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V1Observational study on the effectiveness of the Dragon Boat in reducing
the risk of incidence of lymphedema in women with breast cancer
S. Molinaro
, L. Iacorossi
, A. Paterniani
, D. Giannarelli
, A. Fabi
Hospice San Francesco, Rieti;
PhD, MsC, RN, “Regina Elena” National Cancer Institute
- Via Elio Chianesi, 53, Rome;
Coordinator of Nursing Course “ Regina Elena” National
Cancer Institute - Via Elio Chianesi, 53, Rome;
Biostatistical Unit, “Regina Elena”
National Cancer Institute - Via Elio Chianesi, 53, Rome;
Division of Medical Oncology
A, “Regina Elena” National Cancer Institute - Via Elio Chianesi, 53, Rome
Introduction: In women with breast cancer undergoing sentinel node biopsy and axil-
lary lymph node dissection, the ipsilateral upper extremity lymphedema is one of the
most disabling complications. The gold standard for the treatment of this condition is
physiotherapy, called complete decongestant therapy, but also constant exercise is an
important element of prevention. The Dragon Boat, a very popular rowing activity, has
been reported to be of clinical benefit and improve quality of life in some studies .
However, given that studies lacked to demonstrate the effectiveness of this Dragon boat
in reducing the incidence of lymphedema, this study’s objective was created to precisely
assess this influence in women with lymphedema, as well as the impact on quality of life
and on the possible predictors of this condition.
Materials and methods: Observational study of two groups: women who participate in
the Dragon Boat activity for at least six months and women who practice differe nt
physical activities both biweekly. For the collection of epidemiological and clinical data
a questionnaire constructed ad hoc was used for the assessment of QoL the EORTC
QLQ-C30, a and a tape measure was used for the local measurement of lymphedema.
Data were collected at the Hospital Physiotherapy Institutes of Rome (IFO) and the
lake of Castel Gandolfo (RM) from June to October 2016, upon approval from the
Central Ethics Committee IFO. A comparison of categorical variables with the Chi-
square test and statistical significance with p <0.05 through the software Statistical
Package for the Social Sciences (SPSS), version 19.0 was used.
Results: The sample consisted of 100 women, equally divided between the two groups.
The presence of lymphedema was detected mainly in the group of women who did not
practice the Dragon Boat (26% vs 4%), confirmed by measuring limbs before and after
exercise. From the data obtained through the Questionnaire EORTC QLQ C-30, it is
clear, moreover, how the Group of the Dragon Boat present a better quality of life
(p <0.0001), a reduced presence of fatigue (p ¼0.02), insomnia (p ¼0.001), pain
(p ¼0.003), and dyspnea (p ¼0.03 in women who practice the Dragon Boat that ulti-
mately have a lower BMI and a more balanced lifestyle.
Conclusions: Practicing Dragon Boat reduces the risk of onset of lymphedema and
improves QoL. The possible predictive factors: high BMI, reduced physical activity and
high protein diet, rich in carbohydrates and fats.
V2Efficacy of cryotherapy in paclitaxel-induced nail toxicity: Final results
from a Phase II Clinical Study
V. Biasotto
, J. Polesel
, C. Mazzega Fabbro
, G. Tabaro
Centro di Riferimento Oncologico di Aviano, Aviano
Background: Taxanes are cytotoxic agents that induce nail toxicity, including severe
effects such as pain and discomfort. Cryotherapy, causing temporary vasoconst riction,
is a successful approach in preventing nail toxicity. However, so far, few studies, have
described cryotherapy and its effects on nails.
