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Mandato VD, Torricelli F, Mastrofilippo V, Pellegri C, Cerullo L, Annunziata G, Ciarlini G, Pirillo D, Generali M, D'Ippolito G, Leone C, Bologna A, Gasparini E, Palicelli A, Gelli MC, Silvotti M, Aguzzoli L. Impact of 2 years of COVID-19 pandemic on ovarian cancer treatment in IRCCS-AUSL of Reggio Emilia. Int J Gynaecol Obstet 2023; 163:679-688. [PMID: 37358270 DOI: 10.1002/ijgo.14937] [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: 11/11/2022] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To assess compliance with the 2019 regional recommendation to centralize epithelial ovarian cancer (EOC) patients and to assess whether the COVID-19 pandemic has affected the quality of care for EOC patients. METHODS We compared data from EOC patients treated before the introduction of the 2019 regional recommendation (2018-2019) with data obtained from EOC patients treated after the regional recommendation was adopted during the first 2 years of the COVID-19 pandemic (2020-2021). Data were retrieved from the Optimal Ovarian Cancer Pathway records. R software version 4.1.2 (the R Foundation for Statistical Computing, Vienna, Austria) was used for the statistical analysis. RESULTS 251 EOC patients were centralized. The number of EOC patients centralized increased from 2% to 49% despite the COVID-19 pandemic. During the COVID-19 pandemic, there was an increase in the use of neoadjuvant chemotherapy and interval debulking surgery. There was an improvement in the percentage of Stage III patients without gross residual disease following both primary and interval debulking surgery. The percentage of EOC cases discussed by the multidisciplinary tumor board (MTB) increased from 66% to 89% of cases. CONCLUSION Despite the COVID-19 pandemic, centralization has increased and the quality of care has been preserved thanks to the MTB.
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Affiliation(s)
- Vincenzo Dario Mandato
- Obstetrics and Gynecology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Torricelli
- Translational Research Laboratory, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Mastrofilippo
- Gynecological Oncology Surgical Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlotta Pellegri
- Quality Office, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Loredana Cerullo
- Quality Office, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianluca Annunziata
- Obstetrics and Gynecology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gino Ciarlini
- Gynecological Oncology Surgical Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Debora Pirillo
- Obstetrics and Gynecology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matteo Generali
- Obstetrics and Gynecology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni D'Ippolito
- Obstetrics and Gynecology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Leone
- Obstetrics and Gynecology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Elisa Gasparini
- Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Monica Silvotti
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Gynecological Oncology Surgical Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Cigarini F, Daolio J, Caviola G, Pellegri C, Cavuto S, Guberti M, Mazzini E, Cerullo L. Impact of COVID-19 on cancer care pathways in a comprehensive cancer center in northern Italy. Front Public Health 2023; 11:1187912. [PMID: 37333533 PMCID: PMC10275360 DOI: 10.3389/fpubh.2023.1187912] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
The COVID-19 pandemic burdened health care systems worldwide. Health services were reorganized with the dual purpose of ensuring the most adequate continuity of care and, simultaneously, the safety of patients and health professionals. The provision of care to patients within cancer care pathways (cCPs) was not touched by such reorganization. We investigated whether the quality of care provided by a local comprehensive cancer center has been maintained using cCP indicators. A retrospective single-cancer center study was conducted on eleven cCPs from 2019 to 2021 by comparing three timeliness indicators, five care indicators and three outcome indicators yearly calculated on incident cases. Comparisons of indicators between 2019 and 2020, and 2019 and 2021, were performed to assess the performance of cCP function during the pandemic. Indicators displayed heterogeneous significant changes attributed to all cCPs over the study period, affecting eight (72%), seven (63%) and ten (91%) out of eleven cCPs in the comparison between 2019 and 2020, 2020 and 2021, and 2019 and 2021, respectively. The most relevant changes were attributed to a negative increase in time-to-treatment surgery-related indicators and to a positive increase in the number of cases discussed by cCP team members. No variations were found attributed to outcome indicators. Significant changes did not account for clinical relevance once discussed by cCP managers and team members. Our experience demonstrated that the CP model constitutes an appropriate tool for providing high levels of quality care, even in the most critical health situations.
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Affiliation(s)
- Francesca Cigarini
- Quality and Accreditation Office, Medical Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Jessica Daolio
- Quality and Accreditation Office, Medical Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giada Caviola
- Quality and Accreditation Office, Medical Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlotta Pellegri
- Quality and Accreditation Office, Medical Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Clinical Trials and Statistics Unit, S.C. Infrastructure, Research and Statistics, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Monica Guberti
- Health Professions Department, Research and EBP Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Mazzini
- Medical Directorate Hospital Network, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Loredana Cerullo
- Quality and Accreditation Office, Medical Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Caviola G, Daolio J, Pellegri C, Cigarini F, Braglia L, Foracchia M, Mazzini E, Cerullo L. Learning from Adaptations to the COVID-19 Pandemic: How Teleconsultation Supported Cancer Care Pathways at a Comprehensive Cancer Center in Northern Italy. Cancers (Basel) 2023; 15:cancers15092486. [PMID: 37173952 PMCID: PMC10177335 DOI: 10.3390/cancers15092486] [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: 04/05/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Multidisciplinary team (MDT) meetings are recognized as the gold standard for care management of cancer patients, and during the COVID-19 pandemic they were considered a priority to be maintained. Due to pandemic-related restrictions, MDT meetings were forcibly converted from in-person to telematic format. This retrospective study evaluated the annual performance of four MDT meeting indicators (MDT members' attendance, number of discussed cases, frequency of MDT meetings, and duration) between 2019 and 2022 to report on the implementation of teleconsultation in MDT meetings related to 10 cancer care pathways (CCPs). Over the study period, MDT member participation and the number of discussed cases improved or did not change in 90% (9/10) and 80% (8/10) of the CCPs, respectively. We did not observe significant differences in any of the CCPs included in the study regarding the annual frequency and duration of MDT meeting. Considering the rapidity, extent, and intensity with which telematic tools were adopted due to the COVID-19 pandemic, the results of this study showed that MDT teleconsultation supported the CCPs, and consequently, the delivery of cancer care in COVID-19 times, helping to understand the effects of telematic tools on health care performance and the parties involved.
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Affiliation(s)
- Giada Caviola
- Quality and Accreditation Office, Medical Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Jessica Daolio
- Quality and Accreditation Office, Medical Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Carlotta Pellegri
- Quality and Accreditation Office, Medical Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Francesca Cigarini
- Quality and Accreditation Office, Medical Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Luca Braglia
- Clinical Trials Center, Research and Statistics Infrastructure, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Marco Foracchia
- Information Technology Unit Department, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Elisa Mazzini
- Scientific Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Loredana Cerullo
- Quality and Accreditation Office, Medical Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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Di Salvo F, Baili P, Vicentini M, Tumino R, Vercelli M, Pirino D, Contiero P, Foschi R, Minicozzi P, Rossi PG, de Lorenzo F, Micheli A, Marani E, Orengo MA, Rossi PG, Mangone L, Pellegri C, Di Felice E, Cascone G, Cilia S, Morana G, Nicita C, Rollo C, Sigona A, Spata E, Spata G, Budroni M, Cesaraccio R, Contiero P, Maghini A, Tagliabue G, De Lorenzo F, Del Campo L, Polacchi F, Aurora F, Vittone D, Compagni A, Fattore G, Casella I, Cifalà A, Sant M, Gatta G, Trama A, Anselmi V, Casoli C. Cancer Rehabilitation Services: An Italian Population-based Cohort Study. Tumori Journal 2018. [DOI: 10.1177/1578.17224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francesca Di Salvo
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Paolo Baili
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | | | | | - Marina Vercelli
- Liguria Region Cancer Registry, IRCCS AOU S Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa
- Department of Health Sciences, University of Genoa, Genoa
| | | | | | - Roberto Foschi
- Evaluation Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, AUSL Reggio Emilia, Reggio Emilia
| | | | - Andrea Micheli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Minicozzi P, Caldarella A, Giacomin A, de Leon MP, Cesaraccio R, Falcini F, Fusco M, Iachetta F, Pellegri C, Tumino R, Capocaccia R, Sant M. Looking at Differences in Stage and Treatment of Colorectal Cancers across Italy: A EUROCARE-5 High Resolution Study. Tumori 2018; 98:671-7. [DOI: 10.1177/030089161209800601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Aims and background The high incidence and the estimate of a five-year relative survival of 59% for colorectal cancer in Italy were the main reasons to investigate the management of Italian patients with colorectal cancer diagnosed in the early 2000s. Methods Samples of adult (≥15 years) patients diagnosed in 2003–2005 with a colorectal cancer were randomly selected in 8 Italian population-based cancer registries. The z test was used to evaluate differences in proportions of Dukes stage, patients with at least 12 examined lymph nodes, and of cases treated with curative surgery plus chemotherapy or plus radiotherapy and diagnosed with colon or rectal tumors, respectively. Logistic regression models were used to estimate odds ratios of receiving the selected treatment in each cancer registry, age group and stage category, by anatomical subsite. Results A total of 3,938 colorectal cancer patients were analyzed. About 40% of the cases were over 75 years of age at diagnosis and at Dukes A + B stages. Higher proportions of early stages were found in the northern cancer registries. High percentages of resection with a curative intent were observed in Reggio Emilia (northern Italy), in 15 to 74-year-old patients, and at Dukes B stage. At least 12 lymph nodes were more frequently examined in the north of the country. After adjusting for age and stage, no significant differences were seen in the odds ratios of receiving surgery plus chemotherapy between cancer registries, whereas surgery plus radiotherapy was more frequent in Napoli (southern Italy) and less frequent in Biella (northern Italy). Conclusions Some disparities in staging and treatment of colorectal cancer patients persist across Italy. National oncological plans still need to reduce inequalities in provision and access to proper care.
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Affiliation(s)
- Pamela Minicozzi
- Department of Preventive and Predictive Medicine, Descriptive Studies and Health Planning Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan
| | | | - Adriano Giacomin
- Piedmont Cancer Registry, Province of Biella (CPO), Epidemiology Unit, Local Health Unit, Biella
| | - Maurizio Ponz de Leon
- Department of Internal Medicine, Division of Internal Medicine, University of Modena and Reggio Emilia, Modena
| | | | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (Forlì)
| | - Mario Fusco
- Campania Cancer Registry, Local Health Unit 4, Brusciano (Naples)
| | - Francesco Iachetta
- Modena Cancer Registry, Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena
| | - Carlotta Pellegri
- Reggio Emilia Cancer Registry, Santa Maria Nuova Hospital, IRCCS, Reggio Emilia
| | - Rosario Tumino
- Ragusa Cancer Registry and Histopathology Unit, “MP Arezzo” Civic Hospital, Ragusa, Provincial Health Unit, Ragusa
| | - Riccardo Capocaccia
- National Center for Epidemiology, Surveillance and Health Promotion, Department of Cancer Epidemiology, Istituto Superiore di Sanità, Rome, Italy
| | - Milena Sant
- Department of Preventive and Predictive Medicine, Descriptive Studies and Health Planning Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan
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Minicozzi P, Caldarella A, Giacomin A, Ponz de Leon M, Cesaraccio R, Falcini F, Fusco M, Iachetta F, Pellegri C, Tumino R, Capocaccia R, Sant M. Looking at differences in stage and treatment of colorectal cancers across Italy: a EUROCARE-5 high resolution study. Tumori 2013. [PMID: 23389351 DOI: 10.1700/1217.13488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND The high incidence and the estimate of a five-year relative survival of 59% for colorectal cancer in Italy were the main reasons to investigate the management of Italian patients with colorectal cancer diagnosed in the early 2000s. METHODS Samples of adult (≥15 years) patients diagnosed in 2003-2005 with a colorectal cancer were randomly selected in 8 Italian population-based cancer registries. The z test was used to evaluate differences in proportions of Dukes stage, patients with at least 12 examined lymph nodes, and of cases treated with curative surgery plus chemotherapy or plus radiotherapy and diagnosed with colon or rectal tumors, respectively. Logistic regression models were used to estimate odds ratios of receiving the selected treatment in each cancer registry, age group and stage category, by anatomical subsite. RESULTS A total of 3,938 colorectal cancer patients were analyzed. About 40% of the cases were over 75 years of age at diagnosis and at Dukes A + B stages. Higher proportions of early stages were found in the northern cancer registries. High percentages of resection with a curative intent were observed in Reggio Emilia (northern Italy), in 15 to 74-year-old patients, and at Dukes B stage. At least 12 lymph nodes were more frequently examined in the north of the country. After adjusting for age and stage, no significant differences were seen in the odds ratios of receiving surgery plus chemotherapy between cancer registries, whereas surgery plus radiotherapy was more frequent in Napoli (southern Italy) and less frequent in Biella (northern Italy). CONCLUSIONS Some disparities in staging and treatment of colorectal cancer patients persist across Italy. National oncological plans still need to reduce inequalities in provision and access to proper care.
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Affiliation(s)
- Pamela Minicozzi
- Department of Preventive and Predictive Medicine, Descriptive Studies and Health Planning Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, Italy.
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