Although it can also occur in childhood and youth, acute myeloid leukemia is typical of adulthood and advanced age: there are about 3 thousand new diagnoses every year in our country and unfortunately only 30-40% of patients survive five years, not only because it is often an aggressive disease that progresses rapidly, but also because older people who suffer from it cannot tolerate the aggressive treatments that would be necessary to achieve a cure. Fortunately, advances in scientific research have recently made new treatments available and still others are in an advanced phase of experimentation, but there is much to be done in Italy to improve the path of care for patients: from the execution of genetic tests in the various phases of neoplasia (essential for choosing the most effective therapies in each individual case) to psychological support for patients, up to the organization of the network of hospital centers.
The project: improving the treatment path
Almost 19,400 people live in Italy after the diagnosis of acute myeloid leukemia, a blood cancer that originates in the bone marrow and progresses rapidly. Patient care, molecular diagnosis, integrated care pathways and psychological assistance are the issues on which the HemaNet project, promoted and organized by ISHEO with the participation of Favo (Italian Federation of Voluntary Associations in Oncology) Hematological Neoplasms Group (with the unconditional contribution of Astellas Pharma). The first step of the project took place recently, with the aim of disseminating a questionnaire to all hematology centers in Italy, the results of which will make it possible to take a picture of the current management of oncohematological patients and to identify the main obstacles to define a path of improvement. According to the experts and the representatives of the patients who attended the meeting, the critical issues in the treatment path must be resolved as soon as possible: the issue of genetic tests to be carried out not only at the time of diagnosis but throughout the path of disease is crucial, the model must be strengthened. management based on centers of reference (Hub) around which peripheral centers “revolve” (Spoke) overcoming the current territorial differences and psychological support must be implemented, given that as many as 64% of patients have never received medical assistance. this type, although it can give important benefits.
Targeted therapies on the genetic mutations present in the patient
Today the treatment for those suffering from acute myeloid leukemia is really differentiated according to the type of molecular alterations present in the individual case
. For this reason it is essential that all patients, before starting a therapy, do a very sophisticated but currently essential blood and bone marrow cell test to quickly and accurately identify the targets for the drugs to be associated with the traditional treatment. Mutations in the FLT3 gene are among the most common at the basis of acute myeloid leukemia, because they are found in about 30% of cases. “The test to identify them has an important clinical significance because these patients have a worse prognosis, with an increase in the incidence of relapse – explains Luca Arcaini, Full Professor of Hematology and University Director of Hematology of the IRCCS Polyclinic San Matteo Foundation in Pavia – . FLT3 represents a molecular target for which targeted drugs are already present, and under development, which allow to obtain better results in terms of efficacy. And the test should be performed not only at the onset of the disease, but also at the relapse. ”In addition, to ensure the best possible care of the patient, it is important that the centers are adequately equipped and equipped with the necessary technologies. However, there is a great difference between regions and at a territorial level, because not all centers have the possibility to carry out the required diagnostic and molecular tests. “This is the reason why the Ristori Decree of 24 December 2020 established a fund of 5 million euros for the enhancement of Next Generation Sequencing tests to allow the improvement of the effectiveness of treatment interventions and related procedures” says the senator Maria Domenica Castellone, member of the 12th Permanent Commission (Hygiene and Health) of the Senate.
Hospital organization and home care
The establishment of this fund, even if it represents an important signal from the institutions, is not enough. “It is important to entrust the management of patients with acute myeloid leukemia to the Hub centers, defining a model of close collaboration and co-management with the Spoke centers present in the area to ensure continuity of care for the patient – explains Gianluca Gaidano, Professor of Hematology and director of the ‘Hematology at the University of Eastern Piedmont, Novara -. It is also necessary to strengthen the Hub & Spoke model to allow the Hub centers to welcome all patients who need them and at the same time “educate” the Spoke centers to manage some aspects of the therapy to be carried out locally ». With a view to strengthening assistance, according to the experts who attended the meeting, home assistance should also be strengthened, which is still insufficient in our country. Clinicians themselves complain about the absence of a structured service that can reach the patient’s home, which is essential for streamlining procedures and reducing the overload of hospital structures, but also of families and caregivers.
More psychological support
Another fundamental aspect concerns the care of the patient’s psychological sphere, which is increasingly an integral and indispensable part of the therapeutic path. To date, however, psychological support for oncohematological patients represents a fragmented reality in Italy, at times present in hospitals and at others entrusted to voluntary associations that are unable to satisfy the request, given its size. “From surveys conducted by Favo, the anxiety factor strongly emerged: 64% of the interviewees declared, however, that they had not received any proposal for psychological assistance, but those who have benefited from it emphasize that they have benefited greatly” comments Davide Petruzzelli. Favo Haematological Neoplasms coordinator and president of La Lamp di Aladino Onlus.The presence of the psychologist in the care team alongside the patient and family members is therefore essential, as recalled by the same clinicians who during the pandemic had to confront even more with the communicative aspect towards patients who, never as in this historical period, have had to face the disease in complete solitude. “In this regard, it is desirable to establish a dialogue with the institutions that are working to enhance the figure of the psychologist, also taking into consideration the sensitivities of professionals and caregivers” concludes Senator Paola Boldrini, vice president of the 12th Permanent Commission (Hygiene and Health) of the Senate.
April 8, 2021 (change April 8, 2021 | 09:32)
© Time.News