleton, BTcP was highly predictable and triggered by movement.
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Affiliation(s)
- S Mercadante
- Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena Cancer Center, Palermo, Italy.
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Vittori A, Cascella M, Petrucci E, Cortegiani A, Bignami EG, Innamorato MA, Cuomo A, Torrano V, Petrini F, Giarratano A, Natoli S, Marinangeli F. Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists. Pain Pract 2023. [PMID: 36690597 DOI: 10.1111/papr.13207] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE Fulfilling educational needs in pain management should be a lifelong process, even involving physicians board certified in pain medicine such as the anesthesiologists/pain therapists. The aim of the study was to investigate Italian anesthesiologists' self-perceived competency, confidence, and interest to attend educational programs in relation to their seniority in pain management. METHODS SIAARTI members were sent an online questionnaire addressing the following items: education, skills (both soft and hard skills), technical expertise and engaged to participate between December 2020 and January 2021. Participants rated their competence based on the following range (no knowledge, knowledge, competence) while their agreement to attend educational courses was assessed using a 5-point Likert-type scale. RESULTS Less than one in four participants declare to be dedicated to pain medicine activity with greater proportion among older (over 61 years) compared to younger ones (31-40 years). Regarding cancer and chronic noncancer pain a positive gradient of self-perceived competence has been observed in relation to seniority. In contrast, no gradient of self-perceived competence was reported about musculoskeletal and low back pain. Participants self-perceived competent in both opioid use and prevention of opioid-related adverse event while feeling less competent when managing drugs with abuse potential. The lowest competence has been observed in pediatric pain along with the lowest interest to attend educational courses. Participants were much and very much interested to education regarding cancer, noncancer, musculoskeletal, and low back pain, invasive analgesic procedures but less regarding items for which they declared less competence, such as use of pain scales, pain management in children, and use of drugs with abuse potential. CONCLUSION This work provides first evidence of a summative assessment of competency and related educational needs' profile of anesthesiologists/pain therapists thus paving the way for developing a nationwide educational program to improve chronic pain care in Italy.
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Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Marco Cascella
- Unit of Pain Medicine and Research, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, Faculty of Medicine and Surgery, University of Palermo, Palermo, Italy.,Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | | | | | - Arturo Cuomo
- Unit of Pain Medicine and Research, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy
| | - Vito Torrano
- Department of Anesthesia, Critical Care and Pain Medicine, Asst Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Flavia Petrini
- Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI), President 2019-2021, Rome, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science, Faculty of Medicine and Surgery, University of Palermo, Palermo, Italy.,Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS Maugeri, Pavia, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
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Monaco F, Coluccia S, Cuomo A, Nocerino D, Schiavo D, Pasta G, Bifulco F, Buonanno P, Riccio V, Leonardi M, Perri F, Ottaiano A, Sabbatino F, Vittori A, Cascella M. Bibliometric and Visual Analysis of the Scientific Literature on Percutaneous Electrical Nerve Stimulation (PENS) for Pain Treatment. Applied Sciences 2023; 13:636. [DOI: 10.3390/app13010636] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background: Percutaneous electrical nerve stimulation (PENS) is a minimally invasive peripheral neuromodulation approach implemented against chronic neuropathic and mixed pain. This bibliometric study aims to quantitatively evaluate the output of PENS for pain treatment in the scientific literature. The main purpose is to stimulate research in the field and bridge potential scientific gaps. Methods: Articles were retrieved from the Web of Science (WOS) database. The search key term was “percutaneous electrical nerve stimulation (All Fields) and pain (All Fields)”. Year of publication, journal metrics (impact factor and quartile, Q), title, document type, topic, and citations were extracted. The join-point regression was implemented to assess differences in time points for the publication output. The software tool VOSviewer (version 1.6.17) was used for the visual analysis. Results: One thousand three hundred and eighteen articles were included in the knowledge visualization process. A linear upward trend for annual new publications was found. Almost two-thirds of the documents were published in top-ranked journals (Q1 and Q2). The topic “efficacy” was prevalent (12.81%). Concerning article type, the search strategy yielded 307 clinical investigations (23.3%). Articles were cited 36,610 times with a mean of 42.4 citations per article. Approximately one-half of the articles were cited less than 23 times in a range of 21 years. The semantic network analysis for keywords found eight clusters. The analysis of collaborative efforts among researchers showed five thematic clusters including 102 authors with a minimum of five documents produced in collaborations. Most partnerships involved the United States, England, and Germany. Conclusions: despite the upward trend in the number of publications on the subject and the publication of articles in top-ranked journals, there is a need to increase scientific collaborations between researchers and institutions from different countries.
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Cuomo A, Boutis A, Colonese F, Nocerino D. High-rate breakthrough cancer pain and tumour characteristics - literature review and case series. Drugs Context 2023; 12:dic-2022-11-1. [PMID: 36926050 PMCID: PMC10012833 DOI: 10.7573/dic.2022-11-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/08/2023] [Indexed: 03/18/2023] Open
Abstract
Cancer pain requires careful comprehensive patient evaluation and an appropriate and personalized clinical approach by a trained multidisciplinary team. The proper assessment of breakthrough cancer pain (BTcP) is part of an all-inclusive multidimensional evaluation of the patient. The aim of this narrative review is to explore the relationship between high-rate BTcP, which strongly impacts health- related quality of life and tumour characteristics, in the face of novel approaches that should provide guidance for future clinical practice. The presentation of short, emblematic clinical reports also promotes knowledge of BTcP, which, despite the availability of numerous therapeutic approaches, remains underdiagnosed and undertreated. This article is part of the Management of breakthrough cancer pain Special Issue: https://www.drugsincontext.com/special_issues/management-of-breakthrough-cancer-pain.
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Affiliation(s)
- Arturo Cuomo
- IRCCS Istituto Nazionale Tumori Fondazione G Pascale, Napoli, Italy
| | - Anastasios Boutis
- First Department of Clinical Oncology, Theagenio Hospital, Thessaloniki, Greece
| | - Francesca Colonese
- Department Medical Oncology-ASST-Monza Ospedale San Gerardo, Monza, Italy
| | - Davide Nocerino
- IRCCS Istituto Nazionale Tumori Fondazione G Pascale, Napoli, Italy
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Cascella M, Perri F, Ottaiano A, Cuomo A, Wirz S, Coluccia S. Trends in Research on Artificial Intelligence in Anesthesia: A VOSviewer -Based Bibliometric Analysis. ia 2022; 25:126-137. [DOI: 10.4114/intartif.vol25iss70pp126-137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Background: The scientific literature on Artificial Intelligence (AI) in anesthesia is rapidly growing. Considering that applications of AI strategies can offer paramount support in clinical decision processes, it is crucial to delineate the research features. Bibliometric analyses can provide an overview of research tendencies useful for supplementary investigations in a research field. Methods: The comprehensive literature about AI in anesthesia was checked in the Web of Science (WOS) core collection. Year of publication, journal metrics including impact factor and quartile, title, document type, topic, and article metric (citations) were extracted. The software tool VOSviewer (version 1.6.17) was implemented for the co-occurrence of keywords and the co-citation analyses, and for evaluating research networks (countries and institutions). Results: Altogether, 288 documents were retrieved from the WOS and 154 articles were included in the analysis. The number of articles increased from 4 articles in 2017 to 37 in 2021. Only 34 were observational investigations and 7 RCTs. The most relevant topic is “anesthesia management”. The research network for countries and institutions shows severe gaps. Conclusion: Research on AI in anesthesia is rapidly developing. Further clinical studies are needed. Although different topics are addressed, scientific collaborations must be implemented.
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Natoli S, Vittori A, Cascella M, Innamorato M, Finco G, Giarratano A, Marinangeli F, Cuomo A. Raising Awareness on the Clinical and Social Relevance of Adequate Chronic Pain Care. Int J Environ Res Public Health 2022; 20:551. [PMID: 36612872 PMCID: PMC9819839 DOI: 10.3390/ijerph20010551] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Appropriate pain care should be regarded as a right and effectively guaranteed to people with chronic pain (CP). Law 38, enacted in Italy in 2010, establishes the citizen's right not to suffer. Twelve years later, such right appears still disregarded in Italy and the current access to adequate pain care reveals significant shortcomings. In addition, a mismatch between CP-associated burden and the available healthcare resources in the framework of our national health system has been observed. This article gathers the perspectives of a Board of Italian anesthesiologists on the state of the art of CP management in Italy and aims at strengthening the scientific rationale and clinical relevance of pursuing the enforceability of the right not to suffer and at promoting widespread multidisciplinary care of patients with CP.
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Affiliation(s)
- Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Roma, Italy
- IRCCS Maugeri, 27100 Pavia, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80131 Naples, Italy
| | - Massimo Innamorato
- Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Gabriele Finco
- Intensive Care Unit, Azienda Ospedaliero Universitaria Cagliari, 09042 Monserrato, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological, and Oral Science (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, 90127 Palermo, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, 67100 L’Aquila, Italy
| | - Arturo Cuomo
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80131 Naples, Italy
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Cuomo A, Libri C, Barillà G, Cattolico M, Carmellini P, Fagiolini A. QTc interval diurnal variations in patients treated with psychotropic medications: implications for the evaluation of drug induced QTc changes. Int Rev Psychiatry 2022; 34:689-692. [PMID: 36786118 DOI: 10.1080/09540261.2022.2135985] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Psychotropic drugs such as antipsychotics may prolong the QTc interval, increasing the risk of torsades de pointes (TdP) and sudden cardiac death. To assess QTc prolongation by psychotropic drugs, an electrocardiogram (EKG) is usually recorded before and after starting treatment. Circadian variations in the QTc interval have been described but have not been adequately studied in patients taking psychotropic drugs. In psychiatric clinical practice, EKGs before and after treatment initiation are often compared, without considering the time of day at which the two EKGs are recorded. To determine whether there is a circadian change in the QTc interval in patients treated with psychotropic drugs, we evaluated the EKGs of a group of patients treated with psychotropic drugs (85% on antipsychotics) and the EKGs of a group of patients that were not treated with medications. In each group, we compared the EKGs recorded before 11:00 am with those recorded after 5:00 pm. The QTc value was significantly longer in the group treated with psychotropic drugs than in the group without drugs at both morning and evening evaluations (p ≤ 0.001). In each group, a statistically significant difference was found between the EKGs recorded before 11:00 a.m. and the EKGs recorded after 5:00 p.m. In patients treated with medications, the mean QTc in the morning was 453.3 ± 25.4 while the mean QTc in the afternoon was 428.4 ± 24.7 (p < 0.0001). In patients who were not receiving any medication, the morning mean QTc was 422.4 ± 22.6 while the mean afternoon QTc was 409.4 ± 19.6 (p = 0.002). These results suggest that a circadian variation in QTc is observed both in patients taking psychotropic drugs and in patients not taking medication. We conclude that any comparison of EKGs to test the effect on QTc of a medication, should be referred to EKGs recorded at the same time of day.
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Affiliation(s)
- A Cuomo
- School of Medicine, University of Siena, Siena, Italy
| | - C Libri
- School of Medicine, University of Siena, Siena, Italy
| | - G Barillà
- School of Medicine, University of Siena, Siena, Italy
| | - M Cattolico
- School of Medicine, University of Siena, Siena, Italy
| | - P Carmellini
- School of Medicine, University of Siena, Siena, Italy
| | - A Fagiolini
- School of Medicine, University of Siena, Siena, Italy
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Cascella M, Coluccia S, Monaco F, Schiavo D, Nocerino D, Grizzuti M, Romano MC, Cuomo A. Different Machine Learning Approaches for Implementing Telehealth-Based Cancer Pain Management Strategies. J Clin Med 2022; 11:jcm11185484. [PMID: 36143132 PMCID: PMC9502863 DOI: 10.3390/jcm11185484] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/31/2022] [Accepted: 09/14/2022] [Indexed: 12/27/2022] Open
Abstract
Background: The most effective strategy for managing cancer pain remotely should be better defined. There is a need to identify those patients who require increased attention and calibrated follow-up programs. Methods: Machine learning (ML) models were developed using the data prospectively obtained from a single-center program of telemedicine-based cancer pain management. These models included random forest (RF), gradient boosting machine (GBM), artificial neural network (ANN), and the LASSO−RIDGE algorithm. Thirteen demographic, social, clinical, and therapeutic variables were adopted to define the conditions that can affect the number of teleconsultations. After ML validation, the risk analysis for more than one remote consultation was assessed in target individuals. Results: The data from 158 patients were collected. In the training set, the accuracy was about 95% and 98% for ANN and RF, respectively. Nevertheless, the best accuracy on the test set was obtained with RF (70%). The ML-based simulations showed that young age (<55 years), lung cancer, and occurrence of breakthrough cancer pain help to predict the number of remote consultations. Elderly patients (>75 years) with bone metastases may require more telemedicine-based clinical evaluations. Conclusion: ML-based analyses may enable clinicians to identify the best model for predicting the need for more remote consultations. It could be useful for calibrating care interventions and resource allocation.
