Self-criticism and attachment: A systematic review and meta-analysis

Several contributions argue that insecure attachment accounts for the development of self-criticism. However, advances in the field are replete with theoretical issues that limit the integration of past results. This work estimates the strength of the associations between attachment and self-criticism and examines which theoretical and methodological features impact these estimations. A PRISMA systematic search was conducted. A three-level meta-analytic approach has been used to estimate effect sizes and the role of theoretical and methodological moderators. Low levels of secure attachment and high levels of insecure attachment were both positively associated with self-criticism. The type of insecure attachment significantly moderated this result, with attachment anxiety being more strongly associated with self-criticism than avoidant attachment. In some cases, the conceptualization and operationalization of both attachment and self-criticism were significant moderators. Self-criticism is likely to be rooted in insecure attachment, supporting most theoretical models and clinical indications. However, results regarding anxious attachment call for an additional theoretical effort to extend the current model. Furthermore, the bi-dimensional conceptualization of insecure attachment may lead to an overestimation of the association between avoidant attachment and self-criticism. The different nature of the emotional components involved may impact observations, suggesting the need to use multidimensional measures

Fears and perception of the impact of COVID-19 on patients with lung cancer. A mono-institutional survey

In February 2020, Italy became one of the first countries to be plagued by the SARS-CoV-2 pandemic, COVID-19. In March 2020, the Italian government decreed a lockdown for the whole country, which overturned communication systems, hospital organization, and access to patients and their relatives and carers. This issue had a particular regard for cancer patients. Our Thoracic Oncology Division therefore reorganized patient access in order to reduce the risk of contagion and, at the same time, encourage the continuation of treatment. Our staff contacted all patients to inform them of any changes in treatment planning, check that they were taking safety measures, and ascertain their feelings and whether they had any COVID-19 symptoms. To better understand patients’ fears and expectations of during the pandemic period, we created a nine-question interview, administered from April to May 2020 to 156 patients with lung cancer. Patients were classified by age, sex, comorbidity, disease stage, prior treatment, and treatment type. The survey showed that during the pandemic period some patients experienced fear of COVID-19, in particular: women (55% vs. 33%), patients with comorbidities (24% vs. 9%), and patients who had already received prior insult (radiotherapy or surgery) on the lung (30% vs. 11%). In addition, the patients who received oral treatment at home or for whom intravenous treatment was delayed, experienced a sense of relief (90% and 72% respectively). However, only 21% of the patients were more afraid of COVID-19 than of their cancer, in particular patients with long-term (> 12 months) vs. short-term cancer diagnosis (28% vs. 12.5%, respectively). Furthermore, the quarantine period or even just the lockdown period alone, worsened the quality of life of some patients (40%), especially those in oral treatment (47%). Our data demonstrate how lung cancer patients are more afraid of their disease than of a world pandemic. Also this interview indirectly highlights the clinician’s major guiding principle in correctly and appropriately managing not just the patient’s expectations of their illness and its treatment, but also and especially of the patient’s fears

Radiomics and artificial intelligence in malignant uterine body cancers: Protocol for a systematic review

IntroductionUterine body cancers (UBC) are represented by endometrial carcinoma (EC) and uterine sarcoma (USa). The clinical management of both is hindered by the complex classification of patients into risk classes. This problem could be simplified through the development of predictive models aimed at treatment tailoring based on tumor and patient characteristics. In this context, radiomics represents a method of extracting quantitative data from images in order to non-invasively acquire tumor biological and genetic information and to predict response to treatments and prognosis. Furthermore, artificial intelligence (AI) methods are an emerging field of translational research, with the aim of managing the amount of data provided by the various -omics, including radiomics, through the process of machine learning, in order to promote precision medicine.ObjectiveThe aim of this protocol for systematic review is to provide an overview of radiomics and AI studies on UBCs.Methods and analysisA systematic review will be conducted using PubMed, Scopus, and the Cochrane Library to collect papers analyzing the impact of radiomics and AI on UBCs diagnosis, prognostic classification, and clinical outcomes. The PICO strategy will be used to formulate the research questions: What is the impact of radiomics and AI on UBCs on diagnosis, prognosis, and clinical results? How could radiomics or AI improve the differential diagnosis between sarcoma and fibroids? Does Radiomics or AI have a predictive role on UBCs response to treatments? Three authors will independently screen articles at title and abstract level based on the eligibility criteria. The risk of bias and quality of the cohort studies, case series, and case reports will be based on the QUADAS 2 quality assessment tools

