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Cancer patients are increasingly referred for cardiology evaluations. These patients differ from those routinely seen in cardiology clinics because of their psychological burden and because the therapies and cancer itself can cause cardiac symptoms. A humane approach is critical to managing these patients. Cardiologists may see patients who are newly diagnosed with cancer or are in various phases of treatment; these patients may or may not have preexisting cardiac disease, and may develop cardiotoxicity from chemoimmunotherapy or radiotherapy. Each of these situations presents unique communication challenges for cardiologists. Although some oncology centers provide training in communication skills for their personnel, including cardiologists, this training is not widely available to physicians in general hospitals or private practice. This article examines the psychological aspects of cardio-oncology. It offers practical suggestions on how to best communicate with cancer patients in different phases of oncology care, and discusses when professional psychological help is needed.

Key Points Question Does an implementation strategy integrating psychosocial care into cancer centers improve at least 1 of 2 domains (emotional or social function) of health-related quality of life? Findings This stepped-wedge cluster randomized clinical trial included 762 patients with cancer at high risk for reduced quality of life. Health-related quality of life score improved from baseline to 3 months among participants in the Humanization in Cancer Care Quality Improvement Strategy arm vs the usual care arm, showing a statistically significant difference for emotional function, but not for social function. Meaning This study suggests the use of an implementation strategy aiming to provide routine psychosocial care in cancer centers may be beneficial to patients; further investigation is required on factors that can maximize its effects., Importance Many patients with cancer who would benefit from psychosocial care do not receive it. Implementation strategies may favor the integration of psychosocial care into practice and improve patient outcomes. Objective To evaluate the effectiveness of the Humanization in Cancer Care (HuCare) Quality Improvement Strategy vs standard care as improvement of at least 1 of 2 domains (emotional or social function) of patient health-related quality of life at baseline and 3 months. A key secondary aim included investigation of the long-term effect. Design, Setting, and Participants HuCare2 was a multicenter, incomplete, stepped-wedge cluster randomized clinical trial, conducted from May 30, 2016, to August 28, 2019, in three 5-center clusters of cancer centers representative of hospital size and geographic location in Italy. The study was divided into 5 equally spaced epochs. Implementation sequence was defined by a blinded statistician; the nature of the intervention precluded blinding for clinical staff. Participants included consecutive adult outpatients with newly diagnosed cancer of any type and stage starting medical cancer treatment. Interventions The HuCare Quality Improvement Strategy comprised (1) clinician communication training, (2) on-site visits for context analysis and problem-solving, and (3) implementation of 6 evidence-based recommendations. Main Outcomes and Measures The primary outcome was the difference between the means of changes of individual scores in emotional or social functions of health-related quality of life detected at baseline and 3-month follow-up (within each group) and during the postintervention epoch compared with control periods (between groups). Long-term effect of the intervention (at 12 months) was assessed as a secondary outcome. Intention-to-treat analysis was used. Results A total of 762 patients (475 [62.3%] women) were enrolled (400 HuCare Quality Improvement Strategy and 362 usual care); mean (SD) age was 61.4 (13.1) years. The HuCare Quality Improvement Strategy significantly improved emotional function during treatment (odds ratio [OR], 1.13; 95% CI, 1.04-1.22; P = .008) but not social function (OR, 0.99; 95% CI, 0.89-1.09; P = .80). Effect on emotional function persisted at 12 months (OR, 1.05; 95% CI, 1.00-1.10; P = .04). Conclusions and Relevance In this trial, the HuCare Quality Improvement Strategy significantly improved the emotional function aspect of health-related quality of life during cancer treatment and at 12 months, indicating a change in clinician behavior and in ward organization. These findings support the need for strategies to introduce psychosocial care; however, more research is needed on factors that may maximize the effects. Trial Registration ClinicalTrials.gov Identifier: NCT03008993, This randomized clinical trial examines the use of psychosocial interventions in cancer treatment centers to improve patients’ health-related quality of life.

