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Gianpiero Fasola,
Simona Rizzato,
Valentina Merlo,
Marianna Aita,
Tino Ceschia,
Francesco Giacomuzzi,
Emilio Lugatti, Stefano Meduri,
Angelo Morelli,
Maurizio Rocco,
Valeria Tozzi
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ABSTRACT: Integrated care pathways (ICPs) have been proposed as effective strategies for quality improvement. To date, limited data are available that detail the methodology to design an optimal care pathway for patients with non-small-cell lung cancer (NSCLC). The main aim of this study was to assess the quality of health care delivered to lung cancer patients referred to a hub university hospital.
All professionals involved with the management of NSCLC patients, in cooperation with health care researchers, identified 11 quality indicators and associated benchmarks. These were used to estimate the quality and efficiency of health care delivered to a cohort of 175 NSCLC patients.
The gap between "desired" and "actual" performance has been measured by benchmarking current practice against key quality indicators. Diagnostic workup, multidisciplinary team care and medical treatment of advanced disease have emerged as areas of good performance. Conversely, the management of early-stage disease offers room for improvement, in terms of both accuracy of nodal staging and surgical timeliness.
Analyzing the process of caring for NSCLC patients is feasible and offers room for improvement. Acquired knowledge may be shared with hospital administrators, guide the revision of ICPs, and enable the delivery of consistent, high-quality clinical standards.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 05/2012; 7(8):1283-90. · 4.55 Impact Factor
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Ornella Belvedere,
Alessandro Follador,
Ciro Rossetto,
Valentina Merlo,
Carlotta Defferrari,
Angela M Sibau,
Marianna Aita,
Maria G Dal Bello, Stefano Meduri,
Marica Gaiardo,
Gianpiero Fasola,
Francesco Grossi
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ABSTRACT: To date, no combination regimen has proven superior to single agent chemotherapy as a second-line treatment for non-small cell lung cancer (NSCLC).
This multicenter, non-comparative randomised phase II trial evaluated the activity of docetaxel (75 mg/m(2) on day 1) with oxaliplatin (70 mg/m(2) on day 2) every 3 weeks in previously treated NSCLC patients; the reference arm was single-agent docetaxel (75 mg/m(2) on day 1 every 3 weeks). It was designed as a one-stage, three-outcome phase II trial; 21 evaluable patients were required in each arm. The primary end-point was response rate; secondary end-points were toxicity, progression free survival (PFS) and overall survival.
Fifty patients were enrolled. Patient characteristics included male/female, 76/24%; median age 62 years; ECOG PS 0/1, 36/64%; previous platinum-based chemotherapy, 98%. Partial response was seen in 20% and 8%, stable disease in 52% and 32%, of patients treated with docetaxel/oxaliplatin and docetaxel, respectively. Main grade 3-4 toxicities were neutropenia 56% and 64%; febrile neutropenia 4% and 8%; diarrhoea 12% and 4% for docetaxel/oxaliplatin and docetaxel, respectively. Median PFS was 5.0 and 1.7 months, median survival 11.0 and 7.1 months, and 1-year survival 44% and 32% for docetaxel/oxaliplatin and docetaxel, respectively.
The study met its pre-defined study end-point; docetaxel/oxaliplatin and more generally platinum-containing doublets warrant further evaluation as second-line therapy for patients with NSCLC.
European journal of cancer (Oxford, England: 1990) 04/2011; 47(11):1653-9. · 4.12 Impact Factor
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Gianpiero Fasola,
Ornella Belvedere,
Marianna Aita,
Tina Zanin,
Alessandro Follador,
Paolo Cassetti, Stefano Meduri,
Vincenzo De Pangher,
Giusto Pignata,
Valentina Rosolen,
Fabio Barbone,
Francesco Grossi
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ABSTRACT: To evaluate the feasibility of using low-dose computed tomography (LDCT) for the early diagnosis of lung cancer and malignant pleural mesothelioma in an asbestos-exposed population.
Between February 2002 and October 2003, 1,045 volunteers already enrolled in a surveillance program for asbestos-exposed workers and former workers were recruited. The main eligibility criteria were: written informed consent, definite exposure to asbestos, age 40-75, no prior cancer or severe concomitant conditions, no chest CT scan in the past 2 years. A smoking history was not required. After a structured interview, chest X-ray (CXR) and LDCT were performed. Participants with negative examinations were assigned to annual LDCT. Participants with positive findings received high-resolution CT and additional diagnostic workup as appropriate.
Baseline characteristics of the screened population were: median asbestos exposure time, 30 years; median age, 58; median pack-years in smokers/former smokers, 18.5. Thirty-four percent had never smoked. On LDCT, 834 noncalcified nodules were identified in 44% of participants, versus 43 nodules in 4% on CXR. Pleural abnormalities were observed in 44% and 70% of participants by CXR and LDCT, respectively. Overall, LDCT identified nine cases of non-small cell lung cancer-eight stage I, one stage IIA-and one thymic carcinoid, corresponding to 1% of the enrolled population. All cases were radically treated. None had been detected by CXR. No pleural mesothelioma was diagnosed. There were 11 false-positive results.
Our findings first suggest that LDCT may be at least as useful in asbestos workers as in heavy smokers for the early diagnosis of lung cancer; this benefit is evident even in a poor-risk population, with low rates of smoking prevalence and a previous history of radiological surveillance. The role of spiral tomography in screening for pleural mesothelioma remains uncertain.
The Oncologist 11/2007; 12(10):1215-24. · 3.91 Impact Factor
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Francesco Grossi,
Gianpiero Fasola,
Ciro Rossetto,
Riccardo Spizzo, Stefano Meduri,
Angela Sibau,
Enrico Vigevani,
Salvatore Tumolo,
Gianna Adami,
Cosimo Sacco,
Leonardo Recchia,
Simona Rizzato,
Tino Ceschia,
Ornella Belvedere
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ABSTRACT: This study was designed to evaluate the activity and tolerability of irinotecan and docetaxel in patients with previously treated non-small cell lung cancer (NSCLC). Eligibility included recurrent or progressive NSCLC, previous chemotherapy, age > or = 18 years, ECOG PS < or = 2. Treatment consisted of irinotecan (160 mg/m2 i.v.), followed by docetaxel (65 mg/m2 i.v.) on day 1 of a 21-day cycle, for a maximum of 6 cycles. Forty patients were enrolled. Median age was 60 years and median ECOG PS was 1. All patients were evaluable for toxicity and 31 (78%) were evaluable for response. A total of 125 cycles was administered (median, 3; range, 1-6). Most common grade 3-4 toxicities were neutropenia (62%), neutropenic fever (22%), and diarrhea (32%). Response rate was 10%; a further 40% of patients achieved stable disease. All responses were observed in patients with ECOG PS < or = 1, age <70 years, and who had received only one prior chemotherapy regimen. Median time to progression was 2.8 months and median survival was 7.4 months. Because of significant toxicity and limited activity, further investigation of irinotecan plus docetaxel in second line NSCLC is not recommended.
Lung Cancer 04/2006; 52(1):89-92. · 3.43 Impact Factor
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ABSTRACT: To evaluate the reliability of chest radiograph (CR) and abdominal ultrasonography (US) performed in the Emergency Room (ER) in identifying life-threatening thoracic or abdominal lesions in a group of severely injured patients, who developed arterial hypotension immediately after a trauma.
The results of all abdominal US and CX performed in the ER in severe blunt trauma patients, with on-the-scene systolic blood pressure 90 mmHg, from November 2000 to November 2002, were analysed. When these initial investigations failed to identify a possible cause of hypotension, a computed tomography (CT) of the chest and abdomen was obtained.
Overall, 54 patients were studied; twenty-two patients (40.8%) were hypotensive both on accident scene and on the arrival at the ER and 32 (59.2%) were hypotensive on accident scene, but not in the ER. Forty-five patients had an US in the ER, in 3 patients it was inconclusive, whereas 2 other patients died before the confirmatory investigations could be performed. Among the remaining 40 patients, 11 had a hemoperitoneum (HP) hat was diagnosed by US in 7 cases and missed in 4. Twenty-nine patients had no HP and their US was negative in 24 cases and positive in 5; the US had a sensibility of 63.6% and a specificity of 82.8% The CR was obtained in the ER in 39 patients and it was able to identify 6 pneumothoraces (PNX) out of 20 and 2 hemothoraces (HT) out of 17; the sensitivity for PNX and HT was 30.0% and 11.8%, respectively. One patient with an aortic dissection had a normal CX.
Both CX and US are not reliable to identify possible PNX, HT and HP in hypotensive trauma patients and can delay the treatment of life-threatening conditions. In these patients, a CT of the torso is warranted.
La radiologia medica 10/2004; 108(3):218-24. · 1.44 Impact Factor
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Francesco Grossi,
Ornella Belvedere,
Gianpiero Fasola,
Tino Ceschia, Stefano Meduri,
Angela Sibau,
Cosimo Sacco,
Massimo Bazzocchi,
Giovanni Talmassons,
Angelo Morelli,
Fabio Barbone,
Alberto Sobrero
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ABSTRACT: In this study, we addressed the influence of the observer's background and experience on the accuracy of imaging-based tumor measurements. The consistency of measures with Response Evaluation Criteria in Solid Tumors (RECIST) vs. WHO criteria is also reported.
Twenty-five observers (five radiologists, five thoracic surgeons, five radiotherapists, five pulmonologists, and five medical oncologists) were asked to measure three lesions on selected serial chest computed tomographic images from three non-small cell lung cancer patients treated with chemotherapy. The observers were asked to measure the longest diameter (RECIST), along with its perpendicular diameter (WHO criteria). Measurements by radiologists were used as reference values.
There was no significant difference in the accuracy of measurements among the different groups. The highest intraobserver consistency was achieved by radiologists. Neither familiarity with measuring tumor lesions nor years since the MD degree correlated with measurement accuracy. A comparison of RECIST and WHO criteria showed consistent response ratings (kappa=.74, CI 95%=.57-.91).
Measurements of selected lesions were consistent among specialists, suggesting that assessment of tumor response is reliable even when it is not done by radiologists.
Journal of Clinical Epidemiology 09/2004; 57(8):804-8. · 4.27 Impact Factor
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La radiologia medica 105(5-6):529-32. · 1.44 Impact Factor