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Affiliation(s)
- Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80100 Naples, Italy
- Department of Electrical Engineering and Information Technologies—DIETI, University Federico II, 80138 Naples, Italy
- Correspondence: ; Tel.: +39-0815903221
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80100 Naples, Italy
| | - Federica Monaco
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80100 Naples, Italy
| | - Daniela Schiavo
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80100 Naples, Italy
| | - Davide Nocerino
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80100 Naples, Italy
| | - Mariacinzia Grizzuti
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80100 Naples, Italy
| | - Maria Cristina Romano
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80100 Naples, Italy
| | - Arturo Cuomo
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80100 Naples, Italy
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Biancuzzi H, Dal Mas F, Brescia V, Campostrini S, Cascella M, Cuomo A, Cobianchi L, Dorken-Gallastegi A, Gebran A, Kaafarani HM, Marinangeli F, Massaro M, Renne A, Scaioli G, Bednarova R, Vittori A, Miceli L. Opioid Misuse: A Review of the Main Issues, Challenges, and Strategies. Int J Environ Res Public Health 2022; 19:ijerph191811754. [PMID: 36142028 PMCID: PMC9517221 DOI: 10.3390/ijerph191811754] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 05/23/2023]
Abstract
In the United States, from 1999 to 2019, opioid overdose, either regularly prescribed or illegally acquired, was the cause of death for nearly 500,000 people. In addition to this pronounced mortality burden that has increased gradually over time, opioid overdose has significant morbidity with severe risks and side effects. As a result, opioid misuse is a cause for concern and is considered an epidemic. This article examines the trends and consequences of the opioid epidemic presented in recent international literature, reflecting on the causes of this phenomenon and the possible strategies to address it. The detailed analysis of 33 international articles highlights numerous impacts in the social, public health, economic, and political spheres. The prescription opioid epidemic is an almost exclusively North American problem. This phenomenon should be carefully evaluated from a healthcare systems perspective, for consequential risks and harms of aggressive opioid prescription practices for pain management. Appropriate policies are required to manage opioid use and prevent abuse efficiently. Examples of proper policies vary, such as the use of validated questionnaires for the early identification of patients at risk of addiction, the effective use of regional and national prescription monitoring programs, and the proper dissemination and translation of knowledge to highlight the risks of prescription opioid abuse.
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Affiliation(s)
- Helena Biancuzzi
- Department of Clinical and Experimental Pain Medicine, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS Centro di Riferimento Oncologico—CRO of Aviano, 33081 Aviano, Italy
| | - Francesca Dal Mas
- Department of Management, Ca’ Foscari University of Venice, 30100 Venice, Italy
| | - Valerio Brescia
- Department of Management, University of Turin, 10134 Turin, Italy
- Department of Finance, Wrocław University of Economics and Business, 53-345 Wrocław, Poland
| | - Stefano Campostrini
- Department of Economics, Ca’ Foscari University of Venice, 30100 Venice, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, Fondazione Pascale, 80131 Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, Fondazione Pascale, 80131 Naples, Italy
| | - Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- General Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Ander Dorken-Gallastegi
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Anthony Gebran
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Haytham M. Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Maurizio Massaro
- Department of Management, Ca’ Foscari University of Venice, 30100 Venice, Italy
| | - Angela Renne
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Giacomo Scaioli
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Rym Bednarova
- Department of Pain Medicine, Hospital of Latisana, 33053 Latisana, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, 00165 Rome, Italy
| | - Luca Miceli
- Department of Clinical and Experimental Pain Medicine, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS Centro di Riferimento Oncologico—CRO of Aviano, 33081 Aviano, Italy
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Cuomo A, Cascella M, Vittori A, Baciarello M, Badino M, Bignami E. Telemedicine for Managing Cancer Pain. A Great Opportunity to be Exploited for Clinical and Research Purposes. Pain Physician 2022; 25:E886-E888. [PMID: 36122279] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Arturo Cuomo
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Marco Cascella
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesiology and Critical Care, ARCO, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Baciarello
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Badino
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Cascella M, Monaco F, Nocerino D, Chinè E, Carpenedo R, Picerno P, Migliaccio L, Armignacco A, Franceschini G, Coluccia S, Gennaro PD, Tracey MC, Forte CA, Tafuri M, Crispo A, Cutugno F, Vittori A, Natoli S, Cuomo A. Bibliometric Network Analysis on Rapid-Onset Opioids for Breakthrough Cancer Pain Treatment. J Pain Symptom Manage 2022; 63:1041-1050. [PMID: 35151801 DOI: 10.1016/j.jpainsymman.2022.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Proper breakthrough cancer pain (BTcP) management is of pivotal importance. Although rapid-acting, oral and nasal transmucosal, fentanyl formulations (rapid-onset opioids, ROOs) are licensed for BTcP treatment, not all guidelines recommend their use. Presumably, some research gaps need to be bridged to produce solid evidence. We present a bibliometric network analysis on ROOs for BTcP treatment. METHODS Documents were retrieved from the Web of Science (WOS) online database. The string was "rapid onset opioids" or "transmucosal fentanyl" and "breakthrough cancer pain". Year of publication, journal metrics (impact factor and quartile), title, document type, topic, and clinical setting (in-patients, outpatients, and palliative care) were extracted. The software tool VOSviewer (version 1.6.17) was used to analyze the semantic network analyzes, bibliographic coupling, journals analysis, and research networks. RESULTS 502 articles were found in WOS. A declining trend in published articles from 2014 to 2021 was observed. Approximately 50% of documents regard top quartile (Q1) journals. Most articles focused on ROOs efficacy, but abuse and misuse issues are poorly addressed. With respect to article type, we calculated 132 clinical investigations. The semantic network analysis found interconnections between the terms "breakthrough cancer pain," "opioids," and "cancers." The top co-cited article was published in 2000 and addressed pain assessment. The largest number of partnerships regarded the United States, Italy, and England. CONCLUSION In this research area, most articles are published in top-ranked journals. Nevertheless, paramount topics should be better addressed, and the implementation of research networks is needed.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine (M.C., F.M., D.N., M.C.T., C.A.F., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy; Department of Electrical Engineering and Information Technologies (M.C., F.C.), Università di Napoli "Federico II", 80100 Napoli, Italy.
| | - Federica Monaco
- Division of Anesthesia and Pain Medicine (M.C., F.M., D.N., M.C.T., C.A.F., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy
| | - Davide Nocerino
- Division of Anesthesia and Pain Medicine (M.C., F.M., D.N., M.C.T., C.A.F., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy
| | - Elisabetta Chinè
- Unit of Pain Therapy (E.C., R.C., S.N.), Polyclinic of Tor Vergata, Rome, Italy
| | - Roberta Carpenedo
- Unit of Pain Therapy (E.C., R.C., S.N.), Polyclinic of Tor Vergata, Rome, Italy
| | - Paola Picerno
- Residency Programme of Anaesthesiology (P.P., L.M., A. A., G.F.), Intensive Care and Pain Therapy. University of Rome Tor Vergata, Italy
| | - Laura Migliaccio
- Residency Programme of Anaesthesiology (P.P., L.M., A. A., G.F.), Intensive Care and Pain Therapy. University of Rome Tor Vergata, Italy
| | - Angela Armignacco
- Residency Programme of Anaesthesiology (P.P., L.M., A. A., G.F.), Intensive Care and Pain Therapy. University of Rome Tor Vergata, Italy
| | - Giulia Franceschini
- Residency Programme of Anaesthesiology (P.P., L.M., A. A., G.F.), Intensive Care and Pain Therapy. University of Rome Tor Vergata, Italy
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit (S.C., P.D.G., M.T., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80100 Naples, Italy
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit (S.C., P.D.G., M.T., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80100 Naples, Italy
| | - Maura C Tracey
- Division of Anesthesia and Pain Medicine (M.C., F.M., D.N., M.C.T., C.A.F., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy
| | - Cira A Forte
- Division of Anesthesia and Pain Medicine (M.C., F.M., D.N., M.C.T., C.A.F., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy
| | - Mariangela Tafuri
- Epidemiology and Biostatistics Unit (S.C., P.D.G., M.T., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80100 Naples, Italy
| | - Anna Crispo
- Epidemiology and Biostatistics Unit (S.C., P.D.G., M.T., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80100 Naples, Italy
| | - Francesco Cutugno
- Department of Electrical Engineering and Information Technologies (M.C., F.C.), Università di Napoli "Federico II", 80100 Napoli, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care (A.V.), ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Silvia Natoli
- Unit of Pain Therapy (E.C., R.C., S.N.), Polyclinic of Tor Vergata, Rome, Italy; Department of Clinical Science and Translational Medicine University of Rome (S.N.), Tor Vergata, Rome, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine (M.C., F.M., D.N., M.C.T., C.A.F., A.C.), Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy
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21
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Di Franco R, Cascella M, Fusco M, Borzillo V, Scipilliti E, Ferraioli P, Iannacone E, De Palma G, Silvestro G, Gherardi F, Buonopane S, Alberti D, Totaro G, Manzo R, Guida G, Cuomo A, Pignata S, Di Napoli M, Rossetti S, Celentano E, Crispo A, Grimaldi M, Ravo V, Muto P. Management of Metastatic Disease in Campania (MAMETIC): An Observational Multicenter Retrospective and Prospective Trial on Palliative Radiotherapy in an Italian Region. Study Protocol. J Pain Res 2022; 15:1003-1010. [PMID: 35422656 PMCID: PMC9005129 DOI: 10.2147/jpr.s336357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Methods Conclusion
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Affiliation(s)
- Rossella Di Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
- Correspondence: Rossella Di Franco, Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia, Email
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, Italia
| | - Mario Fusco
- Cancer Registry Unit, ASL Napoli 3 SUD, Napoli, Italia
| | - Valentina Borzillo
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Esmeralda Scipilliti
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Piera Ferraioli
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Eva Iannacone
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Giampaolo De Palma
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Giustino Silvestro
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Federica Gherardi
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Sergio Buonopane
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Domingo Alberti
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Giuseppe Totaro
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Roberto Manzo
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Giovanna Guida
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, Italia
| | - Sandro Pignata
- Department of Uro-Gynecological, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Marilena Di Napoli
- Department of Uro-Gynecological, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Sabrina Rossetti
- Department of Uro-Gynecological, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Vincenzo Ravo
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
| | - Paolo Muto
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italia
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Cascella M, Cuomo A, Bifulco F, Perri F, Carbone F, Aprea M, Forte CA, Fiore M. Could the perioperative use of opioids influence cancer outcomes after surgery? A scoping review protocol. BMJ Open 2022; 12:e054520. [PMID: 35292495 PMCID: PMC8928327 DOI: 10.1136/bmjopen-2021-054520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND During and after general anaesthesia, opioids are commonly used for pain treatment. Since preclinical studies underlined the potential immunosuppressive activity of these drugs, it was postulated that their perioperative administration could influence cancer outcomes after surgery. Nevertheless, clinical data have been extrapolated mainly from retrospective analyses. Consequently, the precise link between perioperative opioid use and cancer recurrence/metastasis or cancer-related mortality/morbidity is still an unsolved issue. METHODS AND ANALYSIS This scoping review is planned to follow the Joanna Briggs Institute recommendations. The authors will conduct a literature review through the PRISMA statement using PubMed and EMBASE databases; the Grey literature will be explored using Google Scholar and Conference Proceedings Citation Index (via Web of Science). The search strategy will be limited to articles published in the English language and to human studies. The database searches are planned from the inception to January 2022. Two reviewers will independently screen titles and abstracts, followed by a full-text screening of potentially relevant articles with standardised data extraction. Any disagreement for the inclusion between the two reviewers will be discussed with a third reviewer. ETHICS AND DISSEMINATION The review aims to map the available literature, focusing on a possible association between perioperative opioid use and cancer outcomes in patients undergoing surgery. The proposed approach will be useful to identify and analyse the knowledge gap in the field and serve as a prerequisite for future research. SCOPING REVIEW REGISTRATION Open Science Framework https://osf.io/vfhw6/ DOI 10.17605/OSF.IO/VFHW6.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Francesca Bifulco
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Francesco Perri
- Department of Head/Neck and Sarcoma Oncology, INT IRCCS G Pascale, Napoli, Italy
| | - Francesca Carbone
- Dipartimento di Sanità Pubblica, Unversità di Napoli Federico II, Napoli, Italy
| | | | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Marco Fiore
- Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
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23
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Cascella M, Vittori A, Petrucci E, Marinangeli F, Giarratano A, Cacciagrano C, Tizi ES, Miceli L, Natoli S, Cuomo A. Strengths and Weaknesses of Cancer Pain Management in Italy: Findings from a Nationwide SIAARTI Survey. Healthcare (Basel) 2022; 10:healthcare10030441. [PMID: 35326919 PMCID: PMC8951760 DOI: 10.3390/healthcare10030441] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 01/18/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023] Open
Abstract
Objectives: Despite guidelines, a large percentage of cancer patients continue to suffer from ineffectively treated pain. The authors undertook this survey to assess the strengths and weaknesses of cancer pain management in Italy. Design: This was a prospectively administered survey. Participants: The participants were anesthesiologists of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Intervention: A 58-item questionnaire covered the demographics and features of cancer pain management in the Italian context. Results: The authors received responses from 611 pain therapists of 279 centers. Only 22% of physicians are exclusively pain therapists. Seventy-five percent are specialists in anesthesiology, intensive care, and pain medicine. Most pain centers are hospital or university facilities (78%). The strengths of cancer pain management in Italy are the careful opioid prescriptions, the use of strategies for the treatment of neuropathic pain, patient/healthcare provider partnerships, and breakthrough cancer pain management. Weaknesses to be addressed include poor adherence to guidelines, inadequate attention toward the patient’s quality of life, insufficient use of minimally invasive techniques, lack of teamwork approaches, inappropriate timing of pain specialist engagement, and poor telemedicine use. Conclusions: Despite several strengths, further efforts are needed to improve the care of patients suffering from cancer pain in Italy.
