Le esigenze cliniche del paziente oncologico in terapia

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1 Cisef Centro Internazionale di Studi e Formazione Germana Gaslini - Genova Le esigenze cliniche del paziente oncologico in terapia Andrea De Censi, MD S.C. Oncologia Medica Ospedali Galliera, Genova Honorary Professor Wolfson Institute of Preventive Medicine Barts & The London School of Medicine & Dentistry Queen Mary University of London

2 Lesson from cardiology. Placing resources on preventive therapy has resulted in a significant reduction of cardiovascular death From Jemal, A. et al. CA Cancer J Clin 2010;60:

3 Table 7. 3 Leading Causes of Death by Age and Sex, United States, 2012 ALL AGES AGES 40 TO 59 AGES 60 TO 79 Male Female Male Female Male Female All Causes All Causes All Causes All Causes All Causes All Causes 1,273,722 1,269, , , , ,343 Heart diseases 312,491 Heart diseases 287,220 Cancer 54,140 Cancer 50,462 Cancer 161,254 Cancer 132,104 Cancer 305,670 Cancer 276,953 Heart diseases 51,906 Heart diseases 21,666 Heart diseases 121,201 Heart diseases 73,030 Accidents Unintentional injuries) 80,010 Cerebro-vacular diseases 75,908 Accidents unintentional injuries) 25,157 Accidents unintentional injuries) 12,226 Chronic lower respiratory diseases 32,909 Chronic lower respiratory diseases 32,460 Siegel R. et al, CA CANCER J CLIN 2016

4 Time Trends in Annual Death Rates ( ) by Disease in Italy 500,0 Death Rates 450,0 400,0 350,0 300,0 250,0 200,0 150,0 100,0 50,0 Infective diseases Cancer Psychic disorders and nervous system diseases Cardiovascular diseases Respiratory diseases Gastrointestinal diseases Other diseases Undefined symptoms and diseases Accidents and other Violent Deaths 0, Italian Institute of Statistics (ISTAT) 2012

5 Siegel R. et al, CA CANCER J CLIN 2016

6 PREVALENZA DI TUMORE IN ITALIA (AIRTUM) Anno Numero di sopravissuti Incidenza L incremento è dovuto alla crescita dell incidenza di alcune neoplasie, ma anche al miglioramento della sopravvivenza e alla sempre maggior longevità degli italiani. 17/03/16

7 17/03/16 Numero di persone che vivono con una diagnosi di tumore in Italia (AIRTUM)

8 GALLIERA OUTOME RESEARCH PROJECT Determinare incidenza, prevalenza, tipo e mortalità dei SAE negli ultimi 7 anni in una Struttura di DH di Oncologia Medica ospedaliera Campione di 3972 pazienti pari a 8100 schede di terapia antineoplastiche negli anni gli eventi avversi severi (SAE)

9 SAE per anno, per mese e degenza media

10 Distribuzione Rapporto Sae/Pazienti annui Rispetto Mediana periodo Tasso SAE Rapporto SAE/Pazienti annui

11 Distribuzione Rapporto Decessi/Pazienti Rapporto Decessi/Pazienti anni annui Rispetto Mediana periodo Tasso DECESSI

12 Esito dei Ricoveri

13 Decessi per mese e per anno

14 EVENTO DIAGNOSTICA Febbre Emocromo (controllo neutrofili) Parametri vitali (PA, FC, spo2) Vomito/Diarrea/Gastralgia Cefalea Astenia, Fatigue Emorroidi con /senza sanguinamento Ipertensione Elettroliti (Na, K, Cl, Mg) Parametri vitali (PA, FC, spo2) Parametri vitali (PA, FC, spo2) Emocromo (HB) Emocromo Monitoraggio pressorio Parametri vitali (FC, spo2) Ipotensione, Vertigini Monitoraggio pressorio Parametri vitali (FC, spo2) Epistassi Cistite Algie diffuse Calo del visus Emocromo Urino cultura Emocromo, Ioni + Mg Acido Urico, PCR Parametri vitali ( PA, FC, spo2)

15 esmart

16 esmart

17 esmart: Randomised Controlled Trial to Evaluate Electronic Symptom Management Using the Advanced Symptom Management System (ASyMS) Remote Technology for Patients With Cancers Start date February 2015 End date February 2019 Accrual target: 1108 patients The study aims to compare a number of outcomes of patients using the ASyMS intervention with outcomes of patients who receive normal care at their hospital Patients allocated to the mobile phone group will enter information on the phone regarding any symptoms they are experiencing, take their temperature and enter this on the phone The information is sent via secure connection to a computer, which assesses the information and sends an alert to their health care professional in the hospital, who will call the patient at home if the patient has reported problematic symptoms Patients in the normal care group will receive care as normal at their hospital. Both groups of patients will be asked to complete a series of questionnaires before they start treatment, after each chemotherapy cycle and at3, 6, 9, 12 months after treatment completion The study will also evaluate the cost benefit of ASyMS, assess changes in clinical practice as a result of ASyMS and develop a predictive risk model (statistical model) for use in future care of patients receiving chemotherapy for these cancers This multicentre study is taking place across a number of European countries.

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