Anthroposophical medicine and integrated care for cancer patients: Group experience at the Milan “Health Laboratory”

IntroductionThe COVID-19 pandemic has proved to be a historic challenge for healthcare systems, particularly with regard to cancer patients. So far, very limited data have been presented on the impact on integrated care pathways (ICPs).MethodsWe reviewed the ICPs of lung cancer patients who accessed the Veneto Institute of Oncology (IOV)/University Hospital of Padua (Center 1) and the University Hospital of Verona (Center 2) before and after the COVID-19 pandemic, through sixteen indicators chosen by the members of a multidisciplinary team (MDT).ResultsTwo window periods (March and April 2019 and 2020) were chosen for comparison. Endoscopic diagnostic procedures and major resections for early stage NSCLC patients increased at Center 1, where a priority pathway with dedicated personnel was established for cancer patients. A slight decrease was observed at Center 2 which became part of the COVID unit. Personnel shortage and different processing methods of tumor samples determined a slightly longer time for diagnostic pathway completion at both Centers. Personnel protection strategies led to a MDT reshape on a web basis and to a significant selection of cases to be discussed in both Centers. The optimization of patient access to healthcare units reduced first outpatient oncological visits, patient enrollment in clinical trials, and end-of-life cancer systemic treatments; finally, a higher proportion of hypofractionation was delivered as a radiotherapy approach for early stage and locally advanced NSCLC.ConclusionsBased on the experience of the two Centers, we identified the key steps in ICP that were impacted by the COVID-19 pandemic so as to proactively put in place a robust service provision of thoracic oncology.

Download Full-text

New organizational model to foster good practice. Central venous access management in cancer patients

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.045 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

G Mastrandrea ◽

F Cangialosi ◽

P Notarangelo ◽

G Chetta ◽

E A Graps

Keyword(s):

Integrated Care ◽

Cancer Patients ◽

Medical Devices ◽

Remote Monitoring ◽

Central Venous Access ◽

Venous Access ◽

Access Management ◽

Central Venous ◽

Management Procedures ◽

Health And Social Care

Abstract Issue Central Venous Access positioning is a common practice in cancer patients, however improper devices' management lead to complications and multiple accesses to hospital services, increasing costs. Assessment and certification of Central Venous Access insertion site at hospital so as proper dressing at home, are required; patient empowerment in management of complex technologies is desirable to improve outcomes. Problem Description To tackle the abovementioned issues, PICC project was drawn up in joint action between the Strategic Health and Social care Agency and the Research Institute on Cancer in Puglia. The aim is to pilot an organisational model for central venous access positioning and remote monitoring barely technology driven and based on safe storage of outcomes pictures, patient/care-givers empowerment, integrated care approach. A sistematic review of good practices for Central Venous Access management was conducted in june 2019; besides an analysis of medical devices public procurement procedures was performed at national scale; a survey was edited to probe the existence of diverse organisational models to insert and manage Central Venous Access. Results Very preliminary data are avalaible. Procurement analysis showed: around 15 companies of Central Venous Access and related medical devices' producers; a spread of Central Venous Access location medical devices/supply of services based on few firms (including consumables). The analysis helps to identify the “least common multiple” in technologic equipment to support Central Venous Access management to develop a standard and applicable model, not driven by a conditioning “starting choice” (catheter selection, tip location, dressings). Lessons A standard Central Venous Access management certification procedure can be realized regardless of potential technology driven approach. A Central Venous Access remote monitoring model based on images and empowered patients can allow daily review fostering integrated care. Key messages Patients’ proper training, even in complex technologies usage, can increase self awareness and empowerment and promote compliance to innovative organizational models. Collaboration among patients – caregivers and professionals, set up of a dynamic pictures store to record Central Venous Access management procedures can improve oucomes avoiding added costs.

Download Full-text

Psychodrama in the promotion of health and well-being: group experience with cancer patients

Revista Brasileira de Psicodrama ◽

10.15329/2318-0498.20180035 ◽

2018 ◽

Vol 26 (2) ◽

Author(s):

Gilmar Antoniassi Junior ◽

Gisele Aparecida Gomes ◽

Regina Celia de Souza Beretta ◽

Glória Lúcia Alves Figueiredo

Keyword(s):

Cancer Patients ◽

Well Being ◽

Group Experience ◽

Health And Well Being

Download Full-text

A feasibility trial of geriatric assessment and integrated care plan for older cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.10054 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. 10054-10054 ◽

Cited By ~ 2

Author(s):

Martine Puts ◽

Schroder Sattar ◽

Mary Ellen Macdonald ◽

Michael Kulik ◽

Kara McWatters ◽

...

Keyword(s):

Integrated Care ◽

Cancer Patients ◽

Geriatric Assessment ◽

Care Plan ◽

Feasibility Trial ◽

Older Cancer Patients

Download Full-text

Integrated care for cancer patients with depression is effective

The Pharmaceutical Journal ◽

10.1211/pj.2014.20066288 ◽

2014 ◽

Keyword(s):

Integrated Care ◽

Cancer Patients

Download Full-text

Professionally perceived effectiveness of psychosocial interventions for existential suffering of terminally ill cancer patients

Palliative Medicine ◽

10.1191/0269216303pm825oa ◽

2003 ◽

Vol 17 (8) ◽

pp. 688-694

Author(s):

Kei Hirai ◽

Tatsuya Morita ◽

Tetsuo Kashiwagi

Keyword(s):

Palliative Care ◽

Integrated Care ◽

Cancer Patients ◽

Terminally Ill ◽

Psychosocial Interventions ◽

Skills Training ◽

Underlying Structure ◽

Perceived Effectiveness ◽

Terminally Ill Cancer Patients ◽

Existential Suffering

Background: Although integrated care for existential suffering is an essential part of palliative care, little is known about its concept and efficacy as perceived by professionals. A questionnaire survey was carried out to 1) explore the underlying structure of psychosocial interventions recommended by specialists, 2) identify the professionally perceived effectiveness of each intervention for specific existential distress, and 3) examine the effects of specialty on their recommendations. Methods: A questionnaire with three scenarios representing terminally ill cancer patients with uncertainty-related anxiety, guilt feelings, and dependency-related meaninglessness was mailed to 701 Japanese psychiatrists, 118 psychologists, and 372 palliative care nurses. Results: A total of 456 responses were obtained (response rate = 38%). Recommended psychosocial interventions were classified into six subcategories: ’a supportive-expressive approach,fl’providing comfortable environments,fl’meaning-centered approach,fl’being,fl’education and coping skills training,fland ’a religious approach.flA ’supportive-expressive approachflwas consistently recommended in all vignettes. On the other hand, ’providing comfortable environmentsflwas most recommended for patients with uncertainty-related anxiety, and a ’meaning-centered approachfland ’beingflwere most recommended for patients feeling dependency-related meaninglessness. Psychiatrists estimated the effectiveness of psychopharmacological treatment significantly higher than psychologists and nurses, while nurses evaluated efficacy of all other interventions significantly higher than psychiatrists and psychologists. Conclusions: Experts evaluated a variety of clinical interventions as effective in palliating existential suffering, although the perceived levels of efficacy of each intervention differed according to the nature of suffering and their specialties. To effectively alleviate existential suffering in terminally ill cancer patients, an integrated care by an interdisciplinary team is necessary.

Download Full-text