Materials and methods: We conducted a phase II clinical study to investigate the effi-
cacy of cryotherapy in preventing nail toxicity in breast cancer patients treated with
paclitaxel. The study, conducted in a Multidisciplinary Day Hospital at CRO Aviano
from October 2015 to September 2016, was planned to enroll 62 women to estimate a
40% to 25% reduction in nail toxicity (a ¼0.05; b ¼0.20). The study included women
diagnosed with breast cancer, with no previously nail disease, treated with weekly che-
motherapy containing hourly paclitaxel for the first time for 3 cycles. Specifically
excluded were women with Raynoud’s syndrome and those previously treated with tax-
anes. Participants worn frozen gloves (temperature: -5 Cto0C) on hands and feet
during drug infusion for a total of 70 minutes. Nails condition was assessed weekly by
trained nurses. Nail changes, including pain, were evaluated using CTCAE 4.03 grades
and through photographs.
Results: G2-G3 nail toxicity was reported in 13 women (21.0%, 95% confidence inter-
val CI: 11.7-33.2), which was significantly lower than the expected 40% (p ¼0.002).
Nail toxicity was more frequent in women aged 50 years (31.0%, 95% CI:15.3-50.8)
than in younger ones (12.1%, 95% CI: 3.4-28.2). Onycholysis was the most frequent
nail toxicity (10 patients, 16.1%) with a 56-day median time of occurrence. Subungual
hematoma was observed in 6 patients (9.7%; median occurrence time: 56 days) whereas
onychomadesis was observed in only 1 patient after 63 days. Other G1 toxicities were
observed: nail yellowing in 41 women (66.1%, 95% CI: 53.0-77.7); Beau’s lines in 27
women (43.6%, 95% CI: 31.0-56.7); leukonychia in 2 women (3.2%, 95% CI: 0.4-11.2).
Pain was reported by 25 women (40.3%, 95% CI: 28.1-52.5) of whom 15 (24.2%)
with pain 4and it was more frequently reported by women with age 50 years than
younger ones (55.2% vs. 27.3%, p ¼0.033).
Conclusion: Final results confirm the efficacy of cryotherapy in reducing G2-G3 nail
toxicity associated with paclitaxel, providing evidence for a new tool in care manage-
ment. Feasibility of cryotherapy was confirmed by good compliance and by patients’
V3Italian translation of a nursing instructor helping the patient to treat
oral antineoplastic medicine: the MOATT
F. Gambalunga
, R. De Domenico
, L. Iacorossi
MsC student in Nursing Science, Faculty of Pharmacy and Medicine, University of
Rome ‘‘Sapienza’’, Rome;
”Regina Elena” National Cancer Institute Via Elio Chianesi,
53, Rome;
PhD, MsC, “Regina Elena” National Cancer Institute - Via Elio Chianesi, 53 -,
Introduction: In recent years, the introduction of oral therapeutic formulations has
contributed to making oncologic patients responsible, in the first place, for the assump-
tion and management of the therapeutic plan. This “empowerment” required reflects
the need for better information to manage side effects and favor adherence to therape u-
tic treatment. The nurse appears to be the figure mainly inv olved in the therapeutic
education of patients, so they need more and more tools to guide them in favoring the
correct intake of prescription drugs. Among those encouraging/guiding therapeutic
education about taking oral antineoplastic drugs is the Mascc Oral Agent Teaching
Tool (MOATT), created by the Multinational Association of Suppo rtive Care in
Cancer (MASCC), consists of four sections and is present in 16 different languages
??with the exception Italian.
Objective: To translate the MOATT into Italian.
Method: A forward-backward translation was performed following the guidelines pro-
vided by Beaton et al for transcultural adaptation of self-report questionnai res. The
stages of the translation process were: authorization request, forward translation (two
translators with good knowledge of both languages), creation of a new version and
backward translation (concluded with the approval of the MASCC).
Discussion: The main issues arisen in the individual translation phase are largely
dependent on the presence of Anglo-Saxon terms in Italian which provide more than
one translation. It was useful in this regard to resort to a comparison between the trans-
agement of the disease and especially treatment.
V4Development and psychometric testing of a measure of perception of
care dependency in cancer patients
M. Piredda
, G. Gambale
, M.L. Candela
, D. Mecugni
, L. Rasero
, L. Iacorossi
V. Rossi
, J. Brice
, M.T. Capuzzo
, S. Migliore
, T. Petitti
, E. Pettinari
, R. Barbetta
C. Fanni
, M. Marcucci
, A. Marchetti
, M.G. De Marinis
Research Unit Nursing Science Campus Bio-Medico di Roma University, Rome;
Research Unit in Nursing Science, Campus Bio-Medico di Roma University, Rome;
Oncologia IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia;
Universitaria Careggi, Florence;
l’Istituto dei Tumori IRCCS Regina Elena, Rome;
Nazionale dei Tumori IRCCS Fondazione Pascale, Naples;
Clinical Psychology, Campus
Bio-Medico di Roma University, Rome;
Statistics and Epidemiology Unit, Campus Bio-
Medico di Roma University, Rome
Background: The number of patients with comorbidities and cancer-related disabilities
is expected to increase in the near future. Care dependency is ce ntral to nursing and can
be associated with suffering, humiliation, but also with positive balances and personal
developments. Understanding the patients’ perception of care dependency enables
nurses to better meet the patient’s needs. No instrument is available to evaluate patient’
perceptions about their dependency experience.
Material and methods: This study is part of an ongoing project aimed to develop and
validate an instrument to measure the patient’s perception of nursing care, in particular
the patient’s basic emotions anger, guilt, shame and sadness. The project follows the
European Statistical System’ Guidelines for Instrument Development including five
steps: conceptualization, questionnaire design, pre-field and field testing, final valida-
tion. Conceptualisation implied the formation of concepts from a meta-synthesis and
CEuropean Society for Medical Oncology 2017. Published by Oxford University Press.
All rights reserved. For Permissions, please email:
Annals of Oncology 28 (Supplement 6): vi105vi112, 2017
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qualitative studies on cancer patients with dependence that were operationalized into
indicators. Questionnaire design involved a panel of clinical nurses, psychologists and
experts in questionnaire design who met to identify the wording and structure of the
questionnaire draft. Pre-field testing encompassed evaluation of the questionnai re con-
tent validity by clinical nurses’ and its revision by questionnaire design experts. Field
test aimed at improving the questionnaire was conducted by clinical psychologists and
nurse researchers using observational and cognitive interviews, behaviour coding
scheme and respondent debriefing. Retrospective think aloud, retrospective probing,
verbal paraphrasing and evaluating the response latency were used as cognitive inter-
view methods.
Results: From an initial pool of 63 items questionnaire design pro duced a 25-item
draft. We enrolled 13 patients for pre-field test and 12 patients for field test. After pre-
field and field test the wording of several items, the questionnaire layout and the
answers’ structure were modified to increase clarity and 6 items were removed produc-
ing a 19-item tool.
Conclusions: The final questionnaire is being validated in a multicentre study. This
study will provide oncology nurses with an instrument based on patients’ accoun ts,
valid and reliable to assess the patient’ perceptions of care dependency, enabling them
to better meet the dependent patient’ needs through personalized quality care.
V5The predictive role of toxicity induced by chemotherapy: systematic
review on relationship between toxicity and effectiveness
G. Falcone
, F. Gallucci
AUSL Romagna, Ravenna;
INT- IRCCS G. Pascale, Naples
Background: The toxicity of chemotherapy is the major problem for the continuity of
treatments. Despite this, they may be used as a guide to treatment response as demon-
strated by various studies in the literature. The purpose of the review is to deepen the
relationship between the side effects and the effectiveness of chemotherapy in order to
improve the management.
Material and methods: We have been performed several literature research by the fol-
lowing internet databases: PubMed, The Cochrane Library and Toxnet, Biomed
Central, Trip Liberating the literature. The research was performed linking search head-
ings: “correlation toxicity and efficacy chemotherapy”, “toxicity markers correlation”,
“body markers and oncology toxicity”, “prognostic toxicity and chemotherapy”. The
correlation between toxicity and survival was evaluated according to the PFS and OS.
We have applied the following filters: human species and 5 years.
Inclusion criteria: Our research was not limited by study desig n or outcomes. We have
been included full-text and abstract, until January 2017. We have included patients
with all types of tumor and toxicity, both adult and pediatric, subjected to every type of
Exclusion criteria: We have been excluded all articles not written in English or Italian
language. For the fulfilment of this review it has been possible to formulate the question
with Pico model.
Table: V5
PATIENT Patients with chemotherapy-related toxicity
COMPARISON Patient without chemotherapy-related toxicity
OUTCOME Best response to treatment
Results: For review we were found 33 articles, but only 21 meet the inclusion criteria
(for a total of 6537 patients). The review supports the hypothesis that there is a correla-
tion between toxicity such as hand-foot syndrome, rash, hypoalbuminaemia, myelo-
suppression, proteinuria and the effectiveness of the treatment. There was no
correlation between treatment efficacy and hypertension, cachexia, nausea and vomit-
ing. Furthermore, in a few trials, the correlation between the degree of toxicity and the
best therapeutic response has been demonstrated.
Conclusions: Although there are studies in the literature, it is necessary to deepen with
works of greater statistical value and sampling; identifying efficacy classes based on the
degree of toxicity. It is also necessary to identify time-related landmarks that predict the effi-
cacy of treatment, promote conti nuity and improve nursing management of side effects.
V6 Exploring the nutrition nursing’s care surrounding terminally ill patient.
A scoping review
B. Albanesi
, M.T. Capuzzo
, M. Piredda
, D. D’angelo
, M.G. De Marinis
a di Roma Tor Vergata, Rome;
a Campus Bio-Medico, Rome
Background: Eating and drinking have a deep symbolism in all societies because they
are necessary to sustain life [Bryon, 2008]. They are among the most fundamental phys-
iological human needs [Maslow 1943, Henderson, 1958]. Many patients with long-
term conditions experience symptoms that reduce appetite, impair nutrient utilization
and restrict their ability to obtain, consume and enjoy food. For them eat and drink is
very difficult to do, while for healthcare providers is pivotal to restore and maintain a
good state of nutrition and hydration through different interventions [Holme s,
2010].The use of artificial nutrition and hydration for terminally ill is made possible
through diverse site such as enteral or parenteral. Define the nutritional care planning
is a healthcare professionals’ responsibility. Physicians are considered th primary
responsible for decision-making and for prescription of initiating artificial food or
fluid; nurses are usually the main responsible to provide nutritional care essentially
through practical activities but that they are no integrated in a deeper way
Aim: To find the nursing involvement in artificial nutrition and hydration of palliative
care and understand what are their competences and professionals’ provisions on it.
Method: The Arksey and O’Malley five steps approach of scoping review revised by
Levac and colleagues. The research was conducted in Italy with an evaluation of the lit-
erature in an international perspective, to not exclude the different perspectives of this
phenomenon Three nursing students and two experts nursing professors in palliative
and hospice care, formed the research team. After this the meaning was mapped by cre-
ating the main categories.
Results: Twenty-five articles were identified by database searching, five by screening
reference lists and five directly by the journals. The main categories found were related
to: ethics, decision making, clinical aspects and education where nurses act in conjunc-
tion with other health professionals.
Conclusion: Still confusion and not great clarity exists on nutrition and hydration in
palliative care. Nurses have a great importance in such fragile context. It is demon-
strated not just relying on their practical activities or clinical skills but also from their
role and position in the planning and support to the decision-making process of the
artificial nutrition and hydration process.