Twenty years of emotional-behavioural problems in clinical and at-risk adolescents living in Italy assessed through the Achenbach System of Empirically Based Assessment: systematic review and meta-analysis

Background: The current systematic review and meta-analysis aims to synthesize findings from Italian studies that have investigated emotional and behavioural problems in clinical and at-risk samples of adolescents, as assessed by the Achenbach System of Empirically Based Assessment (ASEBA) instruments, including Child Behaviour Checklist (CBCL), the self-report Youth Self Report (YSR) and the teacher-report Teacher Report Form (TRF). It also investigates possible effects of gender, age, and time of assessment (pre-post COVID-19 pandemic), and their link with other psychological factors. Methods: The latest PRISMA guidelines were followed, and this study was registered in PROSPERO (CRD42022299999). Scopus, EBSCO, PubMed, Web of Sciences, and ProQuest databases were used considering the time frame from January 2001 to November 2021. Two blinded investigators remove duplicates and double screened 7103 records. They selected and extract information from 40 eligible studies, which were also evaluated through the Newcastle-Ottawa Scale. Results: Overall, emotional-behavioural problems were mainly investigated through the CBCL 6-18 both in clinical samples (N = 2244), mostly composed of adolescents with a diagnosis of eating disorders and externalized disorders, and at-risk samples (N = 868), mostly of adolescents with a medical condition. As expected, adolescents from clinical samples had higher scores on the ASEBA scales than their peers belonging to the at-risk samples. No effect related to gender, time of assessment and study quality on emotional behavioural problems emerged. However, a significant effect of age was found in clinical samples, specifically a decrease in externalizing symptoms with the increase of age. Lastly, emotional-behavioural problems were mainly investigated in association with emotional regulation difficulties both in clinical and at-risk samples. Conclusions: For the first time, meta-analytic data on rates of emotional-behavioral problems in Italian clinical and at-risk adolescents are provided. Implications include the need of more data, especially with the TRF and from Centre e Southern Italy, to solve doubts emerged about the absence of moderators. The authors discuss limitations related to the heterogeneity of the studies, suggesting future research directions

Impact and Treatment of Sarcopenia in Patients Undergoing Radiotherapy: A Multidisciplinary, AMSTAR-2 Compliant Review of Systematic Reviews and Metanalyses

BackgroundSarcopenia (SP) is defined as the quantitative and functional impairment of skeletal muscles. SP is commonly related to older age and is frequent in patients with cancer. To provide an overview of SP in patients treated with radiotherapy (RT) and to evaluate the current evidence, we analyzed the available systematic reviews and meta-analyses. MethodsReviews were identified using PubMed, Scopus, and Cochrane library databases, without date restriction. Only systematic reviews and meta-analyses on the prognostic impact of SP and on any treatments aimed at reducing SP effect, in patients undergoing RT, were included in this review. The analyses not separately reporting the results in patients treated with RT were excluded. The quality assessment was performed using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews). ResultsFrom the 84 papers identified, five reviews met the inclusion criteria with four reports mainly including non-randomized trials. Three reviews on the effect of SP showed a significantly negative impact on overall survival in patients undergoing RT and/or chemoradiation for H&N cancers (HR: 1.63-2.07). Two reviews on interventional studies showed the possibility of 1) improving physical functions through nutritional and physical interventions and 2) avoiding muscle wasting by means of sufficient protein intake. The quality assessment of the included review showed that two and three analyses are classifiable as having low and moderate overall confidence rating, respectively. ConclusionsThe analyzed reviews uniformly confirmed the negative impact of SP in patients with H&N tumors undergoing RT and the possibility of improving muscle mass and function through nutritional and physical interventions. These results justify further research on this topic based on a more uniform SP definition and on a complete evaluation of the potentially confounding parameters

