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Hooper J, Jervis N, Morgan L, Beckett V, Hand P, Higgs K, Munir A, Prinn J, Pritchard DM, Sarker D, Srirajaskanthan R, Ellis CB. Neuroendocrine neoplasms: Consensus on a patient care pathway. J Neuroendocrinol 2024; 36:e13380. [PMID: 38471798 DOI: 10.1111/jne.13380] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/30/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
People with neuroendocrine neoplasms (NENs) face a multitude of challenges, including delayed diagnosis, low awareness of the cancer among healthcare professionals and limited access to multidisciplinary care and expert centres. We have developed the first patient care pathway for people living with NENs in England to guide disease management and help overcome these barriers. The pathway was developed in two phases. First, a pragmatic review of the literature was conducted, which was used to develop a draft patient care pathway. Second, the draft pathway was then updated following semi-structured interviews with carefully selected expert stakeholders. After each phase, the pathway was discussed among a multidisciplinary, expert advisory group (which comprised the authors and the Deputy Chief Operating Officer, West Suffolk NHS Foundation Trust), who reached a consensus on the ideal care pathway. This article presents the outputs of this research. The pathway identified key barriers to care and highlighted how these may be addressed, with many of the findings relevant to the rest of the UK and international audiences. NENs are increasing in incidence and prevalence in England, compounding pre-existing inequities in diagnosis and disease management. Effective integration of this pathway within NHS England will help achieve optimal, equitable care provision for all people with NENs, and should be feasible within the existing expert multidisciplinary teams across the country.
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Affiliation(s)
| | | | | | - Vivienne Beckett
- Advanced Accelerators Applications (UK & Ireland) Ltd, a Novartis Company, London, UK
| | - Philippa Hand
- London North West University Healthcare NHS Trust, London, UK
| | | | - Alia Munir
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Teaching Hospitals European Neuroendocrine Tumor Society Center of Excellence, Sheffield, UK
| | | | - D Mark Pritchard
- University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool Regional NET Service (European Neuroendocrine Tumor Society Center of Excellence), Liverpool, UK
| | - Debashis Sarker
- Guy's, St Thomas' and King's College Hospitals, King's Health Partners NET Centre (European Neuroendocrine Tumor Society Center of Excellence), London, UK
| | - Raj Srirajaskanthan
- King's College Hospital NHS Foundation Trust, King's Health Partners NET Centre (European Neuroendocrine Tumor Society Center of Excellence), London, UK
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Cives M, Hernando J, Lamarca A, Bouvier C, Caplin M, Pavel M. The impact of COVID-19 on the management of neuroendocrine tumors (NETS): An international NET CONNECT survey of NET patients and healthcare professionals treating net patients. J Neuroendocrinol 2022; 34:e13196. [PMID: 36072989 PMCID: PMC9786666 DOI: 10.1111/jne.13196] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/14/2022] [Accepted: 08/17/2022] [Indexed: 12/30/2022]
Abstract
The COVID-19 outbreak has added complexity in the management of patients with neuroendocrine tumors (NETs). Little information is currently available regarding the real impact of the pandemic in current practice. The present study aimed to capture patients' and healthcare professionals' experiences on how the NET management has changed during the pandemic and how it should be modified in a foreseeable post-pandemic environment. Physicians and nurses working in ENETS Centers of Excellence or other hospitals with high volume of NET patients (n = 48), as well as NET patients residing worldwide (n = 353), were asked to respond to two online anonymous surveys addressing different aspects of NET care. Deferred diagnoses, delayed surveillance procedures and postponed elective surgeries were among the main negative consequences of the COVID-19 outbreak according to 40%, 54% and 46% of healthcare professionals (HPs) respectively. Somatostatin analogs were increasingly used as bridging strategy for delaying surgery based on the views of 31% of HPs and were self-injected or delivered by home care services more frequently than before the initiation of the pandemic (53% of patients during the pandemic vs. 44% before the pandemic). Multidisciplinary tumor boards kept their usual schedule according to 58% of HPs, but were held virtually in the 77% of cases. The contact with healthcare professionals was maintained by remote methods more often than in the past (69% of patients), but only 34% of patients (59% among subjects < 41 years) would prefer telemedicine to face-to-face consultations in the future. New health policy measures should guarantee the highest standard of treatment to NET patients, regardless of the trajectory followed by the COVID-19 pandemic in the next months. Pros and cons of telemedicine should be carefully weighted before systematic implementation.
