Publications by authors named "Chiara Marzorati"

21 Publications

  • Page 1 of 1

"We-Diseases" and Dyadic Decision-Making Processes: A Critical Perspective.

Public Health Genomics 2021 Nov 23:1-5. Epub 2021 Nov 23.

Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.

This is a critical perspective paper discussing the theoretical bases and methodological issues regarding dyadic decision-making processes in the oncological domain. Decision-making processes are of a central interest when one partner in a couple has cancer, and patients and partners make decisions together under an interactive and dynamic process. Given that, the attention in research is progressively shifting from patient and partner considered as individuals to a more holistic view of patient-partner considered as a dyad. The consideration of the dyadic nature of the decision-making represents a challenge from a theoretical and methodological point of view. The Interdependence Theory and the Dyadic Model of decision-making provide the theoretical bases to consider, respectively, the interdependence of the dyadic decision-making and the mechanisms affecting the couple-based decision-making. Dyadic processes require also an appropriate data analysis strategy that is discussed in the study as well. Conclusions of the present critical review suggest to develop a new line of research on dyadic decision-making in the oncological domain, testing the Dyadic Model presented in the study and considering the interdependence of the data with appropriate levels of analysis.
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http://dx.doi.org/10.1159/000518596DOI Listing
November 2021

Remote Relaxation and Acceptance Training for the Management of Stress in Cancer Patients: A Study Protocol.

Front Psychol 2021 13;12:710861. Epub 2021 Oct 13.

Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.

Cancer patients are now facing a double distinctive challenge of survival against both the disease and fear of contracting COVID-19. This challenge has resulted in the forced adoption of social distancing measures and reorganization of the delivery of medical and psychological treatments. The perceived loneliness and uncertainty increased distress and symptoms burden. In the current period, eHealth interventions might provide valuable benefits in the field of cancer care. The overall goal of the study protocol will be to provide an innovative intervention for cancer patients based on an online platform, to help them manage and prevent psychological problems related to social isolation. Specifically, the efficacy of two web-based interventions aimed at lowering stress in cancer patients will be tested and compared. One hundred and fifty participants (75 per group) will be enrolled in a two-group randomized trial. The two interventions will be composed either by exercises on relaxation and meditation practices, presented in both automated online content and interactive group sessions or by fixed psychoeducational online content. Stress, anxiety, and depressive symptoms, distress, resilience, and perceived social isolation will be measured before the start of the interventions (T0), 2 weeks (T1), 4 weeks (T2), and 2 months (T3) after the beginning of the interventions in both groups. A repeated measures ANOVA will be performed to test differences in the questionnaires' scores between groups across the four-time points. We hypothesized greater improvement in the specific domain of stress symptoms (IES-R) assessed in the group receiving the interactive intervention, compared to the group which will receive only fully automated psychoeducational content. Secondarily, we expect the same trend of improvement across all the psychological variables in the blended intervention group. Implementing these practices on people who are forced into mandatory social isolation may help them become more aware of their mind-body condition and reduce negative effects. Moreover, relaxation techniques help individuals in achieving a greater state of well-being, increasing the ability to cope with stressful situations (resilience), and strengthening the immune system.
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http://dx.doi.org/10.3389/fpsyg.2021.710861DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8548685PMC
October 2021

Cognitive, emotional, and behavioral mediators of the impact of coping self-efficacy on adaptation to breast cancer: An international prospective study.

Psychooncology 2021 09 24;30(9):1555-1562. Epub 2021 May 24.

Helsinki University Hospital Comprehensive Cancer Center, and Helsinki University, Helsinki, Finland.

Objective: The main objective of this prospective multicenter study was to examine whether illness representations of control, affect, and coping behaviors mediate the effects of self-efficacy to cope with cancer on psychological symptoms and overall quality of life, in breast cancer patients.

Method: Data from 413 women (Mean age = 54.87; SD = 8.01), coming from four countries (i.e., Finland, Israel, Italy, Portugal), who received medical therapy for their early breast cancer, were analyzed. Coping self-efficacy was assessed at baseline. Potential mediators were assessed three months later, and outcomes after six months.

Results: Coping self-efficacy was related to all mediators and outcomes. Illness representations of treatment control, positive and negative affect, and certain coping behaviors (mostly, anxiety preoccupation) mediated the effects of coping self-efficacy. Coping self-efficacy was related to each outcome through a different combination of mediators.

