What experience does the Center have in the treatment of my neoplasm?
« Although most medical treatments are widely available throughout the country, some surgical procedures require High Volume Centers (that is, dealing with many cases), in which expertise and experience, as well as the availability of support structures, make it possible to optimize the results – he explains Giordano Beretta, president of the Aiom Foundation (Italian Association of Medical Oncology) —. There are numerous studies that demonstrate how the experience of specialists and the presence of a multidisciplinary team is essential to obtain the best results, especially in rare tumors or where the type of treatment may be particularly complex (pancreas, ovary, brain). The presence of a regional oncology network could facilitate the journey of patients, keeping treatment as close to home as possible and, at the same time, referring them to high-volume centers when necessary.
I would like to get a second opinion, can I?
No shame: the request for a second opinion is, especially in the face of a formidable disease such as cancer, correct. And it is a right. “The important thing is that the second opinion is expressed by a person specialized in the pathology and with in hand all the documentation available on the case – clarifies Beretta, director of medical oncology in breaking latest news -. And it should always be carried out with the patient’s presence (not only on the basis of the “papers”), because his/her clinical conditions are just as important (sometimes even more) than any exam. The desire to seek a second opinion should not be hidden from the treating physician, who should provide all the necessary documentation and, if requested, support the patient in choosing the other clinician to contact. Then the patient and his family should rely on the professional who most convinced them, avoiding “jumping from one structure to another”. The outcome of the second opinion should always be reported to the attending physician».
Are there treatments to counteract the side effects of anticancer therapies?
The most common disorders among the sick are represented by chronic fatigue, nausea, vomiting, stomatitis, constipation and diarrhea. In general, the type of problems to deal with depends a lot on the type of neoplasm and the treatments performed, but the final effect is always the same: they considerably worsen people’s quality of life. They often make it impossible to return to “normality”, the return to work, the resumption of domestic, social or sporting activities. «However, counteracting the side effects of chemotherapy is often possible and is essential both to allow patients to follow the treatments to the end, without having to suspend or interrupt them because they are too debilitated, and to guarantee them the best quality of life during and after the treatments – underlines the oncologist -. There are specialized physiotherapists and rehabilitators depending on the ailments to treat the body, supportive medicines against undesirable consequences, therapies and psychologists to help the mind cope with a difficult battle, enhancing individual resources».
I already take medicines for other diseases, what do I do?
Half of the cancer cases recorded each year in Italy concern the elderly, who often have concomitant diseases: hypertension, diabetes, kidney failure or heart problems they are frequent after the age of 65 and this, in the event of an oncological diagnosis, makes patients more “fragile”, also because it involves taking different types of drugs. I am factors that must be considered when establishing oncological therapy e must be communicated in detail to the specialists involved in the treatment of the tumor, for the sole purpose of better calibrating the choice of therapy, putting together the various “pieces of the puzzle”. In the absence of an absolute contraindication explicitly expressed by the doctor, the treatments in progress for the other pathologies should be continued as usual.
I’m losing weight, what can I do? Can you give me advice on nutrition?
«Not losing weight is crucial in order to continue anti-cancer treatments, also because maintaining muscle mass reduces the side effects of therapies. This is why it is important for patients and their families to speak to the doctor if they notice constant weight loss: there is much that can be done» recalls Beretta. Nearly half of cancer patients are at risk of malnutrition, while Eating right can help reduce the toxicity of radio and chemotherapyput the patient in the best condition to face the therapies, strengthen the body’s defenses and contribute to prevent post-operative complications, decreasing both the frequency and the overall duration of hospitalizations. Often when food becomes a problem, even the practical advice of an expert nutritionist is enough to “get around” the obstacle and manage not to lose weight, other times the parenteral nutrition (intravenously) when oral intake is insufficient.
Do I need psychological support?
Half or more of cancer patients experience psychological distress: anxiety, depression and stress disorders are widespread. Also in this case we must not be ashamed to ask for help, if we realize we need it. Indeed, it has been proven that psychological support programmes, where necessary, have positive effects on subjective well-being and the course of the disease, because they influence adherence to therapies, the doctor-patient relationship and that with family members. Sometimes just a few sessions, a chat, some useful suggestions or a brochure with information and contacts of psycho-oncologists to turn to if desired.
Are there any experimental therapies for my cancer?
“It is now natural that patients and family members also seek information on therapies on the internet, but it is essential to be careful not to fall victim to hoaxes and sellers of false hopes at a high price – explains Giordano Beretta -. The “old” chemotherapy remains an irreplaceable weapon for the treatment of many tumours, alongside the new immunotherapy molecules, the target therapiessurgery and radiotherapy. When standard cures no longer work o when innovative and promising experimental programs are available, it is the oncologist who proposes an experimental cure to the patient, if it exists and if it is feasible in that specific case. If this does not happen, it is essential to ask the doctor if there are possible new drugs to try and possibly seek advice from another center or specialist. having well explained any benefits and side effects».
What awaits me after the course of treatment?
«When you start a therapy, standard or experimental, surgical, pharmacological or with radiation you need to know what you’re getting into – underlines the expert -. This is why there is the informed consentThat not only requires filling out a form, but must be accompanied by proper communication, leaving the patient the possibility of formulating questions and ask for clarification. We need to communicate the prospects for healing or for making the disease chronic or, in the more advanced stages, for symptomatology control. They have to know the possible pros and cons of the various options. Especially when healing is not possible, introducing palliative care alongside “traditional” anticancer treatments right from the beginning of the therapeutic process, immediately after diagnosis, improves the quality of life and decreases the depression of family members who look after a cancer patient . It helps patients to better understand their own prognosis and to make motivated treatment choices accordingly. It should also be remembered that aggressive treatments in terminally ill patients do not improve quality of life and great attention is needed to assessment and symptoms, such as pain or psychological distress».
Have you talked to my primary care physician?
When the patient is discharged it is essential that the hospital sends his general practitioner a complete report on the stage of the disease, the treatments carried out, the controls foreseen and the possible complications. The integration between oncologists and family doctors, who know the patient best, is crucial to better manage the situation and possible complications.
In case of sudden problems, who can I talk to?
Coming home is a long-awaited moment, but it can be stressful. There may be side effects to treatments, unexpected complications, problems in taking the prescribed therapies. «A good rule is to prepare a list of questions to ask the doctor when preparing to be discharged – concludes Beretta -, so as not to forget anything. And then ask for a telephone number, an email, a contact address to refer to in case of unexpected events: in many cases a phone call with the appropriate contact person can be enough to solve the problem and relieve the anxiety of patients and family members».