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Gebbia V, Cusumano N, Piazza D, Tralongo P. Some Considerations on a Patient's Sense of Immortality: Bringing a Human Dimension to the Process. J Cancer Educ 2024:10.1007/s13187-024-02410-3. [PMID: 38369649 DOI: 10.1007/s13187-024-02410-3] [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] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 02/20/2024]
Abstract
One of the most frequent, although widely understandable, reactions of people diagnosed with an incurable tumor is represented by incredulity, anger, and the denial of the impossibility of a definitive cure. Often, a picture of intense anxiety quickly takes over, overlapping the ever-growing collective hysteria of modern society, the result of a complex cultural mechanism in which technocracy often prevails over thought, introspection, and, in a broader sense, humanism. In this health drama, all actors often complain of formal inaccuracies while paying little attention to substantive ones. We argue that a more human emphatic patient-family-doctor relationship training to consider the undeniable progress of medicine and the fragility of all of us.
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Affiliation(s)
- Vittorio Gebbia
- Medical Oncology Unit, University of Enna Kore, Enna, Italy.
- Medical Oncology Unit, C.d.C. Torina, Palermo, Italy.
| | | | | | - Paolo Tralongo
- Medical Oncology Unit, Ospedale Umberto I, Siracusa, Italy
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2
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Speranza D, Sapuppo E, Aprile G, Auriemma A, Bergamo F, Bianco R, Bordonaro R, Brandi G, Brunetti O, Carnaghi C, Ciliberto D, Cinieri S, Corallo S, De Vita F, Di Donato S, Ferraù F, Fornaro L, Barucca V, Giommoni E, Lotesoriere C, Luchini C, Masini C, Niger M, Pisconti S, Rapposelli IG, Rimassa L, Rognone C, Rodriquenz MG, Corsini LR, Santin D, Scarpa A, Scartozzi M, Soto Parra H, Tonini G, Tortora G, Tralongo P, Silvestris N. The Italian Rare Biliary tract Cancer initiative (IRaBiCa): A multicentric observational study of Gruppo Oncologico dell'Italia Meridionale (GOIM) in collaboration with Gruppo Italiano Colangiocarcinoma (GICO). Tumori 2024:3008916231222761. [PMID: 38326240 DOI: 10.1177/03008916231222761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
INTRODUCTION About 90% of cholangiocarcinomas are adenocarcinomas with glandular or tubular structures lined by epithelial cells, with no bile production and with a variable degree of differentiation, arising in the background of desmoplastic stroma. The remaining 10% is represented by rarer histological variants of which there is little knowledge regarding the biological behavior, molecular characterization, and sensitivity to the various possible therapies, including molecular-based treatments. Such rare tumors are described only in case reports or small retrospective series because of their exclusion from clinical trials. This national initiative, here presented, aims to address the following knowledge gap: a) how much does histological diversity translate into clinical manifestation variety? b) are those chemotherapy regimens, recommended for conventional biliary tract cancers, potentially active in rare variants?Therefore, epidemiological, pathological, and clinical characterization of series of rare biliary histotypes/variants, for which therapeutic and follow-up data are available, will be collected. METHODS An Italian task force on rare tumors of the biliary tract (IRaBiCa) has been created, whose initiative is a multicenter retrospective study involving 34 Italian cancer centers.Clinical data from approximately 100 patients will be collected and analyzed. Continuous variables will be presented as median ± standard deviation, while categorical variables will be expressed in terms of frequency. Kaplan-Maier analyses will be used to compare disease free, progression free and overall survival, according to the different histotypes. CONCLUSIONS We expect to gather novel data on rare histotypes of biliary tract cancer that will be useful to support their molecular and immunological characterization.
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Affiliation(s)
- Desirèe Speranza
- Medical Oncology Unit, Department of Human Pathology G. Barresi, University of Messina, Messina, Sicily, Italy
| | - Elena Sapuppo
- Medical Oncology Unit, Department of Human Pathology G. Barresi, University of Messina, Messina, Sicily, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, ULSS 8 Berica-Vicenza, Vicenza, Veneto, Italy
| | - Alessandra Auriemma
- Medical Oncology Section, Department of Medicine, University of Verona, Verona, Veneto, Italy
| | - Francesca Bergamo
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Veneto, Italy
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Campania, Italy
| | | | - Giovanni Brandi
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
- Alma Mater Studiorum - University of Bologna - Department of Medical and Surgical Sciences, Bologna, Emilia-Romagna, Italy
| | - Oronzo Brunetti
- Medical Oncology Unit, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Apulia, Italy
| | - Carlo Carnaghi
- Clinical Trials Unit, Istituto Clinico Humanitas, Centro Catanese di Oncologia, Catania, Sicily, Italy
| | | | - Saverio Cinieri
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Apulia, Italy
| | - Salvatore Corallo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of Campania Luigi Vanvitelli, Naples, Campania, Italy
| | - Samantha Di Donato
- Medical Oncology Department ASL Toscana Centro, Santo Stefano Hospital Prato
| | - Francesco Ferraù
- St. Vincent Hospital, Division of Medical Oncology, Taormina, Messina, Sicily, Italy
| | - Lorenzo Fornaro
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Tuscany, Italy
| | - Viola Barucca
- UOC Oncologia, Azienda Ospedaliera San Camillo- Forlanini, Roma, Lazio, Italy
| | - Elisa Giommoni
- Medical Oncology Unit, Careggi University Hospital, Florence, Tuscany, Italy
| | - Claudio Lotesoriere
- Oncology Unit of National Institute of Gastroenterology - IRCCS Saverio de Bellis, Research Hospital Castellana Grotte, Bari, Apulia, Italy
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, and ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Veneto, Italy
| | - Cristina Masini
- Medical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardy, Italy
| | | | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Emilia-Romagna, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Lombardy, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Lombardy, Italy
| | - Chiara Rognone
- Department of Oncology, University of Turin, AO Ordine Mauriziano Hospital, Turin, Italy
| | | | - Lidia Rita Corsini
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Sicily, Italy
| | - Daniele Santin
- Oncology Unit (UOC) Oncologia A, Department of Radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, Sapienza University of Rome, Rome, Lazio, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, and ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Veneto, Italy
| | - Mario Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Sardinia, Italy
| | - Hector Soto Parra
- Department of Oncology, Medical Oncology, University Hospital Policlinico-San Marco, Catania, Sicily, Italy
| | - Giuseppe Tonini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Lazio, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Lazio, Italy
| | - Giampaolo Tortora
- Medical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
- Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Paolo Tralongo
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, Siracusa, Sicily, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology G. Barresi, University of Messina, Messina, Sicily, Italy
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Tralongo P, Bordonaro R, Ferrau F, Trombatore G. Are the Number of Operations Appropriate to Define a High-Quality Breast Cancer Center? World J Oncol 2023; 14:443-445. [PMID: 37869247 PMCID: PMC10588504 DOI: 10.14740/wjon1629] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/07/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- Paolo Tralongo
- Department of Oncology, Medical Oncology Unit, Umberto I Hospital, and Breast Unit, ASP Siracusa, Italy
| | - Roberto Bordonaro
- Department of Oncology, Medical Oncology Unit ARNAS Garibaldi, Catania, Italy
| | - Francesco Ferrau
- Medical Oncology Unit, S. Vincenzo Hospital, Taormina (Messina), Italy
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Tralongo P, Bordonaro S, Di Lorenzo G, De Giorgi U, Borsellino N, Facchini G, Rossetti S, Fornarini G, Longo V, Tralongo AC, Caspani F, Spada M, Calvani N, Carlini P. Feasibility of cabazitaxel in octogenarian prostate cancer patients. Curr Urol 2023; 17:153-158. [PMID: 37448615 PMCID: PMC10337820 DOI: 10.1097/cu9.0000000000000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/17/2020] [Indexed: 11/26/2022] Open
Abstract
Background To evaluate the effectiveness and safety of cabazitaxel in castration-resistant prostate cancer patients aged ≥80 years, we performed a retrospective study on a sample of patients from 11 Italian cancer centers. Materials and methods Fifty-seven patients aged ≥80 years were treated with cabazitaxel after previous failure with docetaxel; 39 completed a comprehensive geriatric assessment questionnaire (34 fit and 5 vulnerable) and 8 patients (14%) had an Eastern Cooperative Oncology Group performance status (PS) ≥2, while most had a PS of 0-1 (86%). Cabazitaxel was administered at a dose of 25 mg/m2 in 30 (52%) patients and 20 mg/m2 or adapted schedules in 27 (48%) patients. These schedules were adopted mainly in patients ≥85 years (75%), with a PS ≥2 (87.5%), and those classified as vulnerable (100%). Results The duration of treatment was 4.8 months and was comparable in all subgroups; disease control rate was reported in 36 patients (63%); prostate-specific antigen response was recorded in 18 patients (31.5%). Median overall survival was 13.1 months regardless of age (<85/≥85 years), but overall survival was reduced in vulnerable (7.2 months) and PS ≥ 2 patients (6.8 months). The most frequently documented grade 3-4 toxicities were neutropenia (14%) and diarrhea (10.5%). Six patients (10.5%) dropped out due to severe toxicity. Conclusions Octogenarian patients can be treated with cabazitaxel with reduced doses or alternative schedules that are associated with less toxicity and fewer treatment interruptions. Comprehensive geriatric assessment could facilitate more appropriate patient selection.
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Affiliation(s)
- Paolo Tralongo
- Medical Oncology Unit, RAO - Umberto I Hospital, Siracusa, Italy
| | | | - Giuseppe Di Lorenzo
- Department of Medicine and Health Sciences ‘Vincenzo Tiberio’, University of Molise, Campobasso, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Nicolò Borsellino
- Medical Oncology Unit, Ospedale Buccheri La Ferla, Fatebenefratelli, Palermo, Italy
| | - Gaetano Facchini
- Medical Oncology Unit, Santa Maria delle Grazie di Pozzuoli, Napoli, Italy
| | - Sabrina Rossetti
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Giuseppe Fornarini
- Medical Oncology 1, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Vito Longo
- Istituto Tumori Giovanni Paolo II I.R.C.C.S., Ba, Ospedale di Circolo, Varese, Italy
| | | | - Francesca Caspani
- Medical Oncology Unit, ASST SETTE LAGHI, Ospedale di Circolo, Varese, Italy
| | - Massimiliano Spada
- Medical Oncology Unit, Fondazione Istituto G. Giglio di Cefalù, Palermo, Italy
| | - Nicola Calvani
- Medical Oncology Division & Breast Unit, Sen. A. Perrino Hospital, Brindisi, Italy
| | - Paolo Carlini
- Medical Oncology 1, Istituto Nazionale Tumori Regina Elena, Roma, Italy
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Trevisan B, Pepe FF, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V, Cazzaniga ME. Final results of the real-life observational VICTOR-6 study on metronomic chemotherapy in elderly metastatic breast cancer (MBC) patients. Sci Rep 2023; 13:12255. [PMID: 37507480 PMCID: PMC10382472 DOI: 10.1038/s41598-023-39386-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023] Open
Abstract
Nowadays, treatment of metastatic breast cancer (MBC) has been enriched with novel therapeutical strategies. Metronomic chemotherapy (mCHT) is a continuous and frequent administration of chemotherapy at a lower dose and so whit less toxicity. Thus, this strategy could be attractive for elderly MBC patients. Aim of this analysis is to provide insights into mCHT's activity in a real-life setting of elderly MBC patients. Data of patients ≥ 75 years old included in VICTOR-6 study were analyzed. VICTOR-6 is a multicentre, Italian, retrospective study, which collected data on mCHT in MBC patients treated between 2011 and 2016. A total of 112 patients were included. At the beginning of mCHT, median age was 81 years (75-98) and in 33% of the patients mCHT was the first line choice. Overall Response Rate (ORR) and Disease Control Rate (DCR) were 27.9% and 79.3%, respectively. Median PFS ranged between 7.6 and 9.1 months, OS between 14.1 and 18.5 months. The most relevant toxicity was the hematological one (24.1%); severe toxicity (grade 3-4) ranged from 0.9% for skin toxicity up to 8% for hematologic one. This is a large study about mCHT in elderly MBC patients, providing insights to be further investigated in this subgroup of frail patients.
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Affiliation(s)
- B Trevisan
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - F F Pepe
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - I Vallini
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - E Montagna
- European Institute of Oncology, Milan, Italy
| | | | - R Berardi
- Azienda Ospedaliera Universitaria Ospedali Riuniti, Torrette, Italy
| | - A Butera
- Nuovo Ospedale San Giovanni Di Dio, Florence, Italy
| | | | - L Cavanna
- Azienda Ospedaliera Piacenza, Piacenza, Italy
| | | | - S Cinieri
- Ospedale A. Perrino, Brindisi, Italy
| | | | | | - A Febbraro
- Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Ospedale San Vincenzo, Taormina, Italy
| | - A Ferzi
- Azienda Ospedaliera Ospedale Civile Di Legnano, Magenta, Italy
| | | | - A Fontana
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - O Garrone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Gebbia
- Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Istituti Ospitalieri Cremona, Cremona, Italy
| | | | | | | | | | - S Sarti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | | | - C Putzu
- Azienda Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Ospedale Antonio Cardarelli, Naples, Italy
| | - D Santini
- Università Campus Bio-Medico, RomE, Italy
| | | | | | | | - P Spadaro
- Casa di Cura Villa Salus-Messina, Messina, Italy
| | | | | | | | | | | | - M R Valerio
- A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- INT Regina Elena, Rome, Italy
| | - L Clivio
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
| | - V Torri
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
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Tralongo P, Cappuccio F, Gori S, Donato V, Beretta G, Elia A, Romano F, Iacono M, Tralongo AC, Bordonaro S, Di Mari A, Giuliano SR, Buccafusca G, Careri MC, Santoro A. Clinicians' and Patients' Perceptions and Use of the Word "Cured" in Cancer Care: An Italian Survey. Curr Oncol 2023; 30:1332-1353. [PMID: 36826064 PMCID: PMC9955737 DOI: 10.3390/curroncol30020103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The words "hope" and "cure" were used in a greater number of articles and sentences in narrative and editorial papers than in primary research. Despite concomitant improvements in cancer outcomes, the related reluctance to use these terms in more scientifically oriented original reports may reflect a bias worthy of future exploration. This study aims to survey a group of physicians and cancer patients regarding their perception and use of the word cure. MATERIALS AND METHOD An anonymous online and print survey was conducted to explore Italian clinicians' (the sample includes medical oncologists, radiotherapists, and oncological surgeons) and cancer patients' approach to the perception and use of the word "cure" in cancer care. The participants received an email informing them of the study's purpose and were invited to participate in the survey via a linked form. A portion, two-thirds, of questionnaires were also administered to patients in the traditional paper form. RESULTS The survey was completed by 224 clinicians (54 oncologists, 78 radiotherapists, and 92 cancer surgeons) and 249 patients. The results indicate a favourable attitude for patients in favour of a new language ("cured" vs. "complete remission") of the disease experience. CONCLUSIONS The use of the word cured is substantially accepted and equally shared by doctors and patients. Its use can facilitate the elimination of metaphoric implications and toxic cancer-related connotations registered in all cultures that discourage patients from viewing cancer as a disease with varied outcomes, including cure.
