Symptom clusters in cancer patients: An Italian survey to validate and describe unwarranted clinical variation, inequality in access to healthcare, knowledge, and risk of malpractice.

BACKGROUND AND AIMS: The perceptions of professionals involved in cancer care regarding the importance of their symptoms-specific knowledge, unwarranted clinical variation (UCV), and inequalities in access to healthcare are still underdescribed. This study aims to confirm the construct validity of a previously initially developed questionnaire and describe nurses' perceptions about the relevance of their knowledge referred to cancer symptoms management, the UCV, the inequalities in access to healthcare, and malpractice risk. METHOD: A cross-sectional pan-national study was conducted using a convenience sample, collecting data through a previously initially validated questionnaire. Construct validity was corroborated through confirmatory factor analysis, and descriptive statistics were employed for summarizing the questionnaire's scores. The scores between the nurses working in accredited cancer centers and nurses employed in general hospitals were inferentially compared. RESULTS: The sample comprised 810 nurses, 480 were nurses working in accredited cancer centers, and 330 were nurses working in general hospitals. The questionnaire showed adequate construct validity and reliability. Nurses perceived the cluster of psychosocial symptoms with a greater risk of UCV and inequalities in access to cancer services than the cluster of physical symptoms. DISCUSSION AND CONCLUSIONS: A paradigm shift aimed at integrating psychosocial cancer symptoms in the care paths emerged as pivotal for improving Italy's cancer care.

Symptom-Level Description of Nursing Perceptions About Unwarranted Clinical Variation, Inequality in Access to Cancer Services, Specific-Symptom Knowledge: An Italian Web-Based Survey.

OBJECTIVES: This study aimed to describe the cancer nurses' views regarding the relevance of cancer symptom-specific knowledge, unwarranted clinical variation, and inequities in access to cancer services. Describing how nurses perceive these aspects could help identify research priorities and a practical framework to prioritize clinical practice guidelines. DATA SOURCES: A web-based survey was performed using a convenience sample of 810 nurses employed in cancer settings and cross-sectional data collection. The survey adopted a previously validated questionnaire investigating 14 symptoms. CONCLUSION: This study revealed which cancer symptoms require priority attention to define evidence-grounded guidance for decreasing unwarranted clinical variation and inequities in access to cancer services. Future multiprofessional and multinational studies are recommended to provide an in-depth description of the investigated phenomena. IMPLICATIONS FOR NURSING PRACTICE: Participants reported higher mean scores in pain-specific knowledge than other symptoms. Social functioning alterations and psychological disorders seem to be highly susceptible to unwarranted clinical variation and inequities in access to cancer services. This information could drive tailored interventions to improve nursing practice.

Safe use of Peripherally Inserted Central Catheters for chemotherapy of solid malignancies in adult patients: A 1-year monocentric, prospectively-assessed, unselected cohort of 482 patients.

INTRODUCTION: Aim of this study was to analyze the overall complication and failure rates of Peripherally Inserted Central Catheters (PICCs), in a 1-year consecutive unselected cohort of 482 adult patients, affected by non-hematological malignancies undergoing chemotherapy. METHODS: Adult outpatients (aged 18-75 years), with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, bearing solid tumors and candidates for intravenous chemotherapy were eligible for the study. Exclusion criteria were active infections, coagulopathy (defined as platelet count <50,000/µL and/or prothrombin time more than 18 s), life expectancy <6 months, or inability to give written informed consent. Devices were all implanted in an outpatients' hospital facility, following predefined evidence-based institutional guidelines and protocols by a PICC-dedicated team at the European Institute of Oncology in Milan, Italy, during the 12-month period from January 1 to December 31, 2019. RESULTS: Five-hundred PICCs were implanted in a cohort of 482 patients during the time interval of this study. Thirty devices were overall removed (6.2%), 23 as a consequence of a complication occurred, and seven inadvertently. The inserted PICCs accounted for a total of 49,718 catheter days in situ, median duration was 85.5 days [interquartile range (IQR): 56-146]. Overall there were 42 (8.7%) complications, corresponding to 0.84 catheter-adverse events (CAE)/1000 PICC-days (95% CI: 0.61-1.14). There were N = 13 (2.7%) thromboses, N = 11 (2.3%) irreversible occlusions, N = 7 (1.5%) accidental removals, N = 5 (1.0%) infections [two Catheter Related Blood Stream Infection (CRBSI) and three exit site/local infection], N = 3 (0.6%) ruptures and N = 3 (0.6%) primary or secondary malpositions. CONCLUSION: This large prospective study supports the increasing use of PICCs in adult oncology outpatients treated in specialized centers with chemotherapy for non-hematological malignancies. In this clinical setting, PICC failure occurred in 6% only of the inserted devices.

Living with cancer in the COVID-19 pandemic: An Italian survey on self-isolation at home.

OBJECTIVE: To investigate the perception of self-isolation at home in patients with cancer during the lockdown period resulting from the COVID-19 outbreak in Italy. METHODS: A cross-sectional descriptive study was conducted through an online survey of patients with cancer who were sheltering at home from 29th March to 3rd May 2020. Perception of self-isolation was assessed using the ISOLA scale, after evaluation of its psychometric properties. Content analysis was used to analyse two open-ended questions. RESULTS: The participants were 195 adult patients with cancer (female = 76%; mean age = 50.3 ± 11.2; haematological malignancy = 51.3%). They reported moderate isolation-related suffering (M = 2.64 ± 0.81), problems in their relationships with others (M = 3.31 ± 1.13) and difficulties in their relationships with themselves (M = 3.14 ± 1.06). Patients who experienced significantly more social problems were older, had less education and were living without minor children. Overall, four main categories emerged from the qualitative content analysis: (1) lack of freedom and social life, (2) uncertainty and worries, (3) feeling supported and (4) dealing with isolation. CONCLUSION: Living with cancer in the COVID-19 pandemic was often perceived as an isolating experience, primarily in terms of detachment from loved ones.

