OP0320-PARE FIBROMYALGIA NETWORK – A MULTIDIMENSIONAL PROJECT FOR PEOPLE WITH FIBROMYALGIA SYNDROME

Background:Fibromyalgia Syndrome (FMS) is a clinical non-joint syndrome characterized by diffuse, prolonged, and unexplained muscle pains. The health effects of FMS are pervasive and wide ranging. It is frequently associated with depression, anxiety and post-traumatic stress disorder. Patients describe living with daily unrelenting chronic widespread pain, persistent chronic fatigue, sleep issues, and cognitive effects. Fibromyalgia impacts all aspects of patients' lives. Patients report severe limitations in maintaining relationships, performing at work or school, and caring for self and family. They experience stigma within society, social isolation, healthcare and financial challenges of treatment, and fears of living with an often misunderstood condition. In 2019 APMARR launched Fibromyalgia Network a project that aimed at improving the quality of life of patients with FMS.Objectives:Experiment a set of good practices at territorial level to be expanded nationally to improve the FMS patients' conditionsCreate a multisectoral, patient-oriented network with different stakeholdersLaunch a communication campaign to inform and change the perception of the pathologyTrain the General Practitioners in order to increase early diagnosisEmpower the PatientsPromote innovative treatments and the data acquisition about hyperbaric oxygen therapyProvide free psychological and information supportMethods:The project was based on the assumption supported by evidence that a multi-modal treatment approach improves the quality of life of person with FMS including a combination of drug and non-drug treatments and a range of health care specialties. All the activities implemented were shaped on a holistic approach to treating Fibromyalgia, including lifestyle management, diet and exercise, and psychosocial techniques, in addition to medical treatments.Results:1) A territorial network coordinated by APMARR was created involving Puglia Region, Health Authorities, Professional board of Psychologists, National Association of People with FMS, Professional board of Physicians, Italian Society Of Rheumatology-Puglia2) A communication campaign was widely spread among social network, a brochure was written in collaboration with the Italian Society of Rheumatology and distributed to the general public, a national level conference was organized in Bari3) A training program acknowledged by the Italian Health Minister Program involved more than 120 GPs4) A patients expert program involved more than 100 patients5) A group of patients were tutored in their treatment with hyperbaric oxygen therapy and a report was sent to the HTA Italian Program in collaboration with the Puglia Region HTA Center. It was the first HTA report elaborated in collaboration with a patient organization in Italy6) Self-mutual help groups were organized with free psychological support, as well as an information desk and a toll-free number7) High satisfaction and pain relief of the participants as detected by a qualitative satisfaction questionnaireConclusion:The project demonstrated the good results of the holistic approach in the patients who took part in the program that reported the improvements of their quality of lives and relieve from their daily pains. The Self-mutual help group was the most appreciated free service, in which participants shared personal stories and perspectives thoughtfully and courageously. The training initiatives organized in collaboration with physicians helped them to learn tips for a better lifestyle management, diet and exercise, and psychosocial techniques but above all helped to overcame concerns and frustration regarding the lack of understanding in the medical community. The network succeeds to increased awareness and understanding of FMS across the public opinion and GPs.References:[1]Author: S.Mingolla, APMARR Project Manager; Co-authors: A.Celano, APMARR President; I. Cinieri, Psychologist, A. Marsico, RheumatologistDisclosure of Interests:None declare

Vaccination for seasonal influenza in patients with cancer: Recommendations of the Italian Society of Medical Oncology (AIOM)

Background: Influenza virus causes annual epidemics in the winter\u2013spring 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 differ- ent 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

Cancer Predisposition Genes in Adolescents and Young Adults (AYAs): a Review Paper from the Italian AYA Working Group

Purpose of Review: The present narrative systematic review summarizes current knowledge on germline gene mutations predisposing to solid tumors in adolescents and young adults (AYAs). Recent Findings: AYAs with cancer represent a particular group of patients with specific challenging characteristics and yet unmet needs. A significant percentage of AYA patients carry pathogenic or likely pathogenic variants (PV/LPVs) in cancer predisposition genes. Nevertheless, knowledge on spectrum, frequency, and clinical implications of germline variants in AYAs with solid tumors is limited. Summary: The identification of PV/LPV in AYA is especially critical given the need for appropriate communicative strategies, risk of second primary cancers, need for personalized long-term surveillance, potential reproductive implications, and cascade testing of at-risk family members. Moreover, these gene alterations may potentially provide novel biomarkers and therapeutic targets that are lacking in AYA patients. Among young adults with early-onset phenotypes of malignancies typically presenting at later ages, the increased prevalence of germline PV/LPVs supports a role for genetic counseling and testing irrespective of tumor type

The effect of endocrine responsiveness on high-risk breast cancer treated with dose-intensive chemotherapy: results of International Breast Cancer Study Group Trial 15-95 after prolonged follow-up

Background: The role of adjuvant dose-intensive chemotherapy and its efficacy according to baseline features has not yet been established. Patients and methods: Three hundred and forty-four patients were randomized to receive seven courses of standard-dose chemotherapy (SD-CT) or three cycles of dose-intensive epirubicin and cyclophosphamide (epirubicin 200 mg/m2 plus cyclophosphamide 4 mg/m2 with filgrastim and progenitor cell support). All patients were assigned tamoxifen at the completion of chemotherapy. The primary end point was disease-free survival (DFS). This paper updates the results and explores patterns of recurrence according to predicting baseline features. Results: At 8.3-years median follow-up, patients assigned DI-EC had a significantly better DFS compared with those assigned SD-CT [8-year DFS percent 47% and 37%, respectively, hazard ratio (HR) 0.76; 95% confidence interval 0.58-1.00; P = 0.05]. Only patients with estrogen receptor (ER)-positive disease benefited from the DI-EC (HR 0.61; 95% confidence interval 0.39, 0.95; P = 0.03). Conclusions: After prolonged follow-up, DI-EC significantly improved DFS, but the effect was observed only in patients with ER-positive disease, leading to the hypothesis that efficacy of DI-EC may relate to its endocrine effects. Further studies designed to confirm the importance of endocrine responsiveness in patients treated with dose-intensive chemotherapy are encourage

Toxoplasma gondii infection in patients with hematological malignancies.

Toxoplasmosis is one of the most common parasitic infections in humans, but in most cases it does not cause serious illness; this protozoan can nevertheless cause devastating disease in immunocompromised hosts such as HIV-positive individuals. Only rarely is toxoplasmosis documented in hematological patients, and among them, those who undergo a transplant procedure are more frequently affected. In a retrospective multicenter survey, we collected data on six cases of toxoplasmosis in hematological patients. In the majority of cases, patients had undergone transplant procedures (five had undergone autologous or allogeneic transplantation). This complication needed special care in diagnosis, usually based on serology, neuroradiology, and PCR examination. However, in our experience the appropriate therapeutic approach was successful in the majority of cases

Position paper of the Italian Association of Medical Oncology on the impact of COVID-19 on Italian oncology and the path forward: the 2021 Matera statement

The coronavirus disease 2019 (COVID-19) pandemic has severely affected cancer care and research by disrupting the prevention and treatment paths as well as the preclinical, clinical, and translational research ecosystem. In Italy, this has been particularly significant given the severity of the pandemic's impact and the intrinsic vulnerabilities of the national health system. However, whilst detrimental, disruption can also be constructive and may stimulate innovation and progress. The Italian Association of Medical Oncology (AIOM) has recognized the impact of COVID-19 on cancer care continuum and research and proposes the '2021 Matera statement' which aims at providing pragmatic guidance for policymakers and health care institutions to mitigate the impact of the global health crisis on Italian oncology and design the recovery plan for the post-pandemic scenario. The interventions are addressed both to the pillars (prevention, diagnosis, treatment, follow-up, health care professionals) and foundations of cancer care (communication and care relationship, system organization, resources, research, networking). The priorities to be implemented can be summarized in the MATERA acronym: Multidisciplinarity; Access to cancer care; Telemedicine and Territoriality; Equity, ethics, education; Research and resources; Alliance between stakeholders and patients

Phase 2 study of NAB-paclitaxel in SensiTivE and refractory relapsed small cell lung cancer (SCLC) (NABSTER TRIAL)

Background: Despite sensitivity to first-line chemotherapy, most small-cell lung cancer (SCLC) patients relapse. In this setting, topotecan demonstrated modest activity with significant toxicity. Paclitaxel was also active. This study was designed to evaluate activity and safety of nab-paclitaxel in relapsed SCLC. Methods: In this multicentre prospective Phase 2 trial, patients with refractory or sensitive SCLC progressed to first-line platinum-based chemotherapy received nab-paclitaxel 100 mg/smq on days 1, 8, 15 every 4 weeks up to six cycles, progressive disease or intolerable toxicity. Primary endpoint was investigator-assessed objective tumour response. Secondary endpoints were toxicity, progression-free survival (PFS) and overall survival (OS). Results: Of the 68 patients treated, partial response was 8% in the refractory cohort and 14% in the sensitive cohort. Most common toxicities of any grade were fatigue (54%), anaemia (38%), neutropenia (29%), leukopenia (26%) and diarrhoea (21%). Median PFS was similar in both refractory (1.8 months) and sensitive cohorts (1.9 months), while median OS was longer in sensitive one (6.6 versus 3.6 months). Conclusions: Although nab-paclitaxel has shown some modest anti-tumour activity in relapsed SCLC, associated with a favourable toxicity profile, the primary end-point of the study was not met. Clinical Trial registration: Clinical Trial registration number is ClinicalTrials.gov Identifier: NCT03219762