The Hospital Anxiety and Depression Scale (HADS) is a self-report questionnaire designed to screen anxious and depressive states in patients in non-psychiatric settings. In spite of its large use, no agreement exists in literature on HADS accuracy in case finding. The present research addresses the issue of HADS accuracy in cancer patients, comparing its two subscales (HADS-A and HADS-D) against tools not in use in psychiatry, which are able to detect prolonged negative emotional states. 2121 consecutive adult cancer inpatients were administered the HADS together with the State Anxiety subscale of State-Trait Anxiety Inventory and the Center for Epidemiologic Studies Scale on Depression. Receiver operating characteristic (ROC) curves were computed to identify a cut-off for anxious and depressive states in cancer patients. All indicators were computed together with their corresponding 95% confidence interval (95% CI). Data of 1628 and 1035 participants were used to assess the accuracy in case finding of HADS-A and HADS-D, respectively. According to the ROC analysis, the optimal cut-off was > 9 units for the HADS-A and > 7 units for the HADS-D. The area under the ROC curve was 0.90 for HADS-A (95% CI 0.88–0.91) and 0.84 for HADS-D (95% CI 0.81–0.86). This study suggested that risk scores of anxious and depressive states above specific HADS cut-offs are useful in identifying anxious and depressive states in cancer patients, and they may thus be applicable in clinical practice.

Since long-term cancer survivorship is a reality for an increasing number of people, understanding their cognitive functioning is useful for both research and clinical purposes. This study described the cognitive functioning of Italian long-term cancer survivors, using both an objective standardized battery and a self-report questionnaire. A total of 136 Italian adults 5+ years free from cancer and its treatments were administered the Esame Neuropsicologico Breve, the Self-Assessment Scale of Cognitive Functioning, and assessments of other psychological dimensions. A total amount of 15% of the sample showed impaired performance on 2+ of the assessed cognitive functions, and 32% had 1+ impaired function. The subjective perception of their cognitive functioning was worse in the present sample, compared to the normative data (p 0.001). Cognitive functioning, objectively and subjectively measured were significantly correlated (p = 0.006). The number of tests scored outside the normal range correlated positively with depression (p = 0.042) and negatively with both the estimated total IQ (p 0.001) and with estimated performance IQ (p = 0.001). Self-perceived cognitive functioning correlated positively (p 0.001) with depression, anxiety, and fatigue. These data document how cognitive difficulties may remain for a long time in cancer patients, who are likely to continue to subjectively perceive themselves as impaired, although sometimes to a greater extent than objective impairment.

This study examines the development and feasibility of a quality improvement strategy for the translation of evidence-based psychosocial care into clinical practice. The project involved all staff (oncologists, psychologists, and nurses) of the participating centers. Recommendations concerned: improvement of clinician communication skills; use of a patient question prompt list; assignment of a specialist nurse to each patient; screening for psychological distress and social needs; opportunity to attend a Point of Information and Support. The implementation strategy hinged on context analysis and problem solving. Four to six visits were held in each center by the project team to assist staff in identifying obstacles, finding solutions, and strengthening motivation. The primary variable was the adherence percentage to the recommendations (proportion of subjects receiving each intervention). The number of centers that failed to reach the objective was also reported (adherence percentage

In Italy, educational programs for cancer patients are currently provided by the national government, scientific societies, and patient advocate organizations. Several gaps limit their effectiveness, including the lack of coordinated efforts, poor involvement of patient feedback in the planning of programs, as well as a lack of resources on innovative cancer-related topics. This process is parallel to a strong shift in the attitude of patients towards health in general and taking charge of their own health conditions in particular. The National Cancer Institute in the USA and the Organization of European Cancer Institutes encourage comprehensive cancer centers in providing educational programs conceived to overcome these gaps. The goal of this paper is to identify and describe the key elements necessary to develop a global patient education program and provide recommendations for strategies with practical examples for implementation in the daily activities of cancer institutes. A multidisciplinary committee was established for patient education, including patient representatives as equal partners, to define, implement, verify, and evaluate the fundamental steps for establishing a comprehensive education program. Six essential topics were identified for the program: appropriate communication of cancer epidemiology, clinical trial information, new therapeutic technologies, support in the use of medicines, psycho-oncological interventions, age-personalized approaches, and training programs for healthcare providers. Integration of these topics along with patient feedback is the key to a successful model for educational programs. An integrated educational program can transform a comprehensive cancer center to an institution that provides research and care for and with patients.

Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their quality of life (QoL) can inform health care policy as well as help supporting individual patients. This study was aimed to quantify QoL of this specific population in comparison with data provided for both the general population and cancer patients and to assess QoL association with several sociodemographic, clinical, and psychological variables. Three hundred fourteen Italian long-term cancer survivors (people who have been free from cancer and cancer treatments for at least 5 years) completed a battery of questionnaires including the SF12 for QoL assessment. Both physical and mental functioning were higher than those among Italian cancer patients but lower than those of the Italian general population (p

Understanding the quality of life (QoL) of long-term cancer survivors is relevant to daily clinical practice as well as to healthcare policy. This study assessed QoL of Italian survivors and tested the association between QoL and the main clinical and socio-demographic sample’s characteristics. Two hundred and sixty-five Italian adult long-term cancer survivors (people free from cancer and its treatments for at least 5 years) were administered the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, the Impact of Cancer, and the Short Form 36 questionnaires obtaining three different QoL profiles—cancer-specific, survivorship-specific, and generic. In both cancer-specific and generic QoL profiles, participants reported a lower general health and a higher social functioning than normative samples; in addition, they reported low emotional functioning and vitality, respectively, in the former and latter profile. In the survivorship-specific profile, participants scored higher on personal growth and altruism (p

The Impact of Cancer Scale (IOC) is a self-assessment tool designed to capture the unique and multidimensional aspects of the quality of life of long-term cancer survivors. This paper describes the adaptation and psychometric evaluation of its Italian version.After the adaptation (i.e., removal of nonpertinent items and back-translation procedure), the Italian version of IOC has been administered to a sample of Italian long-term cancer survivors (people free from cancer and its treatments for at least 5 years) together with the Short Form 36 Health Survey Questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and the Post-Traumatic Growth Inventory.Data on 304 participants were analyzed. Exploratory factor analysis revealed a three-factor structure composed of Uncertainty/Worry about HealthFuture (13 items), Personal GrowthAltruism (14 items), and DissatisfactionLife Interferences (10 items). Internal consistency (Cronbach's alpha,0.77) and temporal stability (Spearman's rho,0.70) were good for all three factors. The obtained three factors correlated with the theoretically pertinent subscales of the other administered tools. To facilitate cross-cultural comparisons, reliability and convergent/divergent validity data for the eight-factor IOC structure already described in literature (Impact of Cancer Version 2) have been also provided.This study supports the use of the IOC in Italy as a trifactorial instrument that is able to isolate aspects characteristic of the condition of long-term cancer survivorship. However, subsequent studies are needed to confirm these findings as well as shed more light on the validity of the IOC construct and its cultural variability.

Body image is the sum of physical, cognitive, emotional, and relational elements that, when integrated, allow the development of a whole, healthy self-identity. Even though body image is normally studied in relation to eating disorders, it can also be influenced by other pathologies, including cancer. In oncology, an effective body image assessment is fundamental. The physical effects of cancer and cancer treatments are important and frequently irreversible also on a functional and emotional level; however, only few surveys have investigated body image in this peculiar context.An extensive literature review was carried out in PubMed and PsycINFO. We considered articles published from 1990 to 2010.Two hundred sixty-three papers matched the search criteria. Assessment methodologies included clinical interviews, self-report measures, questionnaires, symptom check lists, and graphic tests and projective techniques. After excluding the instruments that referred to eating disorders, validated only for adolescents, and/or projective and graphic tests, we found 81 articles with six questionnaires specifically dedicated to body image assessment in oncology.From our systematic review, we could identify six instruments specifically designed for assessing body image in the oncological area. In this paper, we discuss their general characteristics, psychometrics properties and the clinical implications, and body image relevance on the quality of life in cancer patients.

Background Despite its popularity, not a definitive word has yet been said about the latent structure of the Hospital Anxiety and Depression Scale (HADS). The present work is a contribution to this issue: statistically identifying the best tool structure helps in understanding which constructs the tool actually detects. Participants and methods Five hundred and twelve Italian consecutive hospitalized cancer patients completed the HADS together with a form for the collection of personal and clinical data. Two confirmatory factor analyses (CFAs) were carried out to test the validity of both two- and one-factor models, whereas qualitative and quantitative (i.e. Akaike information criterion) indices were used to assess which model among them would fit better with the observed data. Finally, two multigroup CFAs were carried out to test the factorial invariance across gender and disease phase (diagnostic, therapeutic) of the best-fitting model. Results Although both considered models provide a good fit to the observed data, the two-factor model is more adequate; it is invariant across gender and disease phase. Conclusions The present study gives evidence for using HADS to detect anxious and depressive states separately as originally suggested by its authors. Given that this work involved only Italian cancer inpatients, replications in different cultural/national contexts are recommended.

