Telehealth in oncofertility and breast cancer patients during COVID-19: preliminary results of insenoallasalute.it project

Abstract. – OBJECTIVE: Breast cancer (BC) is the leading diagnosis in premenopausal patients. Lockdown measures during COVID-19 pandemic reduced facilities for premenopausal patients, impairing oncological and reproductive health. To reduce its effect, a telehealth program called insenoallasalute.it was designed in Italy. PATIENTS AND METHODS: A national-based multicentric observational study was undertaken by insenoallasalute.it study group (Italian Ministry of Health, Modena Hospital and Tor Vergata University Hospital) to raise awareness among women on a) BC and its negative role on reproductive health; b) increase adherence to screening programs and self-examination; c) present oncofertility strategies. A webbased platform with two sections was designed: an informative section and a telehealth application activated with a mobile one-time password. After a self-evaluation test to select premenopausal women with maternal desire and family or personal history for BC or ovarian cancer, and premenopausal women with maternity desires with prior medically assisted procreation, a dedicated agenda for telehealth evaluation was displayed and planned. In case the patients fulfilled the criteria for further evaluation, they were invited to perform an outpatient evaluation in one of the pilot centers. RESULTS: From July 2021 to December 2021, 2,830 single accounts were activated, and 2,450 (86.57%) completed the tests. 53 patients were selected to undergo telehealth consultation and 40 (80.0%) scheduled the telehealth visit. 6 patients underwent surgery in the study centers. CONCLUSIONS: In our experience insenoallasalute.it embodied an innovative solution to spread BC awareness, BC screening program, and oncofertility opportunities in the oncological population

Breast cancer treatment de-escalation: breaking the SOUND barrier

Breast Cancer (BC) is the leading oncological diagnosis, with the annual incidence expected to exceed 3 million new cases by 2040 due to population growth and ageing. Despite the increasing number of BC patients, recent advancements in multidisciplinary treatment have enabled surgical de-escalation, maintaining equivalent oncological outcomes. Areas of surgical de-escalation include avoidance of axillary lymph node dissection in patients with low disease burden, re-excision in close margins after breast conserving surgery, and even complete avoidance of surgery in selected cases. Despite the evidence supporting these de-escalation protocols, their implementation is inconsistent. The article discusses how these strategies can be further integrated into BC treatment plans to improve patients' quality of life and optimize health care resources. The future of BC management may be shaped by genomic tests, offering more tailored and potentially less invasive treatment strategies. A comprehensive understanding of tumor biology has facilitated the development of strategies such as neoadjuvant chemotherapy, with the potential to further de-escalate surgery. The need for a multidisciplinary approach to BC care, incorporating emerging diagnostic tools and understanding of individual patient's disease trajectory, is paramount. It is essential to challenge the perception of more aggressive treatments as inherently better and ensure decisions are based on high-quality evidence, preserving the principle of 'do no harm'. The focus of future BC research should be on identifying markers capable of predicting the risk of distant recurrence and implementing a true multidisciplinary de-escalation approach

Autoimmune mastitis as a clinical manifestation of Behçet’s disease: a case report and a systematic literature review

Objective: Behçet’s disease (BD) is a rare autoimmune disorder of unknown origin that causes chronic and systemic inflammation in blood vessels. The condition is traditionally defined by oral and genital ulcers and uveitis; however, cutaneous, articular, neurologic, vascular, gastrointestinal, and pulmonary manifestations may also be observed. It is more prevalent throughout the Silk Road, such the Mediterranean basin and the East Asia. There have been reported only four cases of BD targeting the breast. We herein present a case report of an autoimmune mastitis (AM) in a 23-year-old patient diagnosed for BD treated surgically. Case Presentation: The patient is a 23-year-old Italian female who reported recurrent aphthous ulcers of the oral mucosa, occasional vaginal dryness, and genital lesions, diagnosed for BD according to the International Study Group (ISG) criteria and the skin biopsy. The patient referred to our department for examination of a painful and ulcerating lump at the 5 o’clock position of the right breast, which had been present for one month. Results: In our case, we opted for a surgical approach, which proved to be effective in treating the lesion. Considering the relapsing and remitting nature of BD, surgical intervention is questionable when compared to appropriate conservative treatment. Conclusions: A conservative approach should be evaluated first, in order to have regard to the recurrent course of the disease and to the risk that numerous surgical procedures may result in irreversible aesthetic damage

The Effect of coronavirus (COVID-19) on breast cancer teamwork: A multicentric survey

Background/Aim: Despite the large amount of clinical data available of Coronavirus-19 (COVID-19), not many studies have been conducted about the psychological toll on Health Care Workers (HCWs). Patients and Methods: In this multicentric descriptive study, surveys were distributed among 4 different Breast Cancer Centers (BCC). BCCs were distinguished according to COVID-19 tertiary care hospital (COVID/No-COVID) and district prevalence (DP) (High vs. Low). DASS-21 score, PSS score and demographic data (age, sex, work) were evaluated. Results: A total of 51 HCWs were analyzed in the study. Age, work and sex did not demonstrate statistically significant values. Statistically significant distribution was found between DASS-21-stress score and COVID/No-COVID (p=0.043). No difference was found in the remaining DASS-21 and PSS scores, dividing the HCWs according to COVID-19-hospital and DP. Conclusion: Working in a COVID-19-hospital represents a factor that negatively affects psychosocial wellbeing. However, DP seems not to affect the psychosocial well-being of BCC HCWs. During the outbreak, psychological support for low risk HCWs should be provided regardless DP

Awake breast surgery and de-escalation treatment: strategies for frail and elderly breast cancer patients

Objective: Awake breast surgery has been proven to be a concrete alternative to surgery under general anesthesia. This technique was shown to be advantageous in various aspects such as length of hospitalization and economic sustainability. Our study aims to verify the advantages of this technique in terms of operating room times, length of stay, and outcome in frail patients diagnosed with breast cancer. Patients and methods: Our retrospective study enrolled all frail patients, ASA ≥ 3, diagnosed with breast cancer and scheduled to undergo a surgical intervention. The type of surgery, duration of surgery, length of hospital stay, type of anesthesia, postoperative complications, postoperative dissociative episodes and CCI (Charlson Comorbidity Index) score were evaluated by comparing the data between the group of awake surgery and the group of patients undergoing surgery under general anesthesia. Results: A total of 34 patients were enrolled; 16 patients (45.7%) undergoing awake surgery with a mean age of 78 years [75;95], and 18 patients (54.3%) receiving general anesthesia. CCI was significantly higher in the Awake group with a median score of 12 [9;13] vs. 10 [9;11] in the No-Awake group: relative p-value was <0.001. Postoperative complications were comparable between the groups, showing no statistically significant differences. Six patients (33.3%) in the general anesthesia group experienced dissociative complications vs. 1 (6.3%) in the awake surgery group (p=0.05). There were no statistically significant differences regarding the other parameters. Conclusions: Awake breast surgery in elderly patients, especially in frail ones, could reduce the incidence of postoperative delirium by enabling a shorter hospitalization and allowing for a faster recovery

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries