Systematic versus on-demand early palliative care: results from a multicentre, randomised clinical trial

Background Early palliative care (EPC) in oncology has been shown to have a positive impact on clinical outcome, quality-of-care outcomes, and costs. However, the optimal way for activating EPC has yet to be defined. Methods This prospective, multicentre, randomised study was conducted on 207 outpatients with metastatic or locally advanced inoperable pancreatic cancer. Patients were randomised to receive ‘standard cancer care plus on-demand EPC’ (n = 100) or ‘standard cancer care plus systematic EPC’ (n = 107). Primary outcome was change in quality of life (QoL) evaluated through the Functional Assessment of Cancer Therapy – Hepatobiliary questionnaire between baseline (T0) and after 12 weeks (T1), in particular the integration of physical, functional, and Hepatic Cancer Subscale (HCS) combined in the Trial Outcome Index (TOI). Patient mood, survival, relatives' satisfaction with care, and indicators of aggressiveness of care were also evaluated. Findings The mean changes in TOI score and HCS score between T0 and T1 were −4.47 and −0.63, with a difference between groups of 3.83 (95% confidence interval [CI] 0.10–7.57) (p = 0.041), and −2.23 and 0.28 (difference between groups of 2.51, 95% CI 0.40–4.61, p = 0.013), in favour of interventional group. QoL scores at T1 of TOI scale and HCS were 84.4 versus 78.1 (p = 0.022) and 52.0 versus 48.2 (p = 0.008), respectively, for interventional and standard arm. Until February 2016, 143 (76.9%) of the 186 evaluable patients had died. There was no difference in overall survival between treatment arms. Interpretations Systematic EPC in advanced pancreatic cancer patients significantly improved QoL with respect to on-demand EPC

Erratum to \u201cSystematic versus on-demand early palliative care: A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life\u201d [Eur J Cancer (2016) 69 (110\u2013118)] (S095980491632487X)(10.1016/j.ejca.2016.10.004)

The publisher regrets that the collaborators for this paper were not listed as such within the author details of the published paper. The collaborators were published in the Acknowledgements and are as follows: Alberto Farolfi, Silvia Ruscelli, Martina Valgiusti, Sara Pini, Marina Faedi, Department of Medical Oncology, IRST IRCCS, Meldola; Angela Ragazzini, Unit of Biostatistics and Clinical Trials, IRST IRCCS, Meldola; Cristina Pittureri and Elena Amaducci, Palliative Care and Hospice Unit, AUSL Romagna, Cesena; Irene Guglieri, Psychooncology Service, Veneto Institute of Oncology IOV \u2013 IRCCS, Padua; Francesca Bergamo, Sara Lonardi, Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV \u2013 IRCCS, Padua; Camilla Di Nunzio, Medical Oncology Unit, Oncology\u2013Hematology Department, Guglielmo da Saliceto Hospital, Piacenza; Monica Bosco, Palliative Care Unit, Oncology\u2013Hematology Department, Guglielmo da Saliceto Hospital, Piacenza; Barbara Bocci, Medical Oncology Unit, San Paolo Hospital, Milan; Alfina Bramanti and Chiara Gandini, Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia; Angela Buonadonna, Medical Oncology Unit, Aviano National Cancer Institute, Aviano; Alessandro Comandone, Medical Oncology Unit, Presidio Humanitas Gradenigo, Turin; Sonia Zoccali, Coordinamento Cure Palliative (supported by F.I.L.E., Leniterapia Italian Foundatio), Florence; Maria Simona Pino, Medical Oncology Unit, Oncology Department, S. Maria Annunziata Hospital, Florence; Davide Dalu, Palliative Care Unit, Oncology Department, L. Sacco Hospital, Milan; Pietro Sozzi, Oncology Unit, Ospedale degli Infermi, Ponderano; Alberto Gozza, Medical Oncology, Department of Medicine, E.O. Galliera Hospitals, Genoa; Monica Giordano and Carla Longhi, Oncology Unit, Sant'Anna Hospital, Como; Cristina Autelitano, Palliative Care Unit, Arcispedale S. Maria Nuova \u2013 IRCCS, Reggio Emilia; Teresa Gamucci, Oncology Unit, SS Trinit\ue0 Hospital Sora, ASL Frosinone, Frosinone; Cataldo Mastromauro, Oncology Unit, ULSS 12 Veneziana, Venice; Rodolfo Scognamiglio, Hospice Nazareth, Mestre; Daniela Degiovanni, Palliative Care Unit, Casale Monferrato, ASL Alessandria; Federica Negri, Medical Oncology Unit, Istituti Ospitalieri, Cremona; Augusto Caraceni, Palliative Care, Pain Therapy and Rehabilitation Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan; and Luigi Montanari, Palliative Care Unit Ravenna, AUSL Romagna, Italy. The publisher would like to apologise for any inconvenience caused