Conclusions: Coping self-efficacy is a major self-regulation factor which is linked to well-being through multiple cognitive, emotional, and behavioral pathways. Enhancement of coping self-efficacy should be a central intervention goal for patients with breast cancer, towards promotion of their well-being.
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http://dx.doi.org/10.1002/pon.5730DOI Listing
September 2021

A meta-analysis on heart rate variability biofeedback and depressive symptoms.

Sci Rep 2021 03 23;11(1):6650. Epub 2021 Mar 23.

Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.

Heart rate variability biofeedback (HRVB) has been used for a number of years to treat depressive symptoms, a common mental health issue, which is often comorbid with other psychopathological and medical conditions. The aim of the present meta-analysis is to test whether and to what extent HRVB is effective in reducing depressive symptoms in adult patients. We conducted a literature search on Pubmed, ProQuest, Ovid PsycInfo, and Embase up to October 2020, and identified 721 studies. Fourteen studies were included in the meta-analysis. Three meta-regressions were also performed to further test whether publication year, the questionnaire used to assess depressive symptoms, or the interval of time between T0 and T1 moderated the effect of HRVB. Overall, we analysed 14 RCTs with a total of 794 participants. The random effect analysis yielded a medium mean effect size g = 0.38 [95% CI = 0.16, 0.60; 95% PI =  - 0.19, 0.96], z = 3.44, p = 0.0006. The total heterogeneity was significant, Q = 23.49, p = 0.03, I = 45%, which suggested a moderate variance among the included studies. The year of publication (χ(1) = 4.08, p = 0.04) and the questionnaire used to assess symptoms (χ(4) = 12.65, p = 0.01) significantly moderated the effect of the interventions and reduced heterogeneity. Overall, results showed that HRVB improves depressive symptoms in several psychophysiological conditions in adult samples and should be considered as a valid technique to increase psychological well-being.
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http://dx.doi.org/10.1038/s41598-021-86149-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988005PMC
March 2021

One-Year Quality of Life Trends in Early-Stage Lung Cancer Patients After Lobectomy.

Front Psychol 2020 10;11:534428. Epub 2020 Dec 10.

Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.

Quality of Life (QoL) is an important predictor of patient's recovery and survival in lung cancer patients. The aim of the present study is to identify 1-year trends of lung cancer patients' QoL after robot-assisted or traditional lobectomy and investigate whether clinical (e.g., pre-surgery QoL, type of surgery, and perioperative complications) and sociodemographic variables (e.g., age) may predict these trends. An Italian sample of 176 lung cancer patients undergoing lobectomy completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) at the pre-hospitalization (t0), 30 days (t1), 4 months (t2), 8 months (t3), and 12 months (t4) after surgery. Sociodemographic and clinical characteristics (age, gender, perioperative complications, and type of surgery) were also collected. The individual change over time of the 15 dimensions of the EORTC QLQ-C30 and the effects of pre-surgery scores of QoL dimensions, type of surgery, perioperative complications, and age on patients' QoL after surgery were studied with the individual growth curve (IGC) models. Patients had a good recovery after lobectomy: functioning subscales improved over time, while most of the symptoms became less severe over the care process. Perioperative complications, type of surgery, pre-surgery status, and age significantly affected these trends, thus becoming predictors of patients' QoL. This study highlights different 1-year trends of lung cancer patients' QoL. The measurement of pre- and post-surgery QoL and its clinical and sociodemographic covariables would be necessary to better investigate patients' care process and implement personalized medicine in lung cancer hospital divisions.
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http://dx.doi.org/10.3389/fpsyg.2020.534428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758417PMC
December 2020

Web-Based Relaxation Intervention for Stress During Social Isolation: Randomized Controlled Trial.

JMIR Ment Health 2020 Dec 3;7(12):e22757. Epub 2020 Dec 3.

University of Milan, Department of Oncology and Hematology-Oncology, Milan, Italy.

Background: Relaxation practices might be helpful exercises for coping with anxiety and stressful sensations. They may be of particular utility when used in web-based interventions during periods of social isolation.

Objective: This randomized study aimed to test whether web-based relaxation practices like natural sounds, deep respiration, and body scans can promote relaxation and a positive emotional state, and reduce psychomotor activation and preoccupation related to the COVID-19 pandemic.