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Affiliation(s)
- Mauro Cives
- Department of Biomedical Sciences and Human OncologyUniversity of Bari “Aldo Moro”BariItaly
| | - Jorge Hernando
- Department of Medical OncologyVall d'Hebron University Hospital, Vall d'Hebron Institute of OncologyBarcelonaSpain
| | - Angela Lamarca
- Department of Medical OncologyThe Christie NHS Foundation, Manchester; Division of Cancer Sciences, University of ManchesterManchesterUK
| | - Catherine Bouvier
- International Neuroendocrine Cancer Alliance (INCA)BostonMassachusettsUSA
| | - Martyn Caplin
- Neuroendocrine Tumor UnitRoyal Free HospitalLondonUK
| | - Marianne Pavel
- Department of Medicine 1, EndocrinologyFriedrich Alexander Universität Erlangen‐NürnbergErlangenGermany
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Žarković M, Perros P, Ćirić J, Beleslin B, Stojanović M, Stojković M, Miletić M, Janić T. Health care access of thyroid disease patients in Serbia during the COVID-19 pandemic. J Endocrinol Invest 2022; 45:1521-1526. [PMID: 35325447 PMCID: PMC8944403 DOI: 10.1007/s40618-022-01787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/14/2022] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to assess the impact of repurposing health care facilities in response to COVID-19 on the access of patients with thyroid disease to health care. METHODS This study consisted of a web-based survey. The survey was anonymous and consisted of forty questions. RESULTS This survey included 206 respondents. 91.3% of the respondents had health insurance through the Republic Fund of Health Insurance, 9.7% had private or both health insurances, and 3.4% did not have any health insurance. A significant proportion of respondents (60.4%) had to switch from public to private health care to reach a physician and 73.8% had to switch from public to private laboratories. For the 91.9%, this was perceived as a financial burden. Before the pandemic, 83.1% of respondents reported regular follow-up by physicians, which decreased to 44.9% during the pandemic (p < 0.01). 76.3% of the respondents regarded that their thyroid disease was managed optimally before the pandemic, while this figure declined to only 48% during the pandemic (p < 0.01). CONCLUSIONS The COVID-19 pandemic disrupted the medical care of thyroid patients in Serbia. For the patients treated in the public health care system, access to general practice was hindered, while access to specialist care was disrupted. It led to a switch from public to private health care, which was perceived as a financial burden for almost all the respondents. However, private health care proved to be an important safety net when the public system was overwhelmed.
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Affiliation(s)
- M Žarković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia.
| | - P Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - J Ćirić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - B Beleslin
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - M Stojanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - M Stojković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - M Miletić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - T Janić
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
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Zandee WT, Merola E, Poczkaj K, de Mestier L, Klümpen HJ, Geboes K, de Herder WW, Munir A. Evaluation of multidisciplinary team decisions in neuroendocrine neoplasms: Impact of expert centres. Eur J Cancer Care (Engl) 2022; 31:e13639. [PMID: 35735226 DOI: 10.1111/ecc.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/10/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the impact of multidisciplinary team (MDT) meetings on the management of patients with neuroendocrine neoplasms (NENs). METHODS All newly referred gastro-entero-pancreatic (GEP)-NEN patients discussed from 1 April to 1 October 2017 in the MDT of seven European expert centres were prospectively included. The impact on patients' management was defined as a change in diagnosis, grade, stage or treatment. RESULTS A total of 292 patients were included, mainly small intestinal (siNENs) (32%) and pancreatic NENs (28%), with distant metastases in 51%. Patients had received prior surgery in 43% of cases and prior medical treatment in 32%. A significant change occurred in 61% of NENs: 7% changes in diagnosis, 8% in grade and 16% in stage. The MDT recommended a new treatment for 51% of patients, mainly surgery (9%) or somatostatin analogues (20%). A significant change was most frequently observed in patients with Stage IV disease (hazard ratio [HR] 3.6, 95% confidence interval [CI]: 1.9-6.9 vs. Stage I) and G2 NENs (vs. G1, HR 2.1 95% CI: 1.2-3.8). CONCLUSION NEN-dedicated MDT discussion in expert centres yields significant management changes in over 60% of patients and thus represents the gold standard for the management of these patients.
