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Borsati A, Toniolo L, Trestini I, Tregnago D, Belluomini L, Fiorio E, Lanza M, Schena F, Pilotto S, Milella M, Avancini A. Feasibility of a novel exercise program for patients with breast cancer offering different modalities and based on patient preference. Eur J Oncol Nurs 2024; 70:102554. [PMID: 38615512 DOI: 10.1016/j.ejon.2024.102554] [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: 01/10/2024] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE Exercise improves quality of life and reduces the side effects of cancer therapies. Nevertheless, attendance to exercise programs remains a challenge for patients. This study explored the feasibility of an exercise program in which women with breast cancer may be allowed to choose among three exercise delivery modalities. METHODS Forty-seven patients with breast cancer (stage I-IV) participated in a 12-week combined aerobic and resistance training program. The exercise modality was chosen by patients according to their preferences and needs among three options: the personal training program, the home-based program, or the group-based program. Exercise prescription was similar between the three modalities. Whereas the primary endpoint was feasibility, assessed through recruitment rate, attendance, adherence, dropout rate, tolerability, and safety, secondary endpoints included health-related skills and quality of life. RESULTS Out of 47 recruited patients, 24 chose the home-based program, 19 the personal training program, and four the group-based program. Six dropouts (13%) were registered, and no severe adverse events were recorded. The median program attendance was 98% for personal training programs, 96% for home-based programs, and 100% for group-based programs, whereas compliance resulted in more than 90% in each modality. At postintervention, a significant increase in cardiorespiratory fitness, lower body flexibility, and body weight was observed. Different quality-of-life domains were improved following the intervention, including physical and social functioning, fatigue, and appetite loss. No significant changes in other parameters were detected. CONCLUSIONS An exercise prescription based on a patient-preferred delivery modality showed high feasibility in women with breast cancer.
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Affiliation(s)
| | - Linda Toniolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Ilaria Trestini
- Dietetic Service, Medical Direction, University Hospital of Verona (AOUI), Italy
| | - Daniela Tregnago
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
| | - Lorenzo Belluomini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
| | - Elena Fiorio
- Section of Oncology, University of Verona Hospital Trust (AOUI) Verona, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Sara Pilotto
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
| | - Michele Milella
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
| | - Alice Avancini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy.
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Tregnago D, Avancini A, Belluomini L, Trestini I, Sposito M, Insolda J, Bianchi F, Sava T, Gaiani C, Del Piccolo L, Guarnieri V, Verlato G, Tfaily A, Vesentini R, Zuliani S, Pilotto S, Milella M. Cross-sectional survey evaluating the psychological impact of the COVID-19 vaccination campaign in patients with cancer: The VACCINATE study. PLoS One 2024; 19:e0290792. [PMID: 38271378 PMCID: PMC10810487 DOI: 10.1371/journal.pone.0290792] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/15/2023] [Indexed: 01/27/2024] Open
Abstract
The COVID-19 pandemic has profoundly impacted on cancer patients' psychological well-being and clinical status. We assessed the levels of anxiety, depression, and distress and the attitude towards COVID-19 vaccination in cancer patients, accepting vaccination at the Verona University Hospital and Camposampiero Hospital in the Veneto region. Self-reported questionnaires were administered to patients undergoing COVID-19 vaccination between March and May 2021 (first and second dose). Twenty-seven items were investigated: i) demographics/clinical characteristics; ii) anxiety, depression, and distress (Hospital Anxiety and Depression Scale-HADS-and Distress Thermometer-DT); iii) four specific items regarding awareness about infection risks, interference with anticancer treatments, and vaccine side effects. Sixty-two and 57% of the patients who accepted to be vaccinated responded to the survey in the two participating Hospitals, respectively. Mean age was 63 years (SD: 12 years; range 19-94 years), women were slightly more prevalent (57.6%), most participants were married (70%), and either worker or retired (60%). Borderline and clinical levels of anxiety were recorded in 14% and 10% of respondents; borderline and clinical levels of depression in 14% and 8%; and moderate and severe distress levels in 33% and 9%. Overall, there was high confidence that vaccination would reduce the risk of contracting COVID-19 (70%), which would make patients feel less worried about contracting the infection (60%). Fear that vaccine-related side effects would interfere with anticancer treatment and/or global health status was low (10% and 9% for items 3 and 4, respectively) and significantly associated with baseline levels of anxiety, depression, and distress at multivariate analysis. Results did not differ between the Verona and Camposampiero cohorts. During the COVID-19 vaccination campaign, adult cancer patients demonstrated high levels of confidence towards vaccination; baseline levels of anxiety, depression, and distress were the only significant predictors of reduced confidence.
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Affiliation(s)
- Daniela Tregnago
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, VR, Italy
| | - Alice Avancini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, VR, Italy
| | - Lorenzo Belluomini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, VR, Italy
| | - Ilaria Trestini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, VR, Italy
| | - Marco Sposito
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, VR, Italy
| | - Jessica Insolda
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, VR, Italy
| | - Federica Bianchi
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, VR, Italy
| | - Teodoro Sava
- Medical Oncology, Camposampiero Hospital, Padova, Italy
| | - Chiara Gaiani
- Medical Oncology, Camposampiero Hospital, Padova, Italy
| | - Lidia Del Piccolo
- Department of Neuroscience, Psychological and Psychiatric Sciences and Movement Sciences, University of Verona and Verona University Hospital Trust, Verona, Italy
| | | | - Giuseppe Verlato
- Department of Public Health and Community Medicine, Unit of Epidemiology and Medical Statistics, Istituti Biologici II – University of Verona, Verona, VR, Italy
| | - Ahmad Tfaily
- Department of Public Health and Community Medicine, Unit of Epidemiology and Medical Statistics, Istituti Biologici II – University of Verona, Verona, VR, Italy
| | - Roberta Vesentini
- Department of Public Health and Community Medicine, Unit of Epidemiology and Medical Statistics, Istituti Biologici II – University of Verona, Verona, VR, Italy
| | - Serena Zuliani
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, VR, Italy
| | - Sara Pilotto
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, VR, Italy
| | - Michele Milella
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, VR, Italy
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Avancini A, Borsati A, Baldo E, Ciurnelli C, Trestini I, Tregnago D, Belluomini L, Sposito M, Insolda J, Auriemma A, Fiorio E, Piacentini M, Schena F, Milella M, Pilotto S. A Feasibility Study Investigating an Exercise Program in Metastatic Cancer Based on the Patient-Preferred Delivery Mode. Oncologist 2024:oyae002. [PMID: 38206849 DOI: 10.1093/oncolo/oyae002] [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: 09/20/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Feasibility of exercise in patients with metastatic cancer is still a challenge. This study aimed to determine the feasibility and preliminary efficacy of an exercise intervention based on a patient-preferred delivery mode in patients affected by metastatic cancer. MATERIALS AND METHODS Forty-four patients with a confirmed diagnosis of metastatic cancer were recruited in a 3-month exercise program. Whereas the exercise program consisted of aerobic and resistance activities performed twice a week, the participants may choose the mode of delivery: home based, personal training, or group based. The primary endpoint was the feasibility, defined by recruitment rate, attendance, adherence, dropout rate, tolerability (comparing the session RPE with the target RPE), and safety (using the Common Terminology Criteria for Adverse Events, version 5.0). Secondary endpoints included cardiorespiratory fitness (six minutes walking test), muscle strength (handgrip strength test and isometric leg press test), flexibility (the back scratch and chair sit and reach tests), anthropometric parameters (body mass index and waist-hip ratio), quality of life (EORTC QLQ C-30 questionnaire), and amount of physical exercise (Godin's Shepard Leisure Time Exercise Questionnaire). Descriptive statistics, Student t test, and Wilcoxon signed rank test were used to analyze data. RESULTS The study recruitment rate was 81%. Out of 44 recruited patients, 28 chose the personal training program, 16 chose the home-based program, and none chose the group-based program. Nine dropouts occurred (20%), 6 in the personal training program, and 3 in the home-based intervention. The median attendance rate was 92%, adherence was 88%, tolerability was 100%, and 9 nonsevere adverse events were registered during the exercise sessions. An increase in cardiorespiratory fitness (P < .001) and flexibility (P = .011 for chair sit and reach; P = .040 for back scratch) was observed at the end of the intervention, while no changes in anthropometric values and muscle strength were detected. Different quality-of-life domains were improved following the intervention, including physical (P = .002), emotional (P < .001), and role functioning (P = .018), fatigue (P = .030), and appetite loss (P = .005). CONCLUSION A 3-month exercise program based on a patient-preferred delivery mode is feasible in patients with metastatic cancer and may improve physical function and quality of life. TRIAL REGISTRATION NCT04226508.