Methods: Participants were randomly assigned to one of three experimental conditions. Each condition was characterized by a single online session of a guided square breathing exercise, a guided body scan exercise, or natural sounds. The participants listened to one of the fully automated audio clips for 7 minutes and pre-post completed self-assessed scales on perceived relaxation, psychomotor activation, level of preoccupation associated with COVID-19, and emotional state. At the end of the session, qualitative reports on subjective experience were also collected.

Results: Overall, 294 participants completed 75% of the survey and 240 completed the entire survey as well as one of three randomly assigned interventions. Perceived relaxation, psychomotor activation/stress, and preoccupation related to COVID-19 showed a positive improvement after participants listened to the audio clips. The same pattern was observed for the valence and perceived dominance of the emotional state. The square breathing and body scan exercises yielded superior results compared to natural sounds in lowering perceived stress.

Conclusions: This study provides a novel insight that can guide the development of future low-cost web-based interventions to reduce preoccupation and stress in the general population.

International Registered Report Identifier (irrid): RR2-10.2196/19236.
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http://dx.doi.org/10.2196/22757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080491PMC
December 2020

An Internet-Based Intervention to Alleviate Stress During Social Isolation With Guided Relaxation and Meditation: Protocol for a Randomized Controlled Trial.

JMIR Res Protoc 2020 Jun 17;9(6):e19236. Epub 2020 Jun 17.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

Background: Psychophysiological stress and decreased well-being are relevant issues during prolonged social isolation periods. Relaxation practices may represent helpful exercises to cope with anxiety and stressful sensations.

Objective: The aim of this research protocol is to test whether remote relaxation practices such as natural sounds, deep respiration, and body scan meditation promote relaxation and improved emotional state and reduce psychomotor activation and the preoccupation related to the coronavirus disease (COVID-19) pandemic.

Methods: The study population will consist of 3 experimental groups that will randomly receive one of 3 internet-based audio clips containing a single session of guided breathing exercise, guided body scan exercise, or natural sounds. The participants will listen to the fully automated audio clip for 7 minutes and complete pre-post self-assessment scales on their perceived relaxation, psychomotor activation, level of worry associated with COVID-19, and emotional state. At the end of the session, the participants will also be asked to provide qualitative reports on their subjective experiences.

Results: Analyses will be performed to test the differences in the efficacy of the different audio clips in an internet-based intervention on 252 participants (84 per group), investigating whether natural sounds or remote guided practices such as deep respiration and body scan meditation positively enhance the participants' perceived psychological state.

Conclusions: The study will provide information on if and to what extent guided practices can help in reducing psychological side effects related to social isolation during the COVID-19 pandemic.

International Registered Report Identifier (irrid): PRR1-10.2196/19236.
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http://dx.doi.org/10.2196/19236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301689PMC
June 2020

Dimensionality and Measurement Invariance of the Italian Version of the EORTC QLQ-C30 in Postoperative Lung Cancer Patients.

Front Psychol 2019 8;10:2147. Epub 2019 Oct 8.

Department of Oncology and Hemato-Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.

Background: This study aims to validate and evaluate the psychometric properties and measurement invariance of the Italian version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30), which is a measure of quality of life (QoL) for lung cancer patients after surgery.

Methods: A total of 167 lung cancer patients completed the Italian version of the EORTC QLQ-C30 questionnaire at 30 days after they received a lobectomy. The factor structure of this scale was assessed by performing confirmatory factor analysis (CFA). Measurement invariance was evaluated by considering differential item functioning (DIF) due to age, gender, and type of surgery (i.e., robot- or not robot-assisted).

Results: The CFA demonstrated the validity of the factor structure of the EORTC QLQ-C30 in assessing overall health and eight distinct subscales of adverse events and functioning. Moreover, the results highlighted a minimal DIF with only trivial consequences on measurement invariance. Specifically, the DIF did not affect the mean differences of latent scores of QoL between patients undergoing robot-assisted surgery or traditional surgery.

Conclusion: These findings supported the validity and suitability of the EORTC QLQ-C30 for the assessment of QoL in lung cancer patients of diverse ages and genders undergoing lobectomy with or without robot-assisted surgery.
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http://dx.doi.org/10.3389/fpsyg.2019.02147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792474PMC
October 2019

Validation of the Italian version of the abbreviated expanded prostate Cancer index composite (EPIC-26) in men with prostate Cancer.

