De Tursi M.,University of Chieti Pescara |
Carella C.,University of Chieti Pescara |
Tomao S.,University of Rome La Sapienza |
Cinieri S.,Hospital of Brindisi |
And 24 more authors.
Tumori | Year: 2014
Purpose. Guideline consistency in the prevention of chemotherapy-induced nausea and vomiting (CINV) remains low (29% in the Pan European Emesis Registry study) and very low (11%) in regimens with a high emetogenic risk. The aim of this study was to evaluate the guideline consistency of CINV prophylaxis for acute emesis in daily clinical practice in Italy. Methods. This was a prospective, observational, multicenter study. Patients scheduled to receive antitumor treatment on a single prespecified day were included. Data on patient characteristics (demographic and clinical), type of anticancer therapy, and type of antiemetic therapy prescribed for acute emesis were collected on electronic data capture forms. Chemotherapy regimens and antiemetic prophylaxis were categorized according to the MASCC 2011 guidelines. The study was approved by the local ethics committees. Results. From July 2013 to February 2014, a total of 502 patients were enrolled at 26 study sites. Median age was 62 years (range 27-87 years). Colorectal cancer and breast cancer were the most common malignancies. The emetogenic potential of the chemotherapy regimens used was high (HEC) (23.7%), moderate (MEC) (40.6%), low (31.3%) or minimal (4.4%). Overall, guideline consistency was 19.3%. Consistency reached 45% when the various 5HT3 receptor antagonists were considered equivalent and interchangeable in MEC regimens. Adherence to guidelines was lowest for MEC and MINIMAL risk groups. Ten percent of patients in HEC and MEC regimens did not receive any 5HT3 receptor antagonists. NK1 receptor antagonists were used in 8% of all regimens. Conclusions. Our study indicates that antiemetic guideline inconsistency remains an issue in daily clinical oncology practice in Italy.
PubMed | University of Padua, Santa Maria Annunziata Hospital, Italian National Cancer Institute, University of Turin and 5 more.
Type: Journal Article | Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology | Year: 2016
Cutaneous metastases represent a therapeutic challenge. An increasing body of experience suggests that electrochemotherapy (ECT) provides effective tumor control, although its evidence basis should be strengthened.This prospective, multicenter, observational study enrolled patients with superficial metastases, who underwent ECT at 10 centers between 2008 and 2013. Outcomes included adherence to European Standard Operating Procedures of ECT (ESOPE), tumor response, local progression-free survival (LPFS), toxicity and patient-reported outcomes (PROs, EORTC QLQ-C30 plus an 8-item questionnaire).We enrolled 376 eligible patients. Tumor histotype distribution was as follows: melanoma, 56%; squamous cell carcinoma, 11%; Kaposi sarcoma, 11%; breast carcinoma, 8%; basal cell carcinoma, 6%; soft tissue sarcomas, 3%; others, 5%. We registered 1304 target tumors (median size 1cm). Treatment adhered to ESOPE in 88% of patients as to the route of drug administration, and in 70% as to electrode application. The procedure was mainly performed under sedation (64.6%) and by using intravenous chemotherapy (93.4%). Tumor response rate at 60 days was 88% (complete, 50%). Small tumor size predicted complete response achievement (OR 2.24, p=0.003), higher LPFS (HR 0.68, p=0.004) and improved PROs (Global Health Status, p<0.001; wound bleeding, p<0.001; healing, p=0.002; and aesthetics, p<0.001). Skin toxicity (grade 3, 7.8%) was lower in patients with tumors <2cm (p0.001). One-year LPFS was 73.7% (95%CI 68.4-78.3).ECT represents a valuable skin-directed therapy across a range of malignancies. The most frequently applied treatment modality is intravenous chemotherapy under sedation. Small tumor size predicts durable tumor control, fewer side-effects and better PROs.
Pedrazzoli P.,IRCCS Policlinico San Matteo Foundation |
Baldanti F.,Molecular Virology Unit |
Donatelli I.,Instituto Superiore Of Sanita |
Castrucci M.R.,Instituto Superiore Of Sanita |
And 3 more authors.
Annals of Oncology | Year: 2014
Background: Influenza virus causes annual epidemics in the winter-spring season with significant morbidity in the general population and important mortality in high-risk groups, including cancer patients. Opinions on the suitability of patients with malignancies not undergoing active treatment and in different phases of antineoplastic therapy, to receive influenza vaccination, vary considerably among oncologists, sometimes even within one center. Methods: We reviewed available data, including recommendations by national health authorities, on impact of influenza in patients with cancer and their capacity to mount protective immunological responses to vaccination, thus allowing, on behalf of Italian Association of Medical Oncology, to make suitable recommendations for the prevention and treatment of seasonal influenza. Results and discussion: Patients with cancer often have disease- or treatment-related immunosuppression, and as a consequence, they may have a suboptimal serologic response to influenza vaccination. The protective effect of the different preparations of influenza vaccines in patients with cancer has not been widely investigated, especially in adult patients harboring solid tumors. The optimal timing for administration of influenza vaccines in patients receiving chemotherapy is also not clearly defined. However, since vaccination is the most effective method, along with antiviral drugs in selected patients, for preventing influenza infection, it has to be recommended for cancer patients. Implementing vaccination of close contacts of oncology patients would be an additional tool for enhancing protection in fragile patient populations. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Conio M.,General Hospital |
De Ceglie A.,Giovanni Paolo II Cancer Institute |
Blanchi S.,General Hospital |
Fisher D.A.,Durham Veterans Affairs Medical Center
Techniques in Gastrointestinal Endoscopy | Year: 2010
Self-expandable metal stents (SEMS) have become the most used endoprostheses for palliation of dysphagia in obstructive malignancies of the esophagus or esophagogastric junction. They allow immediate relief from dysphagia and resumption of an almost normal diet within a short period. However, SEMS are associated with early and late complications and procedure-related death has been reported. This article reviews currently available SEMS, considerations for choosing SEMS type, indications for SEMS, techniques for SEMS placement, efficacy data, and complications. © 2010 Elsevier Inc.