Malnutrition, a key factor in oncology, affects 20-70% of cancer patients and influences both cancer risk and outcomes, being linked to decreased treatment tolerance, higher toxicity, lower quality of life, and shorter survival. Although international guidelines recommend early and systematic nutritional screening, its adoption in clinical practice remains inconsistent. This study, promoted by the Italian College of Hospital Medical Oncology Directors (CIPOMO), aimed to provide a national snapshot of current organizational practices regarding nutritional screening, assessment, and management in Italian oncology centers. A 15-item survey was sent to 165 centers to investigate organizational practices and awareness of nutrition and physical activity in cancer care. Data were collected and analyzed as overall percentages. A total of 100 centers responded (61%). Although a nutritional assessment is routinely conducted at diagnosis in 67% of centers (n = 67), only 31 centers perform it for all patients. The remaining centers limit nutritional assessment to high-risk or selected patient groups. Moreover, although 86% of centers have dedicated professionals, multidisciplinary integration remains limited. Validated nutritional screening tools are used in 69% of centers, but follow-up reassessment is rarely systematic (15%). However, awareness of the importance of nutrition is high, with nearly all centers supporting educational interventions and dedicated nutritional pathways. Despite this high level of awareness, a significant gap remains between guideline recommendations and daily clinical practice. Standardizing early nutritional screening, enhancing multidisciplinary collaboration, and ensuring equitable and consistent access to nutritional services are crucial to fully integrating nutrition into oncology care and improving patient outcomes.

BACKGROUND:Stage III non-small cell lung cancer (NSCLC) includes a heterogeneous group of patients with diverse disease presentation, biological portrait, and prognosis. Optimal management requires tailored approaches and multimodal strategies through a multidisciplinary team (MDT) decision-making process. The BE-PACIFIC study primarily aimed at describing treatment strategies of stage III NSCLC according to the Italian standard clinical practice, diagnostic work-up and survival outcomes during observation. PATIENTS AND METHODS:The BE-PACIFIC is an observational multicentre retrospective and prospective cohort study, involving both primary data collection and secondary use of data. Adult patients with confirmed diagnosis of stage III NSCLC were included by 40 sites and followed up for 12 months after diagnosis. RESULTS:From 1st August 2019, to 31st July 2020, 311 subjects were enrolled: 296 (95.2%) were evaluable for the analyses. The median (25th-75th percentiles) duration of the diagnostic process was 30.4 (21.0-60.9) days. MDT was involved in treatment plan definition of 88.7% (n/N=260/293) of patients. Sixty (20.3%) patients had tumour resection, mostly associated with neoadjuvant (n=26, 43.3%) or adjuvant (n=22, 36.7%) treatment alone. Chemoradiation was used in 165 of 236 (69.9%) non-resected patients, followed by durvalumab in 80 cases (48.5%). CONCLUSIONS:MDT was largely involved in stage III NSCLC management, with at least 75% of patients completing the diagnostic process within 2 months. Consolidation durvalumab was used in half of non-resected patients treated with chemoradiation, with favourable retention rates and response, consistently with the PACIFIC trial findings.

Trifluridine/tipiracil (TAS-102) is an oral chemotherapy approved for the treatment of metastatic colorectal cancer. The efficacy and tolerability of TAS-102 were shown in phase II-III clinical trials and in several real-life studies. The elderly and other special subgroups are underrepresented in published literature. We conducted a retrospective multicenter study to assess the effectiveness and safety of TAS-102 in consecutive patients with pretreated mCRC. In particular, we estimated the effectiveness and safety of TAS-102 in elderly patients (aged ≥70, ≥75 and ≥80 years) and in special subgroups, e.g., patients with concomitant heart disease. One hundred and sixty patients were enrolled. In particular, 71 patients (44%) were 70 years of age or older, 50 (31%) were 75 years of age or older, and 23 (14%) were 80 years of age or older. 19 patients (12%) had a concomitant chronic heart disease, three (2%) patients were HIV positive, and one (<1%) patient had a DPYD gene polymorphism. In 115 (72%) cases TAS-102 was administered as a third-line treatment. The median overall survival (OS) in the overall population was 8 months (95% confidence interval [CI], 6-9), while the median progression-free survival (PFS) was 3 months (95% CI, 3-4). No significant age-related reduction in effectiveness was observed in the subpopulations of elderly patients included. The toxicity profile was acceptable in both the whole and subgroups' population. Our study confirms the effectiveness and safety of TAS-102 in patients with pretreated mCRC, suggesting a similar risk-benefit profile in the elderly.

Stage III locally advanced non-small cell lung cancer (NSCLC) includes a heterogeneous group of patients with diverse disease presentation, biological portrait and prognosis. Given its complexity, optimal management of patients requires tailored approach through a multidisciplinary team (MDT) decision-making process. According to the PACIFIC trial [NCT02125461] results, the evolving treatment paradigm in the setting of unresectable disease includes the programmed death-ligand 1 (PD-L1) inhibitor durvalumab as beneficial consolidation immunotherapy following chemoradiation. Here we report the final results from the 'Italian oBsErvational study on Patient mAnagement strategies in real-world Clinical practIce For patIents with loCally advanced (stage III) NSCLC' (BE-PACIFIC), aimed at describing diagnostic work-up and treatment of stage III NSCLC according to the Italian standard clinical practice, and outcomes during observation.

Background: Pain is one of the most debilitating symptoms in oncological diagnosis, and is present in most cancer patient (in the literature range 20 to 95%) Cancer pain is a chronic pain with multifactorial pathogenesis with which intense episodic transient acute pain can coexist (Btcp) Hence the need to assess / correctly measure pain to set an appropriate drug therapy (treatment based on the 'three steps of pain' -OMS 1986-) and it is possible to have a more objective evaluation of the results of the established analgesic therapy During the emergency period, outpatient visits were reduced both in terms of organization and frequency and the reduction in the number of doctors available and the limitations of patient access to hospital clinics for their protection led to a new approach to taking load Material (patients) and methods: Experience of our center, from 1 March 2020 to 31 May 2020, during the covid 19 emergency compared with the pre-covid period from 1 November 2019 to 31 January 2020 regarding the evaluation of pain, the need to set specific analgesic therapy, the need to modify this therapy in the course of time (switching between opioids or association between opioids of two different classes) and the need to add adjuvant drugs Results: During this time we followed 15 patients versus 17 patients in pre-covid period Pain was measured in all the first evaluation (using one-dimensional measurement scales-numerical scale -), in 90% of cases this was done by telephone (versus 0% pre covid) Furthermore, the cargiver's telephone involvement was necessary, especially in monitoring over time to evaluate pain control, Btcp episodes and side effects (in the pre-covid period it was the patient who exposed these data during the visit) On the other hand, as regards the specific analgesic therapy set, the need to rotate the opioids or to associate two opioids of different classes, the prescription of the rescue dose and the adjuvant drugs, there were no differences compared to the pre-emergency period Conclusions: During the emergency period, in consideration of the high frequency of pain and the impact on the patient's quality of life, it was necessary to modify our approach to manage the patient with cancer, make a correct assessment (repeated over time) and set up an effective analgesic therapy

Cancer patients are more susceptible to infections and potentially at higher risk to develop COVID-19. Tumor type and antitumor treatment may also affect both the susceptibility to and the severity of SARS COV-2. To analyze the distribution of patients who developed COVID-19 during active antineoplastic therapy and the related clinical course by tumor type, stage and class of oncologic treatment (chemo, immune, biologic, other) a multicenter, retro-prospective, observational study was proposed to the Hospital Medical Oncologic Units of the National Health Service in Italy (168 centers of the Collegio Italiano dei Primari Oncologi Medici Ospedalieri -CIPOMO). Data were collected on demographics, tumor characteristics, treatment setting, type of ongoing anti-cancer therapy and COVID-19 clinical course (phenotype, hospitalization, therapy, duration and outcome). Eligibility required a positive COVID-19 molecular test before May 4th, 2020 and at least 1 course of antitumor therapy delivered after January 15th. At the present analysis data are available for 116 of 168 centers (7 declined, 28 pending, 17 data awaited). 64 of 116 centers (55%) had COVID-19 positive cases (cases /center: median 3, range 1-40). At these 64 centers, 283 positive cases (males 158, 55.9% - females 125, 44.1%; median age 67 years, range 28-89) were observed among a total population of 40894 patients receiving active treatment between January 15 and May 4 2020. 65 of 283 (23%) had cardiovascular comorbidities and 7 (2%) pre-existent pulmonary disease. 239/283 patients (84.4%) were receiving treatment for metastatic disease and 44 (15.6%) in the adjuvant setting. Breast, lung, colon and prostate cancer were the main tumor types accounting for 61 % of cases. The occurrence of COVID-19 among cancer patients receiving active antitumor treatment appears to reflect tumor epidemiology. Full analysis of the distribution of COVID-19 occurrence and clinical course by tumor type, stage and oncologic treatment will be presented.