V7 Observational study on dietary habits and quality of life in patients with
colorectal cancer
A. D’Ottavio
, R. De Domenico
, D. Giannarelli
, F. Gambalunga
, L. Iacorossi
”Regina Elena” National Cancer Institute Via Elio Chianesi, 53, Rome;
Unit, “Regina Elena” National Cancer Institute Via Elio Chianesi, 53, Rome;
MsC stu-
dent in Nursing Science, Faculty of Pharmacy and Medicine, University of Rome
‘‘Sapienza’’ Piazzale Aldo Moro, 5, Rome;
PhD, MsC, “Regina Elena” National Cancer
Institute - Via Elio Chianesi, 53, Rome
Introduction: Colon cancer is the second leading cause of cancer death in Western
countries after lung cancer and male breast cancer. Numerous studies report the effec-
tiveness of a healthy diet in reducing the risk of developing colon cancer or its recur-
rence. Although the literature provides us with some indications of the most
appropriate foods to be used to reduce the risk of developing the cancer or its recur-
rence, there are not many scientific studies that allow us to understand whether the
quality of life of people diagnosed with carcinoma of the Colon can improve by follow-
ing healthy eating habits. By virtue of this, the objective of this study was to observe the
eating habits and quality of life in patients with colorectal cancer.
Materials and methods: Observational study on a sample with age >18 years and diagno-
sis of colorectal cancer at the Oncology Clinicof an IRCCS in Rome. For the collection of
socio-demographic and clinicaldata (including anthropometric data, bloodtype and eat-
ing habits),an ad hoc questionnairewas used, while EORTC QLQ-C30 was used for QoL
(Version3.0). The data werethen analyzed using theSPSS (version 9.0)program and rep-
resentedby tables describingthe frequency of thevariables under consideration.
Results: 69 patients with a median age of 62 years were recruited, mainly married, with
a low average medical title, with a BMI (Body Mass Index) 25 and a predominantly type
A blood type 36%. The sample included many animal based foods, especially chicken
meat (77.1%), beef (73.2%) and raw ham (77.6%) but not dairy (15.8%) or fish
(20.3%), and few food of origin Vegetable (27.4%). Drinking sparkling beverages
(1.3%) and alcohol (12.3%) is also limited. Despite the presence of some disorders,
such as insomnia (43.5%), abdominal swelling (55.5%) and anxiety (37.4%), the QoL
of the sample being tested is average (57.6).
Conclusion: The study found that patients with colorectal cancer did not follow a bal-
anced diet regime. It is therefore necessary to raise the awareness of patients to take on
foods that can reduce the disturbance and bring quality of life to higher levels.
V8 Distress in the hospitalized oncological patient: a study observation
R. De Domenico
, F. Gambalunga
, A. D’Ottavio
, C. Falicchio
, L. Iacorossi
”Regina Elena” National Cancer Institute Via Elio Chianesi, Rome;
MsC student in
Nursing Science, Faculty of Pharmacy and Medicine, University of Rome ‘‘Sapienza’’,
”Regina Elena” National Cancer Institute Via Elio Chianesi, 53, Rome;
Psychooncology Unit - “Regina Elena” National Cancer Institute Via Elio Chianesi,
53, Rome;
PhD, MsC, “Regina Elena” National Cancer Institute, Rome
Background: Distress is an unpleasant emotional experience of a psychological, social,
and/or spiritual nature that may interfere with the ability to cope with the disease. This
phenomenon appears to be very common in cancer patients, especial ly during hospital-
ization, and is therefore considered to be the sixth vital parameter in oncology. The lit-
erature also reports a significant association between distress and patient compliance
on the therapeutic plan. It is therefore important for the nurse to constantly monitor
patient distress during hospitalization. In practice, the NCCN Guidelines provi de an
algorithm for identifying it with an analogue visual scale, known as the Distress
Thermometer (DT), with a score ranging between 0 to 10. A result greater than 5
abstracts Annals of Oncology
vi106 | V - Oncology Nursing Volume 28 | Supplement 6 | October 2017
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