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Affiliation(s)
- Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80100 Naples, Italy;
- Correspondence: ; Tel.: +39-0815903221
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy;
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, 67100 L’Aquila, Italy;
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy;
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, 90127 Palermo, Italy
| | - Cristina Cacciagrano
- Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI), 80100 Rome, Italy; (C.C.); (E.S.T.)
| | - Emiliano Simone Tizi
- Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI), 80100 Rome, Italy; (C.C.); (E.S.T.)
| | - Luca Miceli
- Unit of Pain Medicine, IRCCS Centro di Riferimento Oncologico (CRO), 33081 Aviano, Italy;
| | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00173 Rome, Italy;
| | - Arturo Cuomo
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80100 Naples, Italy;
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24
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Di Monta G, Marone U, Avino F, Esposito E, Cepparulo V, Morra E, Saponara R, Bifulco F, Cuomo A, Cascella M, Mori S. Superomedial pedicle skin-reducing mastectomy in ptotic and large-sized breasts with two-stage reconstruction through transaxillary video-assisted technique: An effective surgical and anesthetic approach. Front Surg 2022; 9:1040602. [PMID: 36684343 PMCID: PMC9850288 DOI: 10.3389/fsurg.2022.1040602] [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: 09/09/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Skin-reducing mastectomy has been applied to several surgical techniques in which subcutaneous mastectomy is associated with various types of skin reduction, with preservation of a lower dermal flap to reinforce the inferior lateral seat of an implant. The aim of the study is to present a case series of patients with pendulous/ptotic and/or large-sized breasts treated for breast cancer at the Breast Surgery Unit of Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy, with the superomedial pedicle skin-reducing mastectomy technique, two-stage reconstruction, and transaxillary video-assisted technique, when a postoperative radiotherapy was indicated. We verified its effectiveness by discussing its results, especially in patients who are candidates for postmastectomy radiotherapy. Materials and methods A single-center retrospective study was performed between January 2020 and March 2021 on a prospectively filled database of conservative mastectomies. Of the 64 patients who underwent nipple/skin-sparing mastectomies in the mentioned period, 17 (mean age 46 years, range 30-62 years) were treated with superomedial pedicle skin-reducing mastectomy, with two-stage breast reconstruction through transaxillary video-assisted replacement expander with definitive prosthesis and contralateral symmetrization, selected for postmastectomy radiotherapy. Results We had only three minor complications. No flap necrosis, no infections, no breast seromas, and no reconstructive failures were observed. During follow-up of the patients treated with video-assisted reconstruction, there were no cases of infection, hematoma, implant rupture, or suture dehiscence in the reconstructed breast. Discussion Skin-reducing mastectomy with superomedial pedicle is a safe and reliable procedure to treat breast cancer in selected patients, i.e., those with pendulous/ptotic and or large-sized breasts. Particularly, in patients who undergo postmastectomy radiotherapy, the two-stage reconstruction with video-assisted transaxillary endoscopic approach can find its main indication, using incisions positioned far from the mammary region, offering numerous advantages.
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Affiliation(s)
- G Di Monta
- UOSD Oncoplastic Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - U Marone
- UOC Breast Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - F Avino
- UOC Breast Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - E Esposito
- UOC Breast Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - V Cepparulo
- UOSD Oncoplastic Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - E Morra
- UOSD Oncoplastic Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - R Saponara
- UOC Breast Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - F Bifulco
- UOC Division of Anesthesia, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - A Cuomo
- UOC Division of Anesthesia, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - M Cascella
- UOC Division of Anesthesia, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - S Mori
- UOSD Oncoplastic Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
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Crisci M, Cuomo A, Forte CA, Bimonte S, Esposito G, Tracey MC, Cascella M. Advantages and issues of concern regarding approaches to peripheral nerve block for total hip arthroplasty. World J Clin Cases 2021; 9:11504-11508. [PMID: 35071584 PMCID: PMC8717497 DOI: 10.12998/wjcc.v9.i36.11504] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/23/2021] [Accepted: 11/29/2021] [Indexed: 02/06/2023] Open
Abstract
In older patients with comorbidities, hip fractures are both an important and debilitating condition. Since multimodal and multidisciplinary perioperative strategies can hasten functional recovery after surgery improving clinical outcomes, the choice of the most effective and safest pathway represents a great challenge. A key point of concern is the anesthetic approach and above all the choice of the locoregional anesthesia combined with general or neuraxial anesthesia.
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Affiliation(s)
- Marco Crisci
- Division of Anesthesia and Pain Medicine, Institute Nazionale Tumori-IRCCS-Fondazione Pascale, Napoli 80100, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Institute Nazionale Tumori-IRCCS-Fondazione Pascale, Napoli 80100, Italy
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Institute Nazionale Tumori-IRCCS-Fondazione Pascale, Napoli 80100, Italy
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Institute Nazionale Tumori-IRCCS-Fondazione Pascale, Napoli 80100, Italy
| | - Gennaro Esposito
- Division of Anesthesia and Pain Medicine, Institute Nazionale Tumori-IRCCS-Fondazione Pascale, Napoli 80100, Italy
| | - Maura C Tracey
- Scientific Direction, Institute Nazionale Tumori-IRCCS-Fondazione Pascale, Napoli 80100, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Institute Nazionale Tumori-IRCCS-Fondazione Pascale, Napoli 80100, Italy
- Department of Electrical Engineering and Information Technology, Faculty of Engineering, University of Napoli Federico II, No. 21 Via Claudio, Napoli 80125, Italy
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26
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Cascella M, Miceli L, Cutugno F, Di Lorenzo G, Morabito A, Oriente A, Massazza G, Magni A, Marinangeli F, Cuomo A. A Delphi Consensus Approach for the Management of Chronic Pain during and after the COVID-19 Era. Int J Environ Res Public Health 2021; 18:ijerph182413372. [PMID: 34948983 PMCID: PMC8706033 DOI: 10.3390/ijerph182413372] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/29/2022]
Abstract
Due to a lack of published evidence on the topic, a modified Delphi approach was used to develop recommendations useful for chronic pain management during and after the COVID-19 pandemic. Focusing on the available literature and personal clinical expertise, an Italian board of nine professionals from different disciplines identified four main topics: prevention of chronic pain, treatment of chronic pain, consequences of inadequate treatment, and perspectives. They elaborated a semi-structured questionnaire. A multidisciplinary panel of experts in the field of pain management was requested to comment on the statements. Based on the answers provided, a structured questionnaire was prepared (Round 1). It included 21 statements divided into three categories (organizational issues; diagnosis and therapies; telemedicine and future perspectives). A five-point Likert scale was adopted. The threshold for consensus was set at a minimum of 70% of the number of respondents (level of agreement ≥ 4, Agree or Strongly Agree). A final questionnaire with rephrasing of the statements that did not reach the consensus threshold was elaborated (Round 2). A total of 29 clinicians were included in the panel. Twenty clinicians (69%) responded in both the first and second round. After two rounds, consensus (≥70%) was achieved in 20 out of 21 statements. The lack of consensus was recorded for the statement regarding the management of post-COVID pain (55%; Median 4; IQR 2.3). Another statement on telemedicine reached the threshold in the first round (70%), but the value was not confirmed in Round 2 (65%; Median 4; IQR 2). Most of the proposed items reached consensus, suggesting the need to make organizational changes, the structuring of careful diagnostic and therapeutic pathways, and the application of new technologies in pain medicine. Long-COVID-19 care is an issue that needs further research. Remote assistance for chronic pain must be regulated.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, 80100 Napoli, Italy;
- Department of Electrical Engineering and Information Technologies, Università di Napoli “Federico II”, 80100 Napoli, Italy;
- Correspondence:
| | - Luca Miceli
- Department of Pain Medicine, IRCCS C.R.O. National Cancer Institute of Aviano, 33081 Aviano, Italy;
| | - Francesco Cutugno
- Department of Electrical Engineering and Information Technologies, Università di Napoli “Federico II”, 80100 Napoli, Italy;
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
- Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80100 Napoli, Italy;
| | - Alfonso Oriente
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, 80100 Napoli, Italy;
| | - Giuseppe Massazza
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University di Torino, 10121 Torino, Italy;
| | - Alberto Magni
- Italian College of General Practitioners and Primary Care (SIMG), Via Del Sansovino 179, 50142 Firenze, Italy;
| | - Franco Marinangeli
- Department of Life, Health & Environmental Sciences, University of l’Aquila, 67100 l’Aquila, Italy;
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, 80100 Napoli, Italy;
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Vittori A, Petrucci E, Cascella M, Innamorato M, Cuomo A, Giarratano A, Petrini F, Marinangeli F. Pursuing the Recovery of Severe Chronic Musculoskeletal Pain in Italy: Clinical and Organizational Perspectives from a SIAARTI Survey. J Pain Res 2021; 14:3401-3410. [PMID: 34744457 PMCID: PMC8565982 DOI: 10.2147/jpr.s328434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background Increased attention to the functional impact of chronic pain (CP), as highlighted by the 11th revision of the International Classification of Diseases (ICD-11) and advocated by the International Classification of Functioning, Disability and Health (ICF), is an important step forward for optimizing its management. Evidence about perspectives of Italian physicians on the relevance of musculoskeletal (MSK) pain care to improve patients’ functioning and Quality of Life is scant. The study aimed to investigate the physicians’ perception of the value of functional recovery in severe MSK pain patients, their attitude towards its assessment and achievement in Italy. Methods A survey was conducted in Italy between October 2020 and January 2021. Specialist centers members of the SIAARTI (n = 395) were sent an online questionnaire encompassing the Italian pain therapy network. Participants rated their agreement to questionnaire items according to a 5-point Likert-type scale. Results A total of 305 centers (77%) completed the survey. Most physicians rated the recovery of functioning as very relevant in MSK pain treatment and, when they assessed it, devoted great attention to the ability to perform daily activities, pain, ability to ambulate and sleep quality. Multidimensional questionnaires were less employed in favor of physical examination and pain intensity scales. Pharmacological therapy, rehabilitation and lifestyle changes and/or physical exercise were all rated optimal strategies to pursue the recovery of patients’ functioning. When considering pharmacological therapy, weak and strong opioids, either alone or combined with paracetamol, were the most frequently employed analgesics. Conclusion Clinicians seem to recognize the recovery of functioning as equally important as pain intensity reduction, but there is a need of streamlining available tools to effectively assess both across different MSK pain patients.
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Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy
| | - Massimo Innamorato
- Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Arturo Cuomo
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Flavia Petrini
- SIAARTI (Italian Society of Anaesthesia, Analgesia, Reanimation and Intensive Care Medicine), Rome, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
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Bimonte S, Forte CA, Cuomo M, Esposito G, Cascella M, Cuomo A. An Overview on the Potential Roles of EGCG in the Treatment of COVID-19 Infection. Drug Des Devel Ther 2021; 15:4447-4454. [PMID: 34737551 PMCID: PMC8560077 DOI: 10.2147/dddt.s314666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/05/2021] [Indexed: 01/18/2023] Open
Abstract
Coronavirus disease-19 (COVID-19) pandemic is currently ongoing worldwide and causes a lot of deaths in many countries. Although different vaccines for the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection have been developed and are now available, there are no effective antiviral drugs to treat the disease, except for Remdesivir authorized by the US FDA to counteract the emergency. Thus, it can be useful to find alternative therapies based on the employment of natural compounds, with antiviral features, to circumvent SARS-CoV-2 infection. Pre-clinical studies highlighted the antiviral activities of epigallocatechin-3-gallate (EGCG), a catechin primarily found in green tea, against various viruses, including SARS-CoV-2. In this review, we summarize this experimental evidence and highlight the potential use of EGCG as an alternative therapeutic choice for the treatment of SARS-CoV-2 infection.
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Affiliation(s)
- Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Massimiliano Cuomo
- S.C. Project Management e Formazione, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Gennaro Esposito
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
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29
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Crispo A, Bimonte S, Porciello G, Forte CA, Cuomo G, Montagnese C, Prete M, Grimaldi M, Celentano E, Amore A, de Blasio E, Pentimalli F, Giordano A, Botti G, Baglio G, Sileri P, Cascella M, Cuomo A. Strategies to evaluate outcomes in long-COVID-19 and post-COVID survivors. Infect Agent Cancer 2021; 16:62. [PMID: 34717691 PMCID: PMC8556851 DOI: 10.1186/s13027-021-00401-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022] Open
Abstract
SARS-CoV-2 infection can impact the physical, cognitive, mental health of patients, especially in those recovered in intensive care units. Moreover, it was proved that the effects of the virus may persist for weeks or months. The term long-COVID or post-COVID syndrome is commonly used for indicating a variety of physical and psychological symptoms that continue after the resolution of the acute phase. This narrative review is aimed at providing an updated overview of the impact of physical, cognitive, and psychological health disorders in COVID-19 survivors, by summarizing the data already published in literature in the last year. Studies cited were found through PubMed searches. We also presented an overview of the post-COVID-19 health consequences on three important aspects: nutritional status, neurological disorders, and physical health. Moreover, to activate a correct health planning policy, a multidisciplinary approach for addressing the post- COVID-19 issue, has been proposed. Finally, the involvement of health professionals is necessary even after the pandemic, to reduce expected post-pandemic psychosocial responses and mental health disorders.
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Affiliation(s)
- Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori Fondazione G. Pascale, 80131, Naples, Italy.
| | - Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori Fondazione G. Pascale, 80131, Naples, Italy
| | - Gaia Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori Fondazione G. Pascale, 80131, Naples, Italy
| | - Concetta Montagnese
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Melania Prete
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Alfonso Amore
- SSD Chirurgia Melanoma E Dei Tumori Cutanei, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Elvio de Blasio
- Multidisciplinary Emergency Unit for COVID-19 Campania, 80100, Naples, Italy
| | - Francesca Pentimalli
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Antonio Giordano
- Ministry of Health, 00153, Rome, Italy.,Center for Biotechnology, College of Science and Technology, Sbarro Institute for Cancer Research and Molecular Medicine, Temple University, Philadelphia, PA, 19122, USA
| | - Gerardo Botti
- Scientific Direction, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Giovanni Baglio
- Head of the Unit "Research and International Relations", Italian National Agency for Regional Health Services - AGENAS, 00187, Rome, Italy
| | | | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori Fondazione G. Pascale, 80131, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori Fondazione G. Pascale, 80131, Naples, Italy
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Maraolo AE, Crispo A, Piezzo M, Di Gennaro P, Vitale MG, Mallardo D, Ametrano L, Celentano E, Cuomo A, Ascierto PA, Cascella M. The Use of Tocilizumab in Patients with COVID-19: A Systematic Review, Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Studies. J Clin Med 2021; 10:jcm10214935. [PMID: 34768455 PMCID: PMC8584705 DOI: 10.3390/jcm10214935] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Among the several therapeutic options assessed for the treatment of coronavirus disease 2019 (COVID-19), tocilizumab (TCZ), an antagonist of the interleukine-6 receptor, has emerged as a promising therapeutic choice, especially for the severe form of the disease. Proper synthesis of the available randomized clinical trials (RCTs) is needed to inform clinical practice. Methods: A systematic review with a meta-analysis of RCTs investigating the efficacy of TCZ in COVID-19 patients was conducted. PubMed, EMBASE, and the Cochrane COVID-19 Study Register were searched up until 30 April 2021. Results: The database search yielded 2885 records; 11 studies were considered eligible for full-text review, and nine met the inclusion criteria. Overall, 3358 patients composed the TCZ arm, and 3131 the comparator group. The main outcome was all-cause mortality at 28–30 days. Subgroup analyses according to trials’ and patients’ features were performed. A trial sequential analysis (TSA) was also carried out to minimize type I and type II errors. According to the fixed-effect model approach, TCZ was associated with a better survival odds ratio (OR) (0.84; 95% confidence interval (CI): 0.75–0.94; I2: 24% (low heterogeneity)). The result was consistent in the subgroup of severe disease (OR: 0.83; 95% CI: 0.74–0.93; I2: 53% (moderate heterogeneity)). However, the TSA illustrated that the required information size was not met unless the study that was the major source of heterogeneity was omitted. Conclusions: TCZ may represent an important weapon against severe COVID-19. Further studies are needed to consolidate this finding.
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Affiliation(s)
- Alberto Enrico Maraolo
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, 80131 Naples, Italy;
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (P.D.G.); (E.C.)
- Correspondence:
| | - Michela Piezzo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy;
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (P.D.G.); (E.C.)
| | - Maria Grazia Vitale
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto NazionaleTumori, IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (M.G.V.); (D.M.); (P.A.A.)
| | - Domenico Mallardo
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto NazionaleTumori, IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (M.G.V.); (D.M.); (P.A.A.)
| | - Luigi Ametrano
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy;
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (P.D.G.); (E.C.)
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (A.C.); (M.C.)
| | - Paolo A. Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto NazionaleTumori, IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (M.G.V.); (D.M.); (P.A.A.)
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (A.C.); (M.C.)
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Cuomo A, Cascella M, Vittori A, Marinangeli F. Chronic low back pain as a biopsychosocial disease: time to change our point of view. J Anesth Analg Crit Care 2021; 1:7. [PMCID: PMC10245422 DOI: 10.1186/s44158-021-00010-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 06/17/2023]
Affiliation(s)
- Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione Pascale, Naples, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione Pascale, Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, L’Aquila, Italy
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Bimonte S, Cascella M, Forte CA, Esposito G, Del Prato F, Raiano N, Del Prete P, Cuomo A. Effects of the Hypnotic Alkylphenol Derivative Propofol on Breast Cancer Progression. A Focus on Preclinical and Clinical Studies. In Vivo 2021; 35:2513-2519. [PMID: 34410937 DOI: 10.21873/invivo.12532] [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: 05/05/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022]
Abstract
Propofol is a hypnotic alkylphenol derivative with many biological activities. It is predominantly used in anesthesia and is the most used parenteral anesthetic agent in the United States. Accumulating preclinical studies have shown that this compound may inhibit cancer recurrence and metastasis. Nevertheless, other investigations provided evidence that this compound may promote breast cancer cell progression by modulating different molecular pathways. Clinical data on this topic are scarce and derive from retrospective analyses. For this reason, we reviewed and evaluated the available data to reveal insight into this controversial issue. More preclinical and clinical investigations are necessary to determine the potential role of propofol in the proliferation of breast cancer cells.
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Affiliation(s)
- Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy;
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Gennaro Esposito
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Francesco Del Prato
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Nicola Raiano
- Radiology Division, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Paola Del Prete
- Direzione Scientifica, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
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Cascella M, Del Gaudio A, Vittori A, Bimonte S, Del Prete P, Forte CA, Cuomo A, De Blasio E. COVID-Pain: Acute and Late-Onset Painful Clinical Manifestations in COVID-19 - Molecular Mechanisms and Research Perspectives. J Pain Res 2021; 14:2403-2412. [PMID: 34408485 PMCID: PMC8364364 DOI: 10.2147/jpr.s313978] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/01/2021] [Indexed: 01/08/2023] Open
Abstract
Although the respiratory manifestations of COVID-19 are predominant, signs and symptoms of an extra-pulmonary involvement are usually encompassed among the clinical picture of the disease. Several painful manifestations can occur during the acute phase but also as short- or long-term complications. Myalgia, joint pain, sore throat, abdominal pain, chest pain, and headache usually accompany respiratory symptoms, but they can also occur as isolated clinical findings or can be expressed regardless of the severity of COVID-19. On these premises, given the vast spectrum of clinical manifestations and the complexity of their pathogenesis, it would be more appropriate to refer to "COVID-pain", an umbrella term useful for encompassing all these clinical manifestations in a separate chapter of the disease. In this scenario, we addressed the topic from a molecular perspective, trying to provide explanations for the underlying pathophysiological processes. Consequently, this narrative review is aimed at dissecting the mechanisms of acute and chronic painful manifestations, summarizing fundamental concepts on the matter, controversies, current research gaps, and potential developments in this field.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, Naples, 80131, Italy
| | - Alfredo Del Gaudio
- DSC Anestesia e Rianimazione 2, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, 71013, FG, Italy
| | - Alessandro Vittori
- Department of Anesthesiology and Critical Care, ARCO, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, Naples, 80131, Italy
| | - Paola Del Prete
- Direzione Scientifica, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, Naples, 80131, Italy
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, Naples, 80131, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, Naples, 80131, Italy
| | - Elvio De Blasio
- DSC Anestesia e Rianimazione 2, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, 71013, FG, Italy
- Multidisciplinary Emergency Unit for COVID-19 Campania, Naples, 80100, Italy
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Gigliotti S, Cascella M, Santè G, De Marinis P, Cuomo A. Lumbar spinal stenosis as a model for the multimodal and multiprofessional treatment of mixed non-cancer pain. Survey response from a panel of experts of the Italian National Association of Osteoarticular Specialists (ASON). Anaesthesiol Intensive Ther 2021; 53:252-264. [PMCID: PMC10165336 DOI: 10.5114/ait.2021.108153] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/31/2021] [Indexed: 09/12/2023] Open
Abstract
Background Because in degenerative diseases mixed pain represents a complex issue encompassing different types of chronic pain, a multimodal and patient-tailored approach is desirable. By using lumbar spinal stenosis as a model, the study was aimed at identifying what an expert panel believes can be helpful to treat mixed-type pain due to benign osteoarticular lesions. Methods A faculty composed of 2 orthopaedists, a neurosurgeon, and 2 pain therapists performed a literature review (PubMed/MEDLINE, EMBASE, and CENTRAL) for the development of a questionnaire on the management of mixed non-cancer pain. Subsequently, this 17-item tool was submitted to physicians (orthopaedists, physiatrists, and rheumatologists) members of the Italian National Association of Osteoarticular Specialists (ASON), before and after a meeting discussion. Results The database search yielded 256 records. Fifty-seven records were identified through other sources. After removal of 235 duplicates and exclusion of 52 non-pertinent records, 26 full-text articles were assessed for eligibility. Of those, 10 papers were excluded, and 13 articles were included in the qualitative synthesis for the development of the tool. The expert panel developed a 17-item questionnaire focused on 3 main thematic areas: ‘diagnostic approach, counselling, and multidisciplinary approach’, ‘therapeutic approaches’, and ‘patient communication strategies’. Conclusions The most desirable approach to mixed osteoarticular pain must follow a multimodal and multidisciplinary approach. Combined pharmacological and non-pharmacological strategies must be strengthened. The use of opioids in non-cancer chronic pain must follow a careful case-by-case analysis.
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Affiliation(s)
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori – IRCCS – Fondazione Pascale, Napoli, Italy
| | | | - Pasqualino De Marinis
- Neurosurgical Unit, Saint Anna and Saint Sebastian Hospital of Caserta, Caserta, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori – IRCCS – Fondazione Pascale, Napoli, Italy
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Miranda A, Gravina AG, Cuomo A, Mucherino C, Sgambato D, Facchiano A, Granata L, Priadko K, Pellegrino R, de Filippo FR, Camera S, Cuomo R, Melina R, D'Onofrio V, Manguso F, Ciacci C, Romano M. Efficacy of ustekinumab in the treatment of patients with Crohn's disease with failure to previous conventional or biologic therapy: a prospective observational real-life study. J Physiol Pharmacol 2021; 72. [PMID: 34987127 DOI: 10.26402/jpp.2021.4.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/30/2021] [Indexed: 12/08/2022]
Abstract
Ustekinumab (UST), a human anti-IL12/23p40 monoclonal antibody, was approved by FDA and EMA for the treatment of moderate to severe Crohn's disease (CD). Whether UST is effective in inducing deep remission, including mucosal healing and transmural healing, in patients with CD in a real life setting is not completely clear. This study was performed on 92 subjects with confirmed diagnosis of moderate to severe Crohn's disease and no neoplasia. Before inclusion, all patients had been exposed and had failed to respond to conventional and/or at least one biological therapy. All patients underwent endoscopic examination and bowel MRI and ultrasonography at baseline (T0). At week 52 (T52), patients underwent colonoscopy for assessment of mucosal healing and MRI or ultrasonography for assessment of transmural healing. CDAI was used for the assessment of clinical response and clinical remission. SES-CD was used to assess endoscopic response and remission. Incidence of treatment-related adverse events (TRAEs) was recorded during the study period. Clinical response at week 52 was achieved in 38 (50.5%) patients and clinical remission in 29 (39%). Twenty-six (34%) patients showed mucosal healing, 34 (45%) showed partial endoscopic response. We observed a reduction in SES-CD of at least 50% in 34 (45%) patients as well as an SES-CD ≤ 2 in 26 (35%) patients. All patients with mucosal healing also showed transmural healing. No major TRAEs were observed during treatment. In this multicenter, real life study, we show that UST was well tolerated and effective in inducing clinical response and clinical remission in patients with moderate to severe CD who had previously failed to respond to conventional or biologic therapy. UST showed limited efficacy in inducing deep remission (i.e. mucosal+transmural healing).
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Affiliation(s)
- A Miranda
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - A G Gravina
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - A Cuomo
- Gastroenterology Unit "Umberto I" Hospital, Nocera Inferiore, Salerno, Italy
| | - C Mucherino
- Gastroenterology and Endoscopy Unit, S. Anna-S. Sebastiano Hospital, Caserta, Italy
| | - D Sgambato
- Department of Gastroenterology, S. G. Moscati Hospital, Avellino, Italy
| | - A Facchiano
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - L Granata
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - K Priadko
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - R Pellegrino
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - F R de Filippo
- Gastroenterology Unit, Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - S Camera
- Gastroenterology Unit "Umberto I" Hospital, Nocera Inferiore, Salerno, Italy
| | - R Cuomo
- Department of Gastroenterology, S. G. Moscati Hospital, Avellino, Italy
| | - R Melina
- Department of Gastroenterology, S. G. Moscati Hospital, Avellino, Italy
| | - V D'Onofrio
- Department of Gastroenterology, S. G. Moscati Hospital, Avellino, Italy
| | - F Manguso
- Complex Operating Unit of Gastroenterology, AORN 'A. Cardarelli', Naples, Italy
| | - C Ciacci
- Gastroenterology Unit, Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - M Romano
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
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Bimonte S, Cascella M, Forte CA, Esposito G, Cuomo A. The Role of Anti-Nerve Growth Factor Monoclonal Antibodies in the Control of Chronic Cancer and Non-Cancer Pain. J Pain Res 2021; 14:1959-1967. [PMID: 34234542 PMCID: PMC8253925 DOI: 10.2147/jpr.s302004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 12/11/2022] Open
Abstract
Nerve growth factor (NGF) belongs to the neurotrophin family and plays a fundamental role in the endurance of sensory and sympathetic neurons during embryogenesis. NGF, by interacting with tropomyosin receptor kinase A receptor (TrkA), modulates the pain pathway through the enhancement of the neurotrophic and nociceptor functions. Moreover, it has been demonstrated that NGF is upregulated in patients with chronic pain syndromes, which are difficult to treat. Thus, new non-pharmacological approaches, based on the use of different species-specific monoclonal antibodies (mAbs) targeting the NGF pathway, have been tested for the treatment of chronic pain in preclinical and clinical studies. With regard to preclinical investigations, anti-NGF mAbs have been used for the management of osteoarthritis (OA) and chronic low back pain animal models, with encouraging results. Moreover, anti-NGF mAb therapy is effective in animal models of neuropathic cancer pain. As regards patients with OA, although phase II and phase III clinical trials with tanezumab led to pain reduction, the safety was not observed in all these patients. Here, we review the preclinical and clinical studies on anti-NGF mAb therapy in chronic syndromes, dissect the role of NGF in pain transduction, and highlight the use of anti-NGF mAbs in humans.
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Affiliation(s)
- Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Gennaro Esposito
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
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Pensabene M, Von Arx C, Giuliana S, Calabrese F, Capodanno P, Piscopo AM, Cavalcanti E, Cuomo A, Capasso G, De Laurentiis M, Simeoni M. MO234LIFE THREATENING MALIGNANT HYPERCALCEMIA IN BREAST CANCER: CAN THE NEPHROLOGIST CHANGE THE PATIENT DESTINY? Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab092.00112] [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: 11/14/2022] Open
Abstract
Abstract
Background
Malignant hypercalcemia is a common complication in cancer patients and can be predictive of poor prognosis and advanced malignancy. Cancer-related mechanisms of hypercalcemia depends either on ectopic hypersecretion of humoral factors (PTH, PTH-like molecules, Vit D) by the tumoral mass, or on osteolysis due to bone invasion. In consideration of the high renal and cardiac impact of severe hypercalcemia, its prompt recognition and treatment can be lifesaving. AKI is frequently associated with malignant hypercalcemia and recognizes a multifactorial pathogenesis (direct renal vasoconstriction, volume depletion, tubule-interstitial damage, etc.). Substitutive renal treatment can be necessary, but not always viable in patients with poor physical performance and is a difficult choice in cancer patients with advanced malignancies.
Case report
We present the case of a 46 years old woman with an infiltrating non special type (NST) carcinoma of the right breast (luminal B, ER 70%, PgR 60%, Ki67 35%, HER2 1+). Unfortunately, she quickly progressed after a neoadjuvant treatment with Epirubicin/Cyclophosfamide (4 cycles) followed by Paclitaxel (10 cycles). A first line hormonal treatment (Palbociclib, Letrozole and LHRH analogous) was then started, but a further rapid disease progression was observed. A new biopsy showed a muted and more aggressive cancer phenotype (high grade triple negative carcinoma with no PDL1 expression). Due to a rapid worsening of general conditions with cognitive impairment, the patient was admitted to the Oncology department. Blood test showed severe hypercalcemia (corrected calcium: 23.26 mg/dl) and severe hypokalemic metabolic alkalosis (blood pH 7.57; HCO-3 32 mmol/l; K+ 2.6 mmol/l) associated to AKI (creatinine doubled to 1.42 mg/dl; eGFR 45 ml/min/1,73 mq). Alkaline phosphatase and Vitamin D were normal and iPTH was < 2 pg/ml. ECG showed a significant QTc prolongation to 550 msec. Imaging exams revealed lung metastasis, lung carcinomatous lymphangitis and bilateral pleural effusion, while Bone Scan showed a low caption limited to right ribs. Oncologists and Intensive Care Physicians referred to our Nephrology and Dialysis Unit proposing Hemodialysis support. In consideration of the preserved diuresis, the advanced disease stage and the unstable hemodynamics, our advice was instead for a conservative medical approach. An i.v. infusion of 4000 ml NaCl 0.9% + KCl 60 mEq/24h; a continuous i.v. infusion of Furosemide 5mg/h were started and maintained for several days, leading to a progressive and full renal function recovery (creatinine decreased to 0.7 mg/dl) and metabolic alkalosis correction. However, corrected calcium remained largely over target, being 16.3 mg/dl. Sodium bicarbonate 80 mEq, Zoledronic acid 4 mg and Desametasone 4mg/day were administered and at day 16 even calcium was in normal range. We realized that this was a favourable window for acting on the underlaying cause of malignant hypercalcemia, that likely was the aberrant secretion of non-dosable PTH-like molecule(s). Thus, we suggested the Oncologist to start chemotherapy, and they were allowed to treat the patient with Carboplatin/Gemcitabine. The patient was successfully treated with stabilization of normocalcemia and is still alive.
Conclusion
Malignant hypercalcemia is a life-threatening complication in advanced malignancies. Our case report highlights the key role of the nephrologist in treating a complex and fragile oncologic patient, achieving the full correction of several severe renal disorders, hemodialysis avoidance and survival improvement.