Background: On February 21, 2020 the first Italian Covid19 patient was diagnosed From that day the pandemic begins, which spreads with an impressive growth The Oncology Unit Director has responsibilities, which obliged him to execute orders dropped by the Hospital Management in a top-down manner Above all, he has direct responsibilities towards his collaborators and patients It\u0027s not allowed to entrench behind the sentence: I\u0027ve no provisions For this reason, it is necessary to deal with the emergency with clinical intelligence, notwithstanding specific provisions Method: Since March 9, the Sondrio\u0027s Medical Oncology team received specific provisions from its Director, more restrictive than that developed by the hospital summarized in:-obligation to measure body temperature (BT) before leaving home-light protection during work: surgical mask, gloves, cap -complete protection in case of suspect Covid19 patient-placement of active treatments on at least 2 distinct time slots to avoid gatherings -sanitization of the chairs after each patient-from 3 April 2020 obligation for all staff to use KN95 masks, purchased directly -obligation for each patient: o to stay at home if BT \u003e 37 5 ° C o to monitor BT at home before going out o to detect BT before entering in day hospital o it\u0027s always forbidden to have accompanying persons o at least surgical mask o to disinfect hands using gloves Results: With the provisions, no one became infected during work in the last 3 months Only 1 nurse was Covid+, due to her husband By contrast, 44 patients were Covid+ and 21/44 have died 3/44 were diagnosed as Covid19 + as hospitalized patients These data testifies our daily risk No patient produced written complaints to the hospital management for our new rules Discussion: In Sondrio\u0027s Province there\u0027ve been 1,480 infections Almost 400/1,480 were health employers, a doctor has died The most serious pandemic of the last 50 years was managed initially with a lack of tampons, delay in the use of serology, ostracism towards the use of personal protective equipment The provisions of Oncology Unit Director ensured:-protection of staff-guaranteed treatment for all patients At 31 May 2020, the out-inpatients hospitalization activity was comparable to 2019 We used our knowledge for them without deserting On 9 April and 9 May, 2020 all staff underwent rapid qualitative serological tests purchased directly by our decision All were negative

Background: COVID-19 disease quickly spread all over the world starting from Wuhan, China in December 2019 In Italy too, the lockdown was necessary from March to May 2020 to contain the exponential increase in infections The pandemic outbreak has significantly affected the psychological wellbeing of the general population However, according to the recent literature, healthcare workers were subject to greater stress and emotional impact due to a number of factors: active role in assisting COVID-19 patients, increased risk of infection, fear of infecting families, social stigma, exhausting working conditions For this reason, we aimed to evaluate the psychological impact of the emergency in a group of Italian health workers Methods: We examined the psychological discomfort, depression, anxiety and stress experienced by health workers in Italy during the outbreak spike through the use of IES, BAI and BDI-II tests and compared them together with the sample's demographic characteristics as well as several measures strictly related to direct and indirect Covid-19 experiences Results: From 20th April to 4th May 2020, 96 healthcare workers [60 female, 36 male, median age 46 (28-70)] were invited to participate to the integrated self-administered questionnaire The results of the IES test were in 42 (44%) cases not clinically significant while in 19 (20%), 9 (9%) and 26 (27%) there was a light, moderate and severe emergency impact respectively The BAI test indicated a state of anxiety in 76 (79%), 14 (15%) and 6 (6%) respectively as mild, moderate and high The BDI-II test indicated depression in 71 (74%), 12 (13%), 6 (6%) and 7 (7%) as low, mild, moderate and severe, respectively The results of the IES and BAI test had a Pearson correlation index of 0 81, while between IES and BDI-II was 0 71 A multiple linear regression analysis between the dependent variable IES and the independent variables BAI and BDI-II showed an adjusted R-square index of 0 66 (p<0 000001) Conclusions: Applied test results show likely effectiveness in assessing the emotional impact of the COVID-19 emergency Moreover, having a strong correlation between them and considering the measures of anxiety and depression as independent variables, these seem to be a predictive factor of the event's impact perception in the study population These results encourage to underline the importance of adequate psychological support for health workers even after the acute phase of the emergency