Since long-term survivorship is now a reality for an increasing number of people with cancer, understanding their mood states (i.e., transient subjective emotional states) can inform health-care policy as well as help support individual patients. This study described the mood states of Italian long-term cancer survivors, compared them with normative data, and tested their association with the main clinical and socio-demographic sample’s characteristics. One hundred and fifty-eight Italian adults free from cancer and its treatments for at least 5 years were administered the Profile of Mood States (POMS) and two ad hoc 0–10-point visual-analogue scales on personal health-related worry and risk perception for a personal relapse, respectively. In comparison with the Italian normative sample, the current sample displayed a higher score in Vigor-Activity (p = 0.003) and a lower score in Confusion-Bewilderment (p = 0.008). In Tension-Anxiety, Confusion-Bewilderment, Depression-Dejection, Anger-Hostility, Fatigue-Inertia, and Vigor-Activity, 14.6, 15.9, 17.1, 17.8, 19.7, and 13.3 % of the sample, respectively, displayed meaningful scores (i.e., scores above or below 1 standard deviation from the normative mean score). The mood state profile POMS-provided was associated with gender (p = 0.002), occupational status (p = 0.003), reported health issues (p

Long-term cancer survivorship is a reality for a growing number of persons diagnosed with cancer and this fact justifies the great effort made to know and to improve quality of life (QoL) after having experienced a cancer and its treatments. In this paper, the perception of both sexuality and intimacy--that represents a QoL domain--is investigated in a sample of long-term cancer survivors to identify potential problematic areas and to verify its association with the main socio-demographic and clinical variables.96 long-term cancer survivors (i.e. persons free from cancer and its treatments for at least 5 years) filled out a brief questionnaire together with a socio-demographic and clinical form.17.7% of the sample reported lower interest in sexuality and intimacy; 34.3% more interest in tenderness and cuddles; 12.5% discomfort in intimacy; 30.2% decreased frequency of sexual intercourses; 28.2%, 23.9% and 22.9%, respectively, decreased sexual desire, difficulty with arousal, difficulty with orgasm; finally, 37.5% reported absent or poor satisfaction for their own sexual life. The perception of sexuality and intimacy was associated with gender, age, occupational status, cancer type, other health problems, organic/functional genital damage (p0.05), but not with education, marital status, having or not children, length of survivorship.Although preliminary, these data seem to support World Health Organization statement on the centrality of sexuality of being human.

In cancer patients, depression causes suffering during the whole disease trajectory and it also influences the personal perception of well-being as well as treatment adherence. Consequently, its better definition is needed for planning more tailored supportive programmes. This study was aimed to provide information on depressive state intensity and prevalence in an heterogeneous sample of cancer inpatients. In addition, associations were studied between depressive state and different socio-demographic and clinical factors. A total of 1,147 consecutive adult cancer inpatients completed the Center for Epidemiologic Studies Scale on Depression together with a form for collecting socio-demographic and clinical data. The mean score of depression was 16.9 (SD = 9.3). There were differences in depression intensity associated with gender (p

Aims and background The main national and international organisms recommend continuous monitoring of psychological distress in cancer patients throughout the disease trajectory. The reasons for this concern are the high prevalence of psychological distress in cancer patients and its association with a worse quality of life, poor adherence to treatment, and stronger assistance needs. Most screening tools for psychological distress were developed in English-speaking countries. To be fit for use in different cultural contexts (like the Italian), they need to undergo accurate translation and specific validation. In the present work we summarized the validation studies for psychological distress screening tools available in Italian that are most widely employed internationally, with the aim of helping clinicians choose the adequate instrument. With knowledge of the properties of the corresponding Italian versions, researchers would be better able to identify the instruments that deserve further investigation. Methods We carried out a systematic review of the literature. Results Twenty-nine studies of eight different instruments (five relating to psychological distress, three to its depressive component) were identified. Ten of these studies involved cancer patients and 19 referred to the general population or to non-cancer, non-psychiatric subjects. For seven of the eight tools, data on concurrent and discriminant validity were available. For five instruments data on criterion validity were available, for four there were data on construct validity, and for one tool divergent and cross-cultural validity data were provided. For six of the eight tools the literature provided data on reliability (mostly about internal consistency). Conclusions Since none of the eight instruments for which we found validation studies relative to the Italian context had undergone a complete and organic validation process, their use in the clinical context must be cautious. Italian researchers should be proactive and make a valid and reliable screening tool for Italian patients available.