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Affiliation(s)
- Matilde Pensabene
- INT IRCCS Foundation “G.Pascale”, Experimental Clinical Oncology of Breast Cancer, Naples, Italy
| | - Claudia Von Arx
- INT IRCCS Foundation “G.Pascale”, Experimental Clinical Oncology of Breast Cancer, Naples, Italy
| | - Sofia Giuliana
- University of Campania “L. Vanvitelli”, Department of Translational Medical Sciences, Division of Nephrology, Naples, Italy
| | - Filomena Calabrese
- INT IRCCS Foundation “G.Pascale”, Experimental Clinical Oncology of Breast Cancer, Naples, Italy
| | - Paola Capodanno
- INT IRCCS Foundation “G.Pascale”, Intensive Care Unit, Naples, Italy
| | - Anna Maria Piscopo
- INT IRCCS Foundation “G.Pascale”, Dept of Biochemistry Unit, Naples, Italy
| | - Ernesta Cavalcanti
- INT IRCCS Foundation “G.Pascale”, Dept of Biochemistry Unit, Naples, Italy
| | - Arturo Cuomo
- INT IRCCS Foundation “G.Pascale”, Intensive Care Unit, Naples, Italy
| | - Giovambattista Capasso
- Biogem Research Institute s.c.a.r.l, Molecular Biology and Genetics, Ariano Irpino, Italy
| | - Michelino De Laurentiis
- INT IRCCS Foundation “G.Pascale”, Experimental Clinical Oncology of Breast Cancer, Naples, Italy
| | - Mariadelina Simeoni
- University of Campania “L. Vanvitelli”, Department of Translational Medical Sciences, Division of Nephrology, Naples, Italy
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Fiore M, Alfieri A, Pace MC, Simeon V, Chiodini P, Leone S, Wirz S, Cuomo A, Stoia V, Cascella M. A scoping review of retracted publications in anesthesiology. Saudi J Anaesth 2021; 15:179-188. [PMID: 34188638 PMCID: PMC8191241 DOI: 10.4103/sja.sja_1110_20] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 11/14/2020] [Accepted: 11/22/2020] [Indexed: 11/15/2022] Open
Abstract
Context: Fraudulent publication is a scourge of scientific research. Objectives: This scoping review was aimed at characterizing retracted publications for fraud or plagiarism in the field of anesthesia. Does the reputation of the journal (Quartile and Impact Factor, IF) protect the reader from the risk of having the manuscript he read withdrawn for fraud/plagiarism? Methods/Design: This scoping review was planned following the Joanna Briggs Institute recommendations. Data sources: PubMed and the Retraction Watch Database (http://retractiondatabase.org/RetractionSearch.aspx?). Study selection: All types of publications retracted. Data extraction: Year, first author nationality, journal name, journal category, IF, Quartile, H index. Data analysis: The association with Quartile and IF was investigated. Results: No significant association between retraction of papers published in no-Quartile journals and retractions published in journals placed in the highest quartile. Conclusions: The quality of the surveillance in paper submission is not higher in journals of the first Quartile than in journals not placed in other Quartiles. (The protocol was prospectively registered in the Open Science Framework https://doi.org/10.17605/OSF.IO/TGKNE)
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Affiliation(s)
- Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Aniello Alfieri
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Caterina Pace
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vittorio Simeon
- Department of Public, Clinical and Preventive Medicine, Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Chiodini
- Department of Public, Clinical and Preventive Medicine, Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Sebastiano Leone
- Department of General and Specialized Medicine, "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - Stefan Wirz
- Abteilung für Anästhesie, Intensivmedizin, Schmerzmedizin/Palliativmedizin - Zentrum für Schmerzmedizin, Weaningzentrum, CURA Krankenhaus, Betriebsstätte der GFO-Kliniken Bonn, Schülgenstr. 15, Bad Honnef, Deutschland, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Vincenzo Stoia
- Division of Nuclear Medicine, University of Medicine, "Aldo Moro", Bari, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
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De Santis S, Simone MD, Mercadante S, Mediati RD, Vellucci R, Marchetti P, Tonini G, Cuomo A, Caraceni A, Natoli S, Armento G, Blasi L, Mammucari M. Oxycodone/Acetaminophen: The Tailoring Combination Treatment for Specific Clinical Profile of Opioid Well-Responsive Cancer Pain. Cancer Manag Res 2021; 13:1747-1756. [PMID: 33642876 PMCID: PMC7903954 DOI: 10.2147/cmar.s290551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background International guidelines recommend moderate-to-severe cancer pain to be treated with strong opioids. However, pain management remains an unsolved matter, at least in the demanding oncology and palliative care setting. Although cancer pain consists of multiple components, which interact in complex ways where combination therapy can better intercept multiple pain characteristics, few studies have used a non-opioid/opioid association to exploit possible synergistic actions. Even the efforts of a recent approach emphasizing appropriate pain assessment and accurate classification to obtain personalized pain management have not produced a satisfactory analgesic strategy. Objective This analysis was intended to evaluate the effectiveness of the immediate release fixed combination of oxycodone/acetaminophen (OxyIR/Par) for the treatment of moderate-to-severe intensity background pain used alone or in combination with other strong opioids in cancer patients with breakthrough cancer pain (BTcP). This is a secondary analysis of a wider observational, prospective, multicenter study [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] performed on 179 patients treated with opioids for cancer pain who received the fixed combination of oxycodone/acetaminophen (OxyIR/Par) for the treatment of background pain (BGP). Results Cancer patients with breakthrough cancer pain and controlled BGP (Background Pain) were classified according to the presence of analgesic therapy with tablets of fixed combination OxyIR/Par alone (group A, n=120) or tablets of fixed combination OxyIR/Par combined with other strong opioids (group B, n=59). Clinical features of group A were different to group B: higher mean Karnofsky Performance Status Index 70.3% (95% CI=67.2–73.5; median=70, CI=60–80) vs 58.3 (95% CI=53.4–63.2; median=50, CI=45–70) (P<0.001), and mainly group A patients were treated in an ambulatory setting (55.0% group A vs 33.9% group B) (p<0.001). Both groups had managed BGP with similar mean dosages (group A: 12.0, CI=10.5–13.4; group B: 13.1, CI=11.0–15.1) and frequencies of OxyIR/Par alone for group A and in association to other opioids for group B, but Breakthrough cancer Pain (BTcP) exhibited different characteristics in the two groups, showing a lower mean intensity numerical rating scale (NRS) of 7.5 (95% CI=7.2–7.7; median=7, CI=7–8 group A) vs 7.9 (95% CI=7.6, 8.2; median= 8, CI=7–9 group B) (P=0.04) and a higher percentage of patients had a faster onset, defined as the maximum intensity reached in less than 10 minutes, 81.7% (N=98) in group A vs 59.3% (n=35) in group B (P=0.002). Conclusion This is the first analysis about the efficacy of an immediate-release fixed combination of OxyIR/Par in the real world for moderate-to-severe background cancer pain and breakthrough cancer pain. The oral fixed combination OxyIR/Par provided an adequate level of analgesia for moderate–severe background cancer pain, in a different cohort of cancer patients with different performance status, both in ambulatory and palliative settings. The low dosage of fixed combination OxyIR/Par was effective alone or in association with other opioids.
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Affiliation(s)
- Stefano De Santis
- Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, Rome, Italy
| | | | - Sebastiano Mercadante
- Anesthesia and Intensive Care & Pain Relief and Supportive Care, La Maddalena, Palermo, Italy
| | | | - Renato Vellucci
- Palliative Care and Pain Therapy Unit, Careggi Hospital, Florence, Italy
| | - Paolo Marchetti
- Molecular and Clinical Medicine Medical Oncology, La Sapienza University of Rome, Rome, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Arturo Cuomo
- Anesthesiology, Resuscitation, and Pain Therapy Department, National Cancer Institute, IRCCS Foundation, Naples, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation, National Cancer Institute, IRCCS Foundation, Milan, Italy
| | - Silvia Natoli
- Department of Clinical Science and Translational Medicine - University of Rome Tor Vergata and Department of Emergency, Admission and Critical Area - Policlinic of Tor Vergata, Rome, Italy
| | - Grazia Armento
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Livio Blasi
- Medical Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
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Buonaguro FM, Botti G, Ascierto PA, Pignata S, Ionna F, Delrio P, Petrillo A, Cavalcanti E, Di Bonito M, Perdonà S, De Laurentiis M, Fiore F, Palaia R, Izzo F, D'Auria S, Rossi V, Menegozzo S, Piccirillo M, Celentano E, Cuomo A, Normanno N, Tornesello ML, Saviano R, Barberio D, Buonaguro L, Giannoni G, Muto P, Miscio L, Bianchi AAM. The clinical and translational research activities at the INT - IRCCS "Fondazione Pascale" cancer center (Naples, Italy) during the COVID-19 pandemic. Infect Agent Cancer 2020; 15:69. [PMID: 33292365 PMCID: PMC7681193 DOI: 10.1186/s13027-020-00330-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/01/2020] [Indexed: 01/19/2023] Open
Abstract
COVID-19 pandemic following the outbreak in China and Western Europe, where it finally lost the momentum, is now devastating North and South America. It has not been identified the reason and the molecular mechanisms of the two different patterns of the pulmonary host responses to the virus from a minimal disease in young subjects to a severe distress syndrome (ARDS) in older subjects, particularly those with previous chronic diseases (including diabetes) and cancer. The Management of the Istituto Nazionale Tumori - IRCCS "Fondazione Pascale" in Naples (INT-Pascale), along with all Health professionals decided not to interrupt the treatment of those hospitalized and to continue, even if after a careful triage in order not to allow SARS-CoV-2 positive subjects to access, to take care of cancer patients with serious conditions. Although very few (n = 3) patients developed a symptomatic COVID-19 and required the transfer to a COVID-19 area of the Institute, no patients died during the hospitalization and completed their oncology treatment. Besides monitoring of the patients, all employees of the Institute (physicians, nurses, researchers, lawyers, accountants, gatekeepers, guardians, janitors) have been tested for a possible exposure. Personnel identified as positive, has been promptly subjected to home quarantine and subdued to health surveillance. One severe case of respiratory distress has been reported in a positive employees and one death of a family member. Further steps to home monitoring of COVID-19 clinical course have been taken with the development of remote Wi-Fi connected digital devices for the detection of early signs of respiratory distress, including heart rate and oxygen saturation.In conclusion cancer care has been performed and continued safely also during COVID-19 pandemic and further remote home strategies are in progress to ensure the appropriate monitoring of cancer patients.
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Affiliation(s)
| | - Gerardo Botti
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Franco Ionna
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Paolo Delrio
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | | | | | - Sisto Perdonà
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | - Francesco Fiore
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Raffaele Palaia
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Francesco Izzo
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Stefania D'Auria
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Virginia Rossi
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Simona Menegozzo
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Mauro Piccirillo
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Egidio Celentano
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Arturo Cuomo
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Nicola Normanno
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | - Rocco Saviano
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Daniela Barberio
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Luigi Buonaguro
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | - Paolo Muto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Leonardo Miscio
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
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Pantano F, Manca P, Armento G, Zeppola T, Onorato A, Iuliani M, Simonetti S, Vincenzi B, Santini D, Mercadante S, Marchetti P, Cuomo A, Caraceni A, Mediati RD, Vellucci R, Mammucari M, Natoli S, Lazzari M, Dauri M, Adile C, Airoldi M, Azzarello G, Blasi L, Chiurazzi B, Degiovanni D, Fusco F, Guardamagna V, Liguori S, Palermo L, Mameli S, Masedu F, Mazzei T, Melotti RM, Menardo V, Miotti D, Moroso S, Pascoletti G, De Santis S, Orsetti R, Papa A, Ricci S, Scelzi E, Sofia M, Aielli F, Valle A, Tonini G. Breakthrough Cancer Pain Clinical Features and Differential Opioids Response: A Machine Learning Approach in Patients With Cancer From the IOPS-MS Study. JCO Precis Oncol 2020; 4:2000158. [PMID: 33283139 PMCID: PMC7713587 DOI: 10.1200/po.20.00158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Accepted: 10/02/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A large proportion of patients with cancer suffer from breakthrough cancer pain (BTcP). Several unmet clinical needs concerning BTcP treatment, such as optimal opioid dosages, are being investigated. In this analysis the hypothesis, we explore with an unsupervised learning algorithm whether distinct subtypes of BTcP exist and whether they can provide new insights into clinical practice. METHODS Partitioning around a k-medoids algorithm on a large data set of patients with BTcP, previously collected by the Italian Oncologic Pain Survey group, was used to identify possible subgroups of BTcP. Resulting clusters were analyzed in terms of BTcP therapy satisfaction, clinical features, and use of basal pain and rapid-onset opioids. Opioid dosages were converted to a unique scale and the BTcP opioids-to-basal pain opioids ratio was calculated for each patient. We used polynomial logistic regression to catch nonlinear relationships between therapy satisfaction and opioid use. RESULTS Our algorithm identified 12 distinct BTcP clusters. Optimal BTcP opioids-to-basal pain opioids ratios differed across the clusters, ranging from 15% to 50%. The majority of clusters were linked to a peculiar association of certain drugs with therapy satisfaction or dissatisfaction. A free online tool was created for new patients’ cluster computation to validate these clusters in future studies and provide handy indications for personalized BTcP therapy. CONCLUSION This work proposes a classification for BTcP and identifies subgroups of patients with unique efficacy of different pain medications. This work supports the theory that the optimal dose of BTcP opioids depends on the dose of basal opioids and identifies novel values that are possibly useful for future trials. These results will allow us to target BTcP therapy on the basis of patient characteristics and to define a precision medicine strategy also for supportive care.
