3648 Background: Colorectal cancer is a good model for studying adherence to guidelines because of its high incidence and prevalence and availability of clear recommendations. Therefore, we performed a cross-sectional study where the prescriptions of both adjuvant chemotherapy and radiotherapy administered to colorectal cancer patients were audited. Methods: From 2 to 7 October 2000, treatments given to consecutive patients with radically resected colorectal cancer in 82 Italian centers were monitored. Results: Out of 434 patients submitted to adjuvant chemotherapy, 327 (75.4%) were colon cancer, 96 (22.1%) rectal cancer and 11 (2.5%) not specified. Among colon cancer patients, 139 (42.5%) were stage II, 175 (53.5%) stage III and in 13 (4.0%) patients stage was not reported. Treatment at academic centers, young age, T4 and a low total number of lymph nodes removed at surgery were factors explaining the decision to submit stage II colon cancer patients to adjuvant chemotherapy. The most common chemotherapy used was a bolus of 5-fluorouracil / folinic acid for 6 months (77%). Adjuvant radiotherapy was not administered to 37 (38.5%) of 96 patients with stage II and III rectal cancer. Conclusions: A substantial proportion of patients on adjuvant treatment in a large sample of Italian oncological centers are stage II (potential overtreatment) and an undertreatment of stage II and III rectal cancer patients (lack of radiotherapy) occurs too often in daily clinical practice in Italy. No significant financial relationships to disclose.

BACKGROUND:It has been widely shown that the provision of adequate levels of information to patients does have a positive effect on quality of life by reducing anxiety and depression levels. The aim of this study was to show how Italian cancer patients rate the information they are given and whether the use of booklets and videotapes can improve their quality of life.PATIENTS AND METHODS:Cancer patients aged between 18 and 80 years who were about to receive their first chemotherapy course were randomized to fill in questionnaires on perceived quality of information, level of psychological distress, perceived severity and curability of the disease, and quality of life. The results were evaluated by means of statistical analyses.RESULTS:Out of 328 consecutive patients enrolled in 21 cancer centers, 86-93% considered the booklets either "very useful" or "useful". The videotape was regarded as "quite" or "much" more complete than the booklets (87%). According to 81%/87% of patients, the information that had been given had improved their knowledge of the disease/chemotherapy either "a lot" or "enough".CONCLUSIONS:The information patients receive from the oncologist was rated the highest, as long as they were devoted enough time. Booklets and videotapes can partially overcome the lack of oral information given by medical doctors. A better informed patient does help the oncologist save time.

The aims of the study were to evaluate the trend of breast conservative surgery (BCS) in Italian breast cancer patients and to identify its nonclinical determinants. Data of 2062 patients surgically treated patients for primary breast cancer were evaluated; 788 (38.0%) had been submitted to breast conservative surgery. A different percentage of breast conservative surgery was found with respect to geographic patient's residence (North, 41.1%; Central, 37.6%; South, 33.0%). Multifactorial analysis showed that time since diagnosis, age at diagnosis and nonclinical factors, such as geographic area of residence and level of education, were significantly associated with breast conservative surgery.

BACKGROUND The prevention of delayed nausea and vomiting caused by moderately emetogenic chemotherapy for cancer has not been studied systematically. METHODS We enrolled patients who were scheduled to receive chemotherapy for the first time in a double-blind, randomized, multicenter study. All the patients received ondansetron combined with dexamethasone for prophylaxis against emesis that might occur within 24 hours after the start of chemotherapy (acute emesis). They were then divided into two groups: patients who did not have either vomiting or moderate-to-severe nausea (the low-risk group) and patients who had one or both (the high-risk group). Patients in the low-risk group were then randomly assigned to one of the following regimens, given on days 2 through 5 after the start of chemotherapy: oral placebo, 4 mg of dexamethasone given orally twice daily, or 8 mg of ondansetron in combination with 4 mg of dexamethasone, given orally twice daily. Patients in the high-risk group were randomly assigned to receive oral dexamethasone alone or in combination with ondansetron at the same doses as those used in the low-risk group. RESULTS Among the 618 patients in the low-risk group, there was a complete absence of both delayed vomiting and moderate-to-severe nausea in 91.8 percent of those who received ondansetron combined with dexamethasone, 87.4 percent of those who received dexamethasone alone, and 76.8 percent of those who received placebo. The proportions of patients who were protected by dexamethasone combined with ondansetron or by dexamethasone alone were significantly greater than the proportion protected by placebo (P<0.001 and P<0.02, respectively). Of the 87 patients in the high-risk group, complete protection was achieved in 40.9 percent of those treated with ondansetron and dexamethasone and in 23.3 percent treated with dexamethasone alone (P not significant). CONCLUSIONS The best way to prevent delayed nausea and vomiting in patients receiving moderately emetogenic chemotherapy is to control these complications within the first 24 hours after the start of chemotherapy. Dexamethasone alone provides adequate protection against delayed emesis in patients at low risk (those who have not had acute emesis).

