November is the month dedicated to raising awareness of stomach cancer, a disease that every year is responsible for 14,500 new cases in Italy, where more than 82,000 people live with a diagnosis of gastric cancer, and 5-year survival, with no significant differences between different regions, is 32%.
Low survival: a matter of late diagnosis
32% is a low number. “It is, and it depends on the fact that the diagnosis of stomach cancer is often late – says Claudia Santangelo, president of Living without a stomach is possible!, an association that has 4,300 members: all people who have undergone a partial resection due to cancer or total of the organ of digestion. Which are many: 60% of patients diagnosed with gastric cancer in Italy undergo surgery. To give voice to their needs, old and new, the association organized in Rome (the November 19 in attendance and from 21 deferred on the association’s YouTube and Fb channel) its seventh national conference, which will deal with both issues related to quality of life and the state of the art of research and treatments.
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The role of Helicobacter pylori and that exam too often postponed
What are the patients’ questions still unanswered, and what, if any, are the emerging themes? “An ever-greening question is precisely that of diagnosis”, replies Santangelo: “We are talking about a multifactorial form of cancer, but infection with Helicobacter pylori is the first cause of the disease”. Helicobacter pylori it is a bacterium that is found very often in the stomach and which, however, is very unlikely to be attacked by the immune system. In 1994 the Iarc, International agency for research on cancer, included it among the carcinogens. L’Helicobacter it is eliminated with an antibiotic treatment. “But not in all cases”, says Santangelo: “We have found that it is not always eradicated. Furthermore, even today, it happens that patients with mild symptoms of gastritis or gastroesophageal reflux take many cycles of antacids before undergoing gastroscopy, which instead is an examination that brings out the disease at an early stage”.
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There is (still) a lack of nutritionists in hospitals
Living without such an important organ involves many difficulties, first of all that of feeding. “A difficulty that emerges immediately after the operation. Not in all hospitals there is a dedicated nutritionist – says the president, who underwent a gastric resection herself – whereas since 2017 we have had a State-Regions agreement which provides for the presence of this professional in every structure”.
And outside the hospital? “Outside the hospital we find ourselves in a desert – continues Santangelo -. We struggle to feed ourselves: the lack of an organ makes us suffer from malnutrition, we eat very slowly, we drink half an hour between meals, in short, we acquire experience, but expert guidance would help us live better and not lose weight. Some patients weigh 35-40 kilos, and are forced to stop treatment”.
Added to this, says Santangelo, is that still today free access to food for special medical purposes is not guaranteed in all territories. The foods Santangelo refers to are Ons, Oral nutritional supplements, and are used to prevent or manage protein-calorie malnutrition. “These products are expensive and are not offered for free in all regions.”
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An about-face: physical activity is possible and good for you
Precisely because of the fatigue of eating, patients have thought for a long time that they shouldn’t waste calories through physical activity. But today the idea is that exercising, with adequate times and intensity, can and is useful.
“This is one of the emerging themes of this year’s meeting – confirms the president -. Movement, in fact, preserves the muscles and bone health, both put at risk by a problematic diet. The patients normally monitor the health of the skeletal system on the advice of the gynecologist, but men do not do it even though they too, due to a lack of nutrients, have a higher risk of osteoporosis sooner”.
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Too long lead times for drug approval
Finally, there is the problem of bureaucracy. “Patients with gastric cancer need drugs that increase life expectancy and improve their quality. But the approval times are too long: the transition from Ema to Aifa takes over 365 days”, underlines Santangelo.
“However, 2022 was a good year for patients with stomach cancer: after 8 years without news, there were two approvals of new therapies by the Italian Medicines Agency”, adds Stefano Cascinu, director of the Oncology Department medica, IRCCS S. Raffaele Hospital in Milan, who will speak at the conference: “The first arrived at the beginning of the year and concerned trifluridine-tipiracil as a third-line treatment, i.e. for patients with metastatic gastric cancer already treated with at least two classic chemotherapies for advanced disease, but without success or who have become resistant to those treatments. These patients – continues Cascinu – today have a real possibility of lengthening and improving their lives. The second authorization from Aifa, which dates back to a few days ago, has concerned immunotherapy with nivolumab to be used together with classic chemotherapy as first line in advanced metastatic or inoperable cancer. a treatment that really changes clinical practice for so many patients”.
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The role of family doctors
There is no screening for gastric cancer, and the diagnosis arrives early in 7-10% of cases. “That’s right. But today general practitioners are very careful to prescribe gastroscopy even in the case of mild gastritis symptoms – concludes the oncologist -. Gastroscopy is an examination that anticipates the diagnosis: more gastroscopies means more eradications of Helicobacter and fewer advanced cases. General practitioners play a fundamental role in the diagnostic advance and the synergy with them is really important, especially for this type of disease”.