Background: Recent literature suggests that cancer patients are more susceptible to SARS CoV-2 infection and have higher infection-related mortality These data are certainly influenced by age, stage of the disease, type of antitumour treatment and presence of cardiovascular comorbidity Methods: We conducted a retrospective observational study to evaluate the characteristics of patients with a history of oncological/haematological disease who acquired SARS CoV-2 infection during oncologic follow-up or active antineoplastic therapy in our Institution (ASST Valtellina e Alto Lario, Province of Sondrio) from March 1 to April 30, 2020 Eligibility required positive molecular testing on nasopharyngeal swab or bronchoalveolar lavage Results: At the present analysis, a total of 1471 subjects resulted positive for SARS COV-2 infection in our Province;among them 43 subjects (2 94%) had a history of oncological or haematological disease 24/43 (55 8%) were males and 19/43 (44 2%) females;median age was 71 5 (range 53-91) 42/43 patients (97 6%) were hospitalized on a total of 613/1459 positive people who required hospitalization (42/613, 6 8%) 48 8% (21/43) patients died due to viral infection on a total number of deaths of 150 (21/150, 14%);55% were males and 45% females;40% had an age range between 70 and 79, 25% between 50 and 59, 20% between 60 and 69 and 15% over 80 25% of patients had stage IV disease;80% of patients had cardiovascular comorbidities and preexistent pulmonary diseases Breast, lung and colon were the tumor types most represented Conclusions: In our case study, oncologic/haematologic patients are not significantly represented, constituting only less than 3% of total infected and about 7% of hospitalized subjects Although the limited sample, our data reveal, meanwhile, high mortality for SARS CoV-2 in cancer patients This data suggests the need for new strategies for an earlier detection of positive subjects from SARS Cov-2 within the cancer population

Background: The health emergency from Sars-CoV-2 required the implementation of prevention measures that had an important impact on habits and lifestyles Healthcare workers are among the workers who are most exposed to the risk of contagion, also exposing them to a growing emotional and psychological overload In this work, Sars-CoV-2 has been examined as a negative factor coming from the external environment that affects negatively on the internal organizational environment Exposure to the virus, fear of being infected or of infecting your family, prolonged working hours, shortage of personal protective equipment, are just some of the factors that can create situations of stress and burnout To anticipate and monitor the onset of these conditions in healthcare workers, a psychological analysis and support project has been set up since the beginning of the phase of maximum contagion of Sars-CoV-2 Methods: The intervention was proposed to all healthcare workers in the Medical Oncology Unit by subjecting them to the Maslach Burnout Inventory (MBI), to investigate the dimensions of emotional exhaustion, depersonalization and personal accomplishment, the Utrecht Work Engagement Scale (UWES), for engagement in the dimensions of vigor, dedication and absorption From the results obtained, psychological interviews were planned at implementing individual resilience and hardiness, in cases where the subject has reported a high burnout and low value on the engagement scale, and group collaboration and sharing, in the case of burnout of medium level and average engagement, to face the Sars-CoV-2 state of emergency by improving the aspects of group hardiness Results: 43% of healthcare workers reported high engagement while 48% are on average 9% report low values Burnout is present in high value in 39%, average in 35% and not present in 26% of healthcare workers The dimensions detected in the MBI and UWES are directly opposite, therefore burnout healthcare workers can report high values in engagement and vice versa Only in 8% of cases did subjects report high burnout values and low engagement values Conclusions: Providing cognitive tools through psychological support interviews facilitated greater awareness and understanding of the problem, an understanding of the interactions between health professionals and the emergence of Sars-Cov-2, strengthening positive relationships, the problem solving, compensating for anxiety and reorganizing organizational roles