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Affiliation(s)
- Paolo Tralongo
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
- Correspondence:
| | - Francesco Cappuccio
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Stefania Gori
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy
| | - Vittorio Donato
- Radiotherapy Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Giordano Beretta
- Medical Oncology Unit, Santo Spirito Hospital, 65124 Pescara, Italy
| | - Ausilia Elia
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Fabrizio Romano
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Margherita Iacono
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | | | - Sebastiano Bordonaro
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Annamaria Di Mari
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | | | - Gabriella Buccafusca
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Maria Carmela Careri
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital and Humanitas Cancer Center, 20089 Milan, Italy
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7
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Silbermann M, Calimag MM, Eisenberg E, Futerman B, Fernandez-Ortega P, Oliver A, Monje JPY, Guo P, Charalambous H, Nestoros S, Pozo X, Bhattacharyya G, Katz GJ, Tralongo P, Fujisawa D, Kunirova G, Punjwani R, Ayyash H, Ghrayeb I, Manasrah N, Bautista MJS, Kotinska-Lemieszek A, de Simone G, Cerutti J, Gafer N, Can G, Terzioglu F, Kebudi R, Tuncel-Oguz G, Aydin A, Şenel GO, Mwaka AD, Youssef A, Brant J, Alvarez GP, Weru J, Rudilla D, Fahmi R, Hablas M, Rassouli M, Mula-Hussain L, Faraj S, Al-Hadad S, Al-Jadiry M, Ghali H, Fadhil SA, Abu-Sharour L, Omran S, Al-Qadire M, Hassan A, Khader K, Alalfi N, Ahmed G, Galiana L, Sansó N, Abe A, Vidal-Blanco G, Rochina A. Evaluating Pain Management Practices for Cancer Patients among Health Professionals: A Global Survey. J Palliat Med 2022; 25:1243-1248. [PMID: 35442772 DOI: 10.1089/jpm.2021.0596] [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] [Indexed: 10/18/2022] Open
Abstract
Background: Cancer incidence in the world is predicted to increase in the next decade. While progress has been in diagnosis and treatment, much still remains to be done to improve cancer pain therapy, mainly in underserved communities in low-income countries. Objective: To determine knowledge, beliefs, and barriers regarding pain management in both high- and low-income countries (according to the WHO classification); and to learn about ways to improve the current state of affairs. Design: Descriptive survey. Setting/Subjects: Fifty-six countries worldwide; convenience sample of 1639 consisted of 36.8% physicians; 45.1% nurses, and 4.5% pharmacists employed in varied settings. Results: Improved pain management services are key elements. Top barriers include religion factors, lack of appropriate education and training at all levels, nonadherence to guidelines, patients' reluctance to report on pains, over regulation associated with prescribing and access to opioid analgesics, fear of addiction to opioids, and lack of discussions around prognosis and treatment planning. Conclusion: The majority of patients with cancer in low-income countries are undertreated for their pain. Promoting cancer pain accredited program of training and education on pain management for physicians and nurses is crucial, as well as advocating policymakers and the public at large.
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Affiliation(s)
| | | | - Elon Eisenberg
- Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Boris Futerman
- Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Amparo Oliver
- Catedrática de Metodología de las CC del Comportamiento, University of Valencia, Valencia, Spain
| | | | - Ping Guo
- Cecily Saunders Institute of Pediatric Care, King's College, London, United Kingdom
| | - Haris Charalambous
- Department of Medical Oncology, Bank of Cyprus Oncology Center, Nicosia, Cyprus
| | | | - Ximena Pozo
- Pontifical Catholic University of Ecuador, Faculty of Medicine, Quito, Ecuador
| | - Gouri Bhattacharyya
- Department of Medical Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Glynis J Katz
- Department of Information and Control, Sabar Health, Haifa, Israel
| | - Paolo Tralongo
- Department of Medical Oncology, Umberto I Hospital-RAO, Siracuse, Sicily, Italy
| | - Daisuke Fujisawa
- Department of Neuropsychiatry and Palliative Care, Keio University School of Medicine, Tokyo, Japan
| | | | - Rehana Punjwani
- Indus Research Centre, Indus Hospital and Health Network, Karachi, Pakistan
| | - Hani Ayyash
- Department of Clinical Hemato-Oncology, European Gaza Hospital, Khan Yunis, Gaza, Palestine
| | - Ibtisam Ghrayeb
- Intensive Care Unit, Makassed Islamic Charitable Hospital, East Jerusalem
| | - Nemeh Manasrah
- Faculty of Nursing, Hebron University, Hebron, West Bank, Palestinian Authority
| | | | | | - Gustavo de Simone
- Department of Palliative Care, Bonorino Udaondo Public Hospital, Buenos Aires, Argentina
| | - Julie Cerutti
- Department of Pediatric Oncology, Child Cancer Institute, Porto Alegre, Brazil
| | - Nahla Gafer
- Department of Palliative Care, Radiation and Isotope Center, Khartoum, Sudan
| | - Gulbeyaz Can
- Florence Nightingale Faculty of Nursing, Istanbul University, Cerrahpasa, Istanbul
| | - Fusun Terzioglu
- Faculty of Health Science, Kocaeli University of Health Sciences, Turkey
| | - Rejin Kebudi
- Cerrahpasa Medical Faculty, Istanbul University Oncology Institute, Istanbul, Turkey
| | - Gonca Tuncel-Oguz
- Dr. AY Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Ayfer Aydin
- Faculty of Nursing, Koç University, Istanbul, Turkey
| | | | | | - Alexey Youssef
- Queens College, University of Oxford, Oxford, United Kingdom
| | - Jeannine Brant
- Billings Clinic Collaborative Science and Innovation, Billings, Montana, USA
| | | | - John Weru
- Department of Palliative Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - David Rudilla
- Department of Clinical Psychology, La Princesa University Hospital, Madrid, Spain
| | - Rasha Fahmi
- Department of Clinical Oncology, El-Salam Oncology Center Cairo, Cairo, Egypt
| | - Mohamed Hablas
- Saudi German Hospital Cairo, Gharbiah Cancer Society, Tanta, Egypt
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Layth Mula-Hussain
- Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman and the University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Safa Faraj
- Department of Pediatric Oncology, Children Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | - Salma Al-Hadad
- Department of Pediatric Oncology, Children Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | - Mazin Al-Jadiry
- Department of Pediatric Oncology, Children Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | - Hasanein Ghali
- Department of Pediatric Oncology, Children Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | - Samaher A Fadhil
- Department of Pediatric Oncology, Children Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | | | - Suha Omran
- Department of Adult Health, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Al-Qadire
- Al-Bayt University, Mafraq, The Hashemite Kingdom of Jordan and Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Azza Hassan
- Department of Palliative Medicine, National Center for Cancer Care and Research, Doha, Qatar
| | - Khaled Khader
- Department of Nursing and Midwifery, Taif University, Taif, Saudi Arabia
| | | | - Gamila Ahmed
- Department of Psycho-Oncology, National Cancer Center, Aden, Yemen
| | - Laura Galiana
- Catedrática de Metodología de las CC del Comportamiento, University of Valencia, Valencia, Spain
| | - Noemi Sansó
- Department of Sociology, Gender, and Health, University of the Balearic Islands, Palmade Mallorca, Spain
| | - Akiko Abe
- Department of Neuropsychiatry and Palliative Care, Keio University School of Medicine, Tokyo, Japan
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8
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Dal Maso L, Santoro A, Iannelli E, De Paoli P, Minoia C, Pinto M, Bertuzzi AF, Serraino D, De Angelis R, Trama A, Haupt R, Pravettoni G, Perrone M, De Lorenzo F, Tralongo P. Cancer Cure and Consequences on Survivorship Care: Position Paper from the Italian Alliance Against Cancer (ACC) Survivorship Care Working Group. Cancer Manag Res 2022; 14:3105-3118. [PMID: 36340999 PMCID: PMC9635309 DOI: 10.2147/cmar.s380390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023] Open
Abstract
A multidisciplinary panel of experts and cancer patients developed a position paper to highlight recent evidence on "cancer cure" (ie, the possibility of achieving the same life expectancy as the general population) and discuss the consequences of this concept on follow-up and rehabilitation strategies. The aim is to inform clinicians, patients, and health-care policy makers about strategies of survivorship care for cured cancer patients and consequences impacting patient lives, spurring public health authorities and research organizations to implement resources to the purpose. Two identifiable, measurable, and reproducible indicators of cancer cure are presented. Cure fraction (CF) is >60% for breast and prostate cancer patients, >50% for colorectal cancer patients, and >70% for patients with melanoma, Hodgkin lymphoma, and cancers of corpus uteri, testis (>90%), and thyroid. CF was >65% for patients diagnosed at ages 15-44 years and 30% for those aged 65-74 years. Time-to-cure was consistently <1 year for thyroid and testicular cancer patients and <10 years for patients with colorectal and cervical cancers, melanoma, and Hodgkin lymphoma. The working group agrees that the evidence allows risk stratification of cancer patients and implementation of personalized care models for timely diagnosis, as well as treatment of possible cancer relapses or related long-term complications, and preventive measures aimed at maintaining health status of cured patients. These aspects should be integrated to produce an appropriate follow-up program and survivorship care plan(s), avoiding stigma and supporting return to work, to a reproductive life, and full rehabilitation. The "right to be forgotten" law, adopted to date only in a few European countries, may contribute to these efforts for cured patients.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
- Correspondence: Luigino Dal Maso, Epidemiologia Oncologica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, Aviano (PN), 33081, Italy, Tel +39 0434 659354, Email
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Elisabetta Iannelli
- Italian Federation of Cancer Patients Organisations (FAVO), Rome, Italy
- Italian Association of Cancer Patients (Aimac), Rome, Italy
| | | | - Carla Minoia
- SC Haematology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Monica Pinto
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-IRCCS Fondazione G. Pascale, Naples, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Italian National Institute of Health (ISS), Rome, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Riccardo Haupt
- DOPO Clinic, Department of Pediatric Haematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Perrone
- Psychology Unit, IRCCS Regina Elena Cancer Institute, Rome, Italy
| | - Francesco De Lorenzo
- Italian Federation of Cancer Patients Organisations (FAVO), Rome, Italy
- Italian Association of Cancer Patients (Aimac), Rome, Italy
| | - Paolo Tralongo
- Medical Oncology Unit, Umberto I Hospital, Department of Oncology, RAO, Siracusa, Italy
- Paolo Tralongo, Medical Oncology Unit, Umberto I Hospital, Department of Oncology, RAO, Via Giuseppe Testaferrata 1, Siracusa, 96100, Italy, Tel +39 0931 724 464, Email
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9
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Cazzaniga ME, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Marchetti P, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Saracchini S, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Di Mauro P, Cogliati V, Capici S, Clivio L, Torri V. Metronomic chemotherapy (mCHT) in metastatic triple-negative breast cancer (TNBC) patients: results of the VICTOR-6 study. Breast Cancer Res Treat 2021; 190:415-424. [PMID: 34546500 PMCID: PMC8558172 DOI: 10.1007/s10549-021-06375-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose Triple-negative breast cancer (TNBC) represents a subtype of breast cancer which lacks the expression of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2): TNBC accounts for approximately 20% of newly diagnosed breast cancers and is associated with younger age at diagnosis, greater recurrence risk and shorter survival time. Therapeutic options are very scarce. Aim of the present analysis is to provide further insights into the clinical activity of metronomic chemotherapy (mCHT), in a real-life setting. Methods We used data included in the VICTOR-6 study for the present analysis. VICTOR-6 is an Italian multicentre retrospective cohort study, which collected data of metastatic breast cancer (MBC) patients who have received mCHT between 2011 and 2016. Amongst the 584 patients included in the study, 97 were triple negative. In 40.2% of the TNBC patients, mCHT was the first chemotherapy treatment, whereas 32.9% had received 2 or more lines of treatment for the metastatic disease. 45.4% out of 97 TNBC patients received a vinorelbine (VRL)-based regimen, which resulted in the most used type of mCHT, followed by cyclophosphamide (CTX)-based regimens (30.9%) and capecitabine (CAPE)-based combinations (22.7%). Results Overall response rate (ORR) and disease control rate (DCR) were 17.5% and 64.9%, respectively. Median progression free survival (PFS) and overall survival (OS) were 6.0 months (95% CI: 4.9–7.2) and 12.1 months (95% CI: 9.6–16.7). Median PFS was 6.9 months for CAPE-based regimens (95% CI: 5.0–18.4), 6.1 months (95% CI: 4.0–8.9) for CTX-based and 5.3 months (95% CI: 4.1–9.5) for VRL-based ones. Median OS was 18.2 months (95% CI: 9.1-NE) for CAPE-based regimens and 11.8 months for VRL- (95% CI: 9.3–16.7 and CTX-based ones (95%CI: 8.7–52.8). Tumour response, PFS and OS decreased proportionally in later lines. Conclusion This analysis represents the largest series of TNBC patients treated with mCHT in a real-life setting and provides further insights into the advantages of using this strategy even in this poor prognosis subpopulation.
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Affiliation(s)
- M E Cazzaniga
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy.
