Knowledge Translation in Oncology. A Case Study

Knowledge translation (KT) is the ability to make knowledge accessible to different stakeholders by translating it into various contexts. Translating knowledge is particularly crucial in the healthcare sector, which is currently under significant pressure due to technological innovation, increasing demand of services by an ageing population, budget reductions, and new organisational challenges posed by the latest events like the COVID-19 pandemic. While the first definition of KT was focused on the translation of scientific research into clinical practice, other types of KT later emerged. In healthcare, while stakeholders have different skills and competencies (such as clinical scientists versus physicians or other healthcare professionals), others experience diverse emotional feelings (like the patients or their families). An effective KT allows the transfer, sharing, and creation of new knowledge, enhancing innovation and co-production dynamics. The paper employs a case study by analysing the Breast Unit of the C.R.O. National Cancer Institue of Aviano, Italy, one of the most acknowledged hospitals and research centres in Europe in the field of cancer surgery and treatments. The paper aims at studying the knowledge translation dynamics and tools by analysing the various relationships with the internal as well as the external stakeholders of the Breast Unit. Internally, knowledge translation is needed to merge the competencies of highly skilled multidisciplinary teams, which include surgeons and physicians with various specialities, researchers, psychologists, nurses and other healthcare professionals. Externally, knowledge is translated to meet the needs of patients, patients' associations, sponsors, citizens, and policymakers. Results highlight how different techniques and dynamics allow KT to happen within internal as well as external groups. Contributing to the knowledge management and knowledge translation theories, our findings open up to practical as well as research implications

A year of pandemic for European particle radiotherapy:A survey on behalf of EPTN working group

OBJECTIVES: To provide an overview of the impact of the pandemic on the clinical activity and take a snapshot of the contingent challenges that European particle therapy centers are called to face, we surveyed the members of the European Particle Therapy Network (EPTN). MATERIAL AND METHODS: A 52-question survey was conducted from 4th April 2021 to 30th July 2021 using the Google Forms platform. Three dedicated sections analysed the clinical context of each participating institution, the staff management, and the clinical changes in the oncological workflow. RESULTS: Out of the 23 contacted European hubs of particle radiotherapy, a total of 9 (39%) responded to the survey. The number of in-person first evaluations and follow-up visits decreased, but telemedicine was implemented. Multidisciplinary tumour board discussions continued during the outbreak using web-based solutions. A delay in cancer diagnosis and oncological staging leading to an increment in more advanced diseases at first presentation was generally observed. Even if the total number of treatments (photons and particles) in the responding institutions showed a trend of decrease, there was or a stable situation or slight increase in particle treatments. The clinical treatment choices followed the national and international scientific recommendations and were patient/disease-oriented. Hypofractionation and short-schedule of chemotherapy, when applicable, were preferred. CONCLUSIONS: Our findings show a rapid and effective reaction of European particle RT hubs to manage the healthcare crisis. Considering the new waves and virus variants, the vaccination campaign will hopefully reduce the oncological impacts and consequences of the prolonged outbreak

PARP Inhibitors in Combination with Radiotherapy: To Do or Not to Do?

Background: Despite the large use of inhibitors of Poly-ADP ribose polymerase (PARP-I), the feasibility and safety of their combination with radiotherapy (RT) is unclear. Aim: We conducted a literature analysis with the aim to evaluate the efficacy and safety profile of a combination with RT and PARP-I. Method: The key issues for the current review were expressed in two questions according to the Population, Intervention, Control, Outcome (PICO) criteria: 1. What is the outcome and 2. What is the toxicity in patients treated with a combination of PARP-I and RT for a newly diagnosed or recurrent tumors? Results: A total of 12 clinical studies met the inclusion criteria including seven single-arm dose-escalation phase I studies, two phase II (two- and three-arms controlled trials) trials, one parallel-arm phase I study, and two phase I/II studies published between 2015 and 2021. RT was performed with photon beams and several schedules according to the clinical situation. The acute toxicity ≥ grade 3 ranged between 25% and >96%, which was divided into hematological or non-hematological adverse events. Conclusions: despite the heterogeneity of the evaluated patient populations and tumor types, and the limited number of the studies, this review suggests that a combination approach is feasible even though the efficacy profile remains unclear

