Trends in Net Survival from Vulvar Squamous Cell Carcinoma in Italy (1990–2015)

(1) Objective: In many Western countries, survival from vulvar squamous cell carcinoma (VSCC) has been stagnating for decades or has increased insufficiently from a clinical perspective. In Italy, previous studies on cancer survival have not taken vulvar cancer into consideration or have pooled patients with vulvar and vaginal cancer. To bridge this knowledge gap, we report the trend in survival from vulvar cancer between 1990 and 2015. (2) Methods: Thirty-eight local cancer registries covering 49% of the national female population contributed the records of 6274 patients. Study endpoints included 1- and 2-year net survival (NS) calculated using the Pohar-Perme estimator and 5-year NS conditional on having survived two years (5|2-year CNS). The significance of survival trends was assessed with the Wald test on the coefficient of the period of diagnosis, entered as a continuous regressor in a Poisson regression model. (3) Results: The median patient age was stable at 76 years. One-year NS decreased from 83.9% in 1990–2001 to 81.9% in 2009–2015 and 2-year NS from 72.2% to 70.5%. Five|2-year CNS increased from 85.7% to 86.7%. These trends were not significant. In the age stratum 70–79 years, a weakly significant decrease in 2-year NS from 71.4% to 65.7% occurred. Multivariate analysis adjusting for age group at diagnosis and geographic area showed an excess risk of death at 5|2-years, of borderline significance, in 2003–2015 versus 1990–2002. (4) Conclusions: One- and 2-year NS and 5|2-year CNS showed no improvements. Current strategies for VSCC control need to be revised both in Italy and at the global level.

Treatment patterns among patients with malignant pleural mesothelioma: An Italian, population-based nationwide study

Background

Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. Centralization of rare cancer in dedicated centers is recommended to ensure expertise, multidisciplinarity and access to innovation. In Italy, expert centers for MPM have not been identified in all regions. We aimed to describe the treatment patterns among MPM patients across different Italian regions and to identify factors associated with the treatment patterns across the regions.

Methods

We performed an observational study on a random sample of 2026 MPM patients diagnosed in 2003–2008. We included 26 population‐based registries covering 70% of the Italian population. To identify factors associated with treatment patterns, across the different regions, we fitted a multinomial logistic regression model adjusted by age, sex, stage, histology and hospital with thoracic surgical department.

Results

MPM patients mostly received chemotherapy alone (41%) or no cancer‐directed therapy (36%) especially the older patients. The first course of treatment for MPM patients differed across regions. Patients from Piedmont, Liguria and Campania were more likely to receive no cancer‐directed therapy; those living in Tuscany and Sicily were more likely to get surgery; patients from Marche and Lazio were more likely to receive chemotherapy. These differences were not explained by age, sex, stage, histology and availability of a thoracic surgery department.

Conclusions

There is limited expertise available and lack of a network able to maximize the expertise available may contribute to explaining the results of our study. Our findings support the need to ensure the appropriate care of all MPM patients in reorganizing the health care services.

Key points

Incidence trends of vulvar squamous cell carcinoma in Italy from 1990 to 2015

OBJECTIVE

The incidence of vulvar squamous cell carcinoma has increased for decades in most Western countries - a trend virtually restricted to women aged <50 or 60 years. In southern Europe, conversely, the trends have been insufficiently studied. This article reports a study from Italy.

METHOD

Thirty-eight local cancer registries, currently covering 15,274,070 women, equivalent to 49.2% of the Italian national female population, participated. Invasive cancers registered between 1990 and 2015 with an International Classification of Diseases for Oncology, 3rd revision, topography code C51 and morphology codes compatible with vulvar squamous cell carcinoma (n = 6294) were eligible. Incidence trends were analysed using joinpoint regression models, with calculation of the estimated annual percent change (EAPC), and age-period-cohort models.

RESULTS

Total incidence showed a regular and significant decreasing trend (EAPC, -0.96; 95% confidence interval (CI), -1.43 to -0.48). This was entirely accounted for by women aged ≥60 years (EAPC, -1.34; 95% CI, -1.86 to -0.81). For younger women, the EAPC between 1990 and 2012 was 1.20 (95% CI, 0.34 to 2.06) with a non-significant acceleration thereafter. This pattern did not vary substantially in a sensitivity analysis for the effect of geographic area and duration of the registry. The age-period-cohort analysis revealed a risk decrease in cohorts born between 1905 and 1940 and a new increase in cohorts born since 1945.

CONCLUSIONS

The decreasing trend observed among older women and the resulting decrease in total rate are at variance with reports from most Western countries. Age-period-cohort analysis confirmed a decreasing trend for earliest birth cohorts and an opposite one for recent ones.

Knowledge and beliefs on vaccines among a sample of Italian pregnant women: results from the NAVIDAD study

Background

Vaccine hesitancy is an emerging phenomenon in European countries and leads to decreasing trends in infant vaccine coverage. The aim of this study was to analyze the level of confidence and correct awareness about immunizations, which are crucial for the success of vaccination programmes.

Methods

As part of the NAVIDAD multicentre study, we examined vaccination confidence and complacency among a sample of 1820 pregnant women from 14 Italian cities. The questionnaire assessed the interviewee's knowledge, beliefs and misconceptions, as well as their socioeconomic status, information sources about vaccines and confidence in the Italian National Healthcare Service.

Results

Only 9% of women completely believed to the efficacy, necessity and safety of vaccinations. Almost 20% of them had misconceptions on most of the themes. There was a significant difference in the level of knowledge considering educational level: women with a high educational level have less probability of obtaining a low knowledge score (odds ratio (OR) 0.43 [95% confidence interval (CI) 0.34–0.54]). The level of knowledge was also influenced by the sources of information: women who received information from their general practitioner (GP) and from institutional websites had a significantly lower chance of having misconceptions (OR 0.74 [95% CI 0.58–0.96]; OR 0.59 [95% CI 0.46–0.74]). Finally, the results underlined the influence of trust in healthcare professional information on the likelihood of having misconceptions (OR 0.49 [95% CI 0.27–0.89]).

Conclusions

The data suggest the efficacy of GPs and institutional websites as a source of information to contrast misconceptions and underline the importance of confidence in the healthcare system to increase complacency and confidence in vaccines.

Attitudes towards compulsory vaccination in Italy: Results from the NAVIDAD multicentre study

BACKGROUND

Vaccine hesitancy is a considerable issue in European countries and leads to low coverage rates. After a long debate, Italy has made vaccination mandatory for admission to its schools.

METHODS

In the NAVIDAD study (a cross-sectional multicentre study), a 63-item questionnaire was administered to 1820 pregnant women from 15 Italian cities. The questionnaire assessed the interviewee's opinion on mandatory vaccines, as well as their socioeconomic status, sources of information about vaccines, confidence in the Italian National Healthcare Service (NHS), and intention to vaccinate their newborn.

RESULTS

Information sources play a key role in determining the opinion on restoration of mandatory vaccines; in particular, women who obtained information from anti-vaccination movements are less likely to accept the vaccines (OR: 0.35, 95% CI: 0.21-0.58, p < 0.001). Women who had confidence in healthcare professional information agreed more on mandatory vaccination than did the other women (OR: 2.66, 95% CI: 1.62-4.36, p < 0.001); those who perceived that healthcare professionals have economic interest in child immunization and who declared that healthcare providers inform only on vaccinations benefits not on risks were less likely to agree on compulsory vaccination (OR: 0.66, CI 95%: 0.46-0.96, p = 0.03; OR: 0.66, CI 95%: 0.46-0.95, p = 0.03, respectively).

CONCLUSION

Information sources and confidence towards health professionals are the main determinants of acceptance of mandatory vaccine restoration. To increase the acceptability of the restoration and reduce vaccine hesitancy, these aspects need to be strengthened.

Changing the smoking habit: prevalence, knowledge and attitudes among Umbrian hospital healthcare professionals

BACKGROUND

Health care professionals should work against smoking habit to promote a correct life style. This study aimed to evaluate smoking prevalence and attitudes towards tobacco among Umbrian hospital professionals in a period between 2006 and 2015, since the approbation of the law that ban smoking in hospitals and all public areas in 2003.

METHODS

A cross-sectional study was carried out using a questionnaire administered in 2006, 2011 and 2015 to healthcare professionals. It consists of 53 multiple-choice questions. Potential predictors of current smoking habits were evaluated using univariate and multivariate logistic regression.

RESULTS

The sample included 475 healthcare professionals. Current smokers constituted 34.53% of the sample and no significant difference (p = 0.257) emerged in prevalence over time (33.74% in 2006; 36.02% in 2011 and 33.77% in 2015). The risk of being a smoker increased by not considering the smoking habit as the main cause of preventable deaths (OR = 2.25; 95% CI: 1.47- 3.45). The strongest risk factor, which was significant in both models (p < 0.01), was being against the "No Smoking" law (OR = 18.90; 95% CI: 2.43-147.71; adjusted OR = 22.10; 95% CI: 1.85-264.78).

CONCLUSIONS

The hospital staff has higher prevalence of smoking than the general population. The No Smoking law alone has been shown to be inadequate. Effective results can be achieved only by a common strategy and shared intervention programmes that are based on a workplace health promotion strategy. That for the moment has demonstrated to give interesting outcomes in modifying deep-rooted behaviour patterns.

Delphi consensus on the monitoring tools of main individual risk factors for chronic diseases by the company doctor

BACKGROUND

Data on individual risk factors for chronic diseases (smoking, physical activity, body mass) are collected by company physicians in heterogeneous ways. This makes comparisons, researches and evaluations difficult.

OBJECTIVES

The aim of the study was to find a consensus on evaluation tools for chronic diseases risk factors and for health promotion programs in workplaces that could be performed by company physicians during their clinical activity.

METHODS

A first set of tools, proposed by a working group of occupational physicians in Bergamo, was submitted through the Delphi technique to a national expert panel of 22 persons including recognized national experts in specific fields and occupational physicians skilled in health promotion.

RESULTS

In three Delphi rounds, the panel selected a set of tools to monitor the main individual risk factors for chronic diseases (smoking, alcohol, physical activity, nutrition, stress and mental health) as well as general data related to the worker and his job.

CONCLUSIONS

The use of these specific tools, collected in a homogeneous format, should be recommended to all Italian company physicians, in particular those who work in WHP-programs, in order to allow analysis, comparison and evaluation of health promotion programs effectiveness at a national level.

Human papillomavirus and gastrointestinal cancer: A review

Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. Exposure to HPV is very common, and an estimated 65%-100% of sexually active adults are exposed to HPV in their lifetime. The majority of HPV infections are asymptomatic, but there is a 10% chance that individuals will develop a persistent infection and have an increased risk of developing a carcinoma. The International Agency for Research on Cancer has found that the following cancer sites have a strong causal relationship with HPV: cervix uteri, penis, vulva, vagina, anus and oropharynx, including the base of the tongue and the tonsils. However, studies of the aetiological role of HPV in colorectal and esophageal malignancies have conflicting results. The aim of this review was to organize recent evidence and issues about the association between HPV infection and gastrointestinal tumours with a focus on esophageal, colorectal and anal cancers. The ultimate goal was to highlight possible implications for prognosis and prevention.

[Assessment of the impact over one year of a workplace health promotion programme in the province of Bergamo]

OBJECTIVES

To estimate short-term effects of integrated health promotion in the workplace within the framework of the Bergamo WHP (Workplace Health Promotion) network, which involves 94 companies and about 21,000 workers.