- Oncology Unit, ASST Monza, Monza, MB, Italy.
| | - I Vallini
- Medical Oncology, ASST Sette Laghi Ospedale Di Circolo E Fondazione Macchi, Varese, VA, Italy
| | - E Montagna
- Medical Senology Division, IEO, Milan, Italy
| | - D Amoroso
- Medical Oncology, Ospedale Versilia, ATNO, Lido Di Camaiore, LU, Italy
| | - R Berardi
- Medical Oncology, Università Politecnica Delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - A Butera
- Medical Oncology, Ospedale San Giovanni Di Dio, Agrigento, Italy
| | - K Cagossi
- Medical Oncology, Ospedale Ramazzini, Carpi, Italy
| | - L Cavanna
- Medical Oncology, Azienda Ospedaliera Piacenza, Piacenza, Italy
| | - M Ciccarese
- Medical Oncology, Ospedale Vito Fazzi, Lecce, Italy
| | - S Cinieri
- Medical Oncology, ASL Brindisi, Brindisi, Italy
| | - E Cretella
- Medical Oncology, Ospedale Bolzano, Bolzano, Italy
| | | | - A Febbraro
- Medical Oncology, Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Medical Oncology, Osp Taormina, Taormina, Italy
| | - A Ferzi
- Medical Oncology, A.S.S.T. Ovest Milanese Legnano, Legnano, Italy
| | - A Baldelli
- Medical Oncology, Ospedale San Salvatore, Pesaro, Italy
| | - A Fontana
- Medical Oncology 2, Az. Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A R Gambaro
- Medical Oncology, ASST Fatebenefratelli Sacco, Milano, Italy
| | - O Garrone
- Breast Unit Medical Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | - V Gebbia
- Medical Oncology, Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, Italy
| | - L Gianni
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - F Giovanardi
- AUSL IRCCS Reggio Emilia Provincial Oncology Unit, Reggio Emilia, Italy
| | - A Grassadonia
- Medical Oncology, P.O. SS Annunziata -ASL2 Lanciano-Vasto, Chieti, Italy
| | - V Leonardi
- Medical Oncology, Ospedale Civico, Palermo, Italy
| | - P Marchetti
- Medical Oncology, A.O. Sant'Andrea, Roma, Italy
| | - S Sarti
- IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - A Musolino
- Department of Medicine and Surgery, Medical Oncology and Breast Unit, University of Parma and University Hospital of Parma, Parma, Italy
| | - M Nicolini
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - C Putzu
- Medical Oncology, A. Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Medical Oncology, A. Ospedaliera Antonio Cardarelli, Napoli, Italy
| | - D Santini
- Medical Oncology, Università Campus Bio-Medico, Roma, Italy
| | - S Saracchini
- Medical Oncology, Az. Osp. Santa Maria degli Angeli, Pordenone, Italy
| | - M G Sarobba
- Medical Oncology, Ospedale San Francesco, Nuoro, Italy
| | - M G Schintu
- Medical Oncology, Osp Giovanni Paolo II, Olbia, Italy
| | | | - P Spadaro
- Medical Oncology, Casa di Cura Villa Salus-Messina, Messina, Italy
| | - C Taverniti
- Medical Oncology, A.O.U. Città della Salute e della Scienza, Osp. Molinette, Torino, Italy
| | - D Toniolo
- Medical Oncology, ASST Rhodense, Ospedale di Circolo Rho, Rho, Italy
| | - P Tralongo
- Medical Oncology, Osp. Umberto I, Siracusa, Italy
| | - A Turletti
- Medical Oncology, P.O. Martini, Torino, Italy
| | - R Valenza
- Medical Oncology, P.O. Vittorio Emanuele, Gela, Italy
| | - M R Valerio
- Department of Discipline Chirurgiche, Oncologiche e Stomatologiche (DICHIRONS), Medical Oncology, A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- Phase IV trials, IRCCS, INT Regina Elena, Rome, Italy
| | - P Di Mauro
- Oncology Unit, ASST Monza, Monza, MB, Italy
| | - V Cogliati
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - S Capici
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - L Clivio
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
| | - V Torri
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
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10
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Rosti G, Romano F, Secondino S, Caccialanza R, Lobascio F, Carminati O, Pedrazzoli P, Tralongo P. The Role of Nutritional Support in Cured/Chronic Patients. Nutrients 2020; 12:nu12103167. [PMID: 33081215 PMCID: PMC7602732 DOI: 10.3390/nu12103167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/03/2022] Open
Abstract
Improvements in Clinical Oncology, due to earlier diagnoses and more efficient therapeutic strategies, have led to increased numbers of long-term survivors, albeit many with chronic diseases. Dealing with the complex care needs of these survivors is now an important part of Medical Oncology. Suitable diet and physical activity regimes will be important in maintaining their health. This paper will review what we know and what we can do in the near future for these patients.
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Affiliation(s)
- Giovanni Rosti
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (S.S.); (P.P.)
- Correspondence:
| | - Fabrizio Romano
- Medical Oncology Department, Ospedale Umberto 1-RAO-Siracusa, 96100 Syracuse, Italy; (F.R.); (P.T.)
| | - Simona Secondino
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (S.S.); (P.P.)
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy; (R.C.); (F.L.)
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy; (R.C.); (F.L.)
| | - Ornella Carminati
- Medical Oncology, Department of Oncology and Hematology, AUSL Romagna, 48100 Ravenna, Italy;
| | - Paolo Pedrazzoli
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (S.S.); (P.P.)
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Paolo Tralongo
- Medical Oncology Department, Ospedale Umberto 1-RAO-Siracusa, 96100 Syracuse, Italy; (F.R.); (P.T.)
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11
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Buccafusca G, Cappuccio F, Cordio S, Mare M, Bruera G, Colombo A, Formica V, Montesarchio V, Tonini G, Leo S, Antonuzzo L, Gemma D, Biglietto M, Giuseppina B, Carlomagno C, Tralongo P. P-66 Treatment with FOLFIRI-aflibercept in an elderly population (over 75 and octogenarians) with metastatic colorectal cancer after failure of an oxaliplatin-based regimen: Experience in a real-life population. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.148] [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] Open
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12
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Gebbia V, Bordonaro R, Blasi L, Piazza D, Pellegrino A, Iacono C, Spada M, Tralongo P, Firenze A. Liability of clinical oncologists and the COVID-19 emergency: Between hopes and concerns. J Cancer Policy 2020; 25:100234. [PMID: 32562478 PMCID: PMC7282757 DOI: 10.1016/j.jcpo.2020.100234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/11/2020] [Accepted: 06/05/2020] [Indexed: 11/28/2022]
Abstract
To contain COVID-19 spread, Italy is under a global lockdown except for health services and food supply. In this scenario, growing apprehension concerning legal consequences is rising among health professionals. Hospitals and health professionals are highly exposed to liability. More articulated legal regulations are strongly needed.
To contain COVID-19 spread, Italy is under a global lockdown since February 21, 2020, except for health services and food supply. In this scenario, growing apprehension concerning legal consequences is rising among health professionals due to several ethical and legal questions. Even if medical ethicists may approve patients’ prioritization protocols, hospitals and health professionals remain highly exposed to liability. The so-called smart-working may be very useful, but it may harbor potential legal harms for health personnel and patients and safety. Moreover, personal umbrella policies also often exclude liability arising out of the transmission of a communicable disease, especially a pandemic state, is declared. Under the pressure of medical associations, Italian Government political forces have very recently presented an amendment to the recently released ordinances for the COVID-19 emergency aimed to reduce medical liability. Presumably, similar epidemics or other wide-scale similar events may happen again in an unpredictable future. Therefore, more articulated legal regulations are strongly needed starting from lessons learned from this epidemic.
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Affiliation(s)
- Vittorio Gebbia
- Medical Oncology Unit, La Maddalena Clinic for Cancer, Chair of Medical Oncology, Department Promise, University of Palermo, Italy.,Consultant at the Labor Court, Palermo, Italy
| | | | - Livio Blasi
- Medical Oncology Unit, Ospedale Civico, Arnas, Palermo, Italy
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13
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Blasi L, Bordonaro R, Borsellino N, Butera A, Caruso M, Cordio S, Liborio DC, Ferraù F, Giuffrida D, Parra HS, Spada M, Tralongo P, Valenza R, Verderame F, Vitello S, Zerilli F, Piazza D, Firenze A, Gebbia V. Reactions and countermeasures of medical oncologists towards the incoming COVID-19 pandemic: a WhatsApp messenger-based report from the Italian College of Chief Medical Oncologists. Ecancermedicalscience 2020; 14:1046. [PMID: 32565899 PMCID: PMC7289620 DOI: 10.3332/ecancer.2020.1046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Indexed: 12/30/2022] Open
Abstract
Background This descriptive, unplanned investigation has been undertaken to report reactions, attitudes and countermeasures which have been put in place and implemented by medical oncology units facing the COVID-19 outbreak in Southern Italy. Materials and methods Data have been retrospectively obtained from the time-related analysis of conversations via a WhatsApp messenger-based group chat between the medical directors belonging to the Italian College of Medical Oncology Directors. Overall number, intensity and time trend of conversations related to reactions during the 4 weeks of observation related to the crucial events which occurred between 24 February and 28 March, 2020 2020 are included. A sentiment analysis of conversations was also carried out. Results We report 956 conversations among 19 medical oncology units related to reactions to the crucial events, such as epidemic spread, Government ordinances and guidelines during the 4 weeks of observation. Data show significant awareness of problems linked to the COVID-19 spread among oncologists and rapid diffusion of countermeasures. Actions taken were correlated time wise to crucial events. A correlation between conversations and the volume of activity of oncology units was found. By analysing the sentiment analysis of raw data, positive emotions were reduced in percentage over the weeks. A significant increase in negative emotions was observed as the outbreak impacted on the healthcare system. Conclusion In our experience, the WhatsApp instant-messaging system seems to be a useful tool to share news and reactions between medical oncologists to rapidly implement necessary health measures and answers to most cancer patients' needs and queries in the COVID-19 pandemic scenario.
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Affiliation(s)
- Livio Blasi
- Medical Oncology Unit, Arnas, Ospedale Civico, Palermo, 90100, and National President of CIPOMO, Italy
| | - Roberto Bordonaro
- Medical Oncology Unit, Arnas, Ospedale Garibaldi, Catania, 95100, Italy
| | - Nicolò Borsellino
- Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo, 90100, Italy
| | - Alfredo Butera
- Medical Oncology Unit, Ospedale San Giovanni di Dio, Agrigento, 92100, Italy
| | - Michele Caruso
- Medical Oncology Unit, Istituto Clinico Humanitas, Catania, 95100, Italy
| | - Stefano Cordio
- Medical Oncology Unit, Ospedale Paterno Arezzo, Ragusa, 97100, Italy
| | - Di Cristina Liborio
- Medical Oncology Unit, Ospedale Vittorio Emanuele, Castelvetrano, 91022, Italy
| | - Francesco Ferraù
- Medical Oncology Unit, Ospedale San Vincenzo, Taormina, 98039, Italy
| | - Dario Giuffrida
- Medical Oncology Unit, Istituto Oncologico Mediterraneo, Viagrande, 95029, Italy
| | | | | | - Paolo Tralongo
- Medical Oncology Unit, Ospedale Umberto I, Siracusa, 96100, Italy
| | - Roberto Valenza
- Medical Oncology Unit, Ospedale Vittorio Emanuele, Gela, 93012, Italy
| | | | - Stefano Vitello
- Medical Oncology Unit, Ospedale Sant'Elia, Caltanissetta, 93100, Italy
| | - Filippo Zerilli
- Medical Oncology Unit, Ospedale San Antonio Abate, Trapani, 91100, Italy
| | | | | | - Vittorio Gebbia
- Medical Oncology Unit, Ospedale La Maddalena, University of Palermo, Palermo, 90100, Italy
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14
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Fu JB, Tralongo P. A Survey of Cancer Rehabilitation Professionals Regarding Emerging Topics in the Field. J Cancer Rehabil 2020; 3:3-4. [PMID: 32905540 PMCID: PMC7473059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jack B. Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
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15
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Berretta M, Rinaldi L, Taibi R, Tralongo P, Fulvi A, Montesarchio V, Madeddu G, Magistri P, Bimonte S, Trovò M, Gnagnarella P, Cuomo A, Cascella M, Lleshi A, Nasti G, Facchini S, Fiorica F, Di Francia R, Nunnari G, Pellicanò GF, Guglielmino A, Danova M, Rossetti S, Amore A, Crispo A, Facchini G. Physician Attitudes and Perceptions of Complementary and Alternative Medicine (CAM): A Multicentre Italian Study. Front Oncol 2020; 10:594. [PMID: 32411599 PMCID: PMC7202223 DOI: 10.3389/fonc.2020.00594] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose: Complementary and Alternative Medicine (CAM) interventions are widely used by patients with chronic disorders, including cancer, and may interact with cancer treatment. Physicians are often unaware of this, probably due to poor patient-physician communication on CAM. The purpose of this study was to evaluate physicians' knowledge, attitudes and practice patterns regarding CAM in a survey conducted in Italy. Methods: A questionnaire was administered to 438 physicians (11 Italian hospitals) who predominantly treat patients with chronic disease, to collect personal and professional data and information on attitudes toward CAM and its possible role in Conventional Medicine (CM). Results: Of the 438 participants, most were specialists in oncology (18%), internal medicine (17%), surgery (15%), and radiotherapy (11%). Most worked at university (44%) or research hospitals (31%). Forty-two percent of participants believed that CAM could have an integrative role within CM. Oncologists were the physicians who were best informed on CAM (58%). Physicians working at research institutes or university hospitals had a greater knowledge of CAM than those employed at general hospitals (p < 0.0001), and those who were also involved in research activity had a greater knowledge of CAM than those who were not (p < 0.003). Length of work experience was significantly related to CAM knowledge. Moreover, 55% of participants suggest CAM interventions to their patients and 44% discuss CAM with them. The best-known interventions were acupuncture, Aloe vera and high-dose vitamin C. Conclusion: CAM use by patients with chronic disease and/or cancer has become a topical issue for the scientific community and for physicians. Knowing the reasons that prompt these patients to use CAM and guiding them in their decisions would improve treatment and outcomes and also benefit healthcare systems. Our findings contribute to a greater understanding of CAM knowledge, attitudes, and practice among Italian physicians. Further research is needed to identify the more effective CAM treatments and to work toward an integrated healthcare model.