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Affiliation(s)
- Francesco Pantano
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paolo Manca
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy.,IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Grazia Armento
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Tea Zeppola
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Angelo Onorato
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Michele Iuliani
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sonia Simonetti
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Bruno Vincenzi
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Daniele Santini
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sebastiano Mercadante
- Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena, Palermo, Italy
| | - Paolo Marchetti
- Molecular and Clinical Medicine Medical Oncology, La Sapienza University of Rome, Rome, Italy
| | - Arturo Cuomo
- Anesthesiology, Resuscitation, and Pain Therapy Department, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy, and Rehabilitation, National Cancer Institute, IRCCS Foundation, Milan, Italy
| | | | - Renato Vellucci
- Palliative Care and Pain Therapy Unit, Careggi Hospital, Florence, Italy
| | | | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marzia Lazzari
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mario Dauri
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Adile
- Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena, Palermo, Italy
| | - Mario Airoldi
- Second Medical Oncology Division, Città della Salute e della Scienza Hospital of Turin, Turin, Italy
| | - Giuseppe Azzarello
- Medical Specialties Department, Oncology and Oncologic Hematology, ASL 13 Mirano, Venice, Italy
| | - Livio Blasi
- Medical Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | | | | | - Flavio Fusco
- Palliative Care Unit, Department of Primary and Community Care, ASL 3 Genovese, Genoa, Italy
| | - Vittorio Guardamagna
- Palliative Care and Pain Therapy Unit, European Oncology Institute IRCCS, Milan, Italy
| | - Simeone Liguori
- Palliative Care and Pain Therapy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Loredana Palermo
- Medical Oncology Unit, National Cancer Research Center "Giovanni Paolo II", Bari, Italy
| | - Sergio Mameli
- Pain Therapy Unit, "A. Businco" Hospital, ASL 8, Cagliari, Italy
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Teresita Mazzei
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
| | | | - Danilo Miotti
- Pain Therapy ICS Maugeri, IRCCS Foundation, Pavia, Italy
| | - Stefano Moroso
- Medical Oncology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Gaetano Pascoletti
- Medical Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Stefano De Santis
- Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Remo Orsetti
- Pain Medicine Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Alfonso Papa
- Pain Relief, A.O. Dei Colli, Monaldi Hospital, Naples, Italy
| | - Sergio Ricci
- Division of Medical Oncology, Department of Oncology, S. Chiara University Hospital, Pisa, Italy
| | - Elvira Scelzi
- Medical Oncology, Castelfranco Veneto Hospital, Treviso, Italy
| | - Michele Sofia
- Department of Palliative Care, Hospice and Pain Therapy Unit, "G. Salvini" Hospital, Milan, Italy
| | - Federica Aielli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Giuseppe Tonini
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
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Cascella M, Vittori A, Miceli L, Bednarova R, Guardamagna VA, Bimonte S, Petrini F, Crispo A, Cuomo A, Marinangeli F. Italian publications on Pain Medicine in 2018. Minerva Anestesiol 2020; 87:250-251. [PMID: 32756547 DOI: 10.23736/s0375-9393.20.15008-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marco Cascella
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy -
| | - Alessandro Vittori
- Department of Anesthesiology and Critical Care, ARCO, Bambino Gesù Children's Hospital, Rome, Italy
| | - Luca Miceli
- Unit of Pain Medicine, IRCCS Centro di Riferimento Oncologico (CRO), Aviano, Pordenone, Italy
| | - Rym Bednarova
- Unit of Anesthesiology, Division of Intensive Care and Pain, Hospital of Latisana, Udine, Italy
| | | | - Sabrina Bimonte
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Flavia Petrini
- Department of Anesthesiology, Resuscitation and Intensive Care, University of Chieti-Pescara, Pescara, Italy
| | - Anna Crispo
- SC of Epidemiology and Biostatistics, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
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Cascella M, Mauro I, De Blasio E, Crispo A, Del Gaudio A, Bimonte S, Cuomo A, Ascierto PA. Rapid and Impressive Response to a Combined Treatment with Single-Dose Tocilizumab and NIV in a Patient with COVID-19 Pneumonia/ARDS. ACTA ACUST UNITED AC 2020; 56:medicina56080377. [PMID: 32727107 PMCID: PMC7466335 DOI: 10.3390/medicina56080377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 11/18/2022]
Abstract
Treatment of acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia (CARDS) represents a clinical challenge, requiring often invasive mechanical ventilation (IMV). Since the pathogenesis of CARDS it probably involves a direct viral attack to pulmonary and endothelium cells, and immune-mediated inflammation with dysfunctional coagulation, it was suggested to interfere with interleukin-6 (IL-6) activity by using the IL-6 receptor monoclonal antibody tocilizumab (TCZ). We reported the case of a 54-year-old 100 kg male COVID-19 patient (BMI 29) with severe respiratory insufficiency featuring dyspnea and hypoxia (SpO2 89% on room; PaO2 53 mmHg). Despite treatment with antiviral and non-invasive ventilation (NIV), after 24 h there was a progressive worsening of clinical conditions with higher fever (40 °C), increased dyspnea, and hypoxia (PaO2/FiO2 or P/F ratio of 150). The patient was at the limit to be sedated and intubated for IMV. He was treated with tocilizumab (8 mg/Kg i.v., single shot 800 mg) and NIV in the prone positioning. After only 96 h, the clinical, laboratory, and imaging findings showed incredible improvement. There was an important gain in oxygenation (P/F 300), a decrease of C-reactive protein values, and a decrease of the fever. Both the neutrophil-to-lymphocyte ratio (NLR) and the derived NLR ratio dropped down to 44%. Chest imaging confirmed the favorable response. This case suggested that for CARDS management efforts are needed for reducing its underlying inflammatory processes. Through a multiprofessional approach, the combination of IL-6-targeting therapies with calibrated ventilatory strategies may represent a winning strategy for improving outcomes.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, 80131 Naples, Italy; (M.C.); (S.B.); (A.C.)
| | - Immacolata Mauro
- Pneumology Unit, Ospedale Mauro Scarlato, 84018 Scafati (SA), Italy;
| | - Elvio De Blasio
- Multidisciplinary Emergency Unit for COVID-19 Campania, 80100 Naples, Italy;
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-0815903597
| | - Alfredo Del Gaudio
- DSC Anestesia e Rianimazione 2, IRCCS Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo (FG), Italy;
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, 80131 Naples, Italy; (M.C.); (S.B.); (A.C.)
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, 80131 Naples, Italy; (M.C.); (S.B.); (A.C.)
| | - Paolo Antonio Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, 80131 Naples, Italy;
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Miceli L, Bednarova R, Cuomo A, Cascella M, Guardamagna V, Romualdi P, Marinangeli F. Prescribing opioids to patients with chronic pain: translation of the Opioid Risk Tool into Italian. Minerva Anestesiol 2020; 86:693-695. [PMID: 32154683 DOI: 10.23736/s0375-9393.20.14312-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
- Luca Miceli
- Department of Pain Medicine, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Pordenone, Italy -
| | - Rym Bednarova
- Department of Pain Medicine, Azienda per l'Assistenza Sanitaria 2, Latisana, Udine, Italy
| | - Arturo Cuomo
- Department of Pain Medicine, IRCCS Pascale, Naples, Italy
| | - Marco Cascella
- Department of Pain Medicine, IRCCS Pascale, Naples, Italy
| | - Vittorio Guardamagna
- Department of Pain Medicine, IRCCS, European Institute of Oncology, Milan, Italy
| | - Patrizia Romualdi
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
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Bimonte S, Crispo A, Amore A, Celentano E, Cuomo A, Cascella M. Potential Antiviral Drugs for SARS-Cov-2 Treatment: Preclinical Findings and Ongoing Clinical Research. In Vivo 2020; 34:1597-1602. [PMID: 32503817 DOI: 10.21873/invivo.11949] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 04/23/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 02/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), initially termed 2019-new CoV (2019-nCoV), is a novel coronavirus responsible for the severe respiratory illness currently ongoing worldwide from the beginning of December 2019. This beta gene virus, very close to bat coronaviruses (bat-CoV-RaTG13) and bat-SL-CoVZC45, causes a severe disease, similar to those caused by Middle East respiratory syndrome (MERS)-CoV and SARS-CoV viruses, featured by low to moderate mortality rate. Unfortunately, the antiviral drugs commonly used in clinical practice to treat viral infections, are not applicable to SARS-Cov-2 and no vaccine is available. Thus, it is extremely necessary to identify new drugs suitable for the treatment of the 2019-nCoV outbreak. Different preclinical studies conducted on other coronaviruses suggested that promising clinical outcomes for 2019-nCoV should be obtained by using alpha-interferon, chloroquine phosphate, arabinol, remdesivir, lopinavir/ritonavir, and anti-inflammatory drugs. Moreover, clinical trials with these suitable drugs should be performed on patients affected by SARS-Cov-2 to prove their efficacy and safety. Finally, a very promising therapeutic drug, tocilizumab, is discussed; it is currently used to treat patients presenting COVID-19 pneumonia. Herein, we recapitulate these experimental studies to highlight the use of antiviral drugs for the treatment of SARS-Cov-2 disease.
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Affiliation(s)
- Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - "Fondazione G.Pascale", Naples, Italy
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Alfonso Amore
- Melanoma and Sarcoma Surgery Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - "Fondazione G.Pascale", Naples, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - "Fondazione G.Pascale", Naples, Italy
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Berretta M, Rinaldi L, Taibi R, Tralongo P, Fulvi A, Montesarchio V, Madeddu G, Magistri P, Bimonte S, Trovò M, Gnagnarella P, Cuomo A, Cascella M, Lleshi A, Nasti G, Facchini S, Fiorica F, Di Francia R, Nunnari G, Pellicanò GF, Guglielmino A, Danova M, Rossetti S, Amore A, Crispo A, Facchini G. Physician Attitudes and Perceptions of Complementary and Alternative Medicine (CAM): A Multicentre Italian Study. Front Oncol 2020; 10:594. [PMID: 32411599 PMCID: PMC7202223 DOI: 10.3389/fonc.2020.00594] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose: Complementary and Alternative Medicine (CAM) interventions are widely used by patients with chronic disorders, including cancer, and may interact with cancer treatment. Physicians are often unaware of this, probably due to poor patient-physician communication on CAM. The purpose of this study was to evaluate physicians' knowledge, attitudes and practice patterns regarding CAM in a survey conducted in Italy. Methods: A questionnaire was administered to 438 physicians (11 Italian hospitals) who predominantly treat patients with chronic disease, to collect personal and professional data and information on attitudes toward CAM and its possible role in Conventional Medicine (CM). Results: Of the 438 participants, most were specialists in oncology (18%), internal medicine (17%), surgery (15%), and radiotherapy (11%). Most worked at university (44%) or research hospitals (31%). Forty-two percent of participants believed that CAM could have an integrative role within CM. Oncologists were the physicians who were best informed on CAM (58%). Physicians working at research institutes or university hospitals had a greater knowledge of CAM than those employed at general hospitals (p < 0.0001), and those who were also involved in research activity had a greater knowledge of CAM than those who were not (p < 0.003). Length of work experience was significantly related to CAM knowledge. Moreover, 55% of participants suggest CAM interventions to their patients and 44% discuss CAM with them. The best-known interventions were acupuncture, Aloe vera and high-dose vitamin C. Conclusion: CAM use by patients with chronic disease and/or cancer has become a topical issue for the scientific community and for physicians. Knowing the reasons that prompt these patients to use CAM and guiding them in their decisions would improve treatment and outcomes and also benefit healthcare systems. Our findings contribute to a greater understanding of CAM knowledge, attitudes, and practice among Italian physicians. Further research is needed to identify the more effective CAM treatments and to work toward an integrated healthcare model.
