Maura Massimino

New strategies to ensure good patient–physician communication when treating adolescents and young adults with cancer: the proposed model of the Milan Youth Project

Adolescence is a particularly complex time of life, entailing physiological, psycho- logical, and social changes that further the individuals cognitive, emotional, and social growth. Being diagnosed with cancer at this time can have important consequences on an individuals emotional and physical development, and adolescent and young adult cancer patients have par- ticular medical and psychosocial needs. Patient-physician communications are important in any clinical relationship, but fundamental in the oncological sphere because their quality can affect the patient-physician relationship, the therapeutic alliance, and patient compliance. A major challenge when dealing with adolescent and young adult patients lies in striking the right bal- ance between their need and right to understand their disease, treatment, and prognosis, and the need for them to remain hopeful and to protect their emotional sensitivity. We herein describe the activities of the Youth Project of the Istituto Nazionale Tumori in Milan, Italy in order to share a possible model of interaction with these special patients and the tactics our group has identified to help them communicate and share their thoughts. This model implies not only the involvement of a multidisciplinary team, including psychologists and spirituality experts, but also the constitution of dedicated creative activities to give patients the opportunity to express feelings they would otherwise never feel at ease putting into words. These efforts seek the goal to minimize the potentially traumatic impact of disease on the patients psychological well-being. Our group focused also on communication using modern media as vehicles of information, eg, integrating the use of social networks in the involvement of patients in adolescent- and young adult-dedicated activities and uploading informative videos on YouTube.

Tra psicoterapia e neuroscienze: il racconto dei sogni nel lavoro di supporto psicologico dei pazienti affetti da neoplasie dell’età pediatrica

Le possibilita di cura dei bambini e degli adolescenti malati di tumore sono aumentate grandemente negli ultimi decenni; come conseguenza di questi progressi, la qualita di vita e gli aspetti psicologici di questi pazienti sono diventati obiettivi centrali delle cure in questo ambito. Ammalarsi di un tumore in eta evolutiva mette alla prova l’adattamento psichico in una fase cruciale per la costruzione dell’identita, delle relazioni e dell’autonomia; occuparsi di questi pazienti quindi offre importanti occasioni di conoscenza sull’adattamento a gravi eventi stressanti e sull’efficacia di un supporto psicologico precoce. In questo lavoro e illustrato il ruolo dell’utilizzare il sogno nella consultazione psicologica o nella psicoterapia di pazienti in eta evolutiva affetti da neoplasie e dei loro famigliari. L’uso del sogno e proposto in questo testo in una prospettiva chiave narrativa e non interpretativa, all’interno di una consultazione clinica. E illustrato come il sogno e la fantasia possano rappresentare una dimensione sospesa nella quale e possibile per il paziente poter manifestare paure e preoccupazioni troppo difficili da esprimere in modo esplicito.

Rehabilitation for children and young people surviving a brain tumor, and their transition to adult services: the main challenges

ABSTRACT Introduction: It is well known that, with advances in the treatment of cancer patients achieving a 5-year overall survival of over 75% nowadays, pediatric neuro-oncologists are worried about long-term sequelae that frequently demand lifelong care and multiple specialist skills. Areas covered: This review aims to discuss the main issues concerning cancer survivors’ disabilities and rehabilitation, including cognitive and neuropsychological aspects, language and social skills, the return to school, starting or returning to work, endocrinological impairments, and supportive measures. The review also covers some experimental rehabilitation pathways based on advanced tools or techniques to provide an overview of the currently-available options for improving patients’ quality of life. We have included our findings deriving from a lengthy experience (2000–2015) of assessing brain tumor patients and managing their intensive tailored rehabilitation. A case report on a patient’s coping with childhood cancer into adult life has been added to give a pragmatic example of the psychological needs and difficulties of young cancer survivors during the necessary transition from pediatric age into adulthood adaptation. Expert commentary: It is important to stress that the tremendous progress made to date in our knowledge of pediatric neuro-oncology and in our management of patients has to be accompanied by a day-to-day effort to provide for their tailored rehabilitation, striving to bridge the gap that separates them from the normal life and experiences of their healthy peers.

The Problem of Cancer in Children

Forty percent of pediatric neoplasms develop by 4 years of age, with a slight prevalence in males, the male–female ratio being 1:1.2. In industrialized countries, the cancer incidence in children is approximately 130–140 new cases per million children a year, meaning that in Italy, for instance, there are about 1350 new pediatric cases of cancer every year. Taking all the malignant histotypes into account, recent data indicate that 70 % of patients are now still alive 5 years after their diagnosis [88].

Commentary: The response and survival of children with recurrent diffuse intrisic pontine glioma based on phase II study of antineoplastons A10 and AS2-1 in patients with brainstem glioma, by Burzynski G, et al

“An efficacious and safe treatment for cancer cure does exist, but doctors and pharmaceutical companies keep it hidden to increase their money interests.” This theory that belongs to the conspiratorial philosophy that sustain the ideas that nobody ever landed on the Moon and that Twin Towers were not destroyed by terrorists attack but by American Government itself finds a fertile environment thanks to the web offers through social networks and dedicated sites where clamorous news are more easily diffused than less sensational science articles. Reality is that cancer can be cured sometimes and often, but not always, and not all the times that we wish. In this background, we have nowadays an even stronger impact of a wide and almost innumerable amount of alternative and unproved therapies, sometimes with very transient success, in some other cases with a more strong impact. In Italy, antineoplaston has been so far not very successful in this respect, but we have assisted, in the last 20 years, at least two scenarios of treatment that promised to be alternative and completely successful. They have created big expectation among patients and media with split of judgments and opinions. First case was the so-called Di Bella protocol [1, 2] by Luigi Di Bella, a multitherapy based on a cocktail containing mainly somatostain, bromocriptin, melatonin, vitamins, and some chemotherapeutic drugs like cyclophosphamide and hydrossiurea. The most recent is the “Stamina” method, invented byDavide Vannoni, a communication degreed teacher, claiming that mesenchimal stem cells could be converted in neurons if cultivated and administered with his never published system. Hospital and Research Institutions are not generally involved in discussion on pseudo-treatments on common communication media. Researchers are in fact busy with building protocols, examining accuracy of their data according to the proposed rationale and publishing results through the stricter and stricter process of peer review. Alternative therapies have some peculiar and common features among different treatments: