ABSTRACT
Background: Nutritional and lifestyle factors are thought to be associated with a higher risk for cancer and recurrence of disease. The literature confirms an important inverse association between adherence to a Mediterranean Diet (MedD) and cancer mortality (1,2). A recent survey reveales that improving physical activity advices in cancer care, in particular if given in a timely manner after diagnosis leads more patients (pts) to make exercise or start a rehabilitation with a specialist when indicated (3). The aim in this study was to analyze adherence to nutritional recommendation and physical activity in Covid-19 era. A secondary aim was to investigate the association between disease progression and specific aspects of diet and lifestyle. Methods: Personnel of LILT administered all questionnaires. All participants answered questions related to the adherence to MedD (MEDI-LITE questionnaire) at baseline (T0) and after 6 months (T1). Adherence scores to MedD were classified as “very low” (score 0-5), “low” (score 6-9), “moderate” (score 10-15), and “high” (score 16-18). IPAQ (questionnaire for monitoring physical activity) was administered (score Met<700: “low”, Met 700- 2519: “moderate”, Met>2520: “high” physical activity). Medical history and BMI were collected too. Results: Seventy-nine pts (20 males/59 females) were recruited from March 2020 to February 2021. Cancer diagnoses were: breast (36), colon (14), gastric (12), gynaecological (4), lung (2) and other cancer (9). Sixty-two pts completed at baseline MEDI-LITE questionnaire and 77 the IPAQ questionnaire. All patients had a personalized dietary program, but for limitation due to pandemic Covid- 19 era, only 29 pts had access to the control assessment. At T0 MEDI-LITE: 46 pts reports a score moderate, 13 pts score low and 3 pts has an score high. At T0 IPAQ questionnaire: 43 pts report score moderate physical activity, 29 pts score low, and 5 pts report score high. At T0 BMI: 27 pts results overweight, 22 pts are obese, 2 pts are underweight. At T1: 25 pts reported adequate nutrition. The correlations with the socio-anagraphic variables are in progress. Conclusions: The results suggest that adherence to the recommendations on body weight and MedD were relatively high in Covid-19 era and dietary habits of the pts followed by the specialist have improved. Physical activity was poor/moderate for lockdown, so it is very important to promote physical activity in oncology departments.
ABSTRACT
Background: In 2020, in Italy, an estimated 54,976 new diagnoses of breast cancer were made. The State-Regions Agreement has issued the “Guidelines on the organizational and welfare methods of the network on breast unit”, for diagnostic-therapeutic paths in senology. Methods: In the 2018 the Molise Region established a Breast Unit (B.U.);the personalized approach, especially in breast cancer, is more effective by integrating the progress of breast surgery, with staging methods such as MRI, treatment methods, such as neoadjuvant therapy (NACT), able to improve survival and quality of life especially in positive HER2 tumors and typically more aggressive “triple negative” diseases. Every week, in the COVID era on an online platform, the GOM meets to discuss cases;preoperative cases are discussed for which the methods of diagnosis and staging are proposed and the therapeutic hypothesis is discussed. All patients eligible for conservative treatments are stadiated with imaging techniques, in particular MRI, the most accurate tool for the basic evaluation of disease extent, and a biopsy for the evaluation of biological variables. Patological complete response (pCR), defined as the absence of invasive disease in the breast and lymphnodes, should be use to measure response to guide decision making. Results: There were 125 patients diagnosed in 2019, in 2020 there were 157, in 2021 there were 50 (until 18 May). In the year 2019, the B.U. gradually structured. In 2020 the median age was 52 a. (32-72 BC). Of the 157 patients evaluated, 8 or 5.1%, performed neoadjuvant chemotherapy (7 T2 cases, 1 T1c case;5 G3 cases, 3 G2 cases;7 cases with positive RE of which 1 HER-2 score 3+, 1 triple negative). All have undergone quadrantectomy. In 2021 the median age of the 50 patients was 64.5 a. (35-81 BC) and 14 cases, or 28%, performed neoadjuvant chemotherapy (9 T2 cases, 5 T4 cases;13 G3 cases, 1 Case G2;6 HER-2 score 3+ cases;3 triple negative cases and 11 cases with positive RE (all patients are still being treated). Conclusions: In Italy NACT is proposeed to about 20% of women with breast cancer, the European average is about 30% with peaks of 50-60% in Germany and the United Kingdom. The activity data of the B.U. Molise and the systemic treatment with NACT indicate an approach in line with Italian data and with the tendency to improve them since closer to European standards denoting a more modern method and perhaps a real cultural change.
