The regional network for healthcare is born in Emilia-Romagna care and assistance of patients with malignant pleural mesothelioma: the guidelines establishing a new have recently been approved by the Council Multidisciplinary and homogeneous therapeutic care path throughout the territory.
The document provides for the activation, in the main hospital sites of each province, of 10 first level centers for diagnosis and non-complex therapies, and of 7 second level centers distributed throughout the vast areas of Emilia-Romagna by 2024 – Emilia Nord, Emilia Centro and Romagna – for the management of surgical and integrated treatments. The University Hospital and the Local Health Authority of Ferrara are also part of this network: S. Anna is included in both the I and II level centres.
According to data provided by the regional mesothelioma registry, between 1996 and 2022, 3,357 cases of people affected by this disease were recorded in Emilia-Romagna. rare tumor form, which is often related to exposure to asbestos, of which 134 in 2022. Furthermore, in 2,034 cases, exposure to asbestos was classified as occupational.
The S. Anna Company of Ferrara also participated in the construction of the Pdta relating to malignant pleural mesothelioma, through the contribution of Dr. Mario Tamburrini of the Pneumology Operational Unit, of Dr. Pio Maniscalco of the Thoracic Surgery Unit, Prof. Luana Calabrò of the Oncology Unit.
The Cona Hospital collaborates with other local facilities in the level I diagnostic phase and has been identified at the same time as one of the seven level II regional centres, where advanced oncological and surgical treatments are performed, thanks to the proven collaboration between the Thoracic Surgery (directed by Dr. Giampiero Dolci), the University and Territorial Pneumology (directed respectively by Prof. Alberto Papi and Prof. Marco Contoli), theOncology (directed by Prof. Antonio Frassoldati), the Radiotherapy (directed by Dr. Antonio Stefanelli) and byWorkplace Prevention and Safety Operational Unit (directed by Dr. Antonia Maria Guglielmin).
L’ONCOLOGIA DEL S. ANNA. Pleural mesothelioma is a rare but very aggressive tumor disease. For years, mesothelioma care pathways have been very uneven and research has been too scarce, mostly supported by non-profit institutions.
It has therefore become essential to implement, in this tumor pathology, a global management strategy through the definition of paths aimed at improving and standardizing diagnostic and treatment approaches, but also promoting clinical and translational research in order to develop more innovative and effective and thus improve clinical outcomes.
For almost twenty years, in fact, the standard medical treatment has been mainly based, in the majority of patients with pleural mesothelioma, on a chemotherapy regimen, although the effectiveness in terms of improvement in overall survival and disease control is limited and short-lived. duration. Just over a year ago, a new chapter opened for the treatment of this disease with the entry into the clinic of an innovative immunotherapy approach which has been shown to significantly improve overall survival compared to chemotherapy in specific subtypes of pleural mesothelioma. We are currently studying, also here in Ferrara, their possible use in the context of integrated therapeutic approaches after surgery. This therapeutic approach, based on a doublet of drugs, can however cause side effects that require early identification and prompt management to avoid interruption of treatment. It is therefore necessary for the patient with mesothelioma to be taken care of by a multidisciplinary group of professionals, experts in the treatment of this pathology, which allows us to more precisely define not only the type of mesothelioma but also the therapeutic path and the most appropriate management. This is possible thanks to a close interaction and cooperation, structured for years between the University Hospital and Territorial Services of Ferraraand which also makes use of digital platforms, facilitating overall patient care.
At the same time, the University Hospital of Ferrara in collaboration with other National Oncology Centers is also carrying out research projects which may allow in the near future to personalize and design the best treatment for these patients, based on the study of the biological characteristics of the tumor and the tumor microenvironment.