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Affiliation(s)
- Massimiliano Berretta
- Department of Medical Oncology, Istituto Nazionale Tumori, IRCCS - CRO, Aviano (PN), Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosaria Taibi
- Department of Medical Oncology, Istituto Nazionale Tumori, IRCCS - CRO, Aviano (PN), Italy
| | - Paolo Tralongo
- Division of Medical Oncology, "Umberto I" Hospital, Siracusa, Italy
| | - Alberto Fulvi
- Division of Medical Oncology, "Gemelli" Hospital, Roman, Italy
| | | | - Giordano Madeddu
- Division of Infectious Diseases, University of Sassari, Sassari, Italy
| | - Paolo Magistri
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Sabrina Bimonte
- Department of Anaesthesia and Pain Medicine, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Marco Trovò
- Division of Radiotherapy, "Santa Maria della Misericordia" Hospital, Udine, Italy
| | - Patrizia Gnagnarella
- Division of Epidemiology and Biostatistics IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Arturo Cuomo
- Department of Anaesthesia and Pain Medicine, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Marco Cascella
- Department of Anaesthesia and Pain Medicine, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Arben Lleshi
- Department of Medical Oncology, Istituto Nazionale Tumori, IRCCS - CRO, Aviano (PN), Italy
| | - Guglielmo Nasti
- Division of Medical Oncology B, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Sergio Facchini
- Department of Urology, University of Naples "Federico II", Naples, Italy
| | | | | | - Giuseppe Nunnari
- Division of Infectious Disease, University of Messina, Messina, Italy
| | | | - Aurelio Guglielmino
- Division of Anaesthesia, Policlinico Universitario, University of Catania, Catania, Italy
| | - Marco Danova
- Department of Internal Medicine and Medical Oncology, Vigevano Civic Hospital, ASST of Pavia, Vigevano, Italy
| | - Sabrina Rossetti
- Medical Oncology, Department of Uro-Gynaecological Oncology 'Istituto Nazionale Tumori' 'Fondazione G. Pascale' IRCCS, Naples, Italy
| | - Alfonso Amore
- Division of Surgery Melanoma and Skin Cancer, 'Istituto Nazionale Tumori' 'Fondazione G. Pascale' IRCCS, Naples, Italy
| | - Anna Crispo
- Unit of Epidemiology, 'Istituto Nazionale Tumori' 'Fondazione G. Pascale' IRCCS, Naples, Italy
| | - Gaetano Facchini
- Medical Oncology, Department of Uro-Gynaecological Oncology 'Istituto Nazionale Tumori' 'Fondazione G. Pascale' IRCCS, Naples, Italy
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Cuomo A, Cascella M, Forte CA, Bimonte S, Esposito G, De Santis S, Cavanna L, Fusco F, Dauri M, Natoli S, Maltoni M, Morabito A, Mediati RD, Lorusso V, Barni S, Porzio G, Mercadante S, Crispo A. Careful Breakthrough Cancer Pain Treatment through Rapid-Onset Transmucosal Fentanyl Improves the Quality of Life in Cancer Patients: Results from the BEST Multicenter Study. J Clin Med 2020; 9:jcm9041003. [PMID: 32252426 PMCID: PMC7230287 DOI: 10.3390/jcm9041003] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To explore the effect of breakthrough cancer pain (BTcP) treatment on quality of sleep and other aspects of the health-related quality of life (HRQoL) in patients with cancer pain. METHODS In an observational, multicenter, cohort study, cancer patients from palliative care units, oncology departments, and pain clinics and affected by BTcP were included. Enrolled patients were assessed at the four visits: T0 (baseline), T7, T14, and T28. Stable chronic background pain (numeric rating scale, NRS ≤ 4) during the whole study period was mandatory. BTcP was treated through transmucosal fentanyl. Three questionnaires were used to measure the HRQoL: EORTC QLQ-C15-PAL, Pittsburgh Sleep Quality Index (PSQI), and the Edmonton Symptom Assessment System (ESAS). RESULTS In 154 patients, the HRQoL showed a significant improvement for all physical and emotional characteristics in the EORTC QLQ-C15-PAL, except for nausea and vomiting (linear p-value = 0.1) and dyspnea (Linear p-value = 0.05). The ESAS and PSQI questionnaires confirmed these positive results (p < 0.0001 and p = 0.002, respectively). CONCLUSIONS This prospective investigation by an Italian expert group, has confirmed that careful management of BTcP induces a paramount improvement on the HRQoL. Because in cancer patients there is a high prevalence of BTcP and this severe acute pain has deleterious consequences, this information can have an important clinical significance.
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Affiliation(s)
- Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
- Correspondence: ; Tel./Fax: +39-081-5903-778
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
| | - Gennaro Esposito
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
| | - Stefano De Santis
- Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, 00149 Rome, Italy;
| | - Luigi Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, 29121 Piacenza, Italy;
| | - Flavio Fusco
- Palliative Home Care Unit, ASL 3, 16153 Genova, Italy;
| | - Mario Dauri
- Department of Anesthesiology and Resuscitation, II University of Rome, Tor Vergata, 00133 Roma, Italy; (M.D.); (S.N.)
| | - Silvia Natoli
- Department of Anesthesiology and Resuscitation, II University of Rome, Tor Vergata, 00133 Roma, Italy; (M.D.); (S.N.)
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Alessandro Morabito
- Medical Oncology Unit, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy;
| | - Rocco Domenico Mediati
- Palliative Care and Pain Therapy Unit, University Hospital Careggi, 50134 Firenze, Italy;
| | - Vito Lorusso
- UO Oncologia Medica, Istituto Tumori “G Paolo II”, 70124 Bari, Italy;
| | - Sandro Barni
- Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio, Italy;
| | - Giampiero Porzio
- Medical Oncology Unit, San Salvatore Hospital, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Sebastiano Mercadante
- Main regional center for Pain Relief & Supportive Care, La Maddalena Cancer Center, 90146 Palermo, Italy;
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy;
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Cascella M, Quarto G, Grimaldi G, Izzo A, Muscariello R, Castaldo L, Di Caprio B, Bimonte S, Del Prete P, Cuomo A, Perdonà S. Neuropathic painful complications due to endopelvic nerve lesions after robot-assisted laparoscopic prostatectomy: Three case reports. Medicine (Baltimore) 2019; 98:e18011. [PMID: 31725673 PMCID: PMC6867760 DOI: 10.1097/md.0000000000018011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/02/2022] Open
Abstract
RATIONALE Robot-assisted laparoscopic prostatectomy (RALP) is the most frequent strategy used for the surgical remedy of patients with localized prostate cancer. Although there is awareness about potential patient positioning nerve injuries, iatrogenic nerve lesions are less described in the literature. Here, we report 3 cases of patients who presented with neuropathic painful complications due to RALP-associated nerve lesions. PATIENT CONCERNS A 62-year-old patient (case 1), a 72-year-old male (case 2), and a 57-year-old patient (case 3) presented at the clinic with symptoms of neuropathic pain after RALP surgery. DIAGNOSIS Patients were diagnosed with a potential injury of different branches of the pudendal nerve (cases 1 and 2), and left obturator nerve (case 3). INTERVENTIONS Patients underwent multimodal pharmacologic treatment through pregabalin, weak opioids, strong opioid, paracetamol, and adjuvants. In cases 2 and 3, a multidisciplinary approach was needed. As the patients responded to conservative treatment, invasive approaches were not necessary. OUTCOMES After treatment, the patients of case 1 showed pain relief after 4 days, paresthesia resolved in 15 days, whereas the anal crushing sensation lasted for approximately 1 month. In case 2, after 4 weeks of treatment, the patient experienced a considerable decrement in pain intensity with complete response after 4 months. In case 3, pain relief was achieved after 2 days, motor symptoms recovery after 2 weeks, and neuropathic features resolved completely after 5 weeks although the obturator sign resolved within 2 months. LESSONS The RALP-associated neurologic injuries may occur even when performed by highly experienced surgeons. A better understanding of the potential iatrogenic nerve lesions can surely allow an improvement in the surgical technique. A multidisciplinary approach and early multimodal pain strategy are mandatory for managing these complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Paola Del Prete
- Direzione Scientifica, Istituto Nazionale Tumori, IRCCS - Fondazione G. Pascale, Naples, Italy
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Bimonte S, Cascella M, Barbieri A, Arra C, Cuomo A. Shining a Light on the Effects of the Combination of (-)-Epigallocatechin-3-gallate and Tapentadol on the Growth of Human Triple-negative Breast Cancer Cells. In Vivo 2019; 33:1463-1468. [PMID: 31471393 PMCID: PMC6754998 DOI: 10.21873/invivo.11625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM Breast cancer is characterized by a high rate of mortality and is considered one of the deadliest types of cancer. It is of note that (-)-epigallocatechin-3-gallate (EGCG), the principal catechin of green tea, is able to hinder the growth of MDA-MB-231 breast cancer cells by influencing different signaling pathways, including apoptosis. Furthermore, EGCG is also used in the treatment of bone cancer pain. Tapentadol, an opioid drug acting at the level of noradrenaline (norepinephrine) reuptake inhibition and μ-opioid receptor, is able to modulate bone cancer pain and influence cancer cell viability by regulating apoptosis. MATERIALS AND METHODS In vitro assays were performed on triple-negative MDA-MB-231 cells treated with tapentadol (1, 5, 10, 20, 40 and 80 μg/ml) and EGCG (1, 10, 20, 40, 80, 160 μmol/l), alone and in combination. The effects of EGCG and TAP on viability were determined by wound-healing and MTT assays, while cell migration was assessed by transwell migration. RESULTS Cell proliferation, viability and apoptosis of MDA-MB-231 cells were impaired by the combination of EGCG and tapentadol. Specifically, our data show that EGCG and TAP reduced the proliferation of MDA-MB-231 cells by impairing cell-cycle progression (p<0.05). These findings suggest that the combination of these substances may represent a new strategy for the treatment of patients suffering from triple-negative breast cancer.
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Affiliation(s)
- Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, National Institute of Tumors, G. Pascale Foundation, Naples, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, National Institute of Tumors, G. Pascale Foundation, Naples, Italy
| | - Antonio Barbieri
- S.S.D Animal Experimentation, National Institute of Tumors, G. Pascale Foundation, Naples, Italy
| | - Claudio Arra
- S.S.D Animal Experimentation, National Institute of Tumors, G. Pascale Foundation, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, National Institute of Tumors, G. Pascale Foundation, Naples, Italy
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Bimonte S, Barbieri A, Cascella M, Rea D, Palma G, Luciano A, Forte CA, Cuomo A, Arra C. Naloxone Counteracts the Promoting Tumor Growth Effects Induced by Morphine in an Animal Model of Triple-negative Breast Cancer. In Vivo 2019; 33:821-825. [PMID: 31028203 DOI: 10.21873/invivo.11545] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIM Our group has previously demonstrated, in in vitro and in vivo studies on triple-negative breast cancer, that morphine promoted breast cancer progression whereas naloxone was able to reduce it. In this subsequent investigation, we aimed to assess the combinatorial effects of these two drugs in an animal model of triple negative breast cancer. MATERIALS AND METHODS In order to evaluate the in vivo effects of the combination of morphine and naloxone in human breast cancer, a mouse model of human triple-negative breast cancer was generated by injecting the MDA-MB-231 cells subcutaneously in nude mice. Naloxone and morphine were daily intraperitoneally co-injected in mice for 4 weeks at two different doses. Micro-vessel formation was detected by fluorescein isothiocyanate-dextran (100 μl) injected into the lateral tail vein of mice and confirmed by immunohistochemistry for PECAM-1 on mice tumor sections. RESULTS In vivo experiments showed that naloxone was able to counteract the promoting effects of morphine on tumor growth. No impairment of micro-vessel formation in tumors of mice treated with the two drugs was observed. CONCLUSION Herein, we demonstrated that naloxone was able to counteract the promoting effects of morphine on tumor growth without impairing micro-vessel formation.
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Affiliation(s)
- Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Antonio Barbieri
- S.S.D. Sperimentazione Animale, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Domenica Rea
- S.S.D. Sperimentazione Animale, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Giuseppe Palma
- S.S.D. Sperimentazione Animale, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Antonio Luciano
- S.S.D. Sperimentazione Animale, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | | | - Claudio Arra
- S.S.D. Sperimentazione Animale, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
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