EGFR-TKI plus anti-angiogenic drugs in EGFR-mutated NSCLC: a meta-analysis of randomized clinical trials

Abstract Background Results of several RCTs testing the combination of an EGFR-TKI plus an anti-angiogenic drug in advanced EGFR-mutated NSCLC were reported. Methods We first report a systematic-review and meta-analysis of all RCTs, to estimate effectiveness and toxicity of such new therapeutic approach as compared with first-generation EGFR-TKIs monotherapy. Subsequently, we present a network meta-analysis (NMA) comparing the combination of an EGFR-TKI plus an anti-angiogenic drug with other two new treatment-options: combination of an EGFR-TKI plus chemotherapy or new EGFR-TKIs of second or third generation as monotherapy. Results Five RCTs were included in the first meta-analysis. The PFS was statistically significantly larger in patients treated with an EGFR-TKI plus an anti-angiogenic drug as compared with EGFR-TKI monotherapy: the pooled PFS-HR was 0.59 (95% CI = 0.51 to 0.69). The pooled median-PFS was 17.8 months (95% CI = 16.5 to 19.3) for the combination versus 11.7 months (95% CI = 11.1 to 12.7) for EGFR-TKI as monotherapy. No statistically significant differences between the two treatment-arms were observed in terms of both OS and ORR. The rate of grade equal or higher than 3 AEs was statistically significantly higher in patients treated with EGFR-TKI plus an anti-angiogenic drug: the pooled-Relative Risk was 1.72 (95% CI = 1.43 to 2.06). Ten RCTs were included in the NMA. All the three experimental treatments were associated with a statistically significant improvement of PFS as compared with first-generation EGFR-TKIs. When compared to each other, none of the three experimental treatments was statistically significantly associated with larger PFS or lower rate of grade ≥3AEs. Conclusion Patients with EGFR-mutated NSCLC derived clinically meaningful larger PFS-benefit from the addition of an anti-angiogenic drug to a first-generation EGFR-TKI, at the cost of an increase of toxicitie

Results of multilevel containment measures to better protect lung cancer patients from COVID-19. the IEO model

A novel coronavirus causing severe acute respiratory syndrome (SARS), named SARS-CoV-2, was identified at the end of 2019. The spread of coronavirus disease 2019 (COVID-19) has progressively expanded from China, involving several countries throughout the world, leading to the classification of the disease as a pandemic by the World Health Organization (WHO). According to published reports, COVID-19 severity and mortality are higher in elderly patients and those with active comorbidities. In particular, lung cancer patients were reported to be at high risk of pulmonary complications related to SARS-CoV2 infection. Therefore, the management of cancer care during the COVID-19 pandemic is a crucial issue, to which national and international oncology organizations have replied with recommendations concerning patients receiving anticancer treatments, delaying follow-up visits and limiting caregiver admission to the hospitals. In this historical moment, medical oncologists are required to consider the possibility to delay active treatment administration based on a case-by-case risk/benefit evaluation. Potential risks associated with COVID-19 infection should be considered, considering tumor histology and natural course, disease setting, clinical conditions, and disease burden, together with the expected benefit, toxicities (e.g., myelosuppression or interstitial lung disease), and response obtained from the planned or ongoing treatment. In this study, we report the results of proactive measures including social media, telemedicine, and telephone triage for screening patients with lung cancer during the COVID-19 outbreak in the European Institute of Oncology (Milan, Italy). Proactive management and containment measures, applied in a structured and daily way, has significantly aided the identification of advance patients with suspected symptoms related to COVID-19, limiting their admission to our cancer center; we have thus been more able to protect other patients from possible contamination and at the same time guarantee to the suspected patients the immediate treatment and evaluation in referral hospitals for COVID-19

Identification and Characterization of Cancer Stem Cells from Head and Neck Squamous Cell Carcinoma Cell Lines