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Affiliation(s)
- Massimiliano Berretta
- Department of Medical Oncology, Istituto Nazionale Tumori, IRCCS - CRO, Aviano (PN), Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosaria Taibi
- Department of Medical Oncology, Istituto Nazionale Tumori, IRCCS - CRO, Aviano (PN), Italy
| | - Paolo Tralongo
- Division of Medical Oncology, "Umberto I" Hospital, Siracusa, Italy
| | - Alberto Fulvi
- Division of Medical Oncology, "Gemelli" Hospital, Roman, Italy
| | | | - Giordano Madeddu
- Division of Infectious Diseases, University of Sassari, Sassari, Italy
| | - Paolo Magistri
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Sabrina Bimonte
- Department of Anaesthesia and Pain Medicine, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Marco Trovò
- Division of Radiotherapy, "Santa Maria della Misericordia" Hospital, Udine, Italy
| | - Patrizia Gnagnarella
- Division of Epidemiology and Biostatistics IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Arturo Cuomo
- Department of Anaesthesia and Pain Medicine, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Marco Cascella
- Department of Anaesthesia and Pain Medicine, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Arben Lleshi
- Department of Medical Oncology, Istituto Nazionale Tumori, IRCCS - CRO, Aviano (PN), Italy
| | - Guglielmo Nasti
- Division of Medical Oncology B, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Sergio Facchini
- Department of Urology, University of Naples "Federico II", Naples, Italy
| | | | | | - Giuseppe Nunnari
- Division of Infectious Disease, University of Messina, Messina, Italy
| | | | - Aurelio Guglielmino
- Division of Anaesthesia, Policlinico Universitario, University of Catania, Catania, Italy
| | - Marco Danova
- Department of Internal Medicine and Medical Oncology, Vigevano Civic Hospital, ASST of Pavia, Vigevano, Italy
| | - Sabrina Rossetti
- Medical Oncology, Department of Uro-Gynaecological Oncology 'Istituto Nazionale Tumori' 'Fondazione G. Pascale' IRCCS, Naples, Italy
| | - Alfonso Amore
- Division of Surgery Melanoma and Skin Cancer, 'Istituto Nazionale Tumori' 'Fondazione G. Pascale' IRCCS, Naples, Italy
| | - Anna Crispo
- Unit of Epidemiology, 'Istituto Nazionale Tumori' 'Fondazione G. Pascale' IRCCS, Naples, Italy
| | - Gaetano Facchini
- Medical Oncology, Department of Uro-Gynaecological Oncology 'Istituto Nazionale Tumori' 'Fondazione G. Pascale' IRCCS, Naples, Italy
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Tralongo P, Surbone A, Serraino D, Dal Maso L. Major patterns of cancer cure: Clinical implications. Eur J Cancer Care (Engl) 2019; 28:e13139. [DOI: 10.1111/ecc.13139] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/26/2019] [Accepted: 07/18/2019] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Diego Serraino
- Cancer Epidemiology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
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Palumbo VD, Tralongo P, Di Trapani B, Carini F, Tomasello G. The use of Argentum-Quartz® solution in primary or recurrent perianal fistulas: first experience on three cases. Clin Ter 2019; 170:e328-e331. [PMID: 31612187 DOI: 10.7417/ct.2019.2155] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary perianal fistulous pathology represents a painful condition often noticeable in patients affected by Crohn's disease or Ulcerative colitis. It causes difficult defecation and can evolve in perianal abscess that should be urgently ascertained and drained. The present work aims to propose Argentum-Quartz® as valid non-surgical therapeutic treatment in order to reach a more comfortable perianal fistula healing. In fact, our preliminary data allow us to consider Argentum Quartz® ideally employable for treatment of perianal fistulas associated or not with IBDs, representing a reliable sphincter-sparing solution.
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Affiliation(s)
- V D Palumbo
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo - Italian Association of Pelvic Organ Dysfunction (AIDOP) - Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo
| | - P Tralongo
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - B Di Trapani
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo - Italian Association of Pelvic Organ Dysfunction (AIDOP)
| | - F Carini
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - G Tomasello
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
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18
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Tralongo P, Bordonaro S, Lorenzo GD, Borsellino N, Facchini G, Rossetti S, Martelli V, Longo V, Tralongo A, Caspani F, Tuzi A, Spada M, Calvani N, Carlini P, De Giorgi U. Cabazitaxel for octogenarian patients with metastatic castration-resistant prostate cancer (MCRPC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz248.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Rosati G, Addeo R, Aprile G, Avallone A, Bilancia D, Brugnatelli S, Buccafusca G, Carlomagno C, Cordio S, Delfanti S, Dell'Aquila E, Di Bisceglie M, Di Donato S, Di Stasi A, Germano D, Giuliani F, Granetto C, Latiano TP, Leo S, Tralongo P, Stroppolo ME, Venturini F, Bianco S. Italian survey on cetuximab-based therapy of elderly patients with metastatic colorectal cancer. Cancer Chemother Pharmacol 2019; 84:1089-1096. [PMID: 31493178 DOI: 10.1007/s00280-019-03943-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/24/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE There is no consensus on the use of cetuximab in elderly patients with metastatic colorectal cancer. To this end, a survey was carried in 17 Italian oncology centers. METHODS The centers answered a 29-item questionnaire structured as follows: (i) demographic characteristics; (ii) medical history; (iii) assessment of RAS/BRAF mutations and DPD/UGT polymorphism before treatment; (iv) treatment schemes and side effects; (v) geriatric assessment and customization of treatment. RESULTS One-third of patients are over 80 years old. The RAS/BRAF mutational status is not primarily evaluated by 17.6% of the centers, while DPD and UGT polymorphism is not evaluated by 82.4% and 76.5% of the centers. The most common therapeutic scheme is cetuximab/FOLFIRI and diarrhea is the main cause of suspension/reduction of treatment. The 70% of centers use systemic tetracyclines for skin toxicity. The 23.5% of the centers do not carry out any geriatric evaluation before the start of the therapy and those who perform it prefer the G8 (70.6%) and VES-13 (29.4%) scales. CONCLUSIONS Greater efforts should be made to improve the evaluation of the patient both about mutational and genetic procedures with geriatric evaluation. As for cetuximab in elderly patients, randomized studies are needed to provide guidance to physicians.
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Affiliation(s)
- Gerardo Rosati
- U.O. Oncologia Medica, Azienda Ospedaliera S. Carlo, Potenza, Italy.
| | - Raffaele Addeo
- U.O. Oncologia Medica, Ospedale "San Giovanni di Dio", ASL NA 2 NORD, Frattamaggiore, Italy
| | - Giuseppe Aprile
- Dipartimento di Oncologia Clinica, Ospedale San Bortolo, AULSS8, Vicenza, Italy
| | - Antonio Avallone
- Unità Oncologia Clinica Sperimentale Addome, Dipartimento Assistenziale e di Ricerca dei Percorsi Oncologici del Distretto Addominale, INT Fondazione 'G. Pascale', Naples, Italy
| | | | - Silvia Brugnatelli
- S.C. Oncologia Medica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Chiara Carlomagno
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Naples, Italy
| | - Stefano Cordio
- S.C. Oncologia Medica, Ospedale Garibaldi, Catania, Italy
| | - Sara Delfanti
- S.C. Oncologia Medica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | | | | | | | | | | | - Tiziana Pia Latiano
- Dipartimento di Oncologia Medica, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
| | | | - Paolo Tralongo
- U.O. Oncologia Medica, Ospedale Umberto I - RAO, Siracusa, Italy
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20
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Cazzaniga ME, Pinotti G, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Fiorentini G, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Marchetti P, Melegari E, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Saracchini S, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V. Metronomic chemotherapy for advanced breast cancer patients in the real world practice: Final results of the VICTOR-6 study. Breast 2019; 48:7-16. [PMID: 31470257 DOI: 10.1016/j.breast.2019.07.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 03/05/2019] [Revised: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 12/21/2022] Open
Abstract
Metronomic chemotherapy (mCHT) refers to the minimum biologically effective dose of a chemotherapy agent given as a continuous dosing regimen, with no prolonged drug-free breaks, that leads to antitumor activity. Aim of the present study is to describe the use of mCHT in a retrospective cohort of metastatic breast cancer (MBC) patients in order to collect data regarding the different types and regimens of drugs employed, their efficacy and safety. Between January 2011 and December 2016, data of 584 metastatic breast cancer patients treated with mCHT were collected. The use of VRL-based regimens increased during the time of observation (2011: 16.8% - 2016: 29.8%), as well as CTX-based ones (2011: 17.1% - 2016: 25.6%), whereas CAPE-based and MTX-based regimens remained stable. In the 1st-line setting, the highest ORR and DCR were observed for VRL-based regimens (single agent: 44% and 88%; combination: 36.7% and 82.4%, respectively). Assuming VRL-single agent as the referee treatment (median PFS: 7.2 months, 95% CI: 5.3-10.3), the longest median PFS were observed in VRL-combination regimens (9.5, 95%CI 88.8-11.3, HR = 0.72) and in CAPE-single agent (10.7, 95%CI 8.3-15.8, HR = 0.70). The VICTOR-6 study provides new data coming from the real-life setting, by adding new information regarding the use of mCHT as an option of treatment for MBC patients.
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Affiliation(s)
- M E Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy; Oncology Unit, ASST Monza, Italy.
| | - G Pinotti
- Medical Oncology, ASST Sette Laghi "Ospedale di Circolo e Fondazione Macchi, Varese, VA, Italy
| | - E Montagna
- Medical Senology Division, IEO, Milan, Italy
| | - D Amoroso
- Medical Oncology, Ospedale Della Versilia, Lido di Camaiore, IT, Italy
| | - R Berardi
- Medical Oncology, A. Ospedaliero-universitaria Ospedali Riuniti, Ancona, IT, Italy
| | - A Butera
- Medical Oncology, Ospedale San Giovanni di Dio, Agrigento, IT, Italy
| | - K Cagossi
- Medical Oncology, Ospedale Ramazzini, Carpi, IT, Italy
| | - L Cavanna
- Medical Oncology, Azienda Ospedaliera Piacenza, Piacenza, IT, Italy
| | - M Ciccarese
- Medical Oncology, Ospedale Vito Fazzi, Lecce, IT, Italy
| | - S Cinieri
- Medical Oncology, ASL Brindisi, Brindisi, Italy
| | - E Cretella
- Medical Oncology, Ospedale Bolzano, IT, Italy
| | | | - A Febbraro
- Medical Oncology, Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Medical Oncology, Osp Taormina, Taormina, IT, Italy
| | - A Ferzi
- Medical Oncology, A.S.S.T. Ovest Milanese, Legnano, IT, Italy
| | - G Fiorentini
- Medical Oncology, Ospedale San Salvatore, Pesaro, Italy
| | - A Fontana
- Medical Oncology, Az. Ospedaliero-Universitaria, Pisana, IT, Italy
| | - A R Gambaro
- Medical Oncology, ASST Fatebenefratelli, Sacco, IT, Italy
| | - O Garrone
- Medical Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | - V Gebbia
- Medical Oncology, Ospedale La Maddalena, Palermo, IT, Italy
| | - D Generali
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, IT, Italy
| | - L Gianni
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, IT, Italy
| | - F Giovanardi
- Medical Oncology, Ospedale Civile, Guastalla, IT, Italy
| | - A Grassadonia
- Medical Oncology, P.O. SS Annunziata -ASL2 Lanciano-Vasto, Chieti, IT, Italy
| | - V Leonardi
- Medical Oncology, Ospedale Civico, Palermo, IT, Italy
| | - P Marchetti
- Medical Oncology, A.O. Sant'Andrea, Roma, IT, Italy
| | - E Melegari
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Musolino
- Medical Oncology, Azienda Ospedaliero-Universitaria di Parma, IT, Italy
| | - M Nicolini
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, IT, Italy
| | - C Putzu
- Medical Oncology, A. Ospedaliera-Universitaria, Sassari, IT, Italy
| | - F Riccardi
- Medical Oncology, A. Ospedaliera Antonio Cardarelli, Napoli, IT, Italy
| | - D Santini
- Medical Oncology Università Campus Bio-Medico, Roma, IT, Italy
| | - S Saracchini
- Medical Oncology, Az. Osp. Santa Maria Degli Angeli, Pordenone, IT, Italy
| | - M G Sarobba
- Medical Oncology, Ospedale San Francesco, Nuoro, IT, Italy
| | - M G Schintu
- Medical Oncology, Osp Giovanni Paolo II, Olbia, IT, Italy
| | | | - P Spadaro
- Medical Oncology, Casa di Cura Villa Salus, Messina, IT, Italy
| | - C Taverniti
- Medical Oncology, A.O.U. Città Della Salute e Della Scienza, Osp. Molinette, Torino, IT, Italy
| | - D Toniolo
- Medical Oncology, ASST Rhodense 3 Ospedale di Circolo Rho, IT, Italy
| | - P Tralongo
- Medical Oncology, Osp. Umberto I, Siracusa, IT, Italy
| | - A Turletti
- Medical Oncology, P.O. Martini, Torino, IT, Italy
| | - R Valenza
- Medical Oncology, P.O. Vittorio Emanuele, Gela, IT, Italy
| | - M R Valerio
- Medical Oncology, A.O.U. Policlinico Paolo Giaccone, Palermo, IT, Italy
| | - P Vici
- Medical Oncology, B, INT Regina Elena, Roma, IT, Italy
| | - L Clivio
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
| | - V Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
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Buccafusca G, Proserpio I, Tralongo AC, Rametta Giuliano S, Tralongo P. Early colorectal cancer: diagnosis, treatment and survivorship care. Crit Rev Oncol Hematol 2019; 136:20-30. [PMID: 30878125 DOI: 10.1016/j.critrevonc.2019.01.023] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/29/2018] [Accepted: 01/29/2019] [Indexed: 12/11/2022] Open
Abstract
CRC is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related death in the world. With advances in treatment, colorectal cancer is being transformed from a deadly disease to an illness that is increasingly curable. With this transformation has come increased interest in the unique problems, risks, needs, and concerns of survivors who have completed treatment and are cancer-free. They often suffer late/long-term side effects of therapies that may compromise their QoL such as fatigue, sleep difficulty, fear of recurrence, anxiety, depression, negative body image, sensory neuropathy, gastrointestinal problems, urinary incontinence, and sexual dysfunction. In this review, we discuss what is known about early colorectal diagnosis, staging, treatments and their long-term effects on quality of life and survivorship care.