Background: The global COVID-19 pandemic has adversely affected all aspects of clinical care and it has not spared even clinical trials on cancer Indeed the need to adopt precautionary measures for the containment of COVID-19 infection have affected the access of cancer patients in clinical trials The devastating effects of this global crisis have also negatively impacted the work of our Oncology Unit which has so far conducted more than 120 phase I-III studies Method: We faced numerous challenges with conducting clinical trials due to COVID-19 In order to contain infection all the actor involved had to apply several precautions Pharmaceutical companies, no-profit Sponsors, CROs and either our organization have applied or extended smartworking in order to continue their activities related to clinical trials but monitoring visit on site were suspended When possible remote monitoring visits have been performed Start initiation visit for new trial, for which it is essential the presence on site, were strongly postponed Ethics Committee evaluation of clinical trials or substantial amendments have suffered inevitable strong delays nearly to 3 months because they had to adapt their activities also with organize their meetings by web-conferences Only access to compassionate use was ever granted Results: At site particular attention was needed in the enrollment of new patients in the trials evaluating the risk/ benefits ratio For each patient the possible postponement of access to receive treatment has been assessed on the basis of the relationship between the risks, for the patient and the community related to access to the site, and the expected benefits of the treatment itself The closure of several Hospital Units due to spread of contagion and limited availability of ancillary services caused the interruption of enrollment in clinical trials Conclusions: Our clinical research activity during the pandemic has suffered negative repercussions but we think that what happened could be an useful opportunity to improve and transform clinical trial conduction system for example by simplifying the study design, optimizing the number of on-site monitoring visits and reducing patient's access to the hospital

Background: COVID-19 disease quickly spread all over the world starting from Wuhan, China in December 2019 In Italy too, the lockdown was necessary from March to May 2020 to contain the exponential increase in infections The pandemic outbreak has significantly affected the psychological wellbeing of the general population However, according to the recent literature, healthcare workers were subject to greater stress and emotional impact due to a number of factors: active role in assisting COVID-19 patients, increased risk of infection, fear of infecting families, social stigma, exhausting working conditions For this reason, we aimed to evaluate the psychological impact of the emergency in a group of Italian health workers Methods: We examined the psychological discomfort, depression, anxiety and stress experienced by health workers in Italy during the outbreak spike through the use of IES, BAI and BDI-II tests and compared them together with the sample\u0027s demographic characteristics as well as several measures strictly related to direct and indirect Covid-19 experiences Results: From 20th April to 4th May 2020, 96 healthcare workers [60 female, 36 male, median age 46 (28-70)] were invited to participate to the integrated self-administered questionnaire The results of the IES test were in 42 (44%) cases not clinically significant while in 19 (20%), 9 (9%) and 26 (27%) there was a light, moderate and severe emergency impact respectively The BAI test indicated a state of anxiety in 76 (79%), 14 (15%) and 6 (6%) respectively as mild, moderate and high The BDI-II test indicated depression in 71 (74%), 12 (13%), 6 (6%) and 7 (7%) as low, mild, moderate and severe, respectively The results of the IES and BAI test had a Pearson correlation index of 0 81, while between IES and BDI-II was 0 71 A multiple linear regression analysis between the dependent variable IES and the independent variables BAI and BDI-II showed an adjusted R-square index of 0 66 (p\u003c0 000001) Conclusions: Applied test results show likely effectiveness in assessing the emotional impact of the COVID-19 emergency Moreover, having a strong correlation between them and considering the measures of anxiety and depression as independent variables, these seem to be a predictive factor of the event\u0027s impact perception in the study population These results encourage to underline the importance of adequate psychological support for health workers even after the acute phase of the emergency

