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Surveys carried out in Mediterranean countries demonstrated very low rates of awareness of both diagnosis and prognosis among cancer patients. In our institution, a long-term training program aimed at improving communication skills among all physicians interacting with cancer patients was conducted. We report here the results of an extensive assessment of patients' awareness conducted after the first training period.In a 2-year period, after every first visit of patients with a histological diagnosis of cancer, oncologists elicited perception of the patients and completed a structured questionnaire focusing on the understanding of the diagnosis and prognosis. Our data are thus a photograph of the results of the informative process conducted during the diagnostic phase.Among the enrolled 649 patients, 79.3% were aware of their diagnosis; factors significantly associated with higher levels of awareness were age younger than 70 and referral from surgery (versus internal medicine). Knowledge about the palliative or curative aims of future treatments (a surrogate sign of prognostic consciousness) was evident in 55.2%.Compared with historical data, our results show a high level of comprehension of the diagnosis of malignancy, probably due to the extensive training effort together with the method chosen for assessment. more...

Aim: Concurrent chemoradiation (CRT) is employed both in curative and postoperative settings in locally advanced head and neck cancer (HNC). The acute toxicity induced by this treatment is a major issue, affecting patients' quality of life and their compliance with timing and dose intensity. No guidelines exist for comprehensive best practices of supportive care (BPSC) to be adopted during this treatment. Methods: Due to the lack of evidence from randomized controlled trials on most aspects of BPSC during CRT, an alternative approach to provide guidance was adopted. A formal consensus methodology was employed according to the model proposed by ASCO (Loblaw DA, J Clin Oncol 2012), through a modified Delphi strategy. Briefly, a consensus group of 40 experts including medical oncologists, radiation oncologists, surgeons, nutritionists, speech language pathologists, infectious disease specialists, dentists and nurses was constituted. A panel of facilitators for each topic performed a systematic review of the literature and a series of statements were defined. These were differentiated according to the timing of intervention (pre-treatment, during and after the treatment) and included an indication of the person in charge of the management of each BPSC aspect (e.g., physician, nurse, patient, caregiver). All experts rated these statements through a two-round process. A 4-point scale was adopted (1 = high consensus, 2 = low consensus, 3 = no consensus and 4 = unable to express an opinion). Consensus was defined as agreement by > 75% of raters. The statements were then finalized according to the suggestions of external reviewers. The process lasted from March 2013 to April 2014. Results: The following topics were included: mucositis, dysphagia, hematological toxicity, infections, nutrition and hydration, pain, skin toxicity and stomatological problems. Recommendations were delivered for each topic. Conclusions: Practice guidelines for BPSC during CRT for HNC have been defined with a recognized methodology, in an area where high-quality evidence is lacking. The results of consensus as well as the areas identified for further consensus development will be presented. *Authors on behalf of the working group AIOM, AIRO, AIOCC. Disclosure: All authors have declared no conflicts of interest. more...