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Affiliation(s)
- Gabriella Buccafusca
- UOC Oncologia Medica, Ospedale Umberto I, Via Giuseppe Testaferrata 1, 96100, Siracusa, Italy
| | - Ilaria Proserpio
- UOC Oncologia Medica, ASST Settelaghi, Ospedale di Circolo e Fondazione Macchi, Via Francesco Guicciardini 9, 21100, Varese, Italy
| | - Antonino Carmelo Tralongo
- UOC Oncologia Medica, ASST Settelaghi, Ospedale di Circolo e Fondazione Macchi, Via Francesco Guicciardini 9, 21100, Varese, Italy
| | | | - Paolo Tralongo
- UOC Oncologia Medica, Ospedale Umberto I, Via Giuseppe Testaferrata 1, 96100, Siracusa, Italy.
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Muzzatti B, Gipponi K, Flaiban C, Cormio C, Carnaghi C, Tralongo P, Caruso M, Cavina R, Tirelli U, Annunziata MA. The impact of cancer: An Italian descriptive study involving 500 long-term cancer survivors. Eur J Cancer Care (Engl) 2019; 28:e13007. [PMID: 30740807 DOI: 10.1111/ecc.13007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/13/2017] [Revised: 09/13/2018] [Accepted: 01/17/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The well-being and quality of life (QoL) of long-term cancer survivors may be affected, both positively and negatively, by psychosocial factors related to the experience of being a cancer patient. We investigated whether, in long-term cancer survivors, the psychosocial impacts of cancer associate with socio-demographic-clinical variables; whether, within the positive and negative dimensions taken separately, some impacts are more intense than others; and whether these impacts explain QoL. METHODS Italian long-term cancer survivors (n = 500) completed the Impact of Cancer (IOC-V2) and Short Form 36 Health Survey (SF-36) questionnaires. RESULTS The IOC-V2 negative impact score associated with gender, education, occupational status and health issues, whereas no association was found between the positive impact score and socio-demographic-clinical variables. Of the positive impacts, Altruism/Empathy was the highest (p < 0.001); Positive self-evaluation was higher than Health awareness (p = 0.001); and Meaning of cancer was the lowest (p < 0.001). Among the negative impacts, Worry was the highest (p < 0.001), whereas Body changes concerns was higher than both Appearance concerns (p < 0.001) and Life Interferences (p < 0.001). The assessed impacts explained more than 25% of the variance of both physical and mental functioning scores. CONCLUSIONS The provided data document psychosocial factors affecting QoL in Italian long-term cancer survivors.
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Affiliation(s)
- Barbara Muzzatti
- Unit of Oncological Psychology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Katiuscia Gipponi
- Unit of Oncological Psychology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Cristiana Flaiban
- Unit of Oncological Psychology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Claudia Cormio
- Experimental Unit of Psycho-Oncology, National Cancer Centre Giovanni Paolo II, Bari, Italy
| | - Carlo Carnaghi
- Medical Oncology, Humanitas Mater Domini, Castellanza, Italy
| | - Paolo Tralongo
- Medical Oncology, Rete Assistenza Oncologica, Siracusa, Italy
| | - Michele Caruso
- Medical Oncology, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | | | - Umberto Tirelli
- Medical Oncology A, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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Costa RP, Bordonaro S, Cappuccio F, Tripoli V, Murabito A, Licari M, Valerio MR, Tralongo P. Hematologic toxicity of radium-223 in elderly patients with metastatic Castration Resistant Prostate Cancer: a real-life experience. Prostate Int 2018; 7:25-29. [PMID: 30937295 PMCID: PMC6424691 DOI: 10.1016/j.prnil.2018.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/21/2018] [Accepted: 08/27/2018] [Indexed: 11/15/2022] Open
Abstract
Background Treatment with radium-223 has been shown to increase survival and to delay skeletal events related to bone metastases of patients with metastatic Castration Resistant Prostate Cancer (mCRPC). This treatment has also proved to be well tolerated, and hematological toxicity, in particular anemia, represents the most represented adverse event. Materials and methods We evaluated the hematologic toxicity of Ra-223 treatment in a real-life experience of 38 patients from two Italian cancer centers, with bone metastases from mCRPC. The main endpoint of the study was the evaluation of the efficacy and tolerability of treatment with radium-223, with greater reference to hematological toxicity (especially anemia) as the cause of interruption of treatment, specifically in the elderly patient. Results From August 2016 to October 2017, a total of 38 consecutive nonselected patients, 20 of them aged >75 years, with mCRPC symptomatic bone metastases, were enrolled for radium-223 at standard doses. Hematologic adverse events were recorded more frequently (72.4% with AE), and 36.8% had anemia. The most frequent cause of treatment discontinuation due to AEs was anemia [8/10 patients (80%)], followed by thrombocytopenia (2 patients) and neutropenia (1 patient). Hematologic AEs were more represented in elderly patients with greater disease burden and previously treated with docetaxel. Conclusions Anemia is the most represented AE related to radium-223 treatment in elderly patients with greater disease burden and previously treated with docetaxel, besides representing the main reason for interruption of treatment. Correct patient selection, appropriate timing, and adequate supportive care are elements that could facilitate successful treatment with radium-223, preventing premature interruption of the same. The results of this experience support the opportunity to propose treatment with radium-223 mostly in patients in the earliest stages.
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Affiliation(s)
- Renato P. Costa
- Division of Radioisotopic Clinical Diagnostic, University Hospital “P. Giaccone”, Palermo, Italy
| | | | | | - Vincenzo Tripoli
- Division of Radioisotopic Clinical Diagnostic, University Hospital “P. Giaccone”, Palermo, Italy
| | - Alessandra Murabito
- Division of Radioisotopic Clinical Diagnostic, University Hospital “P. Giaccone”, Palermo, Italy
| | - Maria Licari
- Division of Radioisotopic Clinical Diagnostic, University Hospital “P. Giaccone”, Palermo, Italy
| | - Maria R. Valerio
- Division of Oncology, University Hospital “P. Giaccone”, Palermo, Italy
| | - Paolo Tralongo
- Division of Oncology, “Umberto I” Hospital – RAO, Siracusa, Italy
- Corresponding author. Division of Oncology, “Umberto I” Hospital – RAO – Siracusa, Via Testaferrata, 1, Siracusa, Italy.
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24
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Cazzaniga ME, Scognamiglio G, Generali DG, Ferzi A, Vandone AM, Spadaro P, Mocerino C, Montagna E, Cretella E, Gambaro A, Taverniti C, Turletti A, Sarobba G, Iezzi L, Roberto M, Ciccarese M, Tralongo P, Clivio L, Pedroli S, Torri V. Metronomic chemotherapy (mCHT) in HER2-ve advanced breast cancer (ABC) patients (pts): Final results of the VICTOR-6 study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13076] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Antonella Ferzi
- Medicina II - Oncologia Medica, Ospedale Civile di Legnano, Legnano, Italy
| | | | | | | | | | | | | | | | - Anna Turletti
- Medical Oncology, ASLTO1 Ospedale Martini, Torino, Italy
| | - Giuseppina Sarobba
- "UOC Oncologia Ospedale San Francesco ATS Sardegna ASSL Nuoro", Nuoro, Italy
| | - Laura Iezzi
- "CeSi-MeT Università G.D'Annunzio Chieti-Pescara", Chieti, Italy
| | - Michela Roberto
- Sant Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | | | - Luca Clivio
- Istituto Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | - Valter Torri
- IRCCS Istituto Di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Rossi P, Difrancia R, Quagliariello V, Savino E, Tralongo P, Randazzo CL, Berretta M. B-glucans from Grifola frondosa and Ganoderma lucidum in breast cancer: an example of complementary and integrative medicine. Oncotarget 2018; 9:24837-24856. [PMID: 29872510 PMCID: PMC5973856 DOI: 10.18632/oncotarget.24984] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/07/2018] [Indexed: 12/29/2022] Open
Abstract
Culinary and medicinal mushrooms are widely used in Asian countries, both as dietary supplements and as nutraceutical foods. They have recently become popular in Europe, as well, for their nutritional and health benefits. In particular, epidemiological studies conducted in Asia suggest that mushroom intake, together with other phytotherapy substances, protects against cancer, specifically gastrointestinal (GI) and breast cancers. Most of the data come from in vitro studies and in vivo experimental animal models. Therefore, in order to translate the updated knowledge to clinical research (i.e., from bench to bedside) a systematic translational research program should be initiated. Future randomized controlled trials comparing the effects of G. frondosa and G. lucidum on conventional treatment outcomes are warranted. The purpose of this review was to describe the emerging mechanisms of action of the mushrooms' anticancer functions which makes their use in clinical practice so promising. Clinical effects of mycotherapy (specifically, the use of Ganoderma lucidum and Grifola frondosa) on long-term survival, tumor response, host immune functions, inflammation, and QoL in cancer patients were also addressed. Adverse events associated with mycotherapy were also investigated. Emerging data point to a potential role of G. lucidum for modulating the carcinogenic potential of GI microbiota, which suggests a new complementary and integrated approach to breast cancer treatment.
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Affiliation(s)
- Paola Rossi
- Department of Biology and Biotechnology “L. Spallanzani”, University of Pavia, Italy
| | | | - Vincenzo Quagliariello
- Department of Abdominal Oncology, National Cancer Institute, IRCCS - Foundation G. Pascale, Naples, Italy
| | - Elena Savino
- Department of Earth and Environmental Science, University of Pavia, Italy
| | | | | | - Massimiliano Berretta
- Department of Medical Oncology, National Cancer Institute, IRCCS, Aviano (PN), Italy
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Tralongo P, Bollina R, Aiello R, Di Mari A, Moruzzi G, Beretta G, Mauceri G, Conti G. Vinorelbine and Prednisone in older Cancer Patients with Hormone-Refractory Metastatic Prostate Cancer a Phase II Study. Tumori 2018; 89:26-30. [PMID: 12729357 DOI: 10.1177/030089160308900106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background Prostate cancer is a common disease in older men. Since it is hormone resistant, no treatment may improve survival. In patients with hormone-refractory prostate cancer, clinical benefit is an important treatment end point. Study Design This study evaluated the efficacy and toxicity of a vinorelbine and prednisone combination in hormone-refractory prostate cancer patients. Vinorelbine was administered at the dose of 25 mg/m2 on days 1 and 8, every three weeks; prednisone was administered orally at the dose of 12 mg/day. Thirty consecutive patients, 65 years or older, with progressive (PSA increase or increase in bidimensionally measurable lesion) metastatic prostate adenocarcinoma were enrolled. Four patients (13%) had a partial response and 14 (46%) stable disease. Time to progression for the entire group was 4.5 months (range, 2–13) and 7.5 months for the group of responders (range, 3–13). A PSA decrease >50% was registered in 36% of the patients. Pain reduction was recorded in 44.4% of the patients and stability in 14.8%. Results The treatment was well tolerated and grade 3 toxicity was found in 2 cases of anemia and 2 cases of leukopenia without fever. Conclusions The schedule is able to control the evolution of hormone-refractory prostate cancer and to give a clinical benefit. These results provide information for further clinical trials in a large series of elderly cancer patients.
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Affiliation(s)
- Paolo Tralongo
- Medical Oncology Unit, G Di Maria Hospital, Avola, Italy.
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Berretta M, Della Pepa C, Tralongo P, Fulvi A, Martellotta F, Lleshi A, Nasti G, Fisichella R, Romano C, De Divitiis C, Taibi R, Fiorica F, Di Francia R, Di Mari A, Del Pup L, Crispo A, De Paoli P, Santorelli A, Quagliariello V, Iaffaioli RV, Tirelli U, Facchini G. Use of Complementary and Alternative Medicine (CAM) in cancer patients: An Italian multicenter survey. Oncotarget 2018; 8:24401-24414. [PMID: 28212560 PMCID: PMC5421857 DOI: 10.18632/oncotarget.14224] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [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: 10/13/2016] [Accepted: 11/20/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Complementary and Alternative Medicine (CAM) include a wide range of products (herbs, vitamins, minerals, and probiotics) and medical practices, developed outside of the mainstream Western medicine. Patients with cancer are more likely to resort to CAM first or then in their disease history; the potential side effects as well as the costs of such practices are largely underestimated. Patients and method We conducted a descriptive survey in five Italian hospitals involving 468 patients with different malignancies. The survey consisted of a forty-two question questionnaire, patients were eligible if they were Italian-speaking and receiving an anticancer treatment at the time of the survey or had received an anticancer treatment no more than three years before participating in the survey. RESULTS Of our patients, 48.9% said they use or have recently used CAM. The univariate analysis showed that female gender, high education, receiving treatment in a highly specialized institute and receiving chemotherapy are associated with CAM use; at the multivariate analysis high education (Odds Ratio, (OR): 1.96 95% Confidence Interval, CI, 1.27-3.05) and receiving treatment in a specialized cancer center (OR: 2.75 95% CI, 1.53-4.94) were confirmed as risk factors for CAM use. Conclusion Roughly half of our patients receiving treatment for cancer use CAM. It is necessary that health professional explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.