Background: Pain is one of the most debilitating symptoms in oncological diagnosis, and is present in most cancer patient (in the literature range 20 to 95%) Cancer pain is a chronic pain with multifactorial pathogenesis with which intense episodic transient acute pain can coexist (Btcp) Hence the need to assess / correctly measure pain to set an appropriate drug therapy (treatment based on the \u0027three steps of pain\u0027 -OMS 1986-) and it is possible to have a more objective evaluation of the results of the established analgesic therapy During the emergency period, outpatient visits were reduced both in terms of organization and frequency and the reduction in the number of doctors available and the limitations of patient access to hospital clinics for their protection led to a new approach to taking load Material (patients) and methods: Experience of our center, from 1 March 2020 to 31 May 2020, during the covid 19 emergency compared with the pre-covid period from 1 November 2019 to 31 January 2020 regarding the evaluation of pain, the need to set specific analgesic therapy, the need to modify this therapy in the course of time (switching between opioids or association between opioids of two different classes) and the need to add adjuvant drugs Results: During this time we followed 15 patients versus 17 patients in pre-covid period Pain was measured in all the first evaluation (using one-dimensional measurement scales-numerical scale -), in 90% of cases this was done by telephone (versus 0% pre covid) Furthermore, the cargiver\u0027s telephone involvement was necessary, especially in monitoring over time to evaluate pain control, Btcp episodes and side effects (in the pre-covid period it was the patient who exposed these data during the visit) On the other hand, as regards the specific analgesic therapy set, the need to rotate the opioids or to associate two opioids of different classes, the prescription of the rescue dose and the adjuvant drugs, there were no differences compared to the pre-emergency period Conclusions: During the emergency period, in consideration of the high frequency of pain and the impact on the patient\u0027s quality of life, it was necessary to modify our approach to manage the patient with cancer, make a correct assessment (repeated over time) and set up an effective analgesic therapy

Background: The emergency state we are living today and the implementation of COVID-19 related restrictions has increased the psychologic distress levels for cancer patients Measures such as not beingallowed to see other people and forced social distancing, have triggered in in patients negative memories and increased their concerns about the efficacy of their treatment plan For these patients, lonelinessis linked to a higher likelihood of death and social distancing has a negative impact on their mental health, by increasing their worries In order to limit these downsides, an important unlock has been to be able to provide continuous psycho-oncology treatments through the remote use of tablets, PCs and smartphones,and thereby reducing the number of visits to hospital Material (patients) and methods: The effectiveness of the remote psychologic treatments has been possible by the use of the psychologic distress thermometer and its impact overall Psychoeducation has helped to normalize the psychologic reactions against COVID-19;patients have experienced daily activities shifts, such as sleep, diet and level of attention, that have reduced security and personal equilibrium in their day to day life Analysis of individual coping skills and use of mindfulness were key to increase patients personal resilience Results: From a 3-month research on cancer patients, from March 3rd to June 3rd, the following results are shown: Conclusions: Technology has allowed the continuity of this service in such vulnerable times and it has enabled the implementation of new functional approaches from a personal, relational and social point of view Now it's time to a new challenge: go back to normality Without psychooncology treatments through the remote use of tablets, PCs and smartphones this would not have been possible, this method will remain a valid alternative over time

Background: Simultaneous care represents an organizational model based on the global care of the cancer patient through continuous assistance and a progressive integration between cancer therapies and palliative care The model responds to global needs (physical, psychological, social) of the patient and his family managed by a multidisciplinary team made up of oncologists, palliativists, radiotherapists, psychologists As compared with cancer patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life and longer survival In the province of Sondrio ASST Valtellina and Alto Lario has activated simultaneous care for cancer patients for about a year Material (patients) and methods: The simultaneous care clinics are structured on defined days and times, managed by a multidisciplinary team which always involve family members During the emergency period the surgeries underwent changes in terms of organization and frequency The reduction in the number of doctors available and the limitations of patient access to hospital clinics for their protection have led to a significant reduction in the numbers of cancer patients treated early in simultaneous treatment The analysis of the data defines a number of 12 cancer patients followed simultaneously in a pre-covid period from 1 November 2019 to 31 January 2020 During the covid-19 emergency, in the period from 1 March 2020 to 31 May 2020, they were followed 5 patients On average 3 patients versus 1 in the emergency period Results: During the covid-19 emergency, the results show a significant reduction in simultaneous care paths In this phase, the simultaneous care clinic was managed as needed by a single professional with telephone consultations and few home visits without the direct involvement of family members Conclusions: The reduction in simulataneous care during the emergency period penalized cancer patients who, in a moment of clinical fragility, experienced a lived experience of abandonment that affected their quality of life In memory of dr Fabio Rubino, Responsible for the Palliative Care Service