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Affiliation(s)
- Alice Avancini
- Section of Innovation Biomedicine-Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - Anita Borsati
- Biomedical, Clinical and Experimental Sciences, Department of Medicine, University of Verona, Verona, Italy
| | - Elisabetta Baldo
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Christian Ciurnelli
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Ilaria Trestini
- Dietetic Service, Medical Direction, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Daniela Tregnago
- Section of Innovation Biomedicine-Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - Lorenzo Belluomini
- Section of Innovation Biomedicine-Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - Marco Sposito
- Section of Innovation Biomedicine-Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - Jessica Insolda
- Section of Innovation Biomedicine-Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - Alessandra Auriemma
- Section of Oncology, University of Verona Hospital Trust (AOUI) Verona, Verona, Italy
| | - Elena Fiorio
- Section of Oncology, University of Verona Hospital Trust (AOUI) Verona, Verona, Italy
| | - Michela Piacentini
- Section of Oncology, University of Verona Hospital Trust (AOUI) Verona, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Michele Milella
- Section of Innovation Biomedicine-Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - Sara Pilotto
- Section of Innovation Biomedicine-Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
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Avancini A, Borsati A, Trestini I, Tregnago D, Belluomini L, Sposito M, Rota M, Insolda J, Schena F, Milella M, Pilotto S. Exploring the feasibility of a combined exercise program for patients with advanced lung or pancreatic cancer. Asia Pac J Oncol Nurs 2023; 10:100298. [PMID: 38197044 PMCID: PMC10772206 DOI: 10.1016/j.apjon.2023.100298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/18/2023] [Indexed: 01/11/2024] Open
Abstract
Objective This study aims to assess the safety, feasibility, and potential benefits of a combined aerobic and resistance exercise intervention for patients diagnosed with advanced pancreatic or lung cancer. Methods A prospective, single-arm study was conducted, enrolling patients with advanced lung or pancreatic cancer. Participants engaged in a 12-week exercise intervention comprising personalized bi-weekly aerobic and resistance training tailored to individual baseline conditions. The primary study outcomes focused on safety (absence of serious adverse events) and feasibility. Secondary outcomes included assessments of functional capacity using the "Six minutes walking test", strength measured through handgrip and leg press tests, anthropometric measures including body mass index and waist-hip ratio, quality of life (QoL), and changes in blood parameters. Results The study involved twelve patients (mean age 57.66 ± 7.40 years), with seven having pancreatic cancer and five having lung cancer. The recruitment rate was 50%, and assessment adherence was 100%, with an 84% adherence to the exercise program and no dropouts. No exercise-related adverse events were recorded, while three non-severe, non-exercise-related adverse events were observed: treatment-related dermatitis (Grade 2), axillary lymphadenopathy (Grade 2), and migraine (Grade 1). Significant enhancements in functional capacity, emotional well-being, and social functioning within the QoL domains were observed. Anthropometric measures, specifically waist-hip ratio and body mass index, remained stable. Conclusions The findings suggest that a tailored 12-week exercise intervention is both feasible and safe for patients with advanced lung or pancreatic cancer. This intervention appears to enhance functional capacity, specific aspects of QoL, and contribute to maintaining body weight.
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Affiliation(s)
- Alice Avancini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
| | - Anita Borsati
- Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Ilaria Trestini
- Dietetics Service, Medical Direction, University Hospital of Verona, Verona, Italy
| | - Daniela Tregnago
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
| | - Lorenzo Belluomini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
| | - Marco Sposito
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
| | - Michele Rota
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
| | - Jessica Insolda
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Milella
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
| | - Sara Pilotto
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Italy
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Sposito M, Belluomini L, Pontolillo L, Tregnago D, Trestini I, Insolda J, Avancini A, Milella M, Bria E, Carbognin L, Pilotto S. Adjuvant Targeted Therapy in Solid Cancers: Pioneers and New Glories. J Pers Med 2023; 13:1427. [PMID: 37888038 PMCID: PMC10608226 DOI: 10.3390/jpm13101427] [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: 08/24/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
Targeted therapy (TT) has revolutionized cancer treatment, successfully applied in various settings. Adjuvant TT in resected early-stage gastrointestinal stromal tumors (GIST), melanoma, non-small cell lung cancer (NSCLC), and breast cancer has led to practice-changing achievements. In particular, standard treatments include BRAF inhibitors for melanoma, osimertinib for NSCLC, hormone therapy or HER2 TT for breast cancer, and imatinib for GIST. Despite the undeniable benefit derived from adjuvant TT, the optimal duration of TT and the appropriate managing of the relapse remain open questions. Furthermore, neoadjuvant TT is emerging as valuable, particularly in breast cancer, and ongoing studies evaluate TT in the perioperative setting for early-stage NSCLC. In this review, we aim to collect and describe the large amount of data available in the literature about adjuvant TT across different histologies, focusing on epidemiology, major advances, and future directions.
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Affiliation(s)
- Marco Sposito
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37134 Verona, Italy; (M.S.); (L.B.); (D.T.); (I.T.); (J.I.); (A.A.); (M.M.)
| | - Lorenzo Belluomini
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37134 Verona, Italy; (M.S.); (L.B.); (D.T.); (I.T.); (J.I.); (A.A.); (M.M.)
| | - Letizia Pontolillo
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (L.P.); (E.B.)
- Medical Oncology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Daniela Tregnago
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37134 Verona, Italy; (M.S.); (L.B.); (D.T.); (I.T.); (J.I.); (A.A.); (M.M.)
| | - Ilaria Trestini
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37134 Verona, Italy; (M.S.); (L.B.); (D.T.); (I.T.); (J.I.); (A.A.); (M.M.)
| | - Jessica Insolda
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37134 Verona, Italy; (M.S.); (L.B.); (D.T.); (I.T.); (J.I.); (A.A.); (M.M.)
| | - Alice Avancini
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37134 Verona, Italy; (M.S.); (L.B.); (D.T.); (I.T.); (J.I.); (A.A.); (M.M.)
| | - Michele Milella
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37134 Verona, Italy; (M.S.); (L.B.); (D.T.); (I.T.); (J.I.); (A.A.); (M.M.)
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (L.P.); (E.B.)
- Medical Oncology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Luisa Carbognin
- Gynecology Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy;
| | - Sara Pilotto
- Section of Innovation Biomedicine—Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, 37134 Verona, Italy; (M.S.); (L.B.); (D.T.); (I.T.); (J.I.); (A.A.); (M.M.)
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Casirati A, Da Prat V, Cereda E, Sebastiani F, Trestini I, Perrone L, Serra F, Cintoni M, Pedrazzoli P, Caccialanza R. Is it time to optimize immunonutrition in cancer patients according to muscle mass? Eur J Surg Oncol 2023; 49:1322-1323. [PMID: 37019805 DOI: 10.1016/j.ejso.2023.03.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Affiliation(s)
- A Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - V Da Prat
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Sebastiani
- Endocrinology and Metabolic Diseases, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - I Trestini
- Medical Oncology Unit, University of Verona Hospital Trust, Verona, Italy
| | - L Perrone
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Serra
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Cintoni
- Clinical Nutrition Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - P Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - R Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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Paiella S, Azzolina D, Trestini I, Malleo G, Nappo G, Ricci C, Ingaldi C, Vacca PG, De Pastena M, Secchettin E, Zamboni G, Maggino L, Corciulo MA, Sandini M, Cereda M, Capretti G, Casadei R, Bassi C, Mansueto G, Gregori D, Milella M, Zerbi A, Gianotti L, Salvia R. Corrigendum: Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: a retrospective, multicenter analysis. Front Nutr 2023; 10:1212436. [PMID: 37284653 PMCID: PMC10240154 DOI: 10.3389/fnut.2023.1212436] [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: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fnut.2023.1065294.].
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Affiliation(s)
- Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Danila Azzolina
- Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy
| | - Ilaria Trestini
- Dietetics Services, Hospital Medical Direction, University Hospital Trust of Verona, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Gennaro Nappo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Claudio Ricci
- Pancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo Ingaldi
- Pancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pier Giuseppe Vacca
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Matteo De Pastena
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Erica Secchettin
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Giulia Zamboni
- Radiology Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Laura Maggino
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Maria Assunta Corciulo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marta Sandini
- General Surgery Unit, University of Siena, Siena, Italy
| | - Marco Cereda
- School of Medicine and Surgery, University of Milano-Bicocca and HPB Unit, San Gerardo Hospital Monza, Monza, Italy
| | - Giovanni Capretti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Riccardo Casadei
- Pancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | | | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca and HPB Unit, San Gerardo Hospital Monza, Monza, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
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Paiella S, Azzolina D, Trestini I, Malleo G, Nappo G, Ricci C, Ingaldi C, Vacca PG, De Pastena M, Secchettin E, Zamboni G, Maggino L, Corciulo MA, Sandini M, Cereda M, Capretti G, Casadei R, Bassi C, Mansueto G, Gregori D, Milella M, Zerbi A, Gianotti L, Salvia R. Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: A retrospective, multicenter analysis. Front Nutr 2023; 10:1065294. [PMID: 36860690 PMCID: PMC9968808 DOI: 10.3389/fnut.2023.1065294] [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: 10/09/2022] [Accepted: 01/23/2023] [Indexed: 02/17/2023] Open
Abstract
Background and aims Body composition parameters and immunonutritional indexes provide useful information on the nutritional and inflammatory status of patients. We sought to investigate whether they predict the postoperative outcome in patients with pancreatic cancer (PC) who received neoadjuvant therapy (NAT) and then pancreaticoduodenectomy. Methods Data from locally advanced PC patients who underwent NAT followed by pancreaticoduodenectomy between January 2012 and December 2019 in four high-volume institutions were collected retrospectively. Only patients with two available CT scans (before and after NAT) and immunonutritional indexes (before surgery) available were included. Body composition was assessed and immunonutritional indexes collected were: VAT, SAT, SMI, SMA, PLR, NLR, LMR, and PNI. The postoperative outcomes evaluated were overall morbidity (any complication occurring), major complications (Clavien-Dindo ≥ 3), and length of stay. Results One hundred twenty-one patients met the inclusion criteria and constituted the study population. The median age at the diagnosis was 64 years (IQR16), and the median BMI was 24 kg/m2 (IQR 4.1). The median time between the two CT-scan examined was 188 days (IQR 48). Skeletal muscle index (SMI) decreased after NAT, with a median delta of -7.8 cm2/m2 (p < 0.05). Major complications occurred more frequently in patients with a lower pre-NAT SMI (p = 0.035) and in those who gained in subcutaneous adipose tissue (SAT) compartment during NAT (p = 0.043). Patients with a gain in SMI experienced fewer major postoperative complications (p = 0.002). The presence of Low muscle mass after NAT was associated with a longer hospital stay [Beta 5.1, 95%CI (1.5, 8.7), p = 0.006]. An increase in SMI from 35 to 40 cm2/m2 was a protective factor with respect to overall postoperative complications [OR 0.43, 95% (CI 0.21, 0.86), p < 0.001]. None of the immunonutritional indexes investigated predicted the postoperative outcome. Conclusion Body composition changes during NAT are associated with surgical outcome in PC patients who receive pancreaticoduodenectomy after NAT. An increase in SMI during NAT should be favored to ameliorate the postoperative outcome. Immunonutritional indexes did not show to be capable of predicting the surgical outcome.
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Affiliation(s)
- Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy,*Correspondence: Salvatore Paiella ✉
| | - Danila Azzolina
- Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy
| | - Ilaria Trestini
- Dietetics Services, Hospital Medical Direction, University Hospital Trust of Verona, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Gennaro Nappo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy,IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Claudio Ricci
- Pancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, University of Bologna, Bologna, Italy,Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo Ingaldi
- Pancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, University of Bologna, Bologna, Italy,Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pier Giuseppe Vacca
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Matteo De Pastena
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Erica Secchettin
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Giulia Zamboni
- Radiology Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Laura Maggino
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Maria Assunta Corciulo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marta Sandini
- General Surgery Unit, University of Siena, Siena, Italy
| | - Marco Cereda
- School of Medicine and Surgery, University of Milano-Bicocca and HPB Unit, San Gerardo Hospital Monza, Monza, Italy
| | - Giovanni Capretti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy,IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Riccardo Casadei
- Pancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, University of Bologna, Bologna, Italy,Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | | | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy,IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca and HPB Unit, San Gerardo Hospital Monza, Monza, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy,Roberto Salvia ✉
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Avancini A, Benato G, Tregnago D, Trestini I, Milella M, Lanza M, Pilotto S. Development of Educational Print Materials for Physical Activity in Cancer: Evaluation of Readability and Suitability. J Cancer Educ 2023; 38:42-49. [PMID: 34523076 PMCID: PMC9852108 DOI: 10.1007/s13187-021-02076-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 05/08/2023]
Abstract
Educational health materials may be important tools to increase physical activity in cancer patients. Nevertheless, most of the available resources regarding physical activity for cancer patients were found not suitable, had a low grade of readability, and thus, represent a significant barrier to behavior change. To date, little data about development criteria and evaluation of physical activity resources for cancer before their spread exist. The purposes of this study were (i) to describe the development of a physical activity guidebook designed for cancer patients and (ii) to test its readability and suitability. The guidebook was developed through multi-step passages, including group discussions, a literature review, identification of a motivational theory, and using previous research on exercise preferences, barriers, and facilitators to target the information. Two validated formulae were used to assess the readability, whereas thirty-four judges completed the Suitability of Assessment Materials questionnaire to evaluate the suitability of the guidebook. The guidebook was found readable for patients having at least a primary education, and the judges scored it as "superior" material. Our guidebook, following a rigorous method in the development phase, was considered to be suitable and readable. Further evaluations through clinical trials could investigate its effectiveness for behavior change and its impact on cancer patients.
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Affiliation(s)
| | - Giulia Benato
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | | | | | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Pilotto
- Medical Oncology, University of Verona, Verona, Italy
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10
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Caccialanza R, Cereda E, Agustoni F, Klersy C, Casirati A, Montagna E, Carnio S, Novello S, Milella M, Pilotto S, Trestini I, Buffoni L, Ferrari A, Pedrazzoli P. Multicentre, randomised, open-label, parallel-group, clinical phase II study to evaluate immunonutrition in improving efficacy of immunotherapy in patients with metastatic non-small cell lung cancer, undergoing systematic nutritional counseling. BMC Cancer 2022; 22:1212. [PMID: 36434615 PMCID: PMC9700895 DOI: 10.1186/s12885-022-10296-x] [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: 05/24/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nutritional support, including nutritional counseling and oral nutritional supplements (ONS), has been recommended as a first-line strategy in patients with non-small cell lung cancer (NSCLC). Evidence on the efficacy of immunonutrition during immunotherapy in these patients is positive, but still limited some secondary endpoints, such as treatment toxicity and tolerance. We hypothesize that early systematic provision of ONS with a high-protein-high calorie mixture containing immunonutrients (Impact®) in addition to nutritional counseling, compared to nutritional counseling alone, is beneficial to patients with NSCLC receiving immunotherapy with or without chemotherapy. We designed the present study to evaluate the efficacy of early systematic provision of ONS enriched with immunonutrients compared to nutritional counseling alone, in patients with NSCLC undergoing immunotherapy. Study endpoints were: treatment response (primary endpoint: progression-free survival), treatment tolerance and toxicity, body weight, body composition, protein-calorie intake, quality of life, fatigue, muscle strength and immunological profile. METHODS This is a pragmatic, multicentre, randomized (1:1), parallel-group, open label, controlled, pilot clinical trial (N = 180). DISCUSSION The improvement of efficacy of nutritional support in oncology still deserves many efforts. Immunonutrition represents a promising approach also in patients with NSCLC, but evidence on its efficacy on clinical outcomes during immunotherapy is still inconclusive. The present pilot study, which guarantees early high-quality nutritional care (assessment and treatment) to all patients in agreement with current guidelines and recommendations, could represent one of the first proofs of efficacy of early oral immunonutrition in patients with cancer undergoing immunotherapy. Further large randomized trials addressing the improvement of supportive care could be hypothesized, accordingly. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov Identifier: NCT05384873.
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Affiliation(s)
- Riccardo Caccialanza
- grid.419425.f0000 0004 1760 3027Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Emanuele Cereda
- grid.419425.f0000 0004 1760 3027Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Francesco Agustoni
- grid.419425.f0000 0004 1760 3027Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- grid.419425.f0000 0004 1760 3027Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amanda Casirati
- grid.419425.f0000 0004 1760 3027Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Elisabetta Montagna
- grid.419425.f0000 0004 1760 3027Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Simona Carnio
- grid.7605.40000 0001 2336 6580Department of Oncology, AOU San Luigi-Orbassano, University of Turin, Turin, Italy
| | - Silvia Novello
- grid.7605.40000 0001 2336 6580Department of Oncology, AOU San Luigi-Orbassano, University of Turin, Turin, Italy
| | - Michele Milella
- grid.411475.20000 0004 1756 948XMedical Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy
| | - Sara Pilotto
- grid.411475.20000 0004 1756 948XMedical Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy
| | - Ilaria Trestini
- grid.411475.20000 0004 1756 948XMedical Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy
| | - Lucio Buffoni
- Medical Oncology Unit, Humanitas Gradenigo, Turin, Italy
| | - Alessandra Ferrari
- grid.419425.f0000 0004 1760 3027Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- grid.419425.f0000 0004 1760 3027Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy ,grid.8982.b0000 0004 1762 5736Internal Medicine Department, University of Pavia, Pavia, Italy
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11
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Trestini I, Caldart A, Dodi A, Cintoni M, Sposito M, Belluomini L, Menis J, Vita E, Sperduti I, Drudi A, Aluffi G, Todesco M, Tregnago D, Avancini A, D'Onofrio M, Mele M, Tortora G, Milella M, Bria E, Pilotto S. 1618P Impact of body composition phenotypes on outcome of non-small cell lung cancer patients treated with immunotherapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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12
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Trestini I, Cintoni M, Caldart A, Dodi A, Sposito M, Kadrija D, Belluomini L, Menis J, Vita E, Sperduti I, Drudi A, Aluffi G, Todesco M, Tregnago D, Avancini A, D'Onofrio M, Mele M, Tortora G, Milella M, Bria E, Pilotto S. EP10.01-011 Prognostic Impact of Body Composition Phenotypes in Non-small Cell Lung Cancer Patients Receiving First-Line Pembrolizumab. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Avancini A, Belluomini L, Tregnago D, Trestini I, Schena F, Milella M, Pilotto S. Exercise in men with prostate cancer: how to move on? Support Care Cancer 2022; 30:9703-9705. [PMID: 35779134 DOI: 10.1007/s00520-022-07260-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Alice Avancini
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy. .,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.
| | - Lorenzo Belluomini
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Daniela Tregnago
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Ilaria Trestini
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Michele Milella
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Sara Pilotto
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
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14
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Avancini A, Belluomini L, Tregnago D, Trestini I, Lanza M, Milella M, Wiskemann J, Pilotto S. Exercise oncology: It is time to make a change. Patient Educ Couns 2022; 105:2629-2631. [PMID: 35120796 DOI: 10.1016/j.pec.2022.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Alice Avancini
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Lorenzo Belluomini
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy.
| | - Daniela Tregnago
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy.
| | - Ilaria Trestini
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy.
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Michele Milella
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy.
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Clinic Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany.
| | - Sara Pilotto
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy.
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15
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Belluomini L, Avancini A, Pasqualin L, Insolda J, Sposito M, Menis J, Tregnago D, Trestini I, Ferrara MG, Bria E, Milella M, Pilotto S. Selpercatinib in RET-fusion positive metastatic non-small cell lung cancer: achievements and gray areas. Expert Rev Anticancer Ther 2022; 22:785-794. [PMID: 35726802 DOI: 10.1080/14737140.2022.2093190] [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] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Selpercatinib is a RET selective tyrosine kinase inhibitor with nanomolar potency against diverse RET alterations, including fusions, activating point mutations, and acquired resistance mutations. Rearranged during transfection (RET) gene is a validated target in non-small-cell lung cancer (NSCLC). Selpercatinib is currently approved for adult patients with metastatic RET fusion-positive NSCLC. AREAS COVERED This review summarizes the efficacy and safety data of selpercatinib in the treatment landscape of RET fusion-positive NSCLC. EXPERT OPINION Globally considered, selpercatinib is an optimal treatment choice, in terms of both (systemic and intracranial) efficacy and safety, in patients affected by advanced NSCLC harboring RET fusions as a driver mechanism. Future challenges include the identification of the most appropriate placement for selpercatinib in the treatment algorithm of RET fusion-positive NSCLC (including early stages), the clarification of resistance mechanisms, as well as of its role in EGFR-mutant NSCLC undergoing progression during osimertinib driven by RET alterations.
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Affiliation(s)
- Lorenzo Belluomini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Alice Avancini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Luca Pasqualin
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Jessica Insolda
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Marco Sposito
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Jessica Menis
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Miriam Grazia Ferrara
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Medical Oncology, Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Medical Oncology, Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
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16
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Avancini A, Sperduti I, Borsati A, Ferri T, Belluomini L, Insolda J, Trestini I, Tregnago D, Schena F, Bria E, Milella M, Pilotto S. Effect of exercise on functional capacity in patients with advanced cancer: A meta-analysis of randomized controlled trials. Crit Rev Oncol Hematol 2022; 175:103726. [PMID: 35659975 DOI: 10.1016/j.critrevonc.2022.103726] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To determine the impact of exercise on functional capacity, measured through the "Six minutes walking test" (6MWT) in patients with advanced cancer stage. METHODS Systematic research on PubMed, Cochrane Library, and SportDiscus was conducted. Randomized controlled trials were eligible if they examined the effect of exercise on 6MWT. RESULTS Overall, a total of ten trials were included in the primary analysis. Compared to the controls, the exercise intervention was associated with an increase in functional capacity (+20.86 m; CI: -5.90 to 47.72, p = 0.12) although not reaching the statistical significance. Sensitivity analysis revealed an improvement for studies proposing a supervised exercise intervention towards the statistical significance. Few adverse events were associated with exercise training, and the median withdrawals rate was 17%. CONCLUSIONS Exercise may have a beneficial role on functional capacity in patients with advanced cancer, especially if supervised.