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Affiliation(s)
| | - Chiara Della Pepa
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Paolo Tralongo
- Division of Medical Oncology, "Umberto I" Hospital, Syracuse, Italy
| | - Alberto Fulvi
- Department of Medicine and Surgery of Integrated Treatment, Division of Thoracic Oncology, "San Camillo Forlanini" Hospital, Rome, Italy
| | | | - Arben Lleshi
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy
| | - Guglielmo Nasti
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | | | - Carmela Romano
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | - Chiara De Divitiis
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | - Rosaria Taibi
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy
| | - Francesco Fiorica
- Department of Radiation Oncology University Hospital Ferrara, Division of Radiotherapy, "Arcispedale Sant'Anna" Hospital, Ferrara, Italy
| | - Raffaele Di Francia
- Department of Hematology, Istituto Nazionale Tumori 'Fondazione Giovanni Pascale', IRCCS, Naples, Italy.,Gruppo Oncologico Ricercatori Italiani, GORI, Pordenone, Italy
| | - Anna Di Mari
- Division of Medical Oncology, "Umberto I" Hospital, Syracuse, Italy
| | - Lino Del Pup
- Division of Gynaecological Oncology, National Cancer Institute, Aviano (PN), Italy
| | - Anna Crispo
- Unit of Epidemiology, Struttura Complessa di Statistica Medica, Biometria e Bioinformatica, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Paolo De Paoli
- Scientific Directorate, National Cancer Institute, Aviano (PN), Italy
| | - Adriano Santorelli
- Department of Plastic Surgery, Regenerative Medicine, Health Park Hospital, Naples, Italy
| | - Vincenzo Quagliariello
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | - Rosario Vincenzo Iaffaioli
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | - Umberto Tirelli
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy
| | - Gaetano Facchini
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
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Costa RP, Raiti F, Bordonaro S, Tripoli V, Murabito A, Licari M, Tralongo P. Cause of radium 223 treatment discontinuation in elderly mCRPC patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.376] [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
376 Background: Prostate cancer is the most common cancer among adult men. Bones are the main metastatic site of prostate cancer. Radium-223 is indicated to treat metastatic castrate-resistant prostate cancer ( mCRPC) with symptomatic skeletal metastases. We evaluate the tolerability of Ra223 treatment in real life setting. Methods: We reported the cases of 38 consecutive non-selected patients with mCRPC symptomatic bone metastases treated in two Italian hospital cancer center from August 2016 to October 2017. The cause of Ra 223 treatment discontinuation in elderly prostate cancer patients were evaluated. Results: due bones metastases, 38 patients were treated with Radium-223; 20 were ≥75 years old (range 75-85 yrs). Patients characteristics and main toxicity are reported (Table). Regarding the elderly patients, hematologic toxicity were the most common adverse events reported. Anemia G2-G3 was observed in 10 pts (50%), thrombocytopoenia G3 in 2 patients (10%) and neutropenia G3 in 4 patients (20%); 12/20 patients interrupted the treatment, of which 10 were ECOG PS2. The number of patients who discontinued the drug because of hematologic adverse events was higher than ALSYMPCA clinical trial. Fatigue G1-G2 incidence was 32%. Unexpectedly we did not record any cases of gastrointestinal toxicity (diarrhea, nausea or constipation). Conclusions: In patients ≥75 years old, anemia G2-G3 was more frequent than data reported in literature, while diarrhea is not found. The data of this experience suggest that elderly vulnerable patients are more exposed to hematologic toxicity that may compromise the outcome of the treatment. For these patients surveillance for early supportive care is relevant. Characteristics of patients with ≥75y. [Table: see text]
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Affiliation(s)
- Renato Patrizio Costa
- Azienda Ospedaliera-Universitaria Policlinico Paolo Giaccone U.O. Di Diagnostica Clinica Radioisotopica, Palermo, Italy
| | | | | | - Vincenzo Tripoli
- Azienda Ospedaliera-Universitaria Policlinico Paolo Giaccone U.O. Di Diagnostica Clinica Radioisotopica, Palermo, Italy
| | - Alessandra Murabito
- Azienda Ospedaliera-Universitaria Policlinico Paolo Giaccone U.O. Di Diagnostica Clinica Radioisotopica, Palermo, Italy
| | - Maria Licari
- Azienda Ospedaliera-Universitaria Policlinico Paolo Giaccone U.O. Di Diagnostica Clinica Radioisotopica, Palermo, Italy
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Tralongo P, Pescarenico MG, Surbone A, Bordonaro S, Berretta M, DI Mari A. Physical Needs of Long-term Cancer Patients. Anticancer Res 2017; 37:4733-4746. [PMID: 28870892 DOI: 10.21873/anticanres.11880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/16/2017] [Revised: 07/04/2017] [Accepted: 07/21/2017] [Indexed: 11/10/2022]
Abstract
The enormous success in the therapeutic area of oncology has allowed achieving a number of long-term survival patients unthinkable until a few decades ago. The number of cancer survivors in the world has, in fact, almost tripled in the last decade alone. Anticancer therapies, including those of the latest generation, aimed at targeting also the chronicity of the disease, are not free from side-effects, especially when used in the long term. This scenario should lead to development of follow-up programs with the purpose of assessing long-term effects related to cancer treatments, in addition to the early detection of any relapse or a second tumor. Oncologists who take care of cancer survivors cannot ignore these effects; it is, therefore, essential to start a program of prevention and treatment of these sequelae, to meet patients' health needs.
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Affiliation(s)
- Paolo Tralongo
- UOC Medical Oncology, Umberto I hospital, Syracuse, Italy
| | | | - Antonella Surbone
- Department of Medicine, New York University Medical School, Division of Medical Oncology, New York, NY, U.S.A
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Affiliation(s)
- Paolo Tralongo
- Paolo Tralongo, Umberto I Hospital, Siracusa, Italy; Mary S. McCabe, Consultant in Survivorship and Bioethics, Arlington, VA; and Antonella Surbone, New York University Medical School, New York, NY
| | - Mary S McCabe
- Paolo Tralongo, Umberto I Hospital, Siracusa, Italy; Mary S. McCabe, Consultant in Survivorship and Bioethics, Arlington, VA; and Antonella Surbone, New York University Medical School, New York, NY
| | - Antonella Surbone
- Paolo Tralongo, Umberto I Hospital, Siracusa, Italy; Mary S. McCabe, Consultant in Survivorship and Bioethics, Arlington, VA; and Antonella Surbone, New York University Medical School, New York, NY
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Bordonaro S, Berretta M, Tralongo AC, Clementi S, Stanzione B, Tralongo P. The Real Impact of Target Therapy in Breast Cancer Patients: Between Hope and Reality. Curr Cancer Drug Targets 2017; 18:480-498. [PMID: 28183251 DOI: 10.2174/1568009617666170209100322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/11/2016] [Revised: 06/03/2016] [Accepted: 06/28/2016] [Indexed: 11/22/2022]
Abstract
Over the last 15 years, we have seen a huge expansion of the development of drugs directed against biomolecular targets within breast cancer cells. The over-expression of certain receptors (ER, PgR, HER-2, VEGF-R), as well as alteration of several intracellular signal transduction pathways (the PI3K-AKT-mTOR pathway, MEK-MAPK pathway, loss of PTEN, etc ...) has a great impact on the likelihood of recurrence and progression of the disease, influencing the natural history of breast cancer. The recent biomolecular classification of breast cancer (Luminal A / B, HER2- driven, Basal Like) allowed finally to identify specific treatments against molecular target to associate or not to traditional chemotherapy, and to use in relation to the prognosis of the disease. In the following paragraphs, we will set out the major targeted drug that have received indications in breast cancer, both in the localized and in advanced disease, referring to the specific target (hormonal receptors, HER2, VEGF, m-TOR, PARP etc ...).
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Affiliation(s)
| | | | | | - Silvia Clementi
- Division of Medical Oncology, "Umberto I" Hospital - RAO - Siracusa, Italy
| | - Brigida Stanzione
- Department of Medical Oncology, National Cancer Institute Aviano (PN), Italy
| | - Paolo Tralongo
- Division of Medical Oncology, "Umberto I" Hospital - RAO - Siracusa, Italy
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Pinto C, Di Fabio F, Rosati G, Lolli IR, Ruggeri EM, Ciuffreda L, Ferrari D, Lo Re G, Rosti G, Tralongo P, Ferrara R, Alabiso O, Chiara S, Ianniello GP, Frassoldati A, Bilancia D, Campanella GA, Signorelli C, Racca P, Benincasa E, Stroppolo ME, Di Costanzo F. Observational study on quality of life, safety, and effectiveness of first-line cetuximab plus chemotherapy in KRAS wild-type metastatic colorectal cancer patients: the ObservEr Study. Cancer Med 2016; 5:3272-3281. [PMID: 27748041 PMCID: PMC5119983 DOI: 10.1002/cam4.888] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 12/22/2022] Open
Abstract
Cetuximab improves efficacy when added to chemotherapy for metastatic colorectal cancer (mCRC). Effective management of skin reactions from cetuximab improves quality of life (QoL), and treatment compliance in clinical trials. No data are available from real‐world settings. The ObservEr observational, multicenter, prospective study evaluated QoL, the incidence of skin reactions, and management of chemotherapy plus cetuximab in first‐line for mCRC. The primary endpoint was QoL measured with the Dermatology Life Quality Index (DLQI) and EORTC QLQ‐C30. Secondary endpoints were the incidence of skin and serious adverse events, median overall and progression‐free survival, tumor response, and resection rates. Between May 2011 and November 2012, 228 patients with KRASwt mCRC were enrolled at 28 Italian centers, 225 evaluable, median age 65 years. QoL did not change during treatment and was not affected by the choice of prophylactic or reactive skin management. The incidence of cetuximab‐specific grade ≥3 skin reactions was 14%, with no grade 4/5 events. Skin reactions correlated with survival (P = 0.016), and their incidence was influenced by chemotherapy regimen (oxaliplatin vs. irinotecan—Incidence rate ratio [IRR] 1.72, P < 0.0001) and gender (male vs. female—IRR 1.38, P = 0.0008). Compliance at first postbaseline evaluation was 97.75%. Median overall survival was 23.6 months, median progression‐free survival 8.3 months. Cetuximab plus chemotherapy did not compromise QoL in the routine clinical setting when patients receive close monitoring plus prophylactic or reactive management of skin reactions. We observed the same correlation between overall survival (OS) and skin reactions reported in controlled clinical trials, also in this setting.
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Affiliation(s)
- Carmine Pinto
- Medical Oncology, Santa Maria Nuova IRCCS Hospital, Reggio Emilia, Italy
| | - Francesca Di Fabio
- Medical Oncology, S. Orsola-Malpighi Policlinic Hospital, Bologna, Italy
| | | | - Ivan R Lolli
- Medical Oncology, Saverio de Bellis IRCCS Hospital, Castellana Grotte, Italy
| | - Enzo M Ruggeri
- Medical Oncology, Belcolle AUSL Hospital Viterbo, Viterbo, Italy
| | - Libero Ciuffreda
- Medical Oncology, Città della Salute e della Scienza, and San Giovanni Battista - Molinette Hospitals, Turin, Italy
| | | | - Giovanni Lo Re
- Medical Oncology, Pordenone AAS5 Hospital, Pordenone, Italy
| | - Giovanni Rosti
- Medical Oncology, Treviso Regional Hospital, Treviso, Italy
| | - Paolo Tralongo
- Medical Oncology, Umberto I RAO Hospital, Siracusa, Italy
| | | | | | - Silvana Chiara
- Medical Oncology, San Martino IRCCS University Hospital - National Cancer Institute, Genoa, Italy
| | | | - Antonio Frassoldati
- Clinical Oncology, Arcispedale Sant'Anna University Hospital, Ferrara, Italy
| | | | | | - Carlo Signorelli
- Medical Oncology, Belcolle AUSL Hospital Viterbo, Viterbo, Italy
| | - Patrizia Racca
- Medical Oncology, Città della Salute e della Scienza, and San Giovanni Battista - Molinette Hospitals, Turin, Italy
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Tralongo P, Bordonaro S, Di Mari A, Cappuccio F, Rametta Giuliano S. Chemotherapy in frail elderly patients with hormone-refractory prostate cancer: A "real world" experience. Prostate Int 2016; 4:15-9. [PMID: 27014659 PMCID: PMC4789324 DOI: 10.1016/j.prnil.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/09/2015] [Accepted: 12/08/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In elderly patients affected by metastatic castration-resistant prostate cancer (mCRPC) chemotherapic treatment may be the choice if one considers not only the chronological age, but also the clinical status, the functional reserve, and the vulnerability of patients. Several studies have confirmed the survival benefit of docetaxel and vinorelbine among every class of age. Most CRP elderly patients are defined as frail, maybe due to comorbidities: these patients, who are unable to be candidates for a standard treatment, should be candidates for a more tolerable treatment. METHODS Twenty-six elderly, frail patients were evaluated. The patients were affected by mCRPC and were receiving chemotherapy with intravenous weekly docetaxel (12 patients) or oral metronomic vinorelbine (14 patients). Safety and efficacy were investigated evaluating clinical and objective response and tolerability. The level of patient satisfaction with treatment was assessed through a questionnaire. RESULTS No significant difference was found between groups in terms of 6-month progression-free survival: 57.1% for patients treated with oral metronomic vinorelbine versus 58.3% for patients treated with docetaxel. Median progression free survival was 8.6 months (95% confidence interval: 7.1-9.4 months), and 8.2 months (95% confidence interval: 6.9-9.3 months) for patients treated with oral metronomic vinorelbine and socetaxel, respectively. Oral metronomic vinorelbine was associated with increased patient satisfaction with respect to docetaxel administration. The most frequent side effect associated with oral metronomic vinorelbine was anemia and vomiting, with similar frequency compared to patients treated with docetaxel. CONCLUSION Weekly docetaxel and oral metronomic vinorelbine are equally effective and well tolerated in elderly unfit and frail patients affected by mCRPC. Metronomic vinorelbine treatment is associated with higher patient compliance and satisfaction.
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Affiliation(s)
- Paolo Tralongo
- Umberto I Hospital, Medical Oncology Unit - Rete Assisstenza Oncologica, Siracusa, Italy
| | - Sebastiano Bordonaro
- Umberto I Hospital, Medical Oncology Unit - Rete Assisstenza Oncologica, Siracusa, Italy
| | - Annamaria Di Mari
- Umberto I Hospital, Medical Oncology Unit - Rete Assisstenza Oncologica, Siracusa, Italy
| | - Francesco Cappuccio
- Umberto I Hospital, Medical Oncology Unit - Rete Assisstenza Oncologica, Siracusa, Italy
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Tralongo P, Giuliano SR, Di Mari AM, Bordonaro S, Romano F, Pumo V, Iacono M, Lanteri E, Tralongo AC, Roccaro S, Iemmolo S. Survivors preferences about the role of the oncologist and primary care provider. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
259 Background: Oncologist and Primary Care Provider are both involved in cancer patients follow-up. Patient's preference is an important issue. Aims This observational study was made to investigate: a) if and how long after the diagnosis the patient prefers to be followed by PCPs, Oncologist or both; b) if they prefer to be followed in the same institute where they received acute phase care; c) if it's important to receive recommendations about their lifestyle. Methods: 150 patients were recruited between May and June 2015 in the transient phase. They were affected by different tumors (breast, colon, prostate, melanoma, gynecological cancers and lymphoma disease) 53 pts under 3 years, 38 pts 5 years, 59 pts 7 years since the diagnosis. A questionnaire investigating the aims of the study was administered. Results: Among the pts on 3 years follow-up, only one preferred to be followed by the PCPs for logistical reasons; 24/53 patients after 5 years follow-up preferred PCPs and 18/53 preferred to be followed only by the oncologist because of more competence. In the 5 and 7 years follow-up 80/97 pts preferred to be exclusively followed by the oncologist for these reasons: A) poor PCPs involvement during the acute phase. B) oncologist expertise in acute phase, follow-up and possible relapse; c) lack of interest shown by the PCPs for survivorship care plan. All pts (150) gave positive response on receiving advices about their lifestyle (diet, sport activities, etc...). For 63% of the patients a unique structure would be suitable for receiving follow-up too. Conclusions: The preferences of patients, followed in the transient phase, suggest that fear of relapse guides patient's choice and the relationship with the oncologist offers security.
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Pumo V, Tralongo A, Di Mari A, Iacono M, Rametta Giuliano S, Lanteri E, Tralongo P. [Models in the management of long-term life]. Recenti Prog Med 2015; 106:358-63. [PMID: 26228858 DOI: 10.1701/1960.21298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The number of cancer survivors is progressively increasing. Despite the significant progress in the cancer therapies, we are facing the emerging concern of the late side effects and/or psycosocial problems that require diversified follow-up. Healthcare models supporting the oncological patient's needs should be established to improve the quality of life after the diagnosis of oncological disease. Several care models have been proposed - mainly focused on the pediatric population - although further research is needed to optimize the programs. Furthermore, the heterogeneity in existing survivorship care should be addressed: the individual patient characteristics and risk factors (histology, treatment received, age, performance status, comorbidities, lifestyle, behavior risk) should be considered. An efficient cooperation between the General practitioner and the Oncologic team is needed.
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Tomasello G, Tralongo P, Amoroso F, Damiani P, Sinagra E, Noto M, Arculeo VM, Jurjus Zein R, Saad W, Jurjus A, Gerbino A, Leone A. DYSMICROBISM, INFLAMMATORY BOWEL DISEASE AND THYROIDITIS: ANALYSIS OF THE LITERATURE. J BIOL REG HOMEOS AG 2015; 29:265-272. [PMID: 26122213] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The human body is colonized by a large number of microbes that are collectively referred to as the microbiota. They interact with the hosting organism and some do contribute to the physiological maintenance of the general good health thru regulation of some metabolic processes while some others are essential for the synthesis of vitamins and short-chain fatty acids. The abnormal variation, in the quality and/or quantity of individual bacterial species residing in the gastro-intestinal tract, is called dysmicrobism. The immune system of the host will respond to these changes at the intestinal mucosa level which could lead to Inflammatory Bowel Diseases (IBD). This inflammatory immune response could subsequently extend to other organs and systems outside the digestive tract such as the thyroid, culminating in thyroiditis. The goal of the present study is to review and analyze data reported in the literature about thyroiditis associated with inflammatory bowel diseases such as Ulcerative Colitis (UC) and Crohns Disease (CD). It was reported that similarities of some molecular bacterial components with molecular components of the host are considered among the factors causing IBD through an autoimmune reaction which could involve other non-immune cell types. The axis dysmicrobism-IBD-autoimmune reaction will be investigated as a possible etiopathogenic mechanism to Autoimmune Thyroiditis. If such is the case, then the employment of specific probiotic strains may represent a useful approach to moderate the immune system.
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Affiliation(s)
- G Tomasello
- School of Medicine and Surgery, University of Palermo, Italy
| | - P Tralongo
- Department of Health Promotion, Tumor Immunology Laboratory, School of Medicine and Surgery, Palermo University, Italy
| | - F Amoroso
- Student School of Medicine and Surgery, University of Palermo, Italy
| | - P Damiani
- Geriatric School of Medicine, University of Palermo, Italy
| | - E Sinagra
- IEMEST, Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | - M Noto
- School of Medicine and Surgery, University of Palermo, Italy
| | - V M Arculeo
- School of Medicine and Surgery, University of Palermo, Italy
| | - R Jurjus Zein
- Department of Anatomy and Regenerative Biology, Faculty of Medicine and Health Sciences, George Washington University, Washington DC, USA
| | - W Saad
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - A Jurjus
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - A Gerbino
- Department of Experimental Biomedicine and Clinical Neuroscience, Section of Histology and Embryology, School of Medicine and Surgery, Palermo, Italy
| | - A Leone
- Department of Experimental Biomedicine and Clinical Neuroscience, Section of Histology and Embryology, School of Medicine and Surgery, Palermo, Italy
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Affiliation(s)
- V Pumo
- Medical Oncology Unit, Umberto I Hospital, RAO, Siracusa, Italy
| | - A Di Mari
- Medical Oncology Unit, Umberto I Hospital, RAO, Siracusa, Italy
| | | | - S Bordonaro
- Medical Oncology Unit, Umberto I Hospital, RAO, Siracusa, Italy
| | - E Lanteri
- Medical Oncology Unit, Umberto I Hospital, RAO, Siracusa, Italy
| | - P Tralongo
- Medical Oncology Unit, Umberto I Hospital, RAO, Siracusa, Italy.
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Tralongo P, Maso LD, Surbone A, Santoro A, Tirelli U, Sacchini V, Pinto C, Crispino S, Ferraù F, Mandoliti G, Tonini G, Russo A, Santini D, Madeddu A, Panebianco V, Pergolizzi S, Respini D, Rolfo C, Bongiovanni M, De Lorenzo F, Spatola C, Di Raimondo F, Terenziani M, Peeters M, Castoro C. Use of the Word “Cured” for Cancer Patients—Implications for Patients and Physicians: The Siracusa Charter. Curr Oncol 2015. [DOI: 10.3747/co.22.2287] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Long-term survival for adult patients with solid tumours continues to increase. For some cancers, the possibility of recurrence after a number of years is extremely low, and the risk of death becomes similar to that of the general population of the same sex and age. During the Fifth European Conference on Survivors and Chronic Cancer Patients held in Siracusa, Italy, June 2014, oncologists, general practitioners, epidemiologists, cancer patients and survivors, and patient advocates joined to discuss the possible use of the term “cured” in reference to some adult patients with solid tumours. The specific focus was the appropriateness of using the term in communicating with cancer patients, survivors, and their families. Initial results of the discussion, in concert with a review of the published literature on the subject, were later further discussed by all participants through electronic communication. The resulting final statement aims to suggest appropriate ways to use the word “cured” in the clinical and communicative setting, to highlight the potential impact of the word on patients, and to open a critical discussion concerning this timely and delicate matter.
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Di Mari A, Bordonaro S, Rametta Giuliano S, Romano F, Lanteri E, Tralongo P. Metformin and Cancer Treatment. World J Oncol 2015; 6:316-317. [PMID: 29147424 PMCID: PMC5649954 DOI: 10.14740/wjon868w] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | - Paolo Tralongo
- Medical Oncology Unit, RAO, ASP 8 Siracusa, Italy
- Corresponding Author: Paolo Tralongo, Medical Oncology Unit, RAO, ASP 8 Siracusa, Italy.
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Russo A, Catania VE, Cavallaro A, Ficili B, Lanteri E, Tralongo P, Cappellani A, Randazzo C, Cammisuli F, Madeddu R, Trichilo V, Libra M, Travali S. Molecular analysis of the APC gene in Sicilian patients with familial adenomatous polyposis (F.A.P.). Int J Surg 2014; 12 Suppl 2:S125-S129. [DOI: 10.1016/j.ijsu.2014.08.365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 10/24/2022]
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43
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Leone A, Uzzo ML, Gerbino A, Tortorici S, Tralongo P, Cappello F, Incandela S, Spatola GF, Jurjus AR. Modulation of MMP-2 and MMP-9 in Churg-Strauss syndrome respiratory mucosa: potential monitoring parameters. Int J Immunopathol Pharmacol 2014; 27:299-304. [PMID: 25004843 DOI: 10.1177/039463201402700219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Churg-Strauss (CSS) syndrome is rare and of unknown etiology. It is associated with vasculitis, blood eosinophilia and granulomatosis, and affects multiple organs and systems at various stages of the disease. Specific diagnostic and monitoring tests are not yet available. This study aims to assess the changes in MMP-2 and MMP-9 along with the histopathological alterations in two cases of CSS, as possible potential diagnostic and monitoring criteria. Two adult male patients were diagnosed with CSS in the otorhinolaryngology clinic in the University of Palermo, based on multiple clinical and histopathologic criteria. Biopsies of respiratory mucosa were taken after the consent of the patients, processed for routine histopathology and immunohistochemistry as well as quantitative polymerase chain reaction (qPCR). Similar biopsies were also taken from a non- CSS patient. The Assessment of MMP-2 and MMP-9 was performed using both immunohistochemistry and qPCR techniques. Histopathological alterations in the respiratory mucosa were consistent with vasculitis and granulomatous tissue formation, in addition to inflammatory cell infiltration with abundance of eosinophils. Immunohistochemistry assay performed on the samples derived from the two CSS patients showed a relative and remarkable increase of both MMP-2 and MMP-9 compared to controls. Such an increase was consistent with the qPCR results which depicted a significant increase between 20 and 30% for both MMP-2 and MMP-9, respectively. Since the secretion of MMPs is an essential step in angiogenesis, could these enzymatic factors be used as parameters to diagnose or monitor the evolution of CSS? The small number of samples analyzed in this study does not allow us to suggest a general statement correlating the increase in expression of MMP-2 and MMP-9 to the appearance or evolution of vasculitis; it is only speculative.
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Affiliation(s)
- A Leone
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Sezione di Istologia ed Embriologia, Universitá degli Studi di Palermo, Palermo, Italia
| | - M L Uzzo
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Sezione di Istologia ed Embriologia, Universitá degli Studi di Palermo, Palermo, Italia
| | - A Gerbino
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Sezione di Istologia ed Embriologia, Universitá degli Studi di Palermo, Palermo, Italia
| | - S Tortorici
- Dipartimento di Chirurgia Orale e Maxillo Facciale, Facoltá di Medicina e Chirurgia, Universitá degli Studi di Palermo, Palermo, Italia
| | - P Tralongo
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Sezione di Anatomia Umana Normale, Universita' degli Studi di Palermo, Palermo, Italia
| | - F Cappello
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Sezione di Anatomia Umana Normale, Universita' degli Studi di Palermo, Palermo, Italia
| | - S Incandela
- Dipartimento delle Scienze Specialistiche Medico Chirurgiche e Riabilitative Unitá Operativa Complessa di Otorinolaringoiatria, Universita degli Studi di Palermo, Palermo, Italia
| | - G F Spatola
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Sezione di Istologia ed Embriologia, Universita degli Studi di Palermo, Palermo, Italia
| | - A R Jurjus
- Department of Anatomy, Cell Biology and Physiology, American University of Beirut, Lebanon
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Soto Parra HJ, Favaretto AG, Bearz A, Cortinovis DL, Galetta D, Cinieri S, Adamo V, Giannitto-Giorgio C, Tralongo P, Borsellino N, Spada M, Ferraú F, Butera A, Barbieri V, Blasi L, Aiello MM, Restuccia N, Franchina T, Alu M, Bruzzi P. The role of cisplatin (CDDP) or carboplatin (CARBO) plus pemetrexed (PEM) in nonsquamous (NON-SQM) non-small cell lung cancer (NSCLC): Results of an Italian retrospective multicentric study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19072] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hector J. Soto Parra
- Medical Oncology, University Hospital Policlinico - Vittorio Emanuele, Catania, Italy
| | | | | | | | | | - Saverio Cinieri
- Medical Oncology & Breast Unit, Senatore Antonio Perrino Hospital, Brindisi, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology University of Messina, Messina, Italy
| | | | - Paolo Tralongo
- Medical Oncology Unit, G Di Maria Hospital, Avola, Italy
| | - Nicolo Borsellino
- Medical Oncology Unit - Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | | | - Francesco Ferraú
- Medical Oncology Department, Ospedale S Vincenzo, Taormina, Italy
| | | | - Vito Barbieri
- Medical Oncology Unit, Campus “Salvatore Venuta”, Magna Græcia University and Tommaso Campanella Cancer Center, Catanzaro, Italy
| | | | - Marco M Aiello
- Medical Oncology, University Hospital Policlinico - Vittorio Emanuele, Catania, Italy
| | - Nunzio Restuccia
- Medical Oncology, University Hospital Policlinico - Vittorio Emanuele, Catania, Italy
| | - Tindara Franchina
- Unit of Medical Oncology, A.O. Papardo; Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Paolo Bruzzi
- IRCCS Azienda Ospedaliera Universitaria San Martino – Ist - Istituto Nazionale Per La Ricerca Sul Cancro, Genoa, Italy
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Di Fabio F, Rosati G, Lolli IR, Ruggeri EM, Ciuffreda L, Ferrari D, Tumolo S, Rosti G, Tralongo P, Ferrara R, Alabiso O, Chiara S, Ianniello GP, Di Costanzo F, Frassoldati A, Iacono C, Clerico M, Pavesi L, Bernardo G, Pinto C. Italian observational study in patients with metastatic colorectal cancer (mCRC) treated with first-line cetuximab based regimen (ObservEr study). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e14600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Gerardo Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - Ivan Roberto Lolli
- Medical Oncology Unit, IRCCS Saveri de Bellis, Castellana Grotte BA, Italy
| | | | | | - Daris Ferrari
- Medical Oncology Unit, San Paolo Hospital, Milan, Italy
| | - Salvatore Tumolo
- Medical Oncology Unit, St Maria degli Angeli Hospital, Pordenone, Italy
| | - Giovanni Rosti
- Medical Oncology Unit, Cà Foncello Hospital, Treviso, Italy
| | - Paolo Tralongo
- Medical Oncology Unit, G Di Maria Hospital, Avola, Italy
| | | | - Oscar Alabiso
- Medical Oncology Unit, Maggiore della Carità Hospital, Novara, Italy
| | - Silvana Chiara
- Medical Oncology Unit, National Cancer Institute, Genoa, Italy
| | | | | | | | - Carmelo Iacono
- Medical Oncology Unit, M.Paternò Hospital, Ragusa, Italy
| | - Mario Clerico
- Medical Oncology Unit, Degli Infermi Hospital, Biella, Italy
| | - Lorenzo Pavesi
- Medical Oncology Unit, IRCCS Salvatore Maugeri Foundation, Pavia, Italy
| | | | - Carmine Pinto
- Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
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Bordonaro S, Romano F, Lanteri E, Cappuccio F, Indorato R, Butera A, D’Angelo A, Ferraù F, Tralongo P. Effect of a structured, active, home-based cancer-treatment program for the management of patients on oral chemotherapy. Patient Prefer Adherence 2014; 8:917-23. [PMID: 25028540 PMCID: PMC4077854 DOI: 10.2147/ppa.s62666] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The advent of oral chemotherapy agents has had a strong impact on several aspects of the management of cancer patients, including survival rates, health-care expenditure, and health-related quality of life. However, access to care and adherence to oral chemotherapy are central to optimal outcomes. PATIENTS AND METHODS In this multicenter observational study, we assessed the effect of the "Active Home Care" initiative - a structured, active, home-based cancer-treatment program - on quality of life, health-care utilization, and patient adherence and satisfaction using self-administered questionnaires. Sixty-two patients treated with oral chemotherapy (capecitabine, vinorelbine, imatinib, sunitinib, sorafenib, temozolomide, ibandronate) were enrolled in the program. Weekly home visits were scheduled, each one with a trained nurse who delivered the home-based chemotherapy and reviewed patients' compliance and treatment toxicity. An oncologist evaluated patients and modified the dosage of oral chemotherapy based on toxicity reported during the previous cycle at bi-weekly visits. RESULTS A total of 460 home visits were performed between April 2012 and February 2013. The Active Home Care initiative was associated with significant improvements in physical functioning and symptoms, and reductions in the access to cancer facilities. Satisfaction with oral chemotherapy and care received was high. All patients reported having taken their medications according to their prescription, and no patient reported difficulties in managing the oral chemotherapy regimen. CONCLUSION The Active Home Care program was associated with improvements in the quality of life of patients and caregivers, better adherence to treatment, and the effective management of therapy and cancer-related symptoms. Home-based cancer treatment may also optimize the utilization of health-care resources.