Health Qual Life Outcomes 2019 Aug 29;17(1):147. Epub 2019 Aug 29.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

Background: This study aims to validate and evaluate the psychometric properties and reliability of the Italian version of the Expanded Prostate Cancer Index Composite - Short Form (EPIC-26), a measure of quality of life (QoL) for prostate cancer patients.

Methods: Two hundred and eighty-four prostate cancer patients completed the Italian version of the EPIC-26 questionnaire at 45 days (T1) and 3 months (T2) after robot-assisted radical prostatectomy (RARP). Psychometric properties were evaluated using structural equation modeling: the goodness of fit of the correlated five-factor model (CFFM) for the EPIC-26 was assessed using the confirmatory factor analysis (CFA), while longitudinal invariance was conducted to assess the ability of the EPIC-26 to measure QoL construct over time. Test-retest reliability was assessed as well by considering intraclass correlations.

Results: At T1, the CFFM model displayed a good fit to data. Similarly, the model showed an adequate fit also at T2. Results of the reliability analysis attested the acceptable internal consistency and test-retest reliability of each dimension: all Cronbach's alphas could be classified as acceptable (i.e., above .65) except for low Cronbach's alpha for hormonal dysfunction at T1 (i.e., .638) and urinary irritation at both waves. (i.e., respectively .585 and .518). Finally, psychometric properties were invariant over time and each of the five dimensions of QoL displayed from moderate (all ICCs above .500) to good test-retest reliability (i.e. ICC for urinary incontinence = .764).

Conclusions: Results of the CFA and the measurement invariance analysis demonstrated the validity of the Italian version of the EPIC-26 to assess QoL in prostate cancer patients. Its reliability and good psychometric qualities are well-supported, thus providing a valid tool to assess health-related quality of life and its change over time in prostate cancer patients.
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http://dx.doi.org/10.1186/s12955-019-1214-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716830PMC
August 2019

Predicting trajectories of recovery in prostate cancer patients undergone Robot-Assisted Radical Prostatectomy (RARP).

PLoS One 2019 4;14(4):e0214682. Epub 2019 Apr 4.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

Objective: To identify trends of patients' urinary and sexual dysfunctions from a clinical and psychological perspective and understand whether sociodemographic and medical predictors could differentiate among patients following different one-year longitudinal trajectories.

Methods: An Italian sample of 478 prostate cancer patients undergone Robot-Assisted Radical Prostatectomy completed the EPIC-26 survey between July 2015 and July 2016 at the pre-hospitalization (T0), 45 days (T1) and 3 (T2), 6 (T3), 9 (T4), and 12 months (T5) after surgery. Sociodemographic and clinical characteristics (age, BMI, diabetes, nerve-sparing procedure) were also collected. Latent Class Growth Analysis was conducted separately for sexual dysfunction and urinary incontinence EPIC-26 subscales. The association between membership in the two longitudinal trajectories of urinary and sexual dysfunctions was assessed by considering Chi-square test and its related contingency table.

Results: People who have a high level of urinary incontinence at T1 are likely to have a worse recovery. Age, BMI and pre-surgical continence may affect the level of incontinence at T1 and the recovery trajectories. Patients with low and moderate sexual problems at T1 can face a moderate linear recovery, while people with high level of impotence immediately after surgery may take a longer period to solve sexual dysfunctions. Age and the pre-surgical sexual condition may impact the recovery. Finally, a great proportion of patients reported both steady problems in sexual function and constant high levels of urinary incontinence over time.

Conclusions: This study highlights different categories of patients at risk who may be important to know in order to develop personalized medical pathways and predictive models in a value-based healthcare.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214682PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448842PMC
January 2020

Empowerment from patient's and caregiver's perspective in cancer care.

Health Psychol Open 2018 Jul-Dec;5(2):2055102918815318. Epub 2018 Dec 5.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

The caregivers' perceptions of the patients' health condition may be biased and induce them to perceive higher needs than patients actually disclose. Our aim was to assess if the level of knowledge and awareness about cancer disease and treatment, and patient participation and assistance differs between caregivers and patients. A descriptive, cross-sectional study was conducted across five countries (Italy, United Kingdom, Spain, France and Germany) on a total of 510 participants who directly (patient) or indirectly (caregiver) faced a cancer diagnosis. Investigating this divergence could help to identify possible difficulties in patient-caregiver relationship, eventually improving patient empowerment.
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http://dx.doi.org/10.1177/2055102918815318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299910PMC
December 2018

A Modified Translaryngeal Tracheostomy Technique in the Neurointensive Care Unit. Rationale and Single-center Experience on 199 Acute Brain-damaged Patients.