METHODS

A controlled non-randomized, before-after evaluation was carried out. Data were collected through anonymous questionnaires before (t0) and after participation in a 12-month health promotion programme (t1). The "control" group consisted of workers of companies participating in the programme who had not yet undertaken any interventions in the theme areas covered by the assessment.

RESULTS

In the workers participating in the programme, positive early effects (after 12 months) were related to intake of food providing protection (fruit and vegetables) and increased rates of smoking cessation. The effects were more evident in males and in white collars. The physical activity and alcohol consumption trends went in the desired direction and with more effects than in the non-participating group, but without statistical significance. In the short term, no evident changes in events of road injury risk or in the quality of personal relationships were seen, probably due to the small size of the sample involved in these study areas.

CONCLUSIONS

The results, although within the methodological limitations of the study, showed that after 12 months there was a reduction in some important risk factors for chronic diseases in workers participating in the programme, particularly for fruit and vegetable intake and smoking cessation. It will be important to monitor the effects of the programme on other risk factors in the medium and long term, and also the impact of employment status and gender so as to adjust the programme interventions accordingly. Cooperation with occupational/authorized physicians with use of their data collected from health surveillance, together with a limited set of general risk factor indicators, would be a desirable development for further studies.

Long-term survival, prevalence, and cure of cancer: a population-based estimation for 818 902 Italian patients and 26 cancer types

Original, population-based estimates of indicators of long-term survival and cure in cancer patients are provided. More than a quarter of cancer patients in Italy have reached death rates similar to those of the general population. Nearly three quarters of them will not die as a result of cancer. These estimates are potentially helpful to health-care planners, clinicians, and patients.

Background

Persons living after a cancer diagnosis represent 4% of the whole population in high-income countries. The aim of the study was to provide estimates of indicators of long-term survival and cure for 26 cancer types, presently lacking.

Patients and methods

Data on 818 902 Italian cancer patients diagnosed at age 15–74 years in 1985–2005 were included. Proportions of patients with the same death rates of the general population (cure fractions) and those of prevalent patients who were not at risk of dying as a result of cancer (cure prevalence) were calculated, using validated mixture cure models, by cancer type, sex, and age group. We also estimated complete prevalence, conditional relative survival (CRS), time to reach 5- and 10-year CRS >95%, and proportion of patients living longer than those thresholds.

Results

The cure fractions ranged from >90% for patients aged <45 years with thyroid and testis cancers to <10% for liver and pancreatic cancers of all ages. Five- or 10-year CRS >95% were both reached in <10 years by patients with cancers of the stomach, colon–rectum, pancreas, corpus and cervix uteri, brain, and Hodgkin lymphoma. For breast cancer patients, 5- and 10-year CRSs reached >95% after 19 and 25 years, respectively, and in 15 and 18 years for prostate cancer patients. Five-year CRS remained <95% for >25 years after cancer diagnosis in patients with liver and larynx cancers, non-Hodgkin lymphoma, myeloma, and leukaemia. Overall, the cure prevalence was 67% for men and 77% for women. Therefore, 21% of male and 31% of female patients had already reached 5-year CRS >95%, whereas 18% and 25% had reached 10-year CRS >95%.

Conclusions

A quarter of Italian cancer patients can be considered cured. This observation has a high potential impact on health planning, clinical practice, and patients' perspective.

The worksite as an asset for promoting health in Europe. Final results of the MoveEurope campaign

Non-communicable diseases are a leading cause of morbidity worldwide and are predicted to increase in the next years. In 2008, 36.1 million people died from conditions such as heart disease, strokes, chronic lung diseases, cancers and diabetes (1). According to the WHO, 63% of the deaths, 77% of the loss of Healthy Life Years and 75% of health expenses in Europe are caused by cardiovascular diseases, cancer, chronic respiratory illnesses and mental health problems. All of these diseases have in common is the presence of modifiable risk factors (such as tobacco smoke, low consumption of fruit and vegetables, excessive intake of fats). Acting on these factors would lead to a reduction in the incidence of the aforementioned diseases. According to several studies conducted in the USA, Canada and Europe, the workplace seems an ideal place for implementing successful preventive strategies for the improvement of lifestyles. In 2006, the European Network for Workplace Health Promotion launched the Move Europe campaign to promote a healthy lifestyle at work, with the financial support of the European Commission. This campaign set new quality standards in behaviour-related workplace health promotion (WHP) and identified and documented good practices. Another aim of the campaign was to promote the benefits of implementing WHP, particularly focusing on four fields of life-style related WHP: physical activity, smoking prevention, nutrition and mental health. In two years, 65,215 contacts have been recorded in dedicated websites, of which 9,761 in Italy. A total of 2,548 enterprises in Europe asked to be certified and 125 events (such as seminars, workshops, conferences)were held.

[A health promotion program aimed at employees and restaurant operators: results of the European FOOD project]

Public health is facing a major challenge: the fight against overweight and obesity. Many projects have been developed and implemented all over the world. FOOD is one of the most important European programs to promote a healthy lifestyle and a balanced diet in the workplace. The program aims to improve the nutritional quality of the food offered in restaurants and to facilitate consumer choice by educating and informing employers and their employees. Different channels, tools and countries have been involved in this program which took place over the course of two years and is ongoing due to the high value of the applied methodology.

[Evaluation of a distance training course on workplace health promotion]

Specialists qualified in workplace health promotion are very few. Results of a pilot distance training course which took place in 2008 show that the course was useful at the individual and organizational level and had a relatively low cost.

Tobacco use prevalence, knowledge and attitudes among Italian hospital healthcare professionals

BACKGROUND

Healthcare professionals play a key role in tobacco use prevention because they are considered as model by patients. This multicenter study was aimed to evaluate smoking prevalence, knowledge and attitudes towards tobacco among Italian hospital professionals.

METHODS

A cross-sectional study was carried out using a questionnaire administered to healthcare professionals in seven Italian hospitals, to investigate personal and occupational data, knowledge, attitudes, job setting, clinical activities, smoking habits and pattern for current smokers. Potential predictors of current smoking habits were evaluated using multiple logistic regressions.

RESULTS

Sample population was comprised of 1082 health professionals (51.4% females; mean age was 37.3 years: 25.3% were nurses, 24.5% medical doctors, 17.1% students and 33.1% other healthcare workers). Smoking prevalence was 44%. Among responders, 67.7% considered healthcare professional as a model for citizens, 90.5% declared to see colleagues smoking cigarettes inside the hospital (47.4% in the dependents' toilets, 33.4% in the department kitchens and 4.7% in the patient room). Multivariate analysis showed that healthcare professionals working in Naples had a higher risk to be smokers in comparison to Rome [odds ratio (OR) = 2.29; 95% confidence interval (CI) 1.40-3.73]. Compared to medical doctors, post-graduate students (OR = 3.42; 95% CI: 1.81-6.44), nurses (OR = 2.48; 95% CI 1.51-4.08), nursing students (OR = 1.91; 95% CI 1.08-3.38) and auxiliary personnel (OR = 2.72; 95% CI 1.51-4.88), showed a higher likelihood of smoking.

CONCLUSIONS

Among Italian hospital personnel there is a paradoxically large prevalence of smokers, higher than in the general population. Interventions aimed for the development of an adequate culture of health promotion, among these professionals, are urgently needed.

The evolution of workplace health promotion in Europe: the Italian case

In this paper the Authors describe the development of workplace health promotion in Europe and show how, despite the fact that they have developed independently of one other the professional disciplines of Occupational Safety and Health together with Public Health have provided a common platform from which has emerged this new philosophy--Workplace Health Promotion (WHP). Whilst the paper draws on the experience of countries throughout Europe, particular attention is paid to the developmental process in Italy.