Optimising the management of patients with multiple myeloma in Spain: A measurement of the social return on investment.

OBJECTIVE: The aim of this study was to reach a consensus on a set of proposals to optimise the disease management of Multiple myeloma (MM) within the Spanish National Health System (SNHS) and to apply the Social Return on Investment (SROI) method to estimate their social impact. METHODS: A Multidisciplinary Working Team (MWT) including MM main stakeholders was organised. A survey was administered to gather information from patients regarding the impact of MM on different life domains. A forecast-type SROI analysis, with a 1-year timeframe, was applied. RESULTS: Fifteen proposals were selected, to optimise MM management, including actions for early diagnosis, psychological support, improvement of information for patients and quick access to palliative care, among others. The implementation of these proposals would benefit patients, their informal caregivers and the SNHS. The investment required would amount to 10.32 million euros with a social return of 43.31 million euros: 4.2 euros for each euro invested. According to the sensitivity analysis, this ratio could range from 3.38 to 5.20 euros from the worst to the best-case scenario. CONCLUSIONS: The current management of MM could be optimised by implementing a set of proposals that would most likely result in an overall positive social return.

Diagnosis, management and impact on patients' lives of cancer-related neuropathic pain (CRNP): A European survey.

OBJECTIVE: This study assessed the impact of cancer-related neuropathic pain (CRNP) on patients and the importance of the patient-healthcare professional (HCP) relationship in diagnosis and management. METHODS: A quantitative online survey was conducted involving adult patients from 13 European countries who had been diagnosed with treatable cancer and experienced symptoms of peripheral neuropathy. RESULTS: Of 24,733 screened respondents, 549 eligible persons met the inclusion criteria and completed the questionnaire. Among individuals still experiencing pain, 75% rated it as 'severe' or 'moderate'. In addition, 61% reported a negative impact on day-to-day activities, and 30% said they had stopped working as a result. A third of respondents had received no diagnosis of CRNP despite reporting painful symptoms to an HCP. HCPs spending enough time discussing pain and understanding the impact on patients' lives were each associated with an increased likelihood of a formal CRNP diagnosis. Compared with individuals currently in active cancer treatment, cancer survivors were less likely to