J Neurosurg Anesthesiol 2019 Jul;31(3):330-336

School of Medicine and Surgery, University of Milan-Bicocca.

Background: Brain-injured patients frequently require tracheostomy, but no technique has been shown to be the gold standard for these patients. We developed and introduced into standard clinical practice an innovative bedside translaryngeal tracheostomy (TLT) technique aided by suspension laryngoscopy (modified TLT). During this procedure, the endotracheal tube is left in place until the airway is secured with the new tracheostomy. This study assessed the clinical impact of this technique in brain-injured patients.

Materials And Methods: This is a retrospective analysis of prospectively collected data from adult brain-injured patients who had undergone modified TLT during the period spanning from January 2010 to December 2016 at the Neurointensive care unit, San Gerardo Hospital (Monza, Italy). The incidence of intraprocedural complications, including episodes of intracranial hypertension (intracranial pressure [ICP] >20 mm Hg), was documented. Neurological, ventilatory, and hemodynamic parameters were retrieved before, during, and after the procedure. Risk factors for complications and intracranial hypertension were assessed by univariate logistic analysis. Data are presented as n (%) and median (interquartile range) for categorical and continuous variables, respectively.

Results: A total of 199 consecutive brain-injured patients receiving modified TLT were included. An overall 52% male individuals who were 66 (54 to 74) years old and who had an admission Glasgow Coma Scale of 7 (6 to 10) were included in the cohort. Intracerebral hemorrhage (30%) was the most frequent diagnosis. Neurointensivists performed 130 (65%) of the procedures. Patients underwent tracheostomy 10 (7 to 13) days after intensive care unit admission. Short (ie, <2 min) and clinically uneventful increases in ICP>20 mm Hg were observed in 11 cases. Overall, the procedure was associated with an increase in ICP from 7 (4 to 10) to 12 (7 to 18) mm Hg (P<0.001). Compared with baseline, cerebral perfusion pressure (CPP), respiratory variables, and hemodynamics were unchanged during the procedure (P-value, not significant). Higher baseline ICP and core temperature were associated with an increased risk of complications and intracranial hypertension. Complication rates were low: 1 procedure had to be converted to a surgical tracheostomy, and 1 (0.5%) episode of minor bleeding and 5 (2.5%) of minor non-neurological complications were recorded. Procedures performed by intensivists did not have a higher risk of complications compared with those performed by ear, nose, and throat specialists.

Conclusions: A modified TLT (by means of suspension laryngoscopy) performed by neurointensivists is feasible in brain-injured patients and does not adversely impact ICP and CPP.
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http://dx.doi.org/10.1097/ANA.0000000000000535DOI Listing
July 2019

Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review.

J Med Internet Res 2018 06 18;20(6):e223. Epub 2018 Jun 18.

Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.

Background: The number of published studies and systematic reviews examining different telehealth interventions targeting patients and their effects on patients' well-being and quality of life have grown in recent decades. However, the use of telemedicine tools aimed at the family members and caregivers of adult cancer patients is less defined.

Objective: We aimed to conduct a systematic review to provide a more complete picture regarding telemedicine tools for informal caregivers (usually family members or close friends) implemented in all phases of cancer care. More specifically, the review aimed to better describe the study samples' characteristics, to analyze measured outcomes and the specific questionnaires used to assess them, and to describe in depth the implemented interventions and their formats. Finally, we examined the role of telehealth, and usability and feasibility trends in supporting patients' caregivers.

Methods: We systematically searched the literature in the following databases: Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, MEDLINE, EMBASE, Google Scholar, and PsycINFO. Inclusion criteria were being written in English, published in peer-reviewed journals, describing a telehealth-implemented intervention, and focusing on caregivers of adult cancer patients at any stage of the disease. We selected studies published up to November 2017. We critically appraised included articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and graded the quality of evidence by outcome using the Centre for Evidence-Based Medicine framework.