Aims and Background Since emotional distress is a relevant psycho-social component of an oncological disease experience, its study is useful in multidisciplinary patient cancer care. In the present research, emotional distress together with needs during hospitalization were recorded and their associations with several socio-demographic and clinical variables were verified. Methods and Study Design Five hundred and forty-four consecutive oncological in-patients completed two self-assessment questionnaires concerning emotional distress and needs (i.e., Hospital Anxiety and Depression Scale, Needs Evaluation Questionnaire). Results 27.4% and 20.8% of the enrolled patients were probable cases, respectively, for anxiety and depression; when possible cases were included the percentages raised to 52.5% and 39.3%, respectively. Furthermore, 11.9% and 20.2% of participants were simultaneously probable and possible cases for both conditions. Few differences in anxiety and depression according to socio-demographic and clinical variables were demonstrated, whereas needs seemed to be more frequently associated to them. Finally, needs also seemed to be associated with both anxiety and depression, with possible and probable cases for anxiety and depression displaying more needs than non-cases. Conclusions The implications for both the quality of care and disease adjustment by cancer patients are discussed together with study limitations.

The presence of depressive symptoms and states compromises the quality of life of the oncological patients and the therapeutic adherence. It can also negatively influence prognosis and survival. In this contribution, relevance, issues and modality of registration of this construct in oncological patients will be discussed.

The diagnosis of cancer marks an immediate passage from a condition of health to one characterized by uncertainty, threat of death, and changes. The psychological distress is recognized as a peculiar component in the process of disease adjustment and it seems to change over time together with needs. In the present study, both psychological distress and needs were assessed twice (i.e., after the diagnosis and later during treatments) in a sample of hospitalized cancer patients. Eighty-five consecutive adult patients from the same Cancer Institute in North-east Italy were involved in the research. Participants were requested to fill out both a distress (i.e., the Hospital Anxiety and Depression Scale) and needs (i.e., Needs Evaluation Questionnaire) self-reported measure within a month of diagnosis (diagnostic phase) and 3–6 months from diagnosis (therapeutic phase). In the diagnostic phase, the prevalence of probable psychological morbidity due to anxiety was 23.5% and 14.1% due to depression. When the inpatients identified as possible cases were included, the respective proportions were 56.5% and 36.5%. Progressing from diagnostic to therapeutic phase, anxiety seems to decrease, while no statistically significant difference has been found in depression levels. In both phases, the most frequently mentioned needs were the informative ones; although the decrement in time is significant only for this type of needs. The implications both for the quality of care and the disease adjustment by cancer patients are discussed together with study limitations.

Purpose No structured modality for providing information and support to patients in oncology wards has been validated in clinical trials. Methods This is a pragmatic, two-arm, cluster randomized trial, with the oncology ward as random assignment unit. Centers were allocated to implement a Point of Information and Support (PIS) or to a control group. The PIS included a library for cancer patients and a specifically trained oncology nurse. End points, measured at patient level, were psychological distress and satisfaction with received information. Both intent-to-treat and per-protocol analyses considering clustering were performed. Results Thirty-eight Italian cancer centers were randomly assigned, and 6 months after PIS creation, 3,286 unselected, consecutive cancer patients were surveyed (1,654 in the experimental group and 1,632 in the control group). Three thousand one hundred ninety-seven (97%) questionnaires were collected and deemed valid. Fifty-two percent of centers (11 of 21 centers) in the experimental arm did not implement the PIS in accordance with the protocol. Overall, 34% of patients showed moderate to severe psychological distress, and only 9% declared dissatisfaction. Intent-to-treat analysis did not yield significant differences. Although the per-protocol analysis did show a reduction in psychological distress (28.9% for functioning PIS v 33.3% for no PIS) and dissatisfaction (6.4% for functioning PIS v 9.3% for no PIS), differences did not reach significance. Conclusion This is the first cluster randomized trial aiming to demonstrate that a structured modality of providing information reduces psychological distress. We did not find this, but we believe results should be interpreted cautiously, particularly because of the low compliance with PIS implementation. Context analysis preceding such interventions is essential.