Background/Aims: Head and neck squamous cell carcinoma (HNSCC) ranks sixth worldwide for tumor-related mortality. A subpopulation of tumor cells, termed cancer stem cells (CSCs), has the ability to support cancer growth. Therefore, profiling CSC-enriched populations could be a reliable tool to study cancer biology. Methods: We performed phenotypic characterization of 7 HNSCC cell lines and evaluated the presence of CSCs. CSCs from Hep-2 cell line and HNSCC primary cultures were enriched through sphere formation and sphere-forming cells have been characterized both in vitro and in vivo. In addition, we investigated the expression levels of Nicotinamide N-methyltransferase (NNMT), an enzyme overexpressed in several malignancies. Results: CSC markers were markedly expressed in Hep-2 cell line, which was found to be highly tumorigenic. CSC-enriched populations displayed increased expression of CSC markers and a strong capability to form tumors in vivo. We also found an overexpression of CSC markers in tumor formed by CSC-enriched populations. Interestingly, NNMT levels were significantly higher in CSC-enriched populations compared with parental cells. Conclusion: Our study provides an useful procedure for CSC identification and enrichment in HNSCC. Moreover, results obtained seem to suggest that CSCs may represent a promising target for an anticancer therapy

Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

BACKGROUND: The safe use of radiotherapy (RT) requires compliance with dose/volume constraints (DVCs) for organs at risk (OaRs). However, the available recommendations are sometimes conflicting and scattered across a number of different documents. Therefore, the aim of this work is to provide, in a single document, practical indications on DVCs for OaRs in external beam RT available in the literature.MATERIAL AND METHODS: A multidisciplinary team collected bibliographic information on the anatomical definition of OaRs, on the imaging methods needed for their definition, and on DVCs in general and in specific settings (curative RT of Hodgkin's lymphomas, postoperative RT of breast tumors, curative RT of pediatric cancers, stereotactic ablative RT of ventricular arrythmia). The information provided in terms of DVCs was graded based on levels of evidence.RESULTS: Over 650 papers/documents/websites were examined. The search results, together with the levels of evidence, are presented in tabular form.CONCLUSIONS: A working tool, based on collected guidelines on DVCs in different settings, is provided to help in daily clinical practice of RT departments. This could be a first step for further optimizations

Baseline Tumor Size as Prognostic Index in Patients With Advanced Solid Tumors Receiving Experimental Targeted Agents

Abstract Background Baseline tumor size (BTS) has been associated with outcomes in patients with cancer treated with immunotherapy. However, the prognostic impact of BTS on patients receiving targeted therapies (TTs) remains undetermined. Methods We reviewed data of patients with advanced solid tumors consecutively treated within early-phase clinical trials at our institution from 01/2014 to 04/2021. Treatments were categorized as immunotherapy-based or TT-based (biomarker-matched or not). BTS was calculated as the sum of RECIST1.1 baseline target lesions. Results A total of 444 patients were eligible; the median BTS was 69 mm (IQR 40-100). OS was significantly longer for patients with BTS lower versus higher than the median (16.6 vs. 8.2 months, P < .001), including among those receiving immunotherapy (12 vs. 7.5 months, P = .005). Among patients receiving TT, lower BTS was associated with longer PFS (4.7 vs. 3.1 months, P = .002) and OS (20.5 vs. 9.9 months, P < .001) as compared to high BTS. However, such association was only significant among patients receiving biomarker-matched TT, with longer PFS (6.2 vs. 3.3 months, P < .001) and OS (21.2 vs. 6.7 months, P < .001) in the low-BTS subgroup, despite a similar ORR (28% vs. 22%, P = .57). BTS was not prognostic among patients receiving unmatched TT, with similar PFS (3.7 vs. 4.4 months, P = .30), OS (19.3 vs. 11.8 months, P = .20), and ORR (33% vs. 28%, P = .78) in the 2 BTS groups. Multivariate analysis confirmed that BTS was independently associated with PFS (P = .03) and OS (P < .001) but not with ORR (P = .11). Conclusions Higher BTS is associated with worse survival outcomes among patients receiving biomarker-matched, but not biomarker-unmatched TT