Sara Campagna

Psychological distress in men with prostate cancer receiving adjuvant androgen-deprivation therapy

OBJECTIVES To compare the occurrence of depression, anxiety, self body image perception, sleep disturbances, and diminished quality of life in prostate cancer patients undergoing adjuvant androgen-deprivation therapy (ADT) as opposed to patients in follow-up alone. METHODS AND MATERIALS Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Restless Legs Syndrome Study Group essential diagnostic criteria, Body Image Scale and Functional Assessment of Cancer Therapy Prostate were administered to consecutive prostate cancer patients who underwent radical prostatectomy or radiation therapy and are presently either under adjuvant ADT or included in a follow-up program. RESULTS Of the 103 patients enrolled, 49 (47.6%) were receiving adjuvant ADT and 54 (52.4%) were not. Compared with the controls, the patients undergoing ADT showed higher levels of depression (P = 0.002), worse self body image perception (P = 0.001), worse quality of life (P = 0.0001) and worse sleep quality (P = 0.04). ADT was significantly associated with depression at multivariate analysis after adjustment for age, stage, Gleason score, as well as demographic and social variables (P = 0.001). Depression scores showed a strong inverse correlation with quality of life scores (P < 0.01). CONCLUSIONS Adjuvant ADT is associated with depression, worse quality of life, and altered self body image in prostate cancer patients.

Factors affecting attitudes and barriers to a medical emergency team among nurses and medical doctors: A multi-centre survey

AIM To identify factors underlying attitudes towards the medical emergency team (MET) and barriers to its utilisation among ward nurses and physicians. METHODS Multicentre survey using an anonymous questionnaire in hospitals with a fully operational MET system in the Piedmont Region, Italy. Response to questions was scored on a 5-point Likert-type agreement scale. Dichotomised results were included in a logistic regression model. RESULTS Among 2279 staff members who were contacted, 1812 (79.6%) completed the survey. The vast majority of respondents valued the MET. Working in a surgical vs. medical ward and having participated in either the MET educational programme (METal course) or MET interventions were associated with better acceptance of the MET system. Reluctance by nurses to call the covering doctor first instead of the MET for deteriorating patients (62%) was significantly less likely in those working in surgical vs. medical wards or having a higher seniority or a METal certification (OR 0.51 [0.4-0.65], 0.69 [0.47-0.99], and 0.6 [0.46-0.79], respectively). Reluctance to call the MET in a patient fulfilling calling criteria (21%), was less likely to occur in medical doctors vs. nurses and in surgical vs. medical ward staff, and it was unaffected by the METal certification. CONCLUSIONS The MET was well accepted in participating hospitals. Nurse referral to the covering physician was the major barrier to MET activation. Medical status, working in surgical vs. medical wards, seniority and participation in the METal educational programme were associated with lower likelihood of showing barriers to MET activation.

Alberta Breakthrough Pain Assessment Tool: A validation multicentre study in cancer patients with breakthrough pain

Cancer‐related breakthrough pain (BTP) is a common and quite challenging pain syndrome, with significant impact on quality of life. To date, no widely recognized and validated tool for the diagnosis and evaluation of BTP exists. The Alberta Breakthrough Pain Assessment Tool (ABPAT) underwent a validation process during its development, but no experience of its implementation in clinical practice has been reported.

Circadian variation of breakthrough pain in cancer patients

Breakthrough cancer pain (BTP) can place physical, psychological and economic burdens on patients and their productive life. By preventing instead of treating BTP after it occurs, the efficacy of analgesic treatment in cancer patients could be maximized. With this study, we investigated circadian variations in the occurrence of BTP events in cancer patients.

Restless legs syndrome as a cause of sleep disturbances in cancer patients receiving chemotherapy.

CONTEXT Sleep disturbances are frequent in cancer patients during chemotherapy; the contributory role of restless legs syndrome (RLS) in this setting has never been assessed. OBJECTIVES This study investigated the role of RLS in causing sleep disturbances and altering the quality of life in cancer patients during chemotherapy. METHODS Evaluation tools included the Pittsburgh Sleep Quality Index (PSQI), the RLS questionnaires, the Functional Assessment of Cancer Therapy-General, and the Hospital Anxiety and Depression Scale for quality of life and anxiety/depression assessment. The study population was 173 cancer patients. The questionnaires were administered during the third chemotherapy cycle. Patients positive for RLS were reassessed six months after the end of chemotherapy. RESULTS In all, 58.8% of patients reported experiencing sleep disturbances (PSQI≥5) and 20% screened positive for RLS. Neither sleep disturbances nor RLS was associated with anemia, neurotoxic cytotoxic drugs, or benzamide treatment. A direct relationship was found between the PSQI and RLS (P=0.007); both PSQI and RLS scores were significantly associated with poor quality of life (P=0.008 and 0.01, respectively) and anxiety (P=0.0001 and 0.01, respectively). PSQI score also was associated with depression (P=0.0001). RLS persisted in four of the 25 RLS-positive patients reassessed at six months after chemotherapy. RLS recovery was associated with a significant reduction in sleep disturbances and improvement in quality of life. CONCLUSION RLS can be a contributory factor in sleep disturbances in cancer patients undergoing chemotherapy. Screening for RLS could aid in tailoring a potentially more efficacious treatment of such disturbances.