Background: The health emergency from Sars-CoV-2 required the implementation of prevention measures that had an important impact on habits and lifestyles Healthcare workers are among the workers who are most exposed to the risk of contagion, also exposing them to a growing emotional and psychological overload In this work, Sars-CoV-2 has been examined as a negative factor coming from the external environment that affects negatively on the internal organizational environment Exposure to the virus, fear of being infected or of infecting your family, prolonged working hours, shortage of personal protective equipment, are just some of the factors that can create situations of stress and burnout To anticipate and monitor the onset of these conditions in healthcare workers, a psychological analysis and support project has been set up since the beginning of the phase of maximum contagion of Sars-CoV-2 Methods: The intervention was proposed to all healthcare workers in the Medical Oncology Unit by subjecting them to the Maslach Burnout Inventory (MBI), to investigate the dimensions of emotional exhaustion, depersonalization and personal accomplishment, the Utrecht Work Engagement Scale (UWES), for engagement in the dimensions of vigor, dedication and absorption From the results obtained, psychological interviews were planned at implementing individual resilience and hardiness, in cases where the subject has reported a high burnout and low value on the engagement scale, and group collaboration and sharing, in the case of burnout of medium level and average engagement, to face the Sars-CoV-2 state of emergency by improving the aspects of group hardiness Results: 43% of healthcare workers reported high engagement while 48% are on average 9% report low values Burnout is present in high value in 39%, average in 35% and not present in 26% of healthcare workers The dimensions detected in the MBI and UWES are directly opposite, therefore burnout healthcare workers can report high values in engagement and vice versa Only in 8% of cases did subjects report high burnout values and low engagement values Conclusions: Providing cognitive tools through psychological support interviews facilitated greater awareness and understanding of the problem, an understanding of the interactions between health professionals and the emergence of Sars-Cov-2, strengthening positive relationships, the problem solving, compensating for anxiety and reorganizing organizational roles

BACKGROUND Osimertinib is a third-generation, irreversible tyrosine kinase inhibitor of the epidermal growth factor receptor (EGFR-TKI) that selectively inhibits both EGFR-TKI-sensitizing and EGFR T790M resistance mutations. A phase 3 trial compared first-line osimertinib with other EGFR-TKIs in patients with EGFR mutation-positive advanced non-small-cell lung cancer (NSCLC). The trial showed longer progression-free survival with osimertinib than with the comparator EGFR-TKIs (hazard ratio for disease progression or death, 0.46). Data from the final analysis of overall survival have not been reported. METHODS In this trial, we randomly assigned 556 patients with previously untreated advanced NSCLC with an EGFR mutation (exon 19 deletion or L858R allele) in a 1:1 ratio to receive either osimertinib (80 mg once daily) or one of two other EGFR-TKIs (gefitinib at a dose of 250 mg once daily or erlotinib at a dose of 150 mg once daily, with patients receiving these drugs combined in a single comparator group). Overall survival was a secondary end point. RESULTS The median overall survival was 38.6 months (95% confidence interval [CI], 34.5 to 41.8) in the osimertinib group and 31.8 months (95% CI, 26.6 to 36.0) in the comparator group (hazard ratio for death, 0.80; 95.05% CI, 0.64 to 1.00; P = 0.046). At 3 years, 79 of 279 patients (28%) in the osimertinib group and 26 of 277 (9%) in the comparator group were continuing to receive a trial regimen; the median exposure was 20.7 months and 11.5 months, respectively. Adverse events of grade 3 or higher were reported in 42% of the patients in the osimertinib group and in 47% of those in the comparator group. CONCLUSIONS Among patients with previously untreated advanced NSCLC with an EGFR mutation, those who received osimertinib had longer overall survival than those who received a comparator EGFR-TKI. The safety profile for osimertinib was similar to that of the comparator EGFR-TKIs, despite a longer duration of exposure in the osimertinib group. (Funded by AstraZeneca; FLAURA ClinicalTrials.gov number, NCT02296125.).