Radiation dose from medical imaging in end stage renal disease patients: a Nationwide Italian Survey

Background and objectives: End stage renal disease (ESRD) patients are exposed to the risk of ionizing radiation during repeated imaging studies. The variability in diagnostic imaging policies and the accompanying radiation doses across various renal units is still unknown. We studied this variability at the centre level and quantified the associated radiation doses at the patient level. Methods: Fourteen Italian nephrology departments enrolled 739 patients on haemodialysis and 486 kidney transplant patients. The details of the radiological procedures performed over one year were recorded. The effective doses and organ doses of radiation were estimated for each patient using standardized methods to convert exposure parameters into effective and organ doses RESULTS: Computed tomography (CT) was the major contributor (> 77%) to ionizing radiation exposure. Among the haemodialysis and kidney transplant patients, 15% and 6% were in the high ( 65 20 mSv per year) radiation dose groups, respectively. In haemodialysis patients, the most exposed organs were the liver (16 mSv), the kidney (15 mSv) and the stomach (14 mSv), while the uterus (6.2 mSv), the lung (5.7 mSv) and the liver (5.5 mSv) were the most exposed in kidney transplant patients. The average cumulative effective dose (CED) of ionizing radiation among centres in this study was highly variable both in haemodialysis (from 6.4 to 18.8 mSv per patient-year; p = 0.018) and even more so in kidney transplant (from 0.6 to 13.7 mSv per patient-year; p = 0.002) patients. Conclusions: Radiation exposure attributable to medical imaging is high in distinct subgroups of haemodialysis and transplant patients. Furthermore, there is high inter-centre variability in radiation exposure, suggesting that nephrology units have substantially different clinical policies for the application of diagnostic imaging studies

Long-term proactive management of psoriasis with calcipotriol and betamethasone dipropionate foam: an Italian consensus through a combined nominal group technique and Delphi approach

none85Background: Although long-term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO-LONG trial, a fixed-dose combination of betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on non-consecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long-term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a consensus on the role of proactive management of psoriasis. Methods: A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process. Results: Eighteen statements were proposed, and the majority of them (14/18) reached a consensus during the Delphi voting. The need to provide long-term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses. Approaches to improve adherence, on the other hand, need further investigation. Conclusions: The inclusion in guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild-moderate psoriasis therapeutic approach.noneDe Simone, Clara; Dapavo, Paolo; Malagoli, Piergiorgio; Martella, Alessandro; Campanati, Anna; Campione, Elena; Errichetti, Enzo; Franchi, Chiara; Gambardella, Alessio; Megna, Matteo; Osti, Federica; Ribero, Simone; Zagni, Giovanni; Calzavara-Pinton, Piergiacomo; Fabbrocini, Gabriella; Amoruso, Giuseppe Fabrizio; Baglieri, Francesco; Biamonte, Anna Silvia; Bianchelli, Tommaso; Bigi, Laura; Bortoli, Jarno; Brunetti, Bruno; Buligan, Cinzia; Cagni, Elisabetta; Calderoni, Ombretta; Calzavara-Pinton, Piergiacomo; Campanati, Anna; Caputo, Alighiero; Carrera, Carlo Giovanni; Carugno, Andrea; Chersi, Karin; Cicchelli, Stefano; De Natale, Flora; De Simone, Clara; Dapavo, Paolo; Di Maria, Domenico; Errichetti, Enzo; Fabbrocini, Gabriella; Ferrari, Angelo Salvatore; Fogli, Emanuela; Forconi, Riccardo; Franchi, Chiara; Galeazzi, Augusto; Gambardella, Alessio; Giovannini, Andrea; Giura, Maria Teresa; Iuculano, Massimo; Lazzaretti, Giuseppe; Leporati, Claudia; Magnanini, Massimiliano; Malagoli, Piergiorgio; Marconi, Barbara; Martella, Alessandro; Maruccia, Adriana; Megna, Matteo; Miglietta, Roberta; Minuti, Anna; Mocci, Luigi; Modica, Sonia; Narcisi, Alessandra; Odorici, Giulia; Osti, Federica; Pazzaglia, Massimiliano; Peila, Rossana; Pertusi, Ginevra; Pezza, Michele; Pezzullo, Elio; Puccia, Nunzio; Raulo, Umberto; Ribero, Simone; Rossi, Mariateresa; Rusignuolo, Sergio; Sapienza, Giada; Savarese, Catello; Scalisi, Mariaelena; Strippoli, Davide; Stroppiana, Elena; Tiberio, Rossana; Trischitta, Antonino; Tucci, Maria Giovanna; Vaira, Fabrizio; Verrone, Anna; Villa, Lucia; Zagni, Fabio; Zoccali, AndreaDe Simone, Clara; Dapavo, Paolo; Malagoli, Piergiorgio; Martella, Alessandro; Campanati, Anna; Campione, Elena; Errichetti, Enzo; Franchi, Chiara; Gambardella, Alessio; Megna, Matteo; Osti, Federica; Ribero, Simone; Zagni, Giovanni; Calzavara-Pinton, Piergiacomo; Fabbrocini, Gabriella; Amoruso, Giuseppe Fabrizio; Baglieri, Francesco; Biamonte, Anna Silvia; Bianchelli, Tommaso; Bigi, Laura; Bortoli, Jarno; Brunetti, Bruno; Buligan, Cinzia; Cagni, Elisabetta; Calderoni, Ombretta; Calzavara-Pinton, Piergiacomo; Campanati, Anna; Caputo, Alighiero; Carrera, Carlo Giovanni; Carugno, Andrea; Chersi, Karin; Cicchelli, Stefano; De Natale, Flora; De Simone, Clara; Dapavo, Paolo; Di Maria, Domenico; Errichetti, Enzo; Fabbrocini, Gabriella; Ferrari, Angelo Salvatore; Fogli, Emanuela; Forconi, Riccardo; Franchi, Chiara; Galeazzi, Augusto; Gambardella, Alessio; Giovannini, Andrea; Giura, Maria Teresa; Iuculano, Massimo; Lazzaretti, Giuseppe; Leporati, Claudia; Magnanini, Massimiliano; Malagoli, Piergiorgio; Marconi, Barbara; Martella, Alessandro; Maruccia, Adriana; Megna, Matteo; Miglietta, Roberta; Minuti, Anna; Mocci, Luigi; Modica, Sonia; Narcisi, Alessandra; Odorici, Giulia; Osti, Federica; Pazzaglia, Massimiliano; Peila, Rossana; Pertusi, Ginevra; Pezza, Michele; Pezzullo, Elio; Puccia, Nunzio; Raulo, Umberto; Ribero, Simone; Rossi, Mariateresa; Rusignuolo, Sergio; Sapienza, Giada; Savarese, Catello; Scalisi, Mariaelena; Strippoli, Davide; Stroppiana, Elena; Tiberio, Rossana; Trischitta, Antonino; Tucci, Maria Giovanna; Vaira, Fabrizio; Verrone, Anna; Villa, Lucia; Zagni, Fabio; Zoccali, Andre