Results: We included 24 studies in the final selection. In 21 of the 24 studies, the patient-caregiver dyad was analyzed, and the study population dealt with different types of cancer at different stages. Included studies considered the caregiver's condition from both an individual and a relational point of view. Along with psychosocial variables, some studies monitored engagement and user satisfaction regarding Web-based platforms or telehealth interventions. All studies reported significant improvements in some of the investigated areas, but they often showed small effect sizes. Two types of telehealth intervention formats were used: Web-based platforms and telephone calls. Some of the included studies referred to the same project, but on study samples with different cancer diagnoses or with new versions of previously developed interventions.

Conclusions: Reported outcomes seem to suggest that we are in an exploratory phase. More detailed and targeted research hypotheses are still needed. Clarifying caregivers' needs related to telehealth tools and better defining outcome measures may yield more significant results.
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http://dx.doi.org/10.2196/jmir.9812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028768PMC
June 2018

Intracerebral hemorrhage in Intensive Care Unit: early prognostication fallacies. A single center retrospective study.

Minerva Anestesiol 2018 05 6;84(5):572-581. Epub 2017 Nov 6.

School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy -

Background: Intracerebral hemorrhage (ICH) admitted to Intensive Care is deem of poor prognosis. The aim of this study was to compare observed and predicted 30-day mortality and to evaluate long term functional outcome in a consecutive ICH cohort.

Methods: Retrospective analysis of prospectively collected data of ICH patients managed in a Neuro-ICU from 2012 to 2015.

Results: Out of 136 consecutive patients, 34 (25%) had "withholding of life-sustaining treatment" (WLST) order and 102 (75%) received a "full treatment" (FT). WLST cohort: median (IQR): 72 (70-77) years old, Glasgow Coma Scale (GCS) 4 (3-4) at admission, ICH volume 114 cm3 (68-152); all patients died during neuro-ICU recovery, 28 (82%) patients had brain death diagnosis and 15 (54%) of these were organ donors. FT cohort: 67 (51-73) years old, GCS 9 (6-12) at admission, ICH volume 46 (24-90) cm3, neurosurgery for clot removal in 65 (64%) (P<0.05 vs. WLST cohort for each of previously listed variables); 13 (13%) patients died during neuro-ICU recovery, of these 11 (85%) patients had brain death diagnosis and 4 (36%) of them were organ donors. Overall 30-day observed mortality for FT group was 18% (95% CI: 11-26%). Patients with ICH Score 1, 2, 3, 4+ had 0%, 10%, 16% and 26% 30-day mortality, respectively (P<0.01 vs. ICH Score). Full treatment group 180-day mortality was 32% (95% CI: 24-42%). Modified Rankin Scale (mRS) after one year was ≤3 in 35 (35%), i.e. good recovery, and >3 in 64 (65%). Neurosurgery for clot removal was associated with a lower 30 and 180-day mortality (P=0.01 and P=0.03, respectively) and along with GCS at admission it was an independent significant prognostic factor.

Conclusions: Mortality and functional outcome is less severe than predicted in patients with ICH receiving a full medical and/or surgical treatment.
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http://dx.doi.org/10.23736/S0375-9393.17.12225-XDOI Listing
May 2018

Professor Umberto Veronesi: a physician, a researcher, a brilliant man.

Ecancermedicalscience 2017 8;11:742. Epub 2017 Jun 8.

Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), Via Ripamonti 435, Milan 20139, Italy.

Many of those who work in oncology or deal with cancer patients know of Prof. Umberto Veronesi and none of them could deny the importance of his battle against cancer. He devoted his life to improving cancer treatment and quality of life for patients. He was a physician, and a politician, but above all he was a researcher. He embodied the true spirit of research, i.e., to believe in something and investigate every aspect of it until all the questions about it have been satisfactorily answered. He never gave up when faced with challenges, and he never stopped being curious. He believed in science, because he wanted to believe in the future. He mixed scientific knowledge with human warmth and was the pioneer of many breast cancer innovations. From the beginning of Prof. Veronesi's career, his mission was clear: ''.
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http://dx.doi.org/10.3332/ecancer.2017.742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481193PMC
June 2017

Neurological failure in ICU patients with hematological malignancies: A prospective cohort study.

PLoS One 2017 9;12(6):e0178824. Epub 2017 Jun 9.

Centre Hospitalier de Versailles, Medical-Surgical Intensive Care Unit, Le Chesnay, France.

Background: Epidemiological studies of neurological complications in patients with hematological malignancies are scant. The objective of the study was to identify determinants of survival in patients with hematological malignancy and neurological failure.