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Affiliation(s)
- Wouter T Zandee
- Department of Internal Medicine, Sector of Endocrinology Erasmus MC, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Endocrinology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Elettra Merola
- Department of Medicine 1, Division of Endocrinology, Friedrich-Alexander University, Erlangen-Nuremberg, Erlangen, Germany.,Department of Gastroenterology, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy
| | - Karolina Poczkaj
- Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice, Poland
| | - Louis de Mestier
- Department of Gastroenterology and Pancreatology, Beaujon Hospital (APHP) and Paris 7 University, Clichy, France
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Karen Geboes
- Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
| | - Wouter W de Herder
- Department of Internal Medicine, Sector of Endocrinology Erasmus MC, Rotterdam, The Netherlands
| | - Alia Munir
- Department of Endocrinology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Lauricella E, Cives M, Bracigliano A, Clemente O, Felici V, Lippolis R, Amoruso B, Pelle' E, Mandriani B, Esposto C, Forte C, Perri F, Porta C, Tafuto S. The psychological impact of COVID-19 pandemic on patients with neuroendocrine tumors: Between resilience and vulnerability. J Neuroendocrinol 2021; 33:e13041. [PMID: 34596289 PMCID: PMC8646700 DOI: 10.1111/jne.13041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/06/2021] [Accepted: 09/05/2021] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has added another layer of complexity to the fears of patients with neuroendocrine tumors (NETs). Little is known regarding the psychological impact of the COVID-19 outbreak on patients with gastroenteropancreatic or bronchopulmonary (BP) NETs. We longitudinally surveyed the mental symptoms and concerns of NET patients during the plateau phase of the first (W1) and second epidemic waves (W2) in Italy. Seven specific constructs (depression, anxiety, stress, health-related quality of life, NET-related quality of life, patient-physician relationship, psychological distress) were investigated using validated screening instruments, including DASS-21, EORTC QLQ-C30, EORTC QLQ GI.NET21, PDRQ9 and IES-R. We enrolled 197 patients (98 males) with a median age of 62 years. The majority of the patients had G1/G2 neoplasms. Some 38% of the patients were on active treatment. At W1, the prevalence of depression, anxiety and stress was 32%, 36% and 26% respectively. The frequency of depression and anxiety increased to 38% and 41% at W2, whereas no modifications were recorded in the frequency of stress. Poor educational status was associated with higher levels of anxiety at both W1 (odds ratio [OR] = 1.33 ± 0.22; p = .07) and W2 (OR = 1.45 ± 0.26; p = .03). Notably, post-traumatic stress symptoms were observed in the 58% of the patients, and both single marital status (OR = 0.16, 95% confidence interval [CI] = 0.06-0.48; p = .0009) and low levels of formal education (OR = 0.47, 95% CI = 0.23-0.99; p = .05) predicted their occurrence. No significant deteriorations of health-related quality of life domains were observed from W1 to W2. High patient care satisfaction was documented despite the changes in health systems resource allocation. NET patients have an increased risk of developing post-traumatic stress symptoms as result of the COVID-19 pandemic. Specific screening measures and psychological interventions should be implemented in NET clinics to prevent, recognize and treat mental distress in this vulnerable population.