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Affiliation(s)
- S Bordonaro
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - F Romano
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - E Lanteri
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - F Cappuccio
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - R Indorato
- Medical Oncology Unit, S Giovanni di Dio Hospital, Agrigento, Italy
| | - A Butera
- Medical Oncology Unit, S Giovanni di Dio Hospital, Agrigento, Italy
| | - A D’Angelo
- Medical Oncology Unit, S Vincenzo Hospital, Taormina, Italy
| | - F Ferraù
- Medical Oncology Unit, S Vincenzo Hospital, Taormina, Italy
| | - P Tralongo
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
- Correspondence: Paolo Tralongo, Medical Oncology Unit, Umberto I Hospital, RAO, Siracusa, Italy, Tel +39 9 3172 4542, Email
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Tralongo P, Annunziata MA, Santoro A, Tirelli U, Surbone A. Beyond Semantics: The Need to Better Categorize Patients With Cancer. J Clin Oncol 2013; 31:2637-8. [DOI: 10.1200/jco.2013.50.0850] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Maria Antonietta Annunziata
- Centro di Riferimento Oncologico, Istituto Ricovero Cura Carattere Scientifico, National Cancer Institute, Aviano, Italy
| | - Armando Santoro
- Humanitas Cancer Center, Istituto Ricovero Cura Carattere Scientifico, Rozzano, Italy
| | - Umberto Tirelli
- Centro di Riferimento Oncologico, Istituto Ricovero Cura Carattere Scientifico, National Cancer Institute, Aviano, Italy
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Caruso M, Adamo V, Tralongo P, Giuffrida D, Gebbia V, Leonardi V, Soto Parra HJ, Valenza R, Borsellino N, Sanò MV, Priolo D, Di Mari AM, Prestifilippo A, Ricciardi G, Miano E, Zacchia A, Ferraú F. Retrast: Retreatment after adjuvant trastuzumab—Our regional southern Italy experience. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e11526] [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
e11526 Background: Trastuzumab (T) is the standard of care for pts with HER2+ve BC. Relapse after adj T remains a rare event. Since the large use of T in adj setting, becomes crucial to evaluate advantages of retreatment with T for pts who relapsed after treatment in early stage. There is still lack of clinical evidence and poor data from CT to say that there is a benefit in T re-exposure after relapse following adj T. Methods: Since Jun 2006 and Dec 2011, we reviewed pts with early BC treated with T in adj therapy, relapsed and re-treated with T in first line therapy, in 10 departments of medical oncology in Sicily. We aimed to study feasibility, responses and treatment outcome. Results: 62 pts with HER2+ve fulfilled the criteria for this analysis and 47 were evaluated. Pts had a median age of 53 ys (29-79). ER/PgR-ve cases were 16 (34 %). Ki67 was > 20% in 34 pts (74%). 31 pts (64%) had >3 nodes+ve. All the pts received adj therapy with anthra+/-taxane. 55% of pts had >2 metastatic sites. 12 (25,5%) pts were revalued for HER2: 10 pts confirmed 3+ and two pts 2+ were FISH+. Median time from diagnosis to relapse was 25 mos (7 – 36). Median time from last dose of T to relapse was 10 ms (2 – 35). 33 (70,2%) pts and 14 pts (29,8%) had early (< 12 ms) and late progression (≥ 12 ms) respectively after adj T. First line of therapy was T in combination with mono/polychemotherapy in 42 pts (89,3%) and 5 pts (10,6%) respectively. 27 pts (57,4%) had objective responses (CR 5, PR 22) and 7 pts (14,8%) stable disease. 13 pts (27,6%) had progression: all of these pts had early progressive disease after adj T, 9 pts (69,2%) had Ki67>20%, 5 pts (38,4%) were ER/PgR-ve and 8 pts (61,5%) ER/PgR+ve. Median TTP was 4 mos (range 2-7). Median TTP for early and late relapses pts were respectively 3,7 and 4,8 mos, (p = 0,4). Median OS from relapse to death was 23 mos (r 12 – 37). LVSD G1 (EF < 60-50%) was observed only in 7 pts (14%). Conclusions: Our data confirm the feasibility and safety of treatment with T after adj T therapy and is active for a disease control rate in 72,4% of cases. These results demonstrate that relapses after adj T occurred early (<12 ms) in 70% of pts. However pts with primary resistance (27,6%) should be well categorized using biomolecular markers to receive up-front drugs that overcome the resistance to T.
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Affiliation(s)
- Michele Caruso
- Medical oncology department, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Vincenzo Adamo
- Unit of Medical Oncology, A.O. Papardo; Department of Human Pathology, University of Messina, Messina, Italy
| | - Paolo Tralongo
- Medical Oncology Unit, G Di Maria Hospital, Avola, Italy
| | | | | | | | - Hector J. Soto Parra
- Medical Oncology, University Hospital Policlinico - Vittorio Emanuele, Catania, Italy
| | | | - Nicolo Borsellino
- Medical Oncology Unit - Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Maria Vita Sanò
- Medical oncology Department, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Domenico Priolo
- Medical Oncology Department, Ospedale S Vincenzo, Taormina, Italy
| | | | | | | | | | - Alessandra Zacchia
- Medical oncology department, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Francesco Ferraú
- Medical Oncology Department, Ospedale S Vincenzo, Taormina, Italy
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Pinto C, Di Fabio F, Rosati G, Lolli I, Ruggeri E, Ciuffreda L, Ferrari D, Tumolo S, Rosti G, Tralongo P, Ferrara R, Alabiso O, Chiara S, Ianniello GP, Di Costanzo F, Frassoldati A, Iacono C, Adamo V, Mattioli R, Valeri M. Management of skin toxicity and cetuximab-based regimen compliance in first-line chemotherapy of metastatic colorectal cancer (mCRC) patients (pts): Results of observer study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e14557] [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
e14557 Background: Cetuximab significantly improves efficacy when added to chemotherapy in mCRC pts. The ObservEr Study evaluated quality of life (QoL), skin toxicity management and treatment compliance of cetuximab-based regimens in first-line treatment of mCRC pts. Methods: ObservEr is a non-interventional, multicenter, prospective study. Primary endpoint is change in QoL during first-line treatment, with focus on the impact of dermatological toxicity. QoL (Dermatology Life Quality Index/DLQI and EORTC QLQ C30) is assessed at baseline and weekly for the first 8 weeks of treatment, then at every evaluation visit until PD or withdrawal. Secondary endpoints are efficacy, rate of liver metastasis resections, incidence of serious adverse events. Results: Between Apr 2011 and Nov 2012, 29 Italian centers enrolled 233 pts, with 226 evaluable pts. Pt characteristics: 152(67.3%) males, 74(32.7%) females; median age 65 (39-81) years; PS ECOG 0-1 95.5%; potentially resectable liver metastasis 59(27.1%); irinotecan regimens 129(57.1%), oxaliplatin regimens 60(26.5%), other regimens 37(16.4%). Median interval between request and result of KRAS test was 10 (6-15) days. Prophylactic skin treatment with vitamin K1 cream was used in 159(70.4%) pts, reactive treatment included vitamin K1 in 59(26.1%). Grade (gr) 1-2 skin toxicity was observed in 128(56.6%) pts, gr 3 in 28(12.4%); no gr 4 was detected. No significant difference in gr 3 skin toxicity was observed between males vs females (13.8 vs 9.5%; p=0.351), age <60 vs ≥60 years (18.1 vs 9.7%; p=0.077), irinotecan vs oxaliplatin regimens (12.4 vs 18.3%; p=0.278), prophylactic vs reactive treatment (15.1 vs 6.8%; p=0.339). Dose reduction, temporary and permanent discontinuation of cetuximab due to skin toxicity was required in 9(4.0%), 32(14.2%) and 7(3.1%) pts respectively; cetuximab compliance ≥70% of dose was reached in 208(92.0%) pts. Conclusions: These results suggest that appropriate skin toxicity management and prophylactic or reactive treatment with Vitamin K1 cream can improve the gr 3 skin toxicity control and the cetuximab compliance. QoL results will be shown at the 2013 ASCO Meeting. Clinical trial information: ID239.
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Affiliation(s)
- Carmine Pinto
- Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Gerardo Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - Ivan Lolli
- Medical Oncology Unit, IRCCS Saverio de Bellis, Castellana Grotte, Italy
| | - Enzo Ruggeri
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | | | - Daris Ferrari
- Medical Oncology Unit, San Paolo Hospital, Milan, Italy
| | - Salvatore Tumolo
- Medical Oncology Department, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Giovanni Rosti
- Medical Oncology Unit, St.Maria di Cà Foncello Hospital, Treviso, Italy
| | - Paolo Tralongo
- Medical Oncology Unit, G Di Maria Hospital, Avola, Italy
| | | | - Oscar Alabiso
- Medical Oncology Unit, Maggiore della Carità Hospital, Novara, Italy
| | - Silvana Chiara
- Medical Oncology Unit, National Cancer Institute, Genoa, Italy
| | | | | | | | - Carmelo Iacono
- Medical Oncology Unit, M.Paternò Hospital, Ragusa, Italy
| | - Vincenzo Adamo
- Unit of Medical Oncology, A.O. Papardo; Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Michele Valeri
- Medical Oncology Unit, General Hospital, Macerata, Italy
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50
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Pinto C, Rosati G, Lolli I, Ruggeri E, Ciuffreda L, Ferrari D, Di Fabio F, Chiara S, Tralongo P, Ianniello GP, Frassoldati A, Tumolo S, DI Costanzo F. Skin toxicity and treatment compliance of first-line cetuximab with irinotecan, oxaliplatin, and fluoropyrimidines-based chemotherapy in metastatic colorectal cancer (mCRC): The preliminary analysis of observer study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
530 Background: The ObservEr study evaluated the quality of life (QoL), skin toxicity control and treatment compliance of cetuximab plus first-line chemotherapy in a general cohort of patients with mCRC. Methods: ObservEr is a non interventional, observational, multicenter, prospective study. The primary end point is the evaluation of change in QoL during the period in which a first line treatment chemotherapy is given, with specific focus on the impact of the dermatological toxicity of this treatment. Data on QoL (Dermatology Life Quality Index/DLQI and EORTC QLQ C30) is assessed at baseline weekly for the first 8 weeks of treatment. Results: Between April 2011 and September 2012, the expected 210 patients (pts) were enrolled in 31 Italian centers. This preliminary analysis includes 112 pts enrolled to until April 2012. Pt characteristics were: 77(68.7%) males, 35(31.3%) females; median age 70 years (44-80 years); PS ECOG-0 86(76.8%), ECOG-1 36(23.2%); potentially resectable liver metastasis 32(28.6%); chemotherapy regimen FOLFIRI 55(49.1%), XELIRI 13(11.6%), FOLFOX 22(19.6%), XELOX 10(8.9%), irinotecan 4(3.6%), 5FU/AF (de Gramont) 2(1.8%), others 6(5.4%). The interval time between request and result of KRAS test was 10 days (7-16 days). Prophylactic skin toxicity with vitamin K1 cream was performed in 79(70.5%) pts, and reactive skin toxicity treatment included vitamin K1 cream in 32(28.6%). Grade 1-3 skin toxicity was observed in 87(77.7%) pts, and grade 3 in 10(8.9%). No significant difference in grade 3 skin toxicity was detected between males vs females (10.4 vs 5.7%; p=0.722), age <60 vs ≥60 years (9.7 vs 8.6%; p=1.000), and prophylactic vs reactive treatment (7.6 vs 12.5%; p=0.470). Cetuximab temporary and permanent discontinuation relation to skin toxicity was observed in 15(13.4%) and 2(1.8%) pts, respectively. Conclusions: This results suggest that the introduction of K1 cream in the prophylactic or reactive treatment reduce the incidence of grade 3 skin toxicity with improvement of cetuximab compliance. The results of QoL will be available for the 2013 ASCO GI Meeting. Clinical trial information: ID239.
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Affiliation(s)
- Carmine Pinto
- Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gerardo Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - Ivan Lolli
- Medical Oncology Unit, IRCCS Saverio de Bellis, Castellana Grotte, Italy
| | - Enzo Ruggeri
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | | | - Daris Ferrari
- Medical Oncology Unit, San Paolo Hospital, Milan, Italy
| | | | - Silvana Chiara
- Medial Oncology Unit, National Cancer Institute, Genoa, Italy
| | - Paolo Tralongo
- Medical Oncology Unit, G Di Maria Hospital, Avola, Italy
| | | | | | - Salvatore Tumolo
- Medical Oncolgy Unit, S. Maria Degli Angeli General Hospital, Pordenone, Italy
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