To evaluate whether the incidence of emesis in patients undergoing cisplatin chemotherapy and receiving the standard antiemetic prophylaxis during daily clinical practice was similar to that obtained in antiemetic trials, a prospective study was carried out, adopting very wide eligibility criteria. In the first cycle of chemotherapy, 308 consecutive adult patients were evaluated, 112 in the second, and 89 in the third cycle. Results were compared with those obtained in three published randomized clinical trials. In the first cycle of chemotherapy, complete protection from acute vomiting/nausea was obtained by 78.9% (243/308) and 71.8% (221/308) of patients. These results were quite similar to those obtained in the three randomized studies: 79.7%/72.1%, 78.3%/71.4%, and 78.7%/77.2%. No significantly different results among these studies were obtained, even in the second and third cycles of chemotherapy. In conclusion, in patients undergoing cisplatin chemotherapy, the effectiveness of the same standard antiemetic prophylaxis is similar to the efficacy found in randomized clinical trials, regardless of the eligibility/exclusion criteria and the setting of the study.

Today, in Italy, many cancer patients are not fully informed about severity/curability of their disease. Because of the impossibility to directly obtain information on the lack of awareness of disease, a cross-sectional study of 160 consecutive patients affected by primary ovarian cancer was carried out. Disease was considered "easy to cure"/"difficult to cure" by 74 (46.2%)/47 (29.4%) patients. Likewise, disease was considered "not severe"/"severe" by 39 (24.4%)/84 (48.7%) patients. Comparing these results with those obtained analyzing the other type of neoplasia, the perception of severity and "difficulty to cure" of the disease was found more frequent among ovarian cancer patients even if still one fourth of them considered their disease not severe. Therefore, some doubt arises regarding the validity of both fully informed consent to therapy and the utility measurements, based on patient preferences.

Background: Studies are available showing that cancer patients in southern Europe may be less well informed about their disease than patients in northern Europe and North America.Patients and methods: In the framework of a survey aimed at exploring the meaning of quality of life for the Italian cancer patient, carried out all over Italy in a one-week time span on 6098 consecutive patients, two visual analogue scales evaluating severity and curability of disease were also submitted to the patients. Four patterns of patients' answers were defined: very easy/difficult-to-cure disease, and not-severe/severe disease. Multifactorial analyses were performed using logistic models for each of the four responses, assuming patient characteristics, time since diagnosis and disease extent as explanatory variables.Results: Only 26% of 2088 patients with disseminated disease believed it to be 'difficult to cure', while 39% felt it to be 'easy to cure'. In the same subgroup of patients, only 47% found their disease `severe'.Conclusions: Authors were impressed by these unexpected results, which are therefore reported separately from the overall analysis of data, aimed at exploring the quality of life domains for the Italian cancer patient. In fact, they would suggest a great lack of awareness of the severity and curability of their disease in a large group of unselected Italian cancer patients. This may depend on various factors, including cross-cultural ones, but could also be partly related to inadequacies in the process by which the Italian patient is informed, and this should be further investigated.

Il lavoro descrive i risultati di una indagine epidemiologica condotta da gennaio a maggio dell’anno 1998 presso le classi di III, IV, V delle scuole elementari del Comune di L’Aquila. Tutti gli scolari sono stati visitati da odontoiatri ed ai loro genitori e stato chiesto di compilare una scheda anamnestica in cui venivano richieste informazioni sulle condizione socio-economiche della famiglia e su abitudini di vita del bambino. I risultati mostrano che la prevalenza della carie dentaria e compresa tra il 65 ed il 69% mentre quella delle malocclusioni e risultata compresa tra il 92 ed il 95.1%; se pero’ vengono considerate le sole malocclusioni con precisa indicazione al trattamento ortodontico la prevalenza si osserva tra il 52 ed il 57.8%.