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Affiliation(s)
- Alice Avancini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Isabella Sperduti
- Biostatistical Unit - Clinical Trials Center IRCCS Istituto Nazionale Tumori Regina Elena, U.O. di Biostatistica e Bioinformatica, Rome, Italy.
| | - Anita Borsati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Thomas Ferri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Lorenzo Belluomini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
| | - Jessica Insolda
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
| | - Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Emilio Bria
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.
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Avancini A, Belluomini L, Borsati A, Riva ST, Trestini I, Tregnago D, Dodi A, Lanza M, Pompili C, Mazzarotto R, Micheletto C, Motton M, Scarpa A, Schena F, Milella M, Pilotto S. Integrating supportive care into the multidisciplinary management of lung cancer: we can't wait any longer. Expert Rev Anticancer Ther 2022; 22:725-735. [PMID: 35608060 DOI: 10.1080/14737140.2022.2082410] [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] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Due to important achievements in terms of diagnostic and therapeutic tools and the complexity of the disease itself, lung cancer management needs a multidisciplinary approach. To date, the classical multidisciplinary team involves different healthcare providers mainly dedicated to lung cancer diagnosis and treatments. Nevertheless, the underlying disease and related treatments significantly impact on patient function and psychological well-being. In this sense, supportive care may offer the best approach to relieve and manage patient symptoms and treatment-related adverse events. AREAS COVERED Evidence report that exercise, nutrition, smoking cessation and psychological well-being bring many benefits in patients with lung cancer, from both a physical and socio-psychological points of view, and potentially improving their survival. Nevertheless, supportive care is rarely offered to patients, and even less frequently these needs are discussed within the multidisciplinary meeting. EXPERT OPINION Integrating supportive care as part of the standard multidisciplinary approach for lung cancer involves a series of challenges, the first one represented by the daily necessity of specialists, such as kinesiologists, dietitians, psycho-oncologists, able to deliver a personalized approach. In the era of precision medicine this is an essential step forward to guarantee comprehensive and patient-centered care for all patients with lung cancer.
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Affiliation(s)
- Alice Avancini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lorenzo Belluomini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Anita Borsati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Silvia Teresa Riva
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Alessandra Dodi
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cecilia Pompili
- Thoracic Surgery Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Renzo Mazzarotto
- Section of Radiotherapy, Department of Surgery and Oncology, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Claudio Micheletto
- Pulmonary Unit, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Massimiliano Motton
- Radiology Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Aldo Scarpa
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
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Avancini A, Belluomini L, Benato G, Trestini I, Tregnago D, Menis J, Lanza M, Milella M, Pilotto S. Exercise for counteracting post-acute COVID-19 syndrome in patients with cancer: an old but gold strategy? Acta Oncol 2022; 61:388-392. [PMID: 34854782 DOI: 10.1080/0284186x.2021.2009565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alice Avancini
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Lorenzo Belluomini
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Giulia Benato
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ilaria Trestini
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Daniela Tregnago
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Jessica Menis
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Milella
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Sara Pilotto
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
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Pilotto S, Agustoni F, Morelli AM, Lobascio F, Cereda E, Bironzo P, Trestini I, Milella M, Novello S, Pedrazzoli P, Caccialanza R. Nutritional support in lung cancer: time to combine immunonutrition with immunotherapy? Nutrition 2022; 98:111637. [DOI: 10.1016/j.nut.2022.111637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 10/18/2022]
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Avancini A, Belluomini L, Tregnago D, Trestini I, Milella M, Lanza M, Pilotto S. Exercise and anemia in cancer patients: could make the difference? Expert Rev Hematol 2021; 14:979-985. [PMID: 34784852 DOI: 10.1080/17474086.2021.2007764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Anemia is one of the most common hematological manifestations occurring in cancer patients, related to a poorer prognosis. Among supportive care in cancer, exercise is emerging as a crucial tool demonstrating to reduce mortality risk, as well as to counteract several diseases and treatment-related adverse events. Nevertheless, the effect of exercise on anemia in cancer is still a relatively unexplored area. AREA COVERED Six studies investigated the impact of exercise on anemia trajectory in cancer patients, with intriguing results. The potential mechanisms by which exercise may modulate the blood system are heterogenous, including bone marrow stimulation, improvements in the hematopoietic microenvironment, and control of both inflammation and hormones levels. Although training and/or living at high altitudes is a recognized method to increase erythropoiesis, the effect of a hypoxic external environment on tumor progression should be clarified before considering this strategy in cancer patients. EXPERT OPINION Although the available investigations about exercise in anemic patients with cancer are few, exercise emerges as an important supportive oncological care capable of assisting patients maintain their autonomy. Our special report offers several suggestions to address future research in this field and determine the real contribution of an active lifestyle on this condition.
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Affiliation(s)
- Alice Avancini
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, 37134, Verona, Italy
| | - Lorenzo Belluomini
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, 37134, Verona, Italy
| | - Daniela Tregnago
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, 37134, Verona, Italy
| | - Ilaria Trestini
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, 37134, Verona, Italy
| | - Michele Milella
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, 37134, Verona, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona Hospital Trust, 37134, Verona, Italy
| | - Sara Pilotto
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, 37134, Verona, Italy
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21
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Belluomini L, Riva ST, Simbolo M, Nocini R, Trestini I, Avancini A, Tregnago D, Ferrara MG, Caldart A, Dodi A, Caliò A, Bria E, Scarpa A, Milella M, Menis J, Pilotto S. Anticipating EGFR Targeting in Early Stages of Lung Cancer: Leave No Stone Unturned. Cells 2021; 10:2685. [PMID: 34685665 PMCID: PMC8535007 DOI: 10.3390/cells10102685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/15/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The current treatment landscape of early stage lung cancer is rapidly evolving, particularly in EGFR mutant non-small cell lung cancer (NSCLC), where target therapy is moving to early stages. In the current review, we collected the available data exploring the impact of EGFR targeting in both neoadjuvant and adjuvant settings, underlying lights and shadows and discussing the existing open issues. Methods: We performed a comprehensive search using PubMed and the proceedings of major international meetings to identify neoadjuvant/adjuvant trials with EGFR tyrosine kinase inhibitors (TKIs) in NSCLC. Results: Limited data are available so far about the activity/efficacy of neoadjuvant TKIs in EGFR mutant NSCLC, with only modest downstaging and pathological complete response rates reported. Differently, the ADAURA trial already proposed osimertinib as a potential new standard of care in resected NSCLC harboring an activating EGFR mutation. Conclusion: Anticipating targeted therapy to early stage EGFR mutant NSCLC presents great opportunities but also meaningful challenges in the current therapeutic/diagnostic pathway of lung cancer care. Appropriate endpoint(s) selection for clinical trials, disease progression management, patients' and treatment selection, as well as need to address the feasibility of molecular profiling anticipation, represent crucial issues to face before innovation can move to early stages.
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Affiliation(s)
- Lorenzo Belluomini
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy; (L.B.); (S.T.R.); (I.T.); (A.A.); (D.T.); (A.C.); (A.D.); (M.M.); (J.M.)
| | - Silvia Teresa Riva
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy; (L.B.); (S.T.R.); (I.T.); (A.A.); (D.T.); (A.C.); (A.D.); (M.M.); (J.M.)
| | - Michele Simbolo
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (M.S.); (A.C.); (A.S.)
| | - Riccardo Nocini
- Otolaryngology—Head and Neck Surgery Department, University of Verona Hospital Trust, 37126 Verona, Italy;
| | - Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy; (L.B.); (S.T.R.); (I.T.); (A.A.); (D.T.); (A.C.); (A.D.); (M.M.); (J.M.)
| | - Alice Avancini
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy; (L.B.); (S.T.R.); (I.T.); (A.A.); (D.T.); (A.C.); (A.D.); (M.M.); (J.M.)
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy; (L.B.); (S.T.R.); (I.T.); (A.A.); (D.T.); (A.C.); (A.D.); (M.M.); (J.M.)
| | - Miriam Grazia Ferrara
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy; (M.G.F.); (E.B.)
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Alberto Caldart
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy; (L.B.); (S.T.R.); (I.T.); (A.A.); (D.T.); (A.C.); (A.D.); (M.M.); (J.M.)
| | - Alessandra Dodi
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy; (L.B.); (S.T.R.); (I.T.); (A.A.); (D.T.); (A.C.); (A.D.); (M.M.); (J.M.)
| | - Anna Caliò
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (M.S.); (A.C.); (A.S.)
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy; (M.G.F.); (E.B.)
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Aldo Scarpa
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (M.S.); (A.C.); (A.S.)
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy; (L.B.); (S.T.R.); (I.T.); (A.A.); (D.T.); (A.C.); (A.D.); (M.M.); (J.M.)
| | - Jessica Menis
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy; (L.B.); (S.T.R.); (I.T.); (A.A.); (D.T.); (A.C.); (A.D.); (M.M.); (J.M.)
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, 37134 Verona, Italy; (L.B.); (S.T.R.); (I.T.); (A.A.); (D.T.); (A.C.); (A.D.); (M.M.); (J.M.)