An accurate assessment of patients' needs is a core point in improving treatment adherence, satisfaction, and quality of life of care receivers. The Needs Evaluation Questionnaire (NEQ) is a practical and short instrument designed to record hospitalized patients' necessities. The present paper is a contribution to its factorial definition, useful in enhancing the understanding of NEQ psychometric properties and in supporting its use in research as well as in current practice.Six hundred consecutive hospitalized cancer patients completed the NEQ together with a form for the collection of personal identification and clinical data. The initial sample was randomly split into two subsamples, and we then conducted: (1) an exploratory factor analysis (EFA) on Subsample 1; (2) a confirmatory factor analysis (CFA) of the factor structure resulting from EFA on Subsample 2; (3) a comparison between the factor structure resulting from CFA and a unidimensional factor solution.EFA revealed the presence of five factors (i.e. informative needs, needs related to assistance/care, relational needs, needs for psychoemotional support, and material needs) explaining a total of 50.5% of the variance. CFA confirmed the validity of the correlated five-factor solution emerging from EFA, demonstrating how the theoretical model provided a good fit to the observed data. Finally, we demonstrated that the five-factor solution was more appropriate in the reconstruction of the observed data than the unidimensional factor solution. According to the present data and despite the limitations raised, using NEQ as a five-factor questionnaire is functional and recommendable.

Aim To examine the effectiveness of reflexology foot massage in hospitalized cancer patients undergoing second or third chemotherapy cycles. Background Since the late-1970s, studies have been conducted to assess the efficacy of behavioural and relaxation approaches in controlling nausea/vomiting, anxiety and other side-effects associated with chemotherapy. Methods The study consisted of 30 patients being admitted to the oncology unit at a Scientific Research Hospital in Italy. Only 15 of the 30 participants received therapeutic massage. The subjects’ self-reports of anxiety (measured by the Spielberger State-Trait Anxiety Inventory) were recorded before, after and 24 hours after the intervention. Results There was an average decrease of 7.9 points on the state-anxiety scale in the treatment group and of 0.8 points in the control group (P

Mental adjustment to cancer has been explored in a large body of the literature by using the Mental Adjustment to Cancer (MAC) scale. Problems in the factor structure of the scale and the need for refining the instrument have determined the development of the Mini-MAC. The aim of this study was to validate, according to a test-oriented approach, the Italian version of the Mini-MAC. Four hundred and thirty cancer patients in five centres in Northern Italy completed the Mini-MAC and the Brief Symptom Inventory (BSI). A subgroup of 153 patients filled out the instruments again within 3 months of the first assessment. The five original subscales (Fighting Spirit, Hopeless, Fatalism, Anxious Preoccupation and Cognitive Avoidance) showed acceptable levels of reliability (Cronbach alpha coefficients ranging from 0.55 to 0.80) although alphas were lower for the scales Fighting Spirit and Fatalism. Factor analysis (Varimax rotation) identified the same five factors with minor variations from the original version. Again, alpha coefficients were less robust for the factors Fighting Sprit and Fatalism. Hopeless and Anxious Preoccupation were significantly related to all the BSI psychological stress symptoms, including the Global Stress Index (GSI). Test-retest reliability showed no differences in the sub-scales scores between assessments.

Aims and background The aim of the study was to evaluate the impact of information level on quality of life in cancer patients previously studied for their information level. Patients and methods The information level was determined by means of a questionnaire that explored the degree of information on diagnosis and status of disease, the patient's interpretation of his/her disease status, and his/her satisfaction with the information received. Quality of life was evaluated, some months after evaluation of the information level, by means of the Functional Living Index for Cancer (FLIC) and the State-Trait Anxiety Inventory (STAI 1-2). Results A total of 175 patients were studied. Information was adequate in 53.7% of patients. An adequate level of information was present more frequently among patients aged ≤65 years and in those patients followed at a cancer institute. There was no difference in the quality of life of adequately versus inadequately informed patients. Satisfaction with the information received influenced quality of life in both age groups. Objective clinical variables (active disease present and ongoing treatment) negatively affected quality of life in patients Conclusions In the study, although the level of information did not affect the quality of life, satisfaction with the information was associated with a better quality of life. The finding stresses the importance of a sensible disclosure of diagnosis and prognosis.

