About this Research Topic
In recent years, the full recovery rates for cancer patients have significantly increased and mean survival has improved. Moreover, the chronicization of cancer disease and concerns about aggressive care close to the end of life raised the awareness of better risk-benefit balancing. As a result, patients are increasingly aware of quality of life (QoL) issues, and physicians need to find the right balance between cancer treatment and patient well-being. Accordingly, recent research of early integrated supportive palliative care aimed to obtain patient-centered therapeutic objectives, such as QoL improvement to preserve patient integration with family and social environment. For many tumors, especially in the advanced stages, the concept of cancer as a disease affecting only organs has been recently replaced by the concept in which cancer is defined as a multidimensional systemic disease. A new way of designing antineoplastic treatments with primary clinical benefit of patients, symptom control and psycho-social well-being is needed. A new concept, thus, must emerge, that of simultaneous care, i.e. early integration of palliative care into the cancer disease trajectory.
Cancer-associated symptoms appear more frequently in advanced stages but they actually starts with the onset of cancer. Therefore, any therapeutic approach should ideally be introduced within a context of the “best supportive care”, which includes both optimal symptom management and careful psychosocial and spiritual counseling. Then, symptoms such as anorexia, fatigue, depression as well as syndromes such as cachexia, which can be either improved or worsened by antineoplastic therapies, should be treated starting concurrently with the planning of the most appropriate cancer therapy. However, to date the exact biological mechanisms of cancer-associated symptoms and their specific treatment has not been well defined yet.
Traditional cornerstones in medicine, such as diagnosis, staging, and the planning of the best anticancer therapy, will of course continue to play a major role. However, to optimize a care focused on patient QoL, the knowledge and awareness of the biological specificity of cancer and associated symptoms should be considered a central issue by the multidisciplinary team in charge. We are awareness that this approach should include also the assessment of the psychosocial and spiritual domains, which can help patients to develop personal priorities regarding relationships, form religious and spiritual beliefs, deal with the urgency of resolving conflicts, and achieve personally meaningful goals.
Therefore, our main topic is to focus on the biological mechanism-based explanation of cancer patient symptoms and syndromes and to implement a proactive structured evaluation and targeted interventions of related psychosocial, existential/spiritual and social aspects.
The topic will include just some symptoms and syndromes, namely anorexia, weight loss/cachexia and fatigue, that are considered important for patient suffering but yet unmet in clinical practice to develop a model, which could be applied also to other symptoms or syndromes. Then, we will discuss on these symptoms: how are the biological mechanisms involved in the pathogenesis of patient phenotype, how to assess and classify them in clinical practice and which patient-centered domains should be included as outcomes in targeted interventions, how individualized mechanism-based multimodal interventions may impact significant endpoints.
A greater insight of cancer-related symptoms and syndromes would enable earlier and more effective palliative intervention.
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