The latest generation therapies are more tolerable, but some disorders may remain: they are widespread and you need to talk to your doctor to be able to better manage them.
It could be called a great problem. Great because it affects millions of people in Italy and in the world, “beautiful” because it derives from the many advances made in recent decades in the treatment of tumors that have led a growing slice of patients to recover completely or turning cancer into a chronic disease to live with for years. Thus a new challenge arises for specialists, namely to ensure that this growing “army” returns a full and satisfying life, stemming as much as possible the aftermath that cancer and therapies may have left on the mind and body of patients. “We are becoming aware that better patient support is needed for take back your life after cancer – he comments Saverio Cinieri, president of the Italian Association of Medical Oncology (Aiom) -. The standard controls in the follow up of cancer patients that we have adopted so far may no longer be suitable for those who pass a cancer today. Furthermore, in returning to everyday life, a very significant part of these people continue to suffer from “Small” disturbances that can have a big impact on the quality of lifewhich we must and can stem ».
In numbers: 3.6 million Italians alive after cancer
The most recent statistics, updated to 2020, indicate that there are 3.6 million in all, equal to 6% of the population Italians alive after a cancer diagnosis: in practice one in 17 countrymen has had cancer, an increase of 37% compared to 10 years ago. And at least one in four former patients, almost one million people, has returned to have the same life expectancy as the general population so that he can be considered definitively cured. “The improvements in early diagnosis and therapies have led us to have, in many cases, a long, very long survival – he comments Massimo Di Maionational secretary of Aiom -: about 60% of our patients exceed the “symbolic” threshold of 5 years from diagnosis, although of course this number is very different depending on the type of neoplasm. For this success to be fully enjoyed, we must also make sure to limit and manage it as well as possible the possible long-term side effects of treatment. It happens too often that doctors do not address this aspect and few patients talk about it, but enjoying a good quality of life is an achievable goal and we must join efforts to achieve it ».
Unwanted consequences
Some unwanted consequences are very common during or immediately after treatment: skin irritation, nausea and vomiting, diarrhea, inflammation of the mouth, loss of appetite and weight, swelling of the arms or legs (or lymphedema) are widespread. The extent of the disorder is partly subjective and partly depends on what is and how “heavy” the treatment prescribed to the individual patient is, whether it is radiotherapy or chemotherapy or new molecular target drugs and immunotherapy (which are yes less toxic, but not without consequences). “If properly reported, however, these symptoms can often be fought or even prevented,” he stresses Franco Perrone, president-elect of Aiom and oncologist director of the Clinical Trials Unit of the National Cancer Institute Pascale of Naples -. An important step, also in Italy, from the point of view of attention to the “voice” of patients in the description of disorders and symptoms was made thanks to questionnaires (the so-called patient reported outcomes) in which the interested parties report and report independently and in detail the side effects of anticancer therapy which is given to them. Patients, ex and family members should know that these disorders as well as the psychological impact that often accompanies cancer are not “inevitable” and they are not to be tolerated with resignationnor neglected or minimized. ‘
Anxiety, depression, mood disorders
If, in fact, practically all sufferers face an emotional shock at the time of diagnosis, when anger, anguish and fear take over, even later about 75% of people who are cured or chronic show symptoms of discomfort: anxiety, depression, mood disorders they often last for a long time, even years after finishing treatment. To photograph reality is a study presented at the European society of medical oncology (Esmo) 2021 conference by German researchers from the Cancer research Center at the University of Heidelberg who analyzed data relating to over 2,500 patients with 15 different types of cancer two years after the discovery of the disease and investigated both what were the most common ailments among the participants, and their severity and satisfaction with the remedies obtained. One of the most common and enduring symptoms was found to be the fatigue, a sense of chronic fatiguewhich is reported as moderate or severe by 40% of respondents even four years after diagnosis, together with a generalized loss of physical ability. Following in the ranking: sleep disorders, sexual problems, joint pain, anxiety, neuropathy, cardiovascular disorders and osteoporosis. The greatest discontent concerns the solutions obtained for the problems relating to the sexualitybut in general over a third of the participants consider the support received on the basis of their needs to be low.
Fatigue
“Almost all cancer patients suffer, at least for a short time, from fatigue,” he comments Paolo Tralongo, director of the medical oncology of the oncological assistance network of the province of Syracuse, where a Clinic for long-term survivors is active -: it is a complex of symptoms that leads to a reduction in physical energy, mental abilities and also has reflexes on the psychological state “. It is like a sum of both psychological and physical tension that the organism is forced to endure, which is underestimated by the directly concerned first, because it is considered inevitable, an “integral part” of the life of a cancer patient, “but several studies have shown that doing light or moderate intensity physical activity, taking care of your diet and sleep are of great help in fighting this problem – explains Tralongo -. Also, reporting the problem to your doctor can help assess whether there is a cause a form of resolvable anemiato integrate lifestyles with any antidepressant treatments or countering any vitamin and nutritional deficiencies“. Fatigue, nervousness, difficulty falling asleep or having a restful sleep, mild dysentery, erectile dysfunction, decreased desire, vaginal dryness: the list of “annoyances” is long and only half of those who suffer from it dare to talk about it openly with the oncologist.
Talk to your doctor
“Don’t be ashamed to turn to one psychologist, often a figure present today in the Oncology wards – says Di Maio, director of Oncology at the Mauritian Order Hospital of Turin -. When necessary, the use of antidepressant drugs can be evaluated, but several studies indicate the beneficial impact they can have yoga and meditation in lowering the levels of stress, anxiety and depression and also useful for sleep problems ». To live better it is essential to overcome the blanket of silence, which is particularly thick when the problem is sexual: However, having a satisfactory intimacy is possible and there are many aids available, which should be prescribed according to the disorder and the condition of the individual patient. “The doctor’s task during the follow-up of cancer patients is not only to identify any recurrence of the disease, but also to pay attention to the many aspects of quality of life in order to respond adequately to the new needs that more and more people are facing»Concludes Di Maio. The guideline on lung-living created by Aiom and updated in 2020 goes in this direction. “Cancer rehabilitation is of strategic importance for the quality of life of patients, because it is the basis for the recovery of physical and psychological well-being – concludes Cinieri, director of the Medical Oncology and Breast Unit of the Perrino Hospital in Brindisi -. In Italy, however, there is a lack of structures and specialists. It is essential to structure it within the hospitals, reimburse it through the National Health Service and make it usable through assistance on the territory, to follow people when they return home without clogging the hospitals with an additional load “.
Right to rehabilitation
“The new challenge of cancer survival, for patients and clinicians, is to go beyond quality of care and ensure quality of life.” For years, doctors and institutions have been drawing attention to the multiple needs related to rehabilitation Francesco De Lorenzo, president of the Italian Federation of Voluntary Associations in Oncology (Favo), also committed to defending the rights of both the sick and those who assist them, family members or caregivers. “The recognition of the right, hitherto denied, to cancer rehabilitation to overcome the more or less serious disabilities resulting from therapeutic treatments, which persist even in healed people, it represents the essential condition for returning to a normal and productive life »underlines De Lorenzo.
March 23, 2022 (change March 23, 2022 | 18:11)
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