Methods: Post hoc analysis of a prospective study of adults with hematological malignancies admitted for any reason to one of 17 university or university-affiliated participating ICUs in France and Belgium (2010-2012). The primary outcome was vital status at hospital discharge.

Results: Of the 1011 patients enrolled initially, 226 (22.4%) had neurological failure. Presenting manifestations were dominated by drowsiness or stupor (65%), coma (32%), weakness (26%), and seizures (19%). Neuroimaging, lumbar puncture, and electroencephalography were performed in 113 (50%), 73 (32%), and 63 (28%) patients, respectively. A neurosurgical biopsy was done in 1 patient. Hospital mortality was 50%. By multivariate analysis, factors independently associated with higher hospital mortality were poor performance status (odds ratio [OR], 3.99; 95%CI, 1.82-9.39; P = 0.0009), non-Hodgkin's lymphoma (OR, 2.60; 95%CI, 1.35-5.15; P = 0.005), shock (OR, 1.95; 95%CI, 1.04-3.72; P = 0.04), and respiratory failure (OR, 2.18; 95%CI, 1.14-4.25; P = 0.02); and factors independently associated with lower hospital mortality were GCS score on day 1 (OR, 0.88/point; 95%CI, 0.81-0.95; P = 0.0009) and autologous stem cell transplantation (OR, 0.25; 95%CI, 0.07-0.75; P = 0.02).

Conclusions: In ICU patients with hematological malignancies, neurological failure is common and often fatal. Independent predictors of higher hospital mortality were type of underlying hematological malignancy, poor performance status, hemodynamic and respiratory failures, and severity of consciousness impairment. Knowledge of these risk factors might help to optimize management strategies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0178824PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466302PMC
September 2017

Rumination in breast and lung cancer patients: Preliminary data within an Italian sample.

Psychooncology 2018 02 16;27(2):703-705. Epub 2017 Jun 16.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

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http://dx.doi.org/10.1002/pon.4468DOI Listing
February 2018

Value as the key concept in the health care system: how it has influenced medical practice and clinical decision-making processes.

J Multidiscip Healthc 2017 21;10:101-106. Epub 2017 Mar 21.

Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

In the last 10 years, value has played a key role in the health care system. In this concept, innovations in medical practice and the increasing importance of patient centeredness have contributed to draw the attention of the medical community. Nonetheless, a large consensus on the meaning of "value" is still lacking: patients, physicians, policy makers, and other health care professionals have different ideas on which component of value may play a prominent role. Yet, shared clinical decision-making and patient empowerment have been recognized as fundamental features of the concept of value. Different paradigms of health care system embrace different meanings of value, and the absence of common and widely accepted definition does not help to identify a unique model of care in health care system. Our aim is to provide an overview of those paradigms that have considered value as a key theoretical concept and to investigate how the presence of value can influence the medical practice. This article may contribute to draw attention toward patients and propose a possible link between health care system based on "value" and new paradigms such as patient-centered system (PCS), patient empowerment, and P5 medicine, in order to create a predictive, personalized, preventive, participatory, and psycho-cognitive model to treat patients. Indeed, patient empowerment, value-based system, and P5 medicine seem to shed light on different aspects of a PCS, and this allows a better understanding of people under care.
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http://dx.doi.org/10.2147/JMDH.S122383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367583PMC
March 2017

Who Is a Cancer Survivor? A Systematic Review of Published Definitions.

J Cancer Educ 2017 Jun;32(2):228-237

Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 432, 20143, Milan, Italy.

The term "cancer survivor" is commonly used by different persons, clinical institutions, academic bodies, and political organizations although it lacks of a unanimous and detailed definition. The objective of the study is to make a systematic review of published and proposed definitions of "cancer survivor." Utilizing a systematic search strategy with different strings of "cancer survivor," we searched the following databases: Medline (June 1975-June 2015), Scopus (all the years), Web of Science (all the years), Google Scholar (all the years), ERIC (all the years). This review suggests that there is not a unique definition of who is a "cancer survivor" and what is "cancer survivorship." However, the most widely used definition sees cancer survivorship as a process that begins at the moment of diagnosis and continues through the balance of life. This definition highlights psychological and legal patient's needs-as well as medical ones-to receive care and assistance from the beginning and, at the same time, it establishes valid criteria for making scientific and statistical sampling research. The extensive use of the term "cancer survivor" indicates that it is a significant term. This review has been written to outline the state of the art and it invites to reflect on a shared definition that could satisfy both clinical and research aspects. Implication for cancer survivors: this compendium of proposed definitions may improve communication among the many patients and patient organizations that use and work with this term.
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http://dx.doi.org/10.1007/s13187-016-0997-2DOI Listing
June 2017

A neurofeedback-based intervention to reduce post-operative pain in lung cancer patients: study protocol for a randomized controlled trial.