Postoperative Pain, an Unmet Problem in Day or Overnight Italian Surgery Patients: A Prospective Study

Background. Because of economic reasons, day surgery rates have steadily increased in many countries and the trend is to perform around 70% of all surgical procedures as day surgery. Literature shows that postoperative pain treatment remains unfulfilled in several fields such as orthopedic and general surgery patients. In Italy, the day surgery program is not yet under governmental authority and is managed regionally by local practices. Aim. To investigate the trends in pain intensity and its relation to type of surgeries and pain therapy protocols, in postoperative patients, discharged from three different Ambulatory Surgeries located in North West Italy (Piedmont region). Method. The present study enrolled 276 patients who undergone different surgical procedures in ambulatory regimen. Patients recorded postoperative pain score twice a day, compliance with prescribed drugs, and pain related reasons for contacting the hospital. Monitoring lasted for 7 days. Results. At discharge, 72% of patients were under weak opioids, 12% interrupted the treatment due to side effects, 17% of patients required extra drugs, and 15% contacted the hospital reporting pain problems. About 50% of patients experienced moderate pain during the first day after surgery. Results from our study show that most of the patients experienced avoidable pain after discharge.

Prevalence, Severity, and Self-Reported Characteristics of Taste Alterations in Patients Receiving Chemotherapy

OBJECTIVES To describe the prevalence, severity, and self-reported characteristics of taste alterations (TAs) induced by chemotherapy and to investigate TAs across chemotherapy regimens. SAMPLE & SETTING 243 adult patients from five outpatient practices in Northern Italy. METHODS & VARIABLES Correlation, univariate, and multivariate linear regression analyses. Variables include TAs, symptoms reported by patients, and the effect of TAs on quality of life. RESULTS A majority of the study sample reported TAs. Difficulty in tasting saltiness was most common, followed by difficulty in tasting umami and sweetness. The severity and characteristics of TAs changed across chemotherapy regimens. TAs correlated with quality of life and were significantly associated with patients age and a 21-day chemotherapy schedule. IMPLICATIONS FOR NURSING TAs are a frequent side effect of chemotherapy, with varying characteristics that have a negative effect on quality of life. Healthcare professionals should routinely assess for TAs and provide patients with specific management strategies depending on the nature of TAs.

The Risk of Adverse Events Related to Extended-Dwell Peripheral Intravenous Access

Midline catheters (MCs) may be useful to avoid repeated venipuncture in patients requiring prolonged intravenous infusions with limited adverse events (AEs). We analyzed 2 Italian hospital databases to ascertain the safety of MCs. Among 1,538 adult patients, 154 MC-related AEs (10%; 2.49 AEs per 1,000 MC days) were reported.Infect Control Hosp Epidemiol 2018;875-877.

Italian validation of the Chemotherapy Induced Taste Alteration Scale

UNLABELLED . Italian validation of the Chemotherapy Induced Taste Alteration Scale. Introdution. Taste alterations (TAs) are an underestimated side effect despite affecting 75% of chemo-radiotherapy patients. TAs may cause discomfort and food aversions up to loss of appetite and anorexia. The available instruments do not discriminate the different types of TAs. AIM The aim of the study is to validate the Italian version of CiTAS, a 18-items scale that assesses specific TAs, symptoms of discomfort and their impact on patient nutrition. METHODS A convenience sample of 243 patients with chemotherapy-induced taste alterations were enrolled. Data were analyzed for item consistency using Cronbach alpha and construct validity using factor analysis. RESULTS The factor analysis identified four dimensions that explained a total variance of 67%: decline in basic taste, discomfort, phantogeusia and parageusia, and general taste alterations. The scale showed good validity (Cronbachs alpha = 0.82). CONCLUSIONS The CiTAS enabled the valid and reliable measurement of specific symptoms of chemotherapy-induced TAs. It can be used both as a clinical tool and in future studies to evaluate the effectiveness of specific TAs treatments.