Medicina Integrata in Oncologia

Paolo Marchetti

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Personalised medicine

The goal of personalised medicine is to better understand the benefits and toxic effects of a given therapy in a specific Patient.

Identify the right Patient for the right treatment.

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Società Italiana di Medicina

P li t

Hanahan D, Weinberg RA. Cell. 2011

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From “…omics” to knowmics

The Problem

Who are our Patients?

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Number of severe symptoms presented at the time of admission by each patient.

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G. Porzio et al., Support Care Cancer 13: 351–355, 2005

How Accurate Is Clinician Reporting of Chemotherapy Adverse Effects?

J Clin Oncol. 2004; 22: 3485-3490.

38 65 77 65 70 17 30 60 100 80 60 40 20

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Perc

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Physician identified Physician missed

Slamon D. SABCS 2005. General Session I.

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Study of unmet needs in symptomatic veterans with advanced cancer

The total number of unmet needs was predictive of a worse QOL.

Shirley S. Hwang et al., 2004

The medical oncologist’s role in palliative care: AIOM’s position

The medical oncologist has to guarantee the best quality of life to the patient and constant and continuous care at every moment of the illness, in addition to the anticancer medical treatment.

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V. Zagonel et al., Tumori, 2009

The medical oncologist’s role in palliative care: AIOM’s position

The medical oncologist should consider prevention and treatment of symptoms of the disease, as well as evaluating response to anticancer therapy.

Assessment of symptoms with validated instruments is necessary during every visit regardless of disease stage or anticancer treatment.

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V. Zagonel et al., Tumori, 2009

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The concept of continuous care

P. Marchetti et al., J NCCN, 2013

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(validated in Italy by Prof Grassi and Dr Costantini)

Good Nutrition Critical to Chemotherapy Weight loss has been shown to be a poor

prognostic sign in cancer. Malnutrition can impair the response to

treatment, quality of life, and the immune system.

It has been estimated that 80% of cancer patients never receive a nutritional evaluation.

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Milayna Subar, Physician's Weekly, 2011

Progetto bi-societario SINPE-AIOM (SINPE, Società Italiana di Nutrizione Artificiale e Metabolismo

Membro della Federazione delle Società Italiane di Nutrizione – FeSIN, AIOM, Associazione Italiana di Oncologia Medica)

Progetto multicentrico sulla Prevalenza della Malnutrizione in Oncologia

Referente per SINPE: Maurizio Muscaritoli Referente per AIOM: Paolo Marchetti

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Role of oncologist in advising patients about fertility issue Many oncologists either do not discuss the

possibility of treatment-related infertility or do so suboptimally

Raising this issue at the first encounter or at the time of diagnosis may not always be practical or wise. Clinician judgment to choose the timing

1. Schover, JCO 20: 1880-89; 2002; 2. Schover Cancer 86: 697-709 1999; 3. Zebrack Psychoncol 13: 689-99 2004; Duffy JCO 23: 766-773 2005.

Breast cancer in the family

Children's perceptions of their mother's cancer and its initial treatment .

Breast cancer in the family

Family fatigue

Predictors of existential and religious well-being among cancer patients P. Marchetti et al., J Supportive Care in Cancer, 2010

Well-being and mental health are not only direct functions of amount of stress, but also depend on how people appraise and face critical situations.

Spiritual well-being seems to be a central component of psychological health in physically healthy individuals and it offers some protection against end-of-life despair in those with chronic diseases.

What is Integrative Medicine?

Integrative medicine is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person's health.

Employing a personalized strategy that considers the patient's unique conditions, needs and circumstances, integrative medicine uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimal health.

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Vicki Weisfeld. (2009)

What is Integrative Medicine?

Integrative medicine is not the same as alternative medicine, which refers to an approach to healing that is utilized in place of conventional therapies, or complementary medicine, which refers to healing modalities that are used to complement allopathic approaches.

If the defining principles are applied, care can be integrative regardless of which modalities are utilized.

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Vicki Weisfeld. (2009)

The defining principles of integrative medicine The patient and practitioner are partners in the healing

process. All factors that influence health, wellness and disease

are taken into consideration, including body, mind, spirit and community.

Providers use all healing sciences to facilitate the body’s innate healing response.

Effective interventions that are natural and less invasive are used whenever possible.

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The defining principles of integrative medicine (ii) Good medicine is based in good science. It is inquiry

driven and open to new paradigms. Alongside the concept of treatment, the broader

concepts of health promotion and the prevention of illness are paramount.

The care is personalized to best address the individual’s unique conditions, needs and circumstances.

Practitioners of integrative medicine exemplify its principles and commit themselves to self-exploration and self-development.

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Integrative medicine 24

Integrative oncology

The Connection Between Lifestyles and Health

Mind-Body Connection Prevention Social Determinants of Health Environmental Aspects of Health and Disease Patient-Centered Care

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Integrative Medicine Academic Hospitals in USA

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Clinical Fellowships: University of Arizona

(Founding Program) University of Michigan University of Maryland University of Wisconsin Maine Medical Center Cooper Health System (NJ) Lawrence MA Beth Israel Medical Center UCLA

Academic Fellowships (Research) Harvard University Tufts Boston University Stanford Duke

Residencies in Integrative Medicine Oregon Health Sciences

University Montefiore Medical Center

(NY)

Consortium of Academic Health Centers for Integrative Medicine

Albert Einstein/Beth Israel Columbia University Duke University George Washington Georgetown Harvard Laval University Mayo Clinic OHSU Stanford University Yale University Wake Forest University University of Alberta University of CA/Irvine Thomas Jefferson UMDNJ University of Arizona University of Calgary University of Hawaii University of Washington

University of California/LA University of California/SF University of Colorado University of Connecticut University of Kansas University of Maryland University of Massachusetts University of New Jersey University of New Mexico University of North Carolina-Chapel

Hill University of Michigan University of Minnesota University of Pennsylvania University of Pittsburgh University of Texas-Galveston University of Vermont University of Wisconsin

Integrative Medicine Academic Hospitals in Italy 28

The Future Is Sometimes Curing, But Always Caring

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“…Following the light of the sun, we left the Old World…” Cristoforo Colombo