The contribution of targeted therapy to the neoadjuvant chemoradiation of rectal cancer.

Neoadjuvant chemoradiation therapy is a commonly used option aimed to make less aggressive surgery approaches and to improve quality of life allowing a high proportion of patients operated with sphincter-sparing surgical techniques in locally advanced rectal cancer (LARC). During the last 5 years a number of studies have tested the efficacy of more intensive chemotherapeutic approaches by combining irinotecan or oxaliplatin with fluoropyrimidines and standard radiation treatments as well as testing combined treatments with targeted agents directed against epidermal growth factor receptor (EGFR) or angiogenesis. Herein, we review the results and critiques of the published studies based on the introduction of novel targeted agents in neoadjuvant therapy of LARC

La mutualità nel caregiving: una revisione della letteratura

Mutuality, considered the feeling of intimacy and the positive relationship between a caregiver and a arereceiver, is gaining an increasing interest in the international research arena, on the light of the socio-demographic changes and the increase in chronic degenerative diseases. The purpose of this article is to make a critical analysis of the literature on mutuality in order to identify its predictors and outcomes. A literature review was performed with the following databases: PubMed, CINAHL, PsycInfo, ASSIA and Pciological Abstract. Twenty articles were selected. From the critical analysis of the literature mutuality emerges as key variable in the process of caregiving and in the mental and physical health of the caregiver and carereceiver. In caregivers, high levels of mutuality are associated with less stress, depression and burden and a better quality of life and perceived health; in patients, high mutuality improves the recovery process from an illness, reduces anxiety and depression and improves the quality of life. Future studies aimed at the study of this variable also in the Italian population could support the development of programs to improve the quality of life of caregivers and carereceiver

Long-Term Effect of Physical Exercise on the Risk for Hospitalization and Death in Dialysis Patients. A Post-Trial Long-Term Observational Study

Background and objectives In the EXerCise Introduction to Enhance Performance in Dialysis (EXCITE) trial, a simple, personalized 6-month walking exercise program at home during the day off of dialysis improved the functional status and the risk for hospitalization in patients with kidney failure. In this post-trial observational study, we tested whether the same intervention was associated with a lower long-term risk of death or hospitalization (combined end point) during a follow-up extended up to 36 months. Design, setting, participants, & measurements In total, 227 patients (exercise, n5104; control, n5123) completed the 6-month trial and entered the post-trial observational study. Data were analyzed by unadjusted and adjusted Cox regression analyses and Bayesian analysis. Results In the long-term observation (up to 36 months), 134 events were recorded (eight deaths not preceded by hospitalization and 126 hospitalizations, which were followed by death in 38 cases). The long-term risk for hospitalization or death was 29% lower (hazard ratio, 0.71; 95% confidence interval, 0.50 to 1.00), and in an analysis stratified by adherence to the walking exercise program during the 6-month trial, the subgroup with high adherence (.60% of prescribed sessions) had a 45% lower risk as compared with the control group (hazard ratio, 0.55; 95% confidence interval, 0.35 to 0.87). A Bayesian analysis showed that the posterior probability of a hazard ratio of 0.71 (95% confidence interval, 0.50 to 1.00) for the risk of the composite outcome observed in the post-trial observational study was 93% under the conservative prior and 97% under the optimistic prior. Sensitivity analyses restricted to the risk of hospitalization only or censoring patients at the time of transplantation fully confirmed these findings. Conclusions A simple, personalized, home-based, low-intensity exercise program was associated with a lower risk of hospitalization

Cancer management during COVID-19 pandemic: is immune checkpoint inhibitors-based immunotherapy harmful or beneficial?

The coronavirus disease 2019 (COVID-19) is currently representing a global health threat especially for fragile individuals, such as cancer patients. It was demonstrated that cancer patients have an increased risk of developing a worse symptomatology upon severe acute respiratory syndrome associated coronavirus-2 (SARS-CoV-2) infection, often leading to hospitalization and intensive care. The consequences of this pandemic for oncology are really heavy, as the entire healthcare system got reorganized. Both oncologists and cancer patients are experiencing rescheduling of treatments and disruptions of appointments with a concurrent surge of fear and stress. In this review all the up-to-date findings, concerning the association between COVID-19 and cancer, are reported. A remaining very debated question regards the use of an innovative class of anti-cancer molecules, the immune checkpoint inhibitors (ICIs), given their modulating effects on the immune system. For that reason, administration of ICIs to cancer patients represents a question mark during this pandemic, as its correlation with COVID-19-associated risks is still under investigation. Based on the mechanisms of action of ICIs and the current evidence, we suggest that ICIs not only can be safely administered to cancer patients, but they might even be beneficial in COVID-19-positive cancer patients, by exerting an immune-stimulating action