Midline catheter as effective device in healthy allogeneic donors and patients without an adequate peripheral venous access for HPC collection by apheresis: Preliminary experience at IEO.

Collection of HPC by apheresis requires adequate venous access for inflow and for outflow. The use of midline has never been reported in this setting. We prospectively analyzed the use of midline for performing apheresis on 3 healthy donors and 3 adults patients requiring autologous transplantation. A total of 8 polyurethane midlines, with an external diameter of 5 French, was inserted (2 midlines in both arms in 2 healthy donors) by our PICC team the day before apheresis and removed at the end of target collection. Mean flow rate was 35 ml/min. Target cellular dose was reached in all patients / donors with a maximum of 2 procedures without any complications. Midline is effective and safe for HPC collection either in donors or patients avoiding the placement of a central venous catheter.

[A bottom-up approach to prioritize the scientific activities of Italian Association of Cancer Nurses (AIIAO): questionnaire validation and pilot study.] / Definire le priorità tra le attività scientifiche dell'Associazione Italiana degli Infermieri di Area Oncologica (AIIAO): validazione di un questionario e studio pilota.

INTRODUCTION: There are no national data aimed to describe nurses' perception of variability in delivering nursing activities in relation to best practice and inequality in receiving nursing care. Moreover, there are no validated tools to be used in research. Therefore, the aims of this study are: a) to develop and validate a questionnaire to describe nurses' perceptions of variability and inequality in the oncology setting; b) to test content and face validity; c) to provide preliminary data (pilot study) to plan strategies for future national studies. MATERIAL AND METHODS: This is a multi-phase and multi-method study. Phase 1 is focused on questionnaire's development (i.e., literature review and consensus discussion); phase 2 is aimed to determine content and face validity of the questionnaire; and phase 3 was a pilot data collection through an on-line survey. RESULTS: The questionnaire that was developed yielded an adequate content and face validity (S-CVI=0.89 and CVR >0.60 for all items). The pilot study (75 nurses) found that nurse participants perceived as the most relevant categories pain and gastrointestinal and oral cavity dysfunctions. Fatigue, impairments of social function and psychological disorders were the areas in which greater variability and inequalities in receiving nursing care emerged. Overall, more than 50% of nurses reported variability and inequalities in oncology symptom management (in the investigated categories). CONCLUSIONS: The study results support the content validity of the questionnaire that can thereby be used for pan-national investigations.

Directed laparoscopic cryomyolysis for symptomatic leiomyomata: one-year follow up.

STUDY OBJECTIVE: To evaluate the long-term effectiveness of laparoscopic cryomyolysis as a minimally invasive technique for the treatment of symptomatic uterine myomas in menstruating women. DESIGN: Open, one-arm pilot study (Canadian Task Force classification II). SETTING: University-affiliated public hospital. PATIENTS: Twenty patients with symptomatic uterine myomas were treated with directed cryomyolysis. All had reported abnormal bleeding and/or pelvic pain/pressure and/or urinary frequency. Myoma diameters varied from 4 to 10 cm. INTERVENTION: One-year follow-up after laparoscopic-directed cryomyolysis. MEASUREMENTS AND MAIN RESULTS: Laparoscopic cryomyolysis was performed using the Her Option Cryoablation Unit (American Medical Systems, Minneapolis, MN). Patients were evaluated 1, 3, 6, 9, and 12 months after surgery. Power color Doppler ultrasound was performed preoperatively and postoperatively to demonstrate the effectiveness of the technique in reducing or eliminating the primary blood supply to the myomas, as well documenting regression of the myomas. All patients reported a high rate of satisfaction with the treatment including absence of symptoms 12 months after surgery, with no bleeding and no myoma-related symptoms, comparable with patients who underwent hysterectomy. Mean shrinkage of myoma volume increased until 9 months after surgery (59.5% +/- 13.2%), reaching a steady mean-volume reduction of approximately 60% (61.9% +/- 11.9%) 12 months after surgery. CONCLUSIONS: Directed laparoscopic cryomyolysis appears to be an effective and safe technique for providing rapid symptom relief and at least 12 months' effectiveness in the treatment of symptomatic uterine leiomyomas.

Directed laparoscopic cryomyolysis: a possible alternative to myomectomy and/or hysterectomy for symptomatic leiomyomas.

OBJECTIVE: The purpose of this study was to develop a minimally invasive, safe, and effective technique for managing symptomatic uterine myomas. STUDY DESIGN: Twenty patients with symptomatic uterine fibroids were treated. All had complaints of abnormal bleeding and/or pelvic pain/pressure and/or urinary frequency. Myoma diameters were 4 to 8 cm. Power color Doppler imaging was performed preoperatively and postoperatively to determine the effectiveness of cryomyolysis in reducing or eliminating the primary blood supply, as well as regression of the myomas. Laparoscopic cryomyolysis was performed with use of the Her Option Cryoablation System (American Medical Systems Gynecology, San Diego, Calif). Patients were evaluated at 1, 3, and 6 months postoperatively. RESULTS: All patients were discharged within 24 hours of treatment. No intraoperative or postoperative complications occurred. Of the 20 patients treated, 19 had complete resolution of their complaints. Myomas regressed up to 80%, and major blood supply to the myomas was eliminated. CONCLUSION: Directed laparoscopic cryomyolysis is an effective and safe technique for symptom relief from leiomyomas.