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Trestini I, Carbognin L, Peretti U, Sperduti I, Caldart A, Tregnago D, Avancini A, Auriemma A, Orsi G, Pilotto S, Frulloni L, Capurso G, Bria E, Reni M, Tortora G, Milella M. Pancreatic Enzyme Replacement Therapy in Patients Undergoing First-Line Gemcitabine Plus nab-paclitaxel for Advanced Pancreatic Adenocarcinoma. Front Oncol 2021; 11:688889. [PMID: 34568019 PMCID: PMC8458827 DOI: 10.3389/fonc.2021.688889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/31/2021] [Accepted: 08/17/2021] [Indexed: 01/06/2023] Open
Abstract
Background The clinical consequences of pancreatic exocrine insufficiency and its treatment in advanced pancreatic ductal adenocarcinoma (PDAC) are poorly investigated. This retrospective study aims at investigating the pancreatic enzyme replacement therapy (PERT) use and its impact on survival and maldigestion-related symptoms in advanced PDAC patients undergoing chemotherapy. Methods A retrospective analysis was conducted on advanced PDAC patients, treated with first-line gemcitabine plus nab-paclitaxel at two academic institutions (March 2015-October 2018). Data were correlated with overall survival (OS) using Cox regression model. Kaplan-Meier curves were compared using Log-Rank test. Results Data from 110 patients were gathered. PERT was administered in 55 patients (50%). No significant differences in baseline characteristics with those who did not receive PERT were found. Median OS for the entire group was 12 months (95% CI 9-15). At multivariate analysis, previous surgical resection of the primary tumor, (HR 2.67, p=0.11), weight gain after 3 months (HR 1.68, p=0.07) and PERT (HR 2.85, p ≤ 0.001) were independent predictors of OS. Patients who received PERT reported an improvement of maldigestion-related symptoms at 3 months more frequently than patients who did not (85.2% vs 14.8%, p ≤ 0.0001). Conclusion PERT is associated with significantly prolonged survival and maldigestion-related symptoms alleviation in advanced PDAC patients.
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Affiliation(s)
- Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Luisa Carbognin
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Biomedical Sciences, Department of Medicine, University of Verona, Verona, Italy
| | - Umberto Peretti
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Isabella Sperduti
- Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alberto Caldart
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Alice Avancini
- Biomedical Sciences, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandra Auriemma
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Giulia Orsi
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Luca Frulloni
- Department of Medicine, University of Verona, Verona, Italy
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Unità Operativa Complessa (UOC) Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Michele Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giampaolo Tortora
- Comprehensive Cancer Center, Unità Operativa Complessa (UOC) Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
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Trestini I, Cintoni M, Rinninella E, Grassi F, Paiella S, Salvia R, Bria E, Pozzo C, Alfieri S, Gasbarrini A, Tortora G, Milella M, Mele MC. Neoadjuvant treatment: A window of opportunity for nutritional prehabilitation in patients with pancreatic ductal adenocarcinoma. World J Gastrointest Surg 2021; 13:885-903. [PMID: 34621468 PMCID: PMC8462076 DOI: 10.4240/wjgs.v13.i9.885] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/28/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
Patients affected by pancreatic ductal adenocarcinoma (PDAC) frequently present with advanced disease at the time of diagnosis, limiting an upfront surgical approach. Neoadjuvant treatment (NAT) has become the standard of care to downstage non-metastatic locally advanced PDAC. However, this treatment increases the risk of a nutritional status decline, which in turn, may impact therapeutic tolerance, postoperative outcomes, or even prevent the possibility of surgery. Literature on prehabilitation programs on surgical PDAC patients show a reduction of postoperative complications, length of hospital stay, and readmission rate, while data on prehabilitation in NAT patients are scarce and randomized controlled trials are still missing. Particularly, appropriate nutritional management represents an important therapeutic strategy to promote tissue healing and to enhance patient recovery after surgical trauma. In this regard, NAT may represent a new interesting window of opportunity to implement a nutritional prehabilitation program, aiming to increase the PDAC patient's capacity to complete the planned therapy and potentially improve clinical and survival outcomes. Given these perspectives, this review attempts to provide an in-depth view of the nutritional derangements during NAT and nutritional prehabilitation program as well as their impact on PDAC patient outcomes.
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Affiliation(s)
- Ilaria Trestini
- Section of Oncology, Department of Medicine, Pancreas Institute, University of Verona Hospital Trust, Verona 37126, Italy
| | - Marco Cintoni
- Scuola di Specializzazione in Scienza dell’Alimentazione, Università di Roma Tor Vergata, Roma 00133, Italy
| | - Emanuele Rinninella
- UOC Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli IRCCS, Roma 00168, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Futura Grassi
- UOC Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli IRCCS, Roma 00168, Italy
| | - Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona 37126, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona 37126, Italy
| | - Emilio Bria
- Oncologia Medica Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma 00167, Italy
- Oncologia Medica Unit, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Carmelo Pozzo
- Oncologia Medica Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma 00167, Italy
- Oncologia Medica Unit, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Sergio Alfieri
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma 00168, Italy
- Digestive Surgery Unit and Pancreatic Surgery Gemelli Center Director, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma 00167, Italy
| | - Antonio Gasbarrini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma 00168, Italy
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma 00167, Italy
| | - Giampaolo Tortora
- Oncologia Medica Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma 00167, Italy
- Oncologia Medica Unit, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, Pancreas Institute, University of Verona Hospital Trust, Verona 37126, Italy
| | - Maria Cristina Mele
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma 00168, Italy
- UOSD Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma 00167, Italy
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Avancini A, Scrivano G, Tregnago D, Trestini I, Riva S, Belluomini L, Menis J, Valentini M, Leone F, Milella M, Lanza M, Pilotto S. 1857P Choose health, oncological patients centered exercise (CHOiCE): Preliminary findings of a pilot randomized controlled trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Tregnago D, Pilotto S, Belluomini L, Menis J, Fiorio E, Pavarana M, Casali M, Benini L, Zacchi F, Caldart A, Trevisani E, Trestini I, Avancini A, Cafaro D, Cadorin C, Rimondini M, Del Piccolo L, Zuliani S, Milella M. 1640P Impact of COVID-19 vaccination campaign on psychological status in cancer patients (pts). Ann Oncol 2021. [PMCID: PMC8454306 DOI: 10.1016/j.annonc.2021.08.1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Trestini I, Cintoni M, Sposito M, Kadrija D, Dodi A, Caldart A, Belluomini L, Menis J, Vita E, Sperduti I, Drudi A, Aluffi G, Tregnago D, Avancini A, D'Onofrio M, Mele M, Tortora G, Milella M, Bria E, Pilotto S. 1675P Potential effect of adipose tissue distribution on clinical outcomes in advanced non-small cell lung cancer (NSCLC) patients (pts) receiving first-line pembrolizumab (PEMBRO). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Avancini A, Tregnago D, Rigatti L, Sartori G, Yang L, Trestini I, Bonaiuto C, Milella M, Pilotto S, Lanza M. Factors Influencing Physical Activity in Cancer Patients During Oncological Treatments: A Qualitative Study. Integr Cancer Ther 2021; 19:1534735420971365. [PMID: 33349064 PMCID: PMC7758643 DOI: 10.1177/1534735420971365] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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] [Indexed: 01/24/2023] Open
Abstract
Introduction: Although the literature supports the importance of physical activity in the oncological context, in Italy a large number of patients are not sufficiently active. Methods: The present study aimed to explore factors influencing an active lifestyle in cancer patients during oncological treatments. Semi-structured focus groups, including 18 patients with different cancer types, were conducted at the Oncology Unit in the University Hospital Trust of Verona (Italy). The interviews were audio-recorded, transcribed verbatim, and analyzed with content analysis. Results: According to the Health Belief Model, transcripts were categorized into the following themes: benefits, barriers, and cues to action. Patients reported a series of physical, physiological, and psychological benefits deriving from an active lifestyle. The main barriers hampering the physical activity participation were represented by treatment-related side effects, advanced disease, and some medical procedures, for example, ileostomy. Several strategies that can trigger patients to exercise were identified. Medical advice, social support from family and friends, features such as enjoyment, setting goals, and owning an animal can motivate patients to perform physical activity. At the same time, an individualized program based on patients’ characteristics, an available physical activity specialist to consult, more detailed information regarding physical activity in the oncological setting, and having accessible structures were found important facilitators to implementing active behavior. Conclusions: Overall, patients have a positive view regarding physical activity, and a variety of obstacles and cues to action were recognized. Considering this information may help to improve adherence to a physical activity program over time, consequently increasing the expected benefits.
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Affiliation(s)
| | | | | | | | - Lin Yang
- Alberta Health Services, Calgary, Canada.,University of Calgary, Calgary, Canada
| | | | | | - Michele Milella
- University of Verona, Verona, Italy.,Medical Oncology, Verona, Italy
| | - Sara Pilotto
- University of Verona, Verona, Italy.,Medical Oncology, Verona, Italy
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Avancini A, Borsati A, Trestini I, Tregnago D, Lanza M, Milella M, Pilotto S. POPULATION’ PERCEPTION ABOUT EXERCISE IN CANCER PATIENTS: PRELIMINARY FINDINGS. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764864.99055.b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Trestini I, Sperduti I, Sposito M, Kadrija D, Drudi A, Avancini A, Tregnago D, Carbognin L, Bovo C, Santo A, Lanza M, D'Onofrio M, Tortora G, Bria E, Milella M, Pilotto S. Evaluation of nutritional status in non-small-cell lung cancer: screening, assessment and correlation with treatment outcome. ESMO Open 2021; 5:e000689. [PMID: 32424067 PMCID: PMC7239526 DOI: 10.1136/esmoopen-2020-000689] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 12/21/2022] Open
Abstract
Background Nutritional derangements are common hallmarks of non-small-cell lung cancer (NSCLC). Nevertheless, their early detection is overlooked in clinical routine. This study aimed to evaluate nutritional status and its correlation with outcome in NSCLC patients. Methods Data regarding NSCLC patients undergoing nutritional evaluation were prospectively collected (May 2016–October 2018). Nutritional risk was assessed by Nutritional Risk Screening 2002 (NRS-2002). Bilateral psoas major muscles were measured at L3 vertebrae level with routine staging-computed tomography and changes were evaluated using Wilcoxon signed-rank test. Clinico-pathological and nutritional data were correlated to progression-free/overall survival (PFS/OS) and response rate (ORR) using a Cox and logistic regression model. Kaplan–Meier curves were compared with log-rank test. Results Thirty-eight patients were included. The majority (65.8%) of them were at nutritional risk (NRS-2002 ≥3). At multivariate analysis for patients with advanced disease, age (HR 2.44, p=0.05), performance status (HR 2.48, p=0.043) and NRS-2002 (HR 1.74, p=0.001) were significant independent predictors for PFS and weight loss (HR 1.07, p=0.008) for OS. Patients with baseline NRS-2002 <3 had significantly longer 1-year PFS (85.7% vs 19.4%, p=0.02) and higher ORR (66.7% vs 21.4%) than those with NRS-2002 ≥3. An explorative evaluation demonstrated that NRS-2002 score significantly decreased after nutritional intervention (p=0.001) for 3 months. Conclusion Baseline nutritional risk represents a prognostic factor in NSCLC. Nutritional counselling should be applied as a fundamental tool to improve nutritional risk in a short period, ameliorating patients’ outcome.