The aim of this study was to determine the influence of socio-demographic and professional factors on physicians' attitudes to the terminally ill. Between May 1992 and May 1993, a survey was conducted in the province of Pordenone (north-east, Italy) in order to analyse a number of specific issues, such as emotional involvement, the need for aggressive treatments and the communication of diagnosis and prognosis. After obtaining a list of board-certified physicians from the Medical Association office in Pordenone, a modification of the cancer questionnaire of Haley and Blanchard (QSPT) was mailed to 916 doctors. Of these, 605 (60%; 487 male, 118 female; mean age 41 +/- 11 SD) returned the completed questionnaire. Within the group of responders, we identified three main subgroups, according to their type of activity: general practitioners (175, 29%), hospital doctors (235, 39%) and other doctors (195, 32%). In age, sex and activity, the only significant difference between responders and non-responders was age (mean age 41 and 43 years respectively). Most of the responders (77%) stated that they were able to deal with the terminally ill patient and his/her needs; 44%, however, admitted that patients' anxiety is sometimes unbearable. For the vast majority of the doctors polled (91%), providing a comfortable environment for an incurable patient was more important than pursuing aggressive treatment, but only 44% were convinced of the uselessness of aggressive care. To the question on whether to disclose information about imminent death to allow patients to prepare spiritually, 37% answered "No", 38% "Yes", and 25% were uncertain. Almost all responders (95%), however, believed in the beneficial effect of hope on the terminally ill. Our results suggest that doctors' professional and, most of all, socio-demographic and cultural factors determine the relationship with the patient on both the emotional and the clinical decision-making levels.

Purpose Cancer survivors often report posttraumatic growth (PTG). The aims of this study were to assess the presence of PTG in Italian long-term disease-free cancer survivors (LCS) and to explore the association between the dimensions of PTG and clinical, demographic variables, various agents of perceived social support and psychological distress. Methods Five hundred forty LCS were assessed with Posttraumatic Growth Inventory (PTGI), Multidimensional Scale of Perceived Social Support (MSPSS), Zung Self-Rating Depression Scale, and State-Trait Anxiety Inventory-Y (STAI-Y). Results Mean age was 57.08 years, mean survival was 11.04 years (range 5–32), and the most common cancer diagnosis was breast cancer (56.9%). The PTGI average total score was higher in more educated LCS, in those employed, in LCS with longer time from diagnosis, and in those with no comorbidities. In this study, PTG was not found correlated with distress, but it correlated with perceived social support, age, education, and employment. Conclusions The absence of a correlation between PTG and psychological distress and the low levels of PTG found let us question the importance of talking about PTG when working as psychotherapists with LCS. It may be suggested that the need of finding benefit and PTG in LCS has been overcome by other experiences or worries happened after the cancer, and LCS may not focus anymore on positive changes occurred. The relevance of work and of perceived social support as linked to PTG stresses the need to protect the LCS’s relationship with work and to promote and sustain their social network, and this can help them to experience sharing and closeness to others.

The international literature data report that good information and communication are fundamental components of a therapeutic process. They contribute to improve the patient-health care professional relationship, to facilitate doctor-patient relationships, therapeutic compliance and adherence, and to the informed consent in innovative clinical trials. We report the results of a multicentric national initiative that developed a 17-information-structure network: 16 Information Points located in the major state-funded certified cancer centers and general hospitals across Italy and a national Help-line at the nonprofit organization AIMaC (the Italian oncologic patients, families and friends association), and updated the already existing services with the aim to create the National Cancer Information Service (SION). The project is the result of a series of pilot and research projects funded by the Italian Ministry of Health. The Information Service model proposed is based on some fundamental elements: 1) human interaction with experienced operators, adequately trained in communication and information, complemented with 2) virtual interaction (Help line, Internet, blog, forum and social network); 3) informative material adequate for both scientific accuracy and communicative style; 4) adequate locations for appropriate positioning and privacy (adequate visibility); 5) appropriate advertising. First results coming from these initiatives contributed to introduce issues related to “Communication and Information to patients” as a “Public Health Instrument” to the National Cancer Plan approved by the Ministry of Health for the years 2010–2012.