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On the occasion of World Cancer Daywhich, like every year, is celebrated on February 4ththe University Hospital and the Local Health Authority of Ferrara present the project “On Connect: territorial oncology of the province of Ferrara”on which a special inter-company working group coordinated by the prof. Antonio Frassoldati (Director of the Oncology Department – Specialist Doctor); project included in the “Oncology and hemato-oncology network of Emilia Romagna”that the Emilia Romagna region presented to the press in recent days.

“The regional oncological network – explains the prof. enlisted – foresees the development of a “proximity” oncologywhere treatments are brought as close as possible to the patient’s residence. In our province this condition has long been favored by the presence of oncological structures distributed in the territory. I Oncological Day Service of the hospitals of Cento, Lagosanto and Argenta work in close liaison with the reference center of theClinical Oncology of the Cona Hospital and make it possible to deliver oncological treatments to patients residing in nearby areas, representing the access point for patients with new diagnoses. The “On Connect” project is aimed at further developing proximity oncology, extending oncological treatments, in compliance with the principles of quality and safety, also at first-level facilities of the Oncology Network (homes and community hospitals)up to the patient’s home. A project that also integrates the general practitioner and the community nurse into the care team, in close collaboration with the oncologists, in order to take care of the patient more and more responsive to his real needs”.

Il role of the nursing profession plays a significant role in these aspects, not only at an operational level but also in the design phase, as emerges from the Dr. Marika Colombi and Dr. Davide Cavedagna, Heads of the Nursing and Technical Departments of Ausl and S. Anna: “the modern treatment of oncological pathologies – the two professionals point out – requires a overall care of the patient (“disease management”) with a strong integration between hospital and territorial resources: hospital admissions limited to the initial diagnostic and therapeutic phases and to serious stabilisations, development of low-care facilities, dedicated follow-up clinics, integrated home care, development of primary care and social-health integration at the district level”.

With greater implementation of therapies in the community, “the utmost attention must be paid to building an effective integration and continuity of the entire process, the realization of which becomes a primary objective also for the Hospital”, add Colombi and Cavedagna, who continue: “it should be facilitated as much as possible dialogue with the territoryin particular with general practitioners, and the exchange of skills and information between all players in the system”.

The hospital will increasingly be characterized as an acute care facility, while the natural history of the oncological patient is made up of short hospital periods linked above all to therapy and long home phases. The “bet” for the future of oncology in the post-pandemic era is therefore that of redesign an oncological path between hospital and territoryassisted by the use of telemedicine and new technologies, ensuring their full integration. “Translated into services – continue Colombi and Vavedagna – proximity care will also be increasingly implemented for chemotherapy, which can be carried out in community houses and, where possible and appropriate, also at home. To do it will be further increased number of nursing and chronic care clinics at the Community Houses and the work of family and community nurses (Ifec) in the network with home assistance will be fundamental”. The advantages, in terms of proximity of treatments, for patients are evident. The consequent lesser “pressure” on hospitals will also lead to a further increase, within them, not only in the quality of care but also in hospitality and humanization.

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Also decisive telemedicine for the “On Connect”, as Professor Frassoldati explains: “Telemedicine represents an additional significant healthcare innovation. The experience of the pandemic has shown the power of this tool in maintaining a contact between patients and healthcare professionals, thus representing an important method for the continuity of care, thanks to tools that maintain the relationship between patient and doctors even outside the hospital. The Regional Oncological Network also configures the implementation of a network of connections not only between patient and doctors but between specialists from different structures and different regional areas, placing telemedicine at the center of this relationship system. In our province, telemedicine is already used in oncology for teleconsultations between specialists who work in various hospitals within Diagnostic Therapeutic Assistance Pathways of the various pathologies and will be further implemented with the territorial oncology project”.

With the occasion of the day, prof. Finally, Frassoldati takes stock of the new frontiers of oncological pathology. “The approach to oncological disease is undergoing a profound transformation on several fronts, thanks – in particular – to the technological development. In the diagnostic field it is Today possible to identify, in many types of cancer, the presence of specific genetic alterations, susceptible to targeted treatments. The investigations of advanced molecular biology with Next Generation Sequencing method, also available at the facilities in the Ferrara area, allow you to search for dozens of different alterations at the same time. The finding of an anomaly allows the use of targeted drugs, much more tolerable than classic chemotherapy, which have shown considerable efficacy in controlling the disease. Since these alterations are often present in different tumors, the concept of “agnostic” therapy is also gaining ground, in which a drug, which has demonstrated efficacy and is commercially available for a particular tumor that has the molecular alteration, can also be used in other tumors with the same alteration.

At the same time, the second revolution we are witnessing is that linked to the use of immune system as a weapon against cancer. In many cases, our defense system is blocked by the tumor itself, through the production of signals that prevent the tumor cells from attacking. The discovery of the mechanism that regulates this interaction has allowed the development of specific drugs able to restore an immune reaction against the tumor”.

And, in the future, “the research is the most important strategy to combat cancer”, says Frassoldati. “All the results obtained so far, in some extraordinary cases, derive from the latter. The preclinical studies they always provide us with new knowledge on the mechanisms that regulate the development of tumors and new targets for which to produce drugs. Certain studies make it possible to analyze in detail the characteristics that distinguish cancer cells from normal ones, to a depth of detail unthinkable until a few years ago. And above all, the knowledge derived from the study ofimmunology applied to oncologythey open Today an important development frontier. Another side is represented by immunoconjugated drugs, in which the ability of specific antibodies to recognize targets on tumor cells and to transport chemotherapy drugs or very powerful radioactive substances into the same cells is exploited. At the Finally, laboratory research joins clinical researchto demonstrate the real effectiveness of treatments, and research on “real world data”, which investigate the effect of treatments on unselected patients and therefore provide results that are closer to clinical reality”.

In the photo, from left: Frassoldati, Colombi, Cavedagna

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