ABSTRACT
Background: On 11 February 2020, the WHO declared the existence of a new viral disease, causing a severe acute respiratory syndrome-Coronavirus-2 (SARS-Cov-2). In Molise, two of the first cases reported were the S. Timoteo hospital of Termoli. On March 5, the hospital closes both routine and emergency/emergency activities until March. At the reopening, a two-tier triage started and from March to May 2020 we collected data to understand the needs of the population for access to the hospital during the pandemic. Methods: Two triage tents were set up at the entrance for the wards and for access to the emergency room. Oncologists performed an internal triage for their patients. Those who had been in high-risk regions were admitted only after quarantine or a swab. Other measures: pre-triage phone, access to accompanying persons and visitors was prohibited, non-urgent follow-up visits were cancelled and made by phone. Each case was discussed jointly and assessed the risk/benefit ratio for the continuation of treatments. In suspected cases a PCR test was performed on a nasopharyngeal sample and, if positive, the patient was sent to the infectious disease department. Results: Dedicated and adequately trained staff, collected access data from 18 March to 31 May 2020. Triage controls were 7856 (F 54%, M 46%): access to the E.R. were 3125 (267 family carers, 150 white codes, 2143 green, 532 yellow, 33 red), among the PTS arrived in PS 139 were suspected of infection and kept in the dedicated area, waiting for their test;of these 6 were positive (1 sent home in quarantine, 5 symptomatic were transferred to the reference centre). Other 3982 accesses have been evaluated to the external triage and 749 to the oncology triage equal to 15,83% of the total accesses entered in hospital (not in PS) to carry out ev therapies, visits and/or not deferable radiological examinations. Of the pts oncology 52.85% was F, 47.15% M with an average age of 66.51 and a median of 67 years (range 35-97). Conclusions: No pts evaluated at the external triage and in oncology were suspected of COVID infection and, at the moment, no oncological PTS was found positive. The triage procedures put in place can be a first screening for the identification of a potential population at risk.
ABSTRACT
Background: The following study aimed to improve the quality of life of cancer patients undergoing cancer treatment or cancer follow-up through the integration of a psychosocial rehabilitation pathway, and students of high school of Larino (CB) and Ascoli Piceno (AP) involved for the project's didactic part on the relationship between nutrition, physical activity and tumours, and encourage volunteering initiatives. Patients and Methods: The study involved 225 pts with cancer disease of the Termoli and San Benedetto oncological D.H., 115 and 110 pts, respectively. Pts were included in this longitudinal observational study on a voluntary basis, upon signing an informed consent. A 'Newlife' IT database was created for collecting data through a dedicated oncology desk. Psychological and nutritional assistance was offered to the involved patients. Psychological assessment of the pts was performed through Psychological Distress Inventory (PDI), Need Evaluation Questionary (NEQ) questionnaires, clinical interviews. Nutritional assessment was performed through Mini Nutritional Assessment (MNA) screening questionnaire and subsequent evaluations. Parameters such as body mass index (BMI), phase angle (PA) and bioelectrical impedance analysis (BIA) were recorded. A satisfaction questionnaire was administered to all 225 pts. Results: All the pts (147 women, 78 men, average age: 63, range 31-89) were involved from November 2018 to December 2019. The most frequently reported pathologies affected breast (75 pts) and colorectal cancer (41 pts). At the time of recruiting, 123 pts were in active treatment for metastatic disease, 50 pts in adjuvant cancer treatment, and 52 pts in follow up. Among all the pts involved, 193 pts completed a PDI and NEQ questionnaires. Among the pts completing the PDI, 57 pts reported severe distress (>35). The most urgent needs the NEQ detected concerned communication and information on the disease status. A very low BMI (<21) was reported in pts with head-neck, gastric, pancreatic and oesophageal cancer. Experiential and laboratory activities were realised for pts and their families and creative activities were also carried out at schools. Conclusions: The study has allowed to identify the needs of pts and to activate the psychological and nutritional service in the target hospitals. All the pts involved appreciated the service. Currently follow-ups are done using smart-working or by phone and mail for the COVID-19 emergency.