Terapia adiuvante nel carcinoma endometriale in stadio iniziale ad alto rischio

Il tumore endometriale è il tumore ginecologico più comune nei paesi industrializzati. Lo stadio tumorale, l'età della paziente alla diagnosi, l'istotipo, il grado citologico, l'invasione miometriale, l'infiltrazione degli spazi vascolo-linfatici e lo stato linfonodale sono significative variabili prognostiche. La chirurgia standard prevede laparotomia, washing peritoneale, isterectomia extrafasciale totale e salpingo-ovariectomia bilaterale con o senza linfadenectomia, sebbene l'approccio mini-invasivo (laparoscopia o robot) rappresenta un approccio chirurgico sicuro in mani esperte. Il ruolo della terapia adiuvante è stato a lungo discusso. La radioterapia esterna pelvica riduce le recidive locoregionali senza aumentare la sopravvivenza globale e sembra offrire un beneficio in termini di outcome clinico solo nei tumori scarsamente differenziati G3 e con un'invasione profonda del miometrio.Gli studi recenti suggeriscono un possibile ruolo della chemioterapia adiuvante a base di platino associata alla radioterapia per i tumori ad altro rischio. Lo scopo di questo studio retrospettivo è stato analizzare le recidive e valutare il ruolo della terapia adiuvante nel carcinoma endometrioide dell’endometrio in stadio iniziale (Ib-II) ad alto rischio di ricaduta. Dall’analisi dei dati sembra emergere che le pazienti sottoposte a chemioterapia seguita da radioterapia abbiano un trend ad una migliore sopravvivenza libera da progressione (a 2 anni 93.7%) e globale a 2 anni (100%) rispetto a quelle che non hanno ricevuto alcun trattamento adiuvante (82% sia per PFS che per OS) e a quelle sottoposte a radioterapia con o senza brachiterapia (85,1% PFS, 94,10% OS). Tuttavia tale trend non è più evidenziabile al quinto anno. Va, tuttavia, fatto presente che il trattamento chemio-radioterapico è stato introdotto solo negli ultimi anni e che pertanto non abbiamo sufficienti dati di follow-up a lungo termine. Ne viene che studi su un numero maggiore di pazienti sono necessari per chiarire questo quesito

Coproduzione e traduzione della conoscenza. Il ruolo del design in oncologia

The knowledge translation stands as a topic of primary importance in the healthcare sector, characterized by the presence of several stakeholders with different skills, needs, and expectations. The transfer of knowledge can take place effectively only following a translation process, through the use of appropriate tools. Among these tools, the contribution of the design elements appears attractive, especially in the case of co-production processes, with significant patient engagement. The case study is about the ‘Oncology in Motion’ project, created by the Irccs Oncological reference center Institute of Aviano (Pordenone) to support and improve the physical and psychological recovery of breast operated patients. The information sources for data collection are manifold, including interviews, direct observations, and materials produced within the project. The use of design elements such as graphics, sketches, images, photographs has helped to support all the stakeholders involved in translating knowledge in all the phases of the co-production project: conception, execution, and external communication. The ‘Oncology in Motion’ experience demonstrates how design elements can constitute strong support for co-production processes in their phases, facilitating the interaction among the various people involved, especially when it comes to the active engagement of patients

Female leadership in the healthcare sector: Possible solutions and facilitators. A case study

Objective The paper aims to deepen the issues related to female leadership of healthcare organizations, identifying, in the international literature and through a case study, the relevant characteristics that impact gender equality. The article investigates the possible solutions and tools that can support and foster female leadership in healthcare to see how the role of women leaders can be strengthened. Methodology The article employs a case study methodology about the National Center for Oncological Hadrontherapy (CNAO Foundation) of Pavia, Italy. The CNAO Foundation is characterized by a predominantly female middle management (of the 130 employees, 66 are women, 30 of whom are mothers). Women lead the scientific, medical, technical-nursing direction. They also hold the responsibility of Communication and PR, Quality and Regulatory Affairs, Accounting and Finance, Clinical Administration, Human Resources, Supply Chain and General Services. Of the 12 current medical doctors, 10 are women, including the Medical Director, in contrast to the international average (for which only 25% of doctors in a hospital environment are women). Results The analysis conducted through the CAOS framework model allows determining some operational tools to facilitate women’s access to leadership positions in the healthcare sector. The paper reports the flexibility solutions adequately applied during the emergency period caused by the Covid-19 pandemic. The results make it possible to propose new tools to enhance women’s role in healthcare management in highly multidisciplinary areas with a high impact on innovation and technology. Theoretical implications The article contributes to the topic of gender diversity in healthcare companies, with particular reference to the barriers, advantages, and operational tools to facilitate female leadership. Operational implications The CNAO Foundation’s experience, adequately grounded on the current literature, makes it possible to identify some best practices of concrete applicability for healthcare companies, stimulating any comparative studies