TO THE S. ANNA PNEUMOLOGY DEPARTMENT is entrusted with the diagnostic, partly therapeutic, task of malignant pleural mesothelioma. In particular, the patient who presents symptoms from which mesothelioma is suspected, in the absence of other known neoplastic or non-neoplastic pathologies, is directed by the occupational medicine clinics for those formerly exposed to asbestos, from general practitioners (GPs) or other specialists to hospital pneumology clinics. Here, after an initial pneumological evaluation, the patient is taken care of at the pneumology DH.
The initial diagnostic phase includes a careful medical history, aimed at identifying known risk factors such as professional, familial or environmental exposure to asbestos and smoking habits. The physical examination is aimed at evaluating symptoms such as cough, dyspnea, chest pain, weight loss and the presence of signs such as pleural effusion and palpable chest masses. Once all the necessary preliminary information has been obtained, we move on to a second diagnostic phase, entrusted to theRespiratory Interventional Endoscopy Operational Unit which involves the collection of material from the pleura for an accurate cyto-histological definition of mesothelioma.
Due to the type of tumor in mesothelioma, a diagnosis is rarely reached with fluid collection alone. For this reason, depending on the clinical pictures, further investigations are necessary such as pleural biopsy guided by ultrasound or CT or medical thoracoscopy; the latter test offers the possibility of easily obtaining biopsies of the pleura.
Interventional Respiratory Endoscopy, Pneumological DH and Thoracic Surgery are involved together with other healthcare facilities in the area in managing the symptoms of tumor pleural effusion, through the positioning of particular “permanent” drains, which allow the patient to avoid hospital admission in favor of home management. Even bronchoscopy through ultrasound endoscopy can, in selected cases, allow diagnosis and staging of the disease.
Once the diagnosis and staging has been obtained, the pneumology DH will have the task of entrusting the patient to oncologists, radiotherapists and thoracic surgeons for continued treatment.
THE THORACIC SURGERY UNIT OF S.ANNA. The surgical treatment of malignant pleural mesothelioma, performed by a highly specialized team of thoracic surgeons assisted by expert anesthesiologists and nursing staff, consists of a complex pleurectomy-decortication operation which involves the complete removal of the pleura affected by the disease. This procedure is, however, reserved for patients carefully selected through scrupulous pre-operative staging. Professional radiologists, nuclear doctors, anatomopathologists, physiotherapists, case managers and staff dedicated to palliative care also take part in the management of the patients included in the Pdta in question, who can make use of the latest generation technologies to best deal with the pitfalls caused by this disease .
THE WORKPLACE PREVENTION AND SAFETY OPERATIONAL UNITas part of the clinic of Occupational Medicine, provides information and health assistance for workers formerly exposed to asbestos, as established by the DGR 3/9/2018 n. 1410, which provides for the establishment of USL companies within the public health departments of dedicated clinics aimed at the prevention and containment of possible asbestos-related pathologies linked to previous work exposure.
Access to the clinic is direct, spontaneous and free and can be requested by a worker previously exposed to asbestos, who resides in the company territory, healthy or ill, employed or self-employed, unemployed, retired or employed in other activities, who declare previous exposure to asbestos.
At the first access, the actual past exposure is ascertained and the degree of the same is determined. The clinical examination and referral for radiodiagnostic tests and assessment of respiratory function, provided for by the protocol, and for any specialist tests are also carried out. Preferential access routes have been defined with Pneumology and Radiology, in order to guarantee uniformity of intervention and free services. There is a regional exemption code.
All those who access the clinic receive counseling and information on the promotion of healthy lifestyles, in particular stopping active smoking and avoiding sources of respiratory irritants; to promote anti-flu and pneumococcal vaccinations; on social security insurance aspects; on the advantages, limits and risks linked to the periodic repetition of chest radiodiagnostic investigations; on the recognition and self-monitoring of alarm symptoms and on methods of facilitated access to first and second level diagnosis and treatment facilities.
Patients diagnosed with malignant mesothelioma can also be sent to the clinic from hospital centers for the sole purpose of evaluating professional exposure and consequent medico-legal obligations.
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