Ivan Gallio’s research while affiliated with Istituto Oncologico Veneto and other places

Background Bereavement is a crucial physiological process in palliative care; grief-processing disorders can be diagnosed at least 6 months after death and can have severe clinical or psychological consequences. This study aims to verify how adequate management of anticipatory mourning and condolence conversations can be protective in the early stages of grief. Methods Patients and caregivers are supported by a multidisciplinary team through semi-structured interviews. In condolence conversations within one month of the death, we identify signs of psychological fragility that require support for adequate processing of the loss. Results From the condolence conversations, only 2–4% of caregivers who had received psychological support during the hospital stay and showed a good level of acceptance of their relative’s end of life exhibited grief problems within 1 month of death; none showed excessive avoidance of memories, difficulties with trust, or feelings of emotional loneliness. Conclusions Despite the limitations, the preliminary data of our study clearly suggest the protective potential of multidisciplinary support, particularly in reducing the risk of developing grief processing disorders. These considerations encourage us to implement our model of clinical and psychological support systems and develop pathways dedicated to caregivers experiencing greater difficulty.

Background Bereavement is a physiological process of great importance in palliative care; grief-processing disorders can be diagnosed after at least 6 months after death and have severe clinical or psychological consequences. Aim of the study is to verify how adequate management of anticipatory mourning and condolence conversation in the early grief stages can be protective. Methods Patients and caregivers are supported by the multidisciplinary team by semi structured interviews. In condolence conversation within 1 month of the death, we identify elements of suspicion of psychological fragility that require support for an adequate processing of the loss. Results From condolence conversation, only 3% of the caregivers who had been psychologically supported during the hospital stay and demonstrated a good level of acceptance of their relative's end of life, showed problems in grieving within 1 month of death; none showed excessive avoidance of memories, difficulties with trust and feelings of emotional loneliness. Conclusions Despite the limitations, the preliminary data of our study clearly suggests the protective potential of multidisciplinary support, particularly in the risk of developing grief processing disorders. These considerations encourage us to implement our model of clinical and psychological support system and develop paths dedicated to caregivers in greater difficulty.

254 Background: Early palliative care has been shown to improve patient (pts) and caregiver satisfaction, symptom control, quality of end-of-life care, cost and in some cases survival in pts with advanced cancer. In accordance with ASCO, ESMO and AIOM guidelines a Simultaneous Care Clinic (SCC) was set up at Veneto Institute of Oncology (IOV) since 2014. In the Castelfranco Branch of the IOV, SCC started in January 2022. Methods: Data from all consecutive outpatient patients seen in SCC were retrieved from a prospectively maintained database.Data collected included cancer type, status of disease, performance status (PS), ongoing oncological treatment, nutritional evaluation, social evaluation, psychological evaluation, activation of home territorial and/or palliative care services,use of other health services after a first visit and place of death. At the first visit pts were evaluated with validated tools for symptom identification, Edmonton Symptom Assessment (ESAS), distress thermometer, Malnutrition Universal Screening Toll (MUST). Results: From January to December 2022seventy-four pts were evaluated by a multidisciplinary team and re-evaluated 2 months later in terms of improvement or stabilization of symptoms, appropriateness of intervention and outcome. All patients had a metastatic disease and were in active oncological treatment. The median age was 73 y and the most prevalent disease type was gastrointestinal cancers (48%). The median time from first SCC visit to death was 3.8 months; 32 pts are still alive. At the first visit symptom management measures were adopted. The median score for the distress thermometer was 5 with higher prevalence of physical problem. A higher prevalence on 7-10 ESAS score (26% of the pts) was found for pain, fatigue and lack of appetite. At the second visit, an improvement was observed: the median score for the distress thermometer was 4 and ESAS score was 7-10 in 18% of the pts. At first SCC visit, patients deemed in need of home care services were 17 (23%) and for these a formal request for Home Care services activation was sent to the Local Health Territorial Unit (Distretto ULSS). Conclusions: The SCC multidisciplinary assessment represents an organizational model effective in granting a global management of needs with the aim of improving the therapeutic path for patients and their caregivers.

Pain is one of the predominant and troublesome symptoms that burden cancer patients during their whole disease trajectory: adequate pain management is a fundamental component of cancer care. Opioid are the cornerstone of cancer pain relief therapy and their skillful management must be owned by physicians approaching cancer pain patients. In light of the increased survival of cancer patients due to advances in therapy, deprescription should be considered as a part of the opioid prescribing regime, from therapy initiation, dose titration, and changing or adding drugs, to switching or ceasing. In clinical practice, opioid tapering after pain remission could be challenging due to withdrawal symptoms’ onset. Animal models and observations in patients with opioid addiction suggested that somatic and motivational symptoms accompanying opioid withdrawal are secondary to the activation of stress-related process (mainly cortisol and catecholamines mediated). In this narrative review, we highlight how the lack of validated guidelines and tools for cancer patients can lead to a lower diagnostic awareness of opioid-related disorders, increasing the risk of developing withdrawal symptoms. We also described an experience-based approach to opioid withdrawal, starting from a case-report of a symptomatic patient with a history of metastatic pheochromocytoma-paraganglioma.