JMIR Res Protoc 2015 May 4;4(2):e52. Epub 2015 May 4.

University of Milan, Department of Health Science, Milan, Italy.

Background: Thoracic surgery appears to be the treatment of choice for many lung cancers. Nevertheless, depending on the type of surgery, the chest area may be painful for several weeks to months after surgery. This painful state has multiple physical and psychological implications, including respiratory failure, inability to clear secretions by coughing, and even anxiety and depression that have negative effects on recovery.

Objective: The aim of this study is to evaluate the effect of a neurofeedback-based intervention on controlling acute post-surgery pain and improving long-term recovery in patients who undergo thoracotomy for lung resection for non-small cell lung cancer (NSCLC) at an academic oncologic hospital.

Methods: This study will be based on a 2-parallel group randomized controlled trial design, intervention versus usual care, with multiple in-hospital assessments and 2 clinical, radiological, and quality of life follow-ups. Participants will be randomized to either the intervention group receiving a neurofeedback-based relaxation training and usual care, or to a control group receiving only usual care. Pain intensity is the primary outcome and will be assessed using the Numeric Pain Rating Scale (NRS) in the days following the operation. Secondary outcomes will include the effect of the intervention on hospital utilization for pain crisis, daily opioid consumption, anxiety, patient engagement, blood test and chest x-ray results, and long-term clinical, radiological, and quality of life evaluations. Outcome measures will be repeatedly taken during hospitalization, while follow-up assessments will coincide with the follow-up visits. Pain intensity will be assessed by mixed model repeated analysis. Effect sizes will be calculated as mean group differences with standard deviations.

Results: We expect to have results for this study before the end of 2016.

Conclusions: The proposed innovative, neurofeedback- and relaxation-based approach to support post-surgery pain management could lead to significant improvements in patient short and long-term outcomes.
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http://dx.doi.org/10.2196/resprot.4251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436521PMC
May 2015

Emergence delirium, pain or both? A challenge for clinicians.

Paediatr Anaesth 2015 May 8;25(5):524-9. Epub 2015 Jan 8.

Department of Anaesthesia and Intensive Care, Niguarda Ca' Granda Hospital, Milan-Bicocca University, Milan, Italy.

Background: Children commonly display early postoperative negative behavior (e-PONB) after general anesthesia, which includes emergence delirium (ED), discomfort, temperament, and pain. However, it is often difficult for the caregiver to discriminate between various aspects of e-PONB.

Objective: This prospective observational study evaluates the possibility to distinguish between ED and pain in young children using validated pediatric observational scales in the early postoperative phase.

Methods: Following institutional approval and written consent, children undergoing elective adenoidectomy and/or tonsillectomy were enrolled. Following standardized anesthesia, two trained observers simultaneously evaluated children's behavior with the Paediatric Anaesthesia Emergence Delirium Scale (PAED) and with the Face, Legs, Activity, Cry, Consolability scale (FLACC) at extubation, and at 5, 10, and 15 min.

Results: Of 150 children that completed the study, 32 (21%) had ED, 7 (5%) had pain, and 98 (65%) had simultaneously both ED and pain. The association of 'No eye contact', 'No purposeful action' and 'No awareness of surroundings' (ED1) had a sensitivity of 0.96 and a specificity of 0.80 (PPV 0.97, NPV 0.78) to identify ED. 'Inconsolability' and 'Restlessness' (ED2) had a sensitivity of 0.69 and a specificity of 0.88 (PPV 0.83 and NPV 0.78) to identify pain.

Conclusion: It is difficult to differentiate between ED and pain using FLACC and PAED scores. 'No eye contact', 'No purposeful action', and 'No awareness of surroundings' significantly correlated with ED. 'Inconsolability' and 'Restlessness' are not reliable enough to identify pain or ED in the first 15 min after awakening.
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http://dx.doi.org/10.1111/pan.12580DOI Listing
May 2015
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