Background: The aim of this study is to highlight through the access of the oncologic patients to the emergency room of the local hospital the health and socio-assistance criticalities present in the territory that affect this category of patients and to identify potential solutions to mitigate the level. Patients and methods: For this purpose, during the three-year period 2014-2016, we examined the total number of patients arriving in the Emergency Room, including the number of cancer patients, distributed by age and sex, the number of oncologic patients given to their home, those hospitalized, the reasons for the hospitalization and the facilities where they were hospitalize.Table: T23ACCESS total96.961oncologic pts hospitalized in: - internal medicine25Total of admission15.587- pneumology7Total of oncologic patients (pts)356- other departments15oncologic pts resigned at home30- oncology total:241oncologic pts sent in hospice11males133oncologic pts who refudes hospitalization17females108oncologic pts who voluntarily left the emergency room10 Open table in a new tab Reasons for Hospitalization:Tabled 1Blood Dyscrasias35Dyspnea25Neurological Symptoms34Cachexia25Pleural Effusion/Ascites33Intestinal Symptoms18Pain31Jaundice12Fever28Other10 Open table in a new tab Distribution By age group/numberof ptsTabled 145-501371-807351-602581-852061-70101>859 Open table in a new tab Conclusions: The Admission of oncologic patients to emergency care continues to be a health problem. Our survey shows: 1. Patients with potentially manageable home illness access the emergency room; 2. Need to provide adequate information to patients about the different health options (hospital, territory, home care, hospice); 3. Improve treatment procedures against pain; 4. Increase efforts for better therapeutic continuity.

Background: The malignant pleural mesothelioma is a health problem of increasing incidence and severity. The association cisplatin-pemetrexed is the standard of care for advanced malignant pleural mesothelioma. There is currently no second-line standard of care. In the absence of standard, it is recommended that patients in good condition in progression are enrolled into clinical trials. Patients and methods: We treated 12 patients: 8 men,4 women,median age 67 years (range 55-74), Ps < 2, with malignant pleural advanced mesothelioma (stage IV by IMIG) in progression after standard chemotherapy. Subtypes: Epithelioid 8, Biphasic 2, Sarcomatoid 2. The aim of the study is to evaluate efficacy and tolerability. We have adopted a chemotherapeutic regimen (acronym: BIG), repeated every 2 weeks, including: Bleomycin 15 MU i.m. day 1, Ifosfamide 2000 mg/m2 (with Mesna uroprotection) e.v. day 1, Gemcitabine 1000 mg/m2 e.v. day 2. Results: After three months we carried out an instrumental revaluation of disease and found 4 objective responses (OR), 3 stable disease (SD), and 5 progression disease (PD). In the 7 patients (4 OR,3 SD) the therapy was continued for further three months, noting 3 OR, 2 SD, 2 PD. The duration of response has been > 6 months. In patients with response there has been a clear reduction of symptoms (pain,dyspnea, weight loss),with improvement of the clinical condition (reduction of the opioid analgesics,non-steroidal anti-inflammatory drugs,corticosteroids and anxiolytics.).None of the patients required an interruption or hospitalization during the treatment period.The toxicities found:nausea and vomiting moderate, myelosuppression (I WHO) : in fact the neutropenia,anaemia have not required the use of hematopoietic growth factors and/or erythropoietin and/or transfusion of blood products. Conclusions: The results are encouraging for: the rate of the response, the moderate toxicity,the improvement of the quality of life.Therefore,the study stimulates to continue for a further valuation.