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Affiliation(s)
- Eleonora Lauricella
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Mauro Cives
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
- National Cancer Institute, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | | | - Ottavia Clemente
- Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Valentina Felici
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Rossella Lippolis
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Brunella Amoruso
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Eleonora Pelle'
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Barbara Mandriani
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Chiara Esposto
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Cira Forte
- Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Francesco Perri
- Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Camillo Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Salvatore Tafuto
- Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Naples, Italy
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Barber TM, Weickert MO. How might remote management of diabetes mellitus during the COVID-19 pandemic impact patient care? Expert Rev Endocrinol Metab 2021; 16:155-158. [PMID: 34187276 DOI: 10.1080/17446651.2021.1947795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Thomas M Barber
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin O Weickert
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Sport, Exercise and Life Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
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Fazio N, Gervaso L, Halfdanarson TR, La Salvia A, Hofland J, Hernando J, Sonbol MB, Garcia-Carbonero R, Capdevila J, de Herder WW, Koumarianou A, Kaltsas G, Rossi M, Grozinsky-Glasberg S, Oleinikov K, Boselli S, Tamayo D, Bagnardi V, Laffi A, Rubino M, Spada F. Coronavirus disease 2019 in patients with neuroendocrine neoplasms: Preliminary results of the INTENSIVE study. Eur J Cancer 2021; 154:246-252. [PMID: 34298375 PMCID: PMC8241688 DOI: 10.1016/j.ejca.2021.06.029] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/16/2021] [Indexed: 12/12/2022]
Abstract
Background Specific data regarding coronavirus disease 2019 (COVID-19) in patients with neuroendocrine neoplasms (NENs) are lacking. The aim of this study is to describe the characteristics of patients with NENs who tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive. Material and methods This is a worldwide study collecting cases of patients with NENs along with a positive nasopharyngeal swab reverse transcriptase-polymerase chain reaction (RT-PCR) test for SARS-CoV-2 between June 1, 2020, and March 31, 2021. Centres treating patients with NENs were directly contacted by the principal investigator. Patients with NENs of any primary site, grade and stage were included, excluding small-cell lung carcinoma and mixed adenoneuroendocrine carcinoma. Results Among 81 centres directly contacted, 88.8% responded and 48.6% of them declined due to lack of cases or interest. On March 31st, 2021, eight recruiting centres enrolled 89 patients. The median age was 64 years at the time of COVID-19 diagnosis. Most patients had metastatic, non-functioning, low-/intermediate-grade gastroenteropancreatic NENs on treatment with somatostatin analogues and radioligand therapy. Most of them had comorbidities. Only 8% of patients had high-grade NENs and 12% were receiving chemotherapy. Most patients had symptoms or signs of COVID-19, mainly fever and cough. Only 3 patients underwent sub-intensive treatment, whereas most of them received medical therapies, mostly antibiotics. In two third of cases, no changes occurred for the anti-NEN therapy. More than 80% of patients completely recovered without sequelae, whereas 7.8% patients died due to COVID-19. Conclusions Patients included in this study reflect the typical NEN population regardless of SARS-CoV-2. In most cases, they overcome COVID-19 without need of intensive care, short-term sequelae and discontinuation of systemic oncological therapy.
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Affiliation(s)
- Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy.
| | - Lorenzo Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy; Molecular Medicine Program, University of Pavia, Pavia, Italy
| | | | - Anna La Salvia
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Imas12, UCM, Madrid, Spain
| | - Johannes Hofland
- Department of Internal Medicine, Sector Endocrinology, Rotterdam, the Netherlands
| | - Jorge Hernando
- Vall Hebron University Hospital and Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Mohamad B Sonbol
- Department of Hematology and Oncology Mayo Clinic, Phoenix, AZ, USA
| | - Rocio Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Imas12, UCM, Madrid, Spain
| | - Jaume Capdevila
- Vall Hebron University Hospital and Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Wouter W de Herder
- Department of Internal Medicine, Sector Endocrinology, Rotterdam, the Netherlands
| | - Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gregory Kaltsas
- 1st Department of Propaedeutic Internal Medicine, Endocrine Unit, National and Kapodistrian, University of Athens, 11527 Athens, Greece
| | - Maura Rossi
- Oncology Unit and Centro Documentazione Osteonecrosi, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumors Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kira Oleinikov
- Neuroendocrine Tumors Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sabrina Boselli
- Data Management-Clinical Trial Office. Scientific Direction. European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Darina Tamayo
- Data Management-Clinical Trial Office. Scientific Direction. European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Alice Laffi
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Manila Rubino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy
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