Locally advanced pancreatic ductal adenocarcinoma: challenges and progress

Pancreatic ductal adenocarcinoma (PDAC) is one of the major causes of death in the Western world, and it is estimated to become the second leading cause of tumour-related mortality in the next 10 years. Among pancreatic cancers, ductal adenocarcinomas are by far the most common, characterised by a challenging diagnosis due to the lack of initial and pathognomonic clinical signs. In this scenario, non-metastatic locally advanced pancreatic cancer (LAPC) accounts for a large proportion of all new pancreatic ductal adenocarcinoma diagnoses. There is no consensus on a common definition of LAPC. Still, it usually includes tumours that are not resectable due to vascular involvement. As of today, treatment is limited, and the prognosis is very unfavourable. Curative-intent surgery remains the gold-standard even if often jeopardized by vascular involvement. Continuing progress in our understanding of LAPC genetics and immunology will permit the development of different treatments, targeted or combined, including radiation therapy, hadrontherapy, targeted immunotherapies or new chemotherapies. A multidisciplinary approach combining various fields of expertise is essential in aiming to limit disease progression as well as patient outcome. Using a narrative literature review approach, the manuscript explores the most up-to-date knowledge concerning locally advanced pancreatic ductal adenocarcinoma management

Population Health Strategies to Support Hospital and Intensive Care Unit Resiliency During the COVID-19 Pandemic: The Italian Experience

Italy was one of the countries most affected by the number of people infected and dead during the first COVID-19 wave. The authors describe the rapid rollout of a population health clinical and organizational response in preparedness and capabilities to support the first wave of the COVID-19 pandemic in the Italian province of Modena. The authors review the processes, the challenges faced, and describe how excess demand for hospital services was successfully mitigated and thus overwhelming the healthcare services avoided the collapse of the local health care system. An analysis of bed occupancy in the region predicted during the first weeks of the epidemic. The SEIR model estimated the number of infected people under different containment measures. Community resources were mobilized to reduce provincial hospitals' burden of care. A population health approach, based on a radical reorganization of the workflow and emergency patient management, was implemented. The bed saturation of the Modena Healthcare Agency was measured by an ad hoc, newly implemented intensive care unit (ICU) bed occupancy and COVID-19 centralized governance dashboard. ICU bed occupancy increased by 114%, avoiding saturation of the Modena Healthcare Agency system. The Emilia-Romagna region achieved a higher rate of ICU bed availability at 2.15 ICU beds per 10,000 inhabitants as compared with community 1 ICU bed availability prior to the pandemic. Rapid and radical local reorganization of regional efforts helped inform the successful development and implementation of strategic choices within the hospital and the community to prevent the saturation of key facilities

PARP Inhibitors in Combination with Radiotherapy: To Do or Not to Do?

Background: Despite the large use of inhibitors of Poly-ADP ribose polymerase (PARP-I), the feasibility and safety of their combination with radiotherapy (RT) is unclear.Aim: We conducted a literature analysis with the aim to evaluate the efficacy and safety profile of a combination with RT and PARP-I.Method: The key issues for the current review were expressed in two questions according to the Population, Intervention, Control, Outcome (PICO) criteria: 1. What is the outcome and 2. What is the toxicity in patients treated with a combination of PARP-I and RT for a newly diagnosed or recurrent tumors?Results: A total of 12 clinical studies met the inclusion criteria including seven single-arm dose-escalation phase I studies, two phase II (two- and three-arms controlled trials) trials, one parallel-arm phase I study, and two phase I/II studies published between 2015 and 2021. RT was performed with photon beams and several schedules according to the clinical situation. The acute toxicity ≥ grade 3 ranged between 25% and >96%, which was divided into hematological or non-hematological adverse events.Conclusions: despite the heterogeneity of the evaluated patient populations and tumor types, and the limited number of the studies, this review suggests that a combination approach is feasible even though the efficacy profile remains unclear