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Affiliation(s)
- Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Isabella Sperduti
- Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Sposito
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Dzenete Kadrija
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Alessandro Drudi
- Department of Radiology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alice Avancini
- Biomedical Sciences, Department of Medicine, University of Verona, Verona, Italy
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Luisa Carbognin
- Division of Gynecologic Oncology, Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, I.R.C.C.S., Università Cattolica del Sacro Cuore, Roma, Italy; Department of Medicine, University of Verona, Verona, Italy
| | - Chiara Bovo
- Healthcare Department, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
| | - Antonio Santo
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giampaolo Tortora
- Medical Oncology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario 'A.Gemelli' I.R.C.C.S, Roma, Italy
| | - Emilio Bria
- Medical Oncology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario 'A.Gemelli' I.R.C.C.S, Roma, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy.
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Avancini A, Trestini I, Tregnago D, Lanza M, Menis J, Belluomini L, Milella M, Pilotto S. A multimodal approach to cancer-related cachexia: from theory to practice. Expert Rev Anticancer Ther 2021; 21:819-826. [PMID: 33971783 DOI: 10.1080/14737140.2021.1927720] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Cachexia represents a relevant issue in oncological care, which is still lacking effective therapies. Although the incidence of cancer cachexia varies across cancer types, it is responsible for approximately a quarter of cancer-related deaths. The pathophysiology of this syndrome is multifactorial, including weight loss, muscle atrophy and impairment of the pro-/anti-inflammatory balance.Areas covered: Diagnostic criteria and optimal endpoints for cachexia-dedicated trials are still debated, slowing the identification of interventions counteracting cachexia sequaele. The multifaceted features of this syndrome support the rationale for personalized therapy. A multimodal approach is likely to offer the best option to address key cachexia-related issues. Pharmacologic agents, physical exercise, nutritional and psycho-social interventions may have a synergistic effect, and improve quality of life.Expert opinion: A personalized multimodal intervention could be the best strategy to effectively manage cancer cachexia. To offer such a comprehensive approach, a specialized staff, including health professionals with different expertise, is necessary. Each specialist plays a specific role inside the multimodal intervention, with the aim of delivering the best cancer care and access to the most effective therapeutic options for each patient.
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Affiliation(s)
- Alice Avancini
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Ilaria Trestini
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Daniela Tregnago
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Jessica Menis
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Lorenzo Belluomini
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Michele Milella
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Sara Pilotto
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
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Trestini I, Caldart A, Dodi A, Avancini A, Tregnago D, Sartori G, Belluomini L, Milella M, Pilotto S. Body composition as a modulator of response to immunotherapy in lung cancer: time to deal with it. ESMO Open 2021; 6:100095. [PMID: 33773420 PMCID: PMC8027687 DOI: 10.1016/j.esmoop.2021.100095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/27/2022] Open
Affiliation(s)
- I Trestini
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - A Caldart
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - A Dodi
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - A Avancini
- Biomedical Sciences, Department of Medicine, University of Verona, Verona, Italy
| | - D Tregnago
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - G Sartori
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - L Belluomini
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - M Milella
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - S Pilotto
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy.
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Avancini A, Cavallo A, Trestini I, Tregnago D, Belluomini L, Crisafulli E, Micheletto C, Milella M, Pilotto S, Lanza M, Infante MV. Exercise prehabilitation in lung cancer: Getting stronger to recover faster. Eur J Surg Oncol 2021; 47:1847-1855. [PMID: 33757650 DOI: 10.1016/j.ejso.2021.03.231] [Citation(s) in RCA: 12] [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: 12/10/2020] [Revised: 02/10/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
Despite several recent advances, lung cancer surgery is still associated with potentially severe postoperative complications. It has been suggested that preoperative exercise training could render patients with borderline functional parameters eligible for surgery, improve perioperative outcomes and that these benefits might reduce healthcare costs. Nevertheless, given the substantial heterogeneity of the available studies, no specific guidelines for preoperative exercise training have been released so far. This narrative review aims to provide an overview of the potential benefits of exercise training in the preoperative period as a central intervention for lung cancer patients. In detail, the effects of exercise (with different regimens) were evaluated in terms of physical functions, patients' eligibility for curative surgery, postoperative complications and length of stay, with an exploratory focus on healthcare costs and long-term outcomes. Furthermore, a feasible approach for every-day clinical practice is proposed in order to increase the expected benefit deriving from a more extensive and methodical application of prehabilitation exercise, ideally in the context of a comprehensive approach to lung cancer patients, including nutritional and psychological support.
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Affiliation(s)
- Alice Avancini
- Biomedical, Clinical and Experimental Sciences, Department of Medicine, University of Verona, Verona, Italy.
| | - Alessandro Cavallo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Lorenzo Belluomini
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Ernesto Crisafulli
- Respiratory Medicine Unit, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Claudio Micheletto
- Department of Cardiovascular and Thoracic, Pneumology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Maurizio Valentino Infante
- Thoracic Surgery Department, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
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Pigozzi E, Tregnago D, Costa L, Insolda J, Turati E, Rimondini M, Donisi V, Madera P, Fiorica F, Giuliani J, Greco F, Mercanti A, Trolese A, Furlani L, Piacentini P, Durante E, Mandarà M, Pilotto S, Avancini A, Trestini I, Zaninelli M, Moretti F, Milella M, Bonetti A. Psychological impact of Covid-19 pandemic on oncological patients: A survey in Northern Italy. PLoS One 2021; 16:e0248714. [PMID: 33724999 PMCID: PMC7963060 DOI: 10.1371/journal.pone.0248714] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/04/2021] [Indexed: 12/19/2022] Open
Abstract
The psychological impact of the Covid 19 pandemic on cancer patients, a population at higher risk of fatal consequences if infected, has been only rarely evaluated. This study was conducted at the Departments of Oncology of four hospitals located in the Verona area in Italy to investigate the psychological consequences of the pandemic on cancer patients under active anticancer treatments. A 13-item ad hoc questionnaire to evaluate the psychological status of patients before and during the pandemic was administered to 474 consecutive subjects in the time frame between April 27th and June 7th 2020. Among the 13 questions, 7 were considered appropriate to elaborate an Emotional Vulnerability Index (EVI) that allows to separate the population in two groups (low versus high emotional vulnerability) according to observed median values. During the emergency period, the feeling of high vulnerability was found in 246 patients (53%) and was significantly associated with the following clinical variables: female gender, being under chemotherapy treatment, age ≤ 65 years. Compared to the pre-pandemic phase, the feeling of vulnerability was increased in 41 patients (9%), remained stably high in 196 (42%) and, surprisingly, was reduced in 10 patients (2%). Overall, in a population characterized by an high level of emotional vulnerability the pandemic had a marginal impact and only a small proportion of patients reported an increase of their emotional vulnerability.
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Affiliation(s)
- Eva Pigozzi
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | - Daniela Tregnago
- Section of Oncology, University of Verona School of Medicine, Verona University Hospital Trust, Verona, Italy
| | - Lucia Costa
- Clinical Psicology Unit, AULSS9 Scaligera, Verona, Italy
| | - Jessica Insolda
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | - Enrico Turati
- Department of Lifesciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Michela Rimondini
- Clinical Psicology Unit, Verona University Hospital Trust, Verona, Italy
| | - Valeria Donisi
- Clinical Psicology Unit, Verona University Hospital Trust, Verona, Italy
| | - Pietro Madera
- Clinical Psicology Unit, AULSS9 Scaligera, Verona, Italy
| | - Francesco Fiorica
- Department of Radiation Oncology and Nuclear Medicine, AULSS 9 Scaligera, Legnago, VR, Italy
| | - Jacopo Giuliani
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | - Filippo Greco
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | - Anna Mercanti
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | - Annarita Trolese
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | - Lara Furlani
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | - Paolo Piacentini
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | - Emilia Durante
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | - Marta Mandarà
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | - Sara Pilotto
- Section of Oncology, University of Verona School of Medicine, Verona University Hospital Trust, Verona, Italy
| | - Alice Avancini
- Biomedical, clinical and experimental sciences, Department of Medicine, University of Verona, Verona, Italy
| | - Ilaria Trestini
- Section of Oncology, University of Verona School of Medicine, Verona University Hospital Trust, Verona, Italy
| | - Marta Zaninelli
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | | | - Michele Milella
- Section of Oncology, University of Verona School of Medicine, Verona University Hospital Trust, Verona, Italy
| | - Andrea Bonetti
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
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Avancini A, Trestini I, Tregnago D, Cavallo A, Bragato M, Bonaiuto C, Lanza M, Milella M, Pilotto S. Multidisciplinary lifestyle intervention to manage pancreatic cancer-related cachexia: a case report. Future Sci OA 2020; 7:FSO659. [PMID: 33437520 PMCID: PMC7787172 DOI: 10.2144/fsoa-2020-0165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/25/2020] [Accepted: 10/27/2020] [Indexed: 01/06/2023] Open
Abstract
Pancreatic cancer remains an aggressive disease, with a poor prognosis and a high risk of incurring into cachexia. Supportive care, such as exercise, nutritional and psychological support, may be effective in reducing functional loss, psychological distress and improving nutritional status. We report the effect of 12 weeks of multimodal lifestyle intervention in a 55-year-old female, diagnosed with unresectable body/tail pancreatic cancer and metastasis in the liver, bone, lymph node and lung, to counteract cachexia. The multimodal program resulted safe and feasible. Over 12 weeks, considerable improvements were found in body weight, health-related physical fitness, nutritional status, distress scores, anxiety and depression levels. These findings highlight the potential role of integrated supportive interventions to manage metastatic cancer and cancer-induced cachexia.
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Affiliation(s)
- Alice Avancini
- Department of Medicine, Biomedical, Clinical & Experimental Sciences, University of Verona Hospital Trust, Verona 37134, Italy
| | - Ilaria Trestini
- Department of Medicine, Medical Oncology, University of Verona Hospital Trust, Verona 37134, Italy
| | - Daniela Tregnago
- Department of Medicine, Medical Oncology, University of Verona Hospital Trust, Verona 37134, Italy
| | - Alessandro Cavallo
- Department of Neurosciences, Biomedicine & Movement Sciences, University of Verona, Verona 37134, Italy
| | - Marco Bragato
- Department of Neurosciences, Biomedicine & Movement Sciences, University of Verona, Verona 37134, Italy
| | - Clelia Bonaiuto
- Department of Medicine, Medical Oncology, University of Verona Hospital Trust, Verona 37134, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine & Movement Sciences, University of Verona, Verona 37134, Italy
| | - Michele Milella
- Department of Medicine, Medical Oncology, University of Verona Hospital Trust, Verona 37134, Italy
| | - Sara Pilotto
- Department of Medicine, Medical Oncology, University of Verona Hospital Trust, Verona 37134, Italy
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Mele MC, Rinninella E, Cintoni M, Pulcini G, Di Donato A, Grassi F, Trestini I, Pozzo C, Tortora G, Gasbarrini A, Bria E. Nutritional Support in Lung Cancer Patients: The State of the Art. Clin Lung Cancer 2020; 22:e584-e594. [PMID: 33303399 DOI: 10.1016/j.cllc.2020.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 06/16/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022]
Abstract
Lung cancer (LC) represents the most commonly diagnosed neoplasm worldwide for both sexes and is the leading cause of cancer mortality. Malnutrition is a comorbidity frequently found in neoplastic patients, but it remains often underestimated and thus undertreated. In this review, we aimed to investigate the incidence of malnutrition among LC patients according to different screening and assessment tools, to evaluate the impact of weight loss and body composition on survival, and to analyze the efficacy of different nutritional interventions in this setting. Although malnutrition, weight loss, and body composition changes can affect survival and other clinical outcomes in LC patients, the role of nutritional interventions is not yet strongly proven, and further studies are recommended. Nevertheless, screening, assessing, and eventually treating malnutrition in LC patients are strongly recommended, according to the most recent nutritional intervention guidelines for oncology patients.
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Affiliation(s)
- Maria Cristina Mele
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Rinninella
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Cintoni
- Scuola di Specializzazione in Scienza dell'Alimentazione, Università di Roma Tor Vergata, Rome, Italy.
| | - Gabriele Pulcini
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Agnese Di Donato
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Futura Grassi
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ilaria Trestini
- Oncologia Medica, Università di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Carmelo Pozzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Bria
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
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Pilotto S, Trestini I, Sperduti I, Sposito M, Kadrija D, Dodi A, Cintoni M, Drudi A, Aluffi G, Belluomini L, Sartori G, Casali M, Lombardo F, Tregnago D, Avancini A, Carbognin L, D'Onofrio M, Mele M, Bria E, Milella M. 1831P Role of body composition (bc) in advanced non-small cell lung cancer (NSCLC) patients receiving first-line pembrolizumab (pembro). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Trestini I, Paiella S, Sandini M, Hank T, Pollini T, Sperduti I, Melisi D, Auriemma A, Soldà C, Tregnago D, Avancini A, Malleo G, D'Onofrio M, Gianotti L, Pilotto S, Salvia R, del Castillo C, Bassi C, Milella M. 1560P Sarcopenia and sarcopenic obesity in pancreatic ductal adenocarcinoma (PDAC) patients undergoing surgery after neoadjuvant therapy (NAT): Prevalence and clinical implications. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Peretti U, Trestini I, Carbognin L, Sperduti I, Caldart A, Melisi D, Auriemma A, Soldà C, Tregnago D, Avancini A, Pilotto S, Bria E, Tortora G, Reni M, Milella M. 1856P Clinical relevance of pancreatic enzyme replacement therapy (PERT) in patients affected by advanced pancreatic ductal adenocarcinoma (PDAC) undergoing first-line chemotherapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Carbognin L, Trestini I, Sperduti I, Caldart A, Cintoni M, Drudi A, Aluffi G, Fiorio E, Parolin V, Tregnago D, Avancini A, Pilotto S, D'Onofrio M, Mele M, Scambia G, Tortora G, Milella M, Bria E. 179P Prognostic impact of body composition (BC) changes during neoadjuvant chemotherapy (NACT) in breast cancer patients (pts). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Avancini A, Trestini I, Carbognin L, Tregnago D, Fiorio E, Parolin V, Lanza M, Bria E, Milella M, Pilotto S. 1847P A longitudinal study investigating lifestyle modification during and after breast cancer treatment. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Avancini A, Trestini I, Tregnago D, Wiskemann J, Lanza M, Milella M, Pilotto S. Physical Activity for Oncological Patients in COVID-19 Era: No Time to Relax. JNCI Cancer Spectr 2020; 4:pkaa071. [PMID: 33385107 PMCID: PMC7499670 DOI: 10.1093/jncics/pkaa071] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/08/2020] [Revised: 06/30/2020] [Accepted: 08/01/2020] [Indexed: 01/09/2023] Open
Abstract
Whereas the coronavirus disease 2019 (COVID-19) storm is relentlessly progressing worldwide, a great effort from scientific societies has been made to give recommendations for safely continuing oncological care, prioritizing the interventions according to patients' condition and type and stage of tumor. Nevertheless, to date no specific suggestions regarding physical activity and exercise in cancer patients during the COVID-19 era have been released, neglecting the potential deleterious effects of quarantine and sedentary behaviour (imposed as containment measures against COVID-19), particularly in these subjects. Moreover, literature is constantly consolidating the crucial impact of regular physical activity in cancer in reducing recurrence and mortality risk. In this commentary, we discuss possible adaptations of the recently published exercise guidelines to the current pandemic emergency, proposing various modalities to prevent or mitigate the physical inactivity risk in cancer patients.
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Affiliation(s)
- Alice Avancini
- Department of Medicine, Biomedical, Clinical and Experimental Sciences, University of Verona, Verona, Italy
| | - Ilaria Trestini
- Department of Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Daniela Tregnago
- Department of Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Clinic Heidelberg, Heidelberg, Germany
| | - Massimo Lanza
- Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Milella
- Department of Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sara Pilotto
- Department of Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Carbognin L, Trestini I, Sperduti I, Caldart A, Bonaiuto C, Fiorio E, Parolin V, Tregnago D, Pilotto S, Scambia G, Tortora G, Milella M, Bria E. ADHERENCE TO DIETARY GUIDELINES AND WEIGHT CHANGE IN BREAST CANCER PATIENTS: PRELIMINARY RESULTS OF A PROSPECTIVE TRIAL. Nutrition 2020. [DOI: 10.1016/j.nut.2020.110906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Avancini A, Pala VM, Sieri S, Krogh V, Mariani L, Trestini I, Tregnago D, Milella M, Pilotto S, Lanza M. EXPLORE EXERCISE LEVEL AND PREFERENCES IN PANCREATIC CANCER PATIENTS. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000679200.90026.0e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Trestini I, Paiella S, Sandini M, Hank T, Sperduti I, Pollini T, Melisi D, Auriemma A, Soldà C, Tregnago D, Avancini A, Pilotto S, Malleo G, D'Onofrio M, Gianotti L, Fernandez-del Castillo C, Bassi C, Milella M. CORRELATION BETWEEN BODY COMPOSITION, INFLAMMATION AND SURVIVAL IN PANCREATIC CANCER TREATED WITH NEOADJUVANT THERAPY. Nutrition 2020. [DOI: 10.1016/j.nut.2020.110909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Trestini I, Paiella S, Sandini M, Sperduti I, Elio G, Melisi D, Auriemma A, Soldà C, Tregnago D, Avancini A, Secchettin E, Bonamini D, Pilotto S, Malleo G, Gianotti L, Bassi C, Milella M. PROGNOSTIC VALUE OF PREOPERATIVE NUTRITIONAL STATUS IN RESECTED PANCREATIC DUCTAL ADENOCARCINOMA: A PROSPECTIVE STUDY. Nutrition 2020. [DOI: 10.1016/j.nut.2020.110910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Trestini I, Sperduti I, Sposito M, Kadrija D, Drudi A, Tregnago D, Avancini A, Gkountakos A, Carbognin L, Lanza M, Santo A, D'Onofrio M, Tortora G, Bria E, Milella M, Pilotto S. NUTRITIONAL DERANGEMENTS IN ADVANCED NON-SMALL CELL LUNG CANCER PATIENTS: PREVALENCE AND IMPACT ON TREATMENT OUTCOME. Nutrition 2020. [DOI: 10.1016/j.nut.2020.110908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sartori G, Belluomini L, Lombardo F, Avancini A, Trestini I, Vita E, Tregnago D, Menis J, Bria E, Milella M, Pilotto S. Efficacy and safety of afatinib for non-small-cell lung cancer: state-of-the-art and future perspectives. Expert Rev Anticancer Ther 2020; 20:531-542. [PMID: 32529917 DOI: 10.1080/14737140.2020.1776119] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Afatinib is a second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, acting as an irreversible and multitarget blocker of ErbB family members. Afatinib is currently approved for advanced non-small-cell lung cancer (NSCLC) harboring common and uncommon sensitizing EGFR mutations and for squamous NSCLC patients progressing after first-line platinum-based chemotherapy. AREAS COVERED This review summarizes the efficacy and safety profile of afatinib compared with chemotherapy and other EGFR TKIs, in order to evaluate its characteristics and potential role in the increasingly complex treatment landscape of EGFR-mutant lung cancer. Future perspectives and innovative drug combinations are also discussed. EXPERT OPINION Afatinib has been demonstrated to improve efficacy and quality of life compared with chemotherapy with a managed toxicity profile. However, in recent years, the increasing availability of different treatment options for advanced EGFR-mutant NSCLC has made the current treatment scenario more complicated, with an increasing need of new and deeper scientific data. In this light, the identification and validation of potential clinicopathological and/or molecular predictors of benefit, as well as the clarification of resistance mechanisms, may help to clarify the most appropriate treatment strategies and sequences for EGFR-mutant patients.
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Affiliation(s)
- Giulia Sartori
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Lorenzo Belluomini
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Fiorella Lombardo
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Alice Avancini
- Biomedical, Clinical and Experimental Sciences, Department of Medicine, University of Verona , Verona, Italy
| | - Ilaria Trestini
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Emanuele Vita
- Medical Oncology, Università Cattolica Del Sacro Cuore, Fondazione Policlinico Universitario 'A. Gemelli' I.R.C.C.S ., Roma, Italy
| | - Daniela Tregnago
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Jessica Menis
- Department of Surgery, Oncology and Gastroenterology, University of Padova , Padova, Italy.,Medical Oncology Department, Istituto Oncologico Veneto IRCCS , Padova, Italy
| | - Emilio Bria
- Medical Oncology, Università Cattolica Del Sacro Cuore, Fondazione Policlinico Universitario 'A. Gemelli' I.R.C.C.S ., Roma, Italy
| | - Michele Milella
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Sara Pilotto
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
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Trestini I, Paiella S, Sandini M, Hank T, Pollini T, Sperduti I, Melisi D, Auriemma A, Soldà C, Tregnago D, Avancini A, Malleo G, D'Onofrio M, Gianotti L, Pilotto S, Bria E, Salvia R, del Castillo CF, Bassi C, Milella M. Sarcopenia and sarcopenic obesity in pancreatic ductal adenocarcinoma (PDAC) patients undergoing surgery after neoadjuvant therapy (NAT): Clinical implications. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16769 Background: Nutritional status may be markedly affected by NAT for PDAC. Sarcopenia and sarcopenic obesity have been studied in several types of cancers and have been reported to be associated with higher morbidity and mortality. The present study assessed the impact of sarcopenia/sarcopenic obesity and changes in body composition (BC) following NAT on surgical and survival outcomes in patients (pts) undergoing surgery for PDAC. Methods: PDAC pts with available CT-scans (both at diagnosis and preoperatively) undergoing surgical resection after NAT at two academic medical institutions from 2013 to 2015 were retrospectively evaluated. BC was assessed by analyzing axial L3 CT images before and after NAT. Data were correlated with overall survival (OS) using a Cox regression model. Kaplan-Meier curves were compared with Log-Rank test. Results: The final cohort consisted of 108 pts, with a median age of 63 years and a median follow-up of 16 months. Ninety-one pts (89.8%) received FOLFIRINOX. Sarcopenia and sarcopenic obesity were found at diagnosis in 41.7% and 16.7% of pts, respectively. After NAT, all body compartments significantly changed (p < 0.001); the prevalence of sarcopenia and sarcopenic obesity decreased to 30.5% and 10.2%, respectively, after NAT. These BC phenotypes were related to a higher overall complications rate after surgery (69.7% vs. 30.3%, p = 0.027 and 81.8% vs. 18.2% %, p = 0.048, respectively). Particularly, cardiac complications were associated with sarcopenia (9% vs. 0%, p = 0.028) and pts that developed postoperative complications had higher preoperative total adipose tissue (300 vs. 229 cm2, p > 0.05). With regards to OS, sarcopenic obesity at baseline (HR 3.45, p = 0.023) was found to be a significant independent predictor for OS at multivariate analysis. Conclusions: Our data provide evidence that BC impacts on both surgical and survival outcomes in PDAC pts undergoing NAT before resection. The associations with worse clinical outcomes emphasize the role of nutritional evaluation, as well as the need to develop appropriate evidence-based nutritional interventions during NAT.
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Affiliation(s)
- Ilaria Trestini
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Marta Sandini
- School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Thomas Hank
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tommaso Pollini
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Isabella Sperduti
- Regina Elena National Cancer Institute IRCCS, Biostatistics, Rome, Italy
| | - Davide Melisi
- Medicine-Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Alessandra Auriemma
- Department of Oncology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Caterina Soldà
- Department of Oncology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Daniela Tregnago
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Alice Avancini
- Biomedical Sciences, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Sara Pilotto
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Emilio Bria
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | | | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Michele Milella
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
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Trestini I, Sperduti I, Caldart A, Bonaiuto C, Fiorio E, Parolin V, Tregnago D, Avancini A, Pilotto S, Lanza M, Scambia G, Tortora G, Milella M, Bria E, Carbognin L. Effect of evidence-based nutrition educational intervention on adherence to dietary guidelines (ADG) and weight management among early-stage breast cancer (EBC) patients (pts): A prospective trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12056 Background: Excess adiposity is linked to an increased risk of worse outcome among EBC pts. Pts undergoing EBC treatment are susceptible to change in nutrition status. However, implementation and assessment of the adherence to lifestyle interventions have been limited. This prospective trial aimed to evaluate the impact of an evidence-based nutrition intervention, according to the ADG, in terms of body composition changes in EBC pts. Methods: Entry criteria: EBC pts candidate to neoadjuvant/adjuvant therapy. At study entry, pts received a nutrition evidence-based tailored intervention. Dietary and anthropometric assessments were evaluated at baseline and after 12-months nutritional intervention. Waist circumference (WC) was assessed as a surrogate measure of fat distribution. ADG was estimated by Med-Diet 14-item questionnaire. Health-Related Quality of Life was analysed with EORTC QLQ-C30. Descriptive statistics was adopted. Associations between variables and groups according to nutritional variables were analysed (Chi-square test). Results: From February 2016 to December 2019, 243 pts were enrolled (median age 49 years): 27.6%/48.6% neoadjuvant/adjuvant treatment. At baseline, 38.3% of pts were overweight and 23.9% were obese. Notably, tumor size was significantly correlated with WC in the whole population (p = 0.003). Moreover, pts with central obesity were more likely to present HER2-negative tumors (57.4% vs. 42.5%, p = 0.03). Most pts reported relevant nutrition impact symptoms and symptoms affected QoL. Particularly, dyspepsia and constipation were more prevalent in overweight and obese pts (p < 0.0001 and p = 0.009, respectively), as well as in pts who gained ≥5% of weight (p = 0.04 and p = 0.02, respectively). At baseline, there was low ADG. After the 12-months intervention, ADG significantly increased (median Med-Diet score: 6 vs.12, p < 0.0001). A high ADG (defines as a Med-Diet score ≥10) significantly correlated with: 1) loss of weight ≥5% from the baseline weight (p = 0.003); 2) change in terms of BMI; 3) prevalence of central obesity. Conclusions: A tailored evidence-based nutritional intervention for EBC pts represents a tool to improve their ADG, weight management and, thus, to potentially influence the disease outcome. [Table: see text]
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Affiliation(s)
- Ilaria Trestini
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Isabella Sperduti
- Regina Elena National Cancer Institute IRCCS, Biostatistics, Rome, Italy
| | - Alberto Caldart
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Clelia Bonaiuto
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Elena Fiorio
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Veronica Parolin
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Daniela Tregnago
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Alice Avancini
- Biomedical Sciences, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Sara Pilotto
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, I.R.C.C.S., Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Fondazione Policlinico Universitario A. Gemelli-IRCCS-UOC Oncologia Medica, Rome, Italy
| | - Michele Milella
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Emilio Bria
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luisa Carbognin
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Trestini I, Paiella S, Sandini M, Sperduti I, Elio G, Pollini T, Melisi D, Auriemma A, Soldà C, Bonaiuto C, Tregnago D, Avancini A, Secchettin E, Bonamini D, Lanza M, Pilotto S, Malleo G, Salvia R, Bovo C, Gianotti L, Bassi C, Milella M. Prognostic Impact of Preoperative Nutritional Risk in Patients Who Undergo Surgery for Pancreatic Adenocarcinoma. Ann Surg Oncol 2020; 27:5325-5334. [PMID: 32388740 DOI: 10.1245/s10434-020-08515-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Nutritional derangements are common hallmarks of pancreatic cancer (PC). Their early detection and management are usually overlooked in routine practice. This study aimed to explore preoperative nutritional status and its prognostic value in patients undergoing surgery for PC. METHODS Data from 73 patients who underwent surgery for PC from November 2015 to January 2018 at the General and Pancreatic Surgery Unit, The Pancreas Institute, University Hospital of Verona Hospital, Verona, Italy, were retrospectively evaluated. The Nutritional Risk Screening (NRS)-2002 was used to evaluate the preoperative nutritional risk. Body composition was assessed using bioimpedance vectorial analysis (BIVA) on the day prior to surgery. The effect of clinical, pathological, and nutritional characteristics on overall survival (OS) was investigated using a Cox and logistic regression model. Kaplan-Meier curves were compared using the log-rank test. RESULTS Most patients (80.8%) were at preoperative risk of malnutrition (NRS-2002 ≥ 3) despite a mean BMI of 24.1 kg/m2(± 4.3). Twenty-four patients (32.9%) received neoadjuvant therapy prior to surgery. Preoperative NRS-2002 was significantly higher in this subset of patients (p = 0.026), with a significant difference by chemotherapy regimens (in favor of FOLFIRINOX, p = 0.035). In a multivariate analysis, the only independent prognostic factor for OS was the NRS-2002 score (HR 5.24, p = 0.013). Particularly, the likelihood of 2-year survival was higher in NRS < 3 (p = 0.009). CONCLUSIONS Our analysis confirms that preoperative malnutrition has a detrimental impact on OS in PC patients undergoing radical surgery for PC. Careful preoperative nutritional evaluation of PC patients should be mandatory, especially in those who are candidates for neoadjuvant therapy.
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Affiliation(s)
- Ilaria Trestini
- Department of Oncology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
| | - Marta Sandini
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Isabella Sperduti
- Biostatistical Unit - Clinical Trials Center, Bio-Statistics Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Elio
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Tommaso Pollini
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Davide Melisi
- Department of Oncology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Alessandra Auriemma
- Department of Oncology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Caterina Soldà
- Department of Oncology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Clelia Bonaiuto
- Department of Oncology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Daniela Tregnago
- Department of Oncology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Alice Avancini
- Biomedical Sciences, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Erica Secchettin
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Deborah Bonamini
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Pilotto
- Department of Oncology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Chiara Bovo
- Healthcare Department Administrator, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Luca Gianotti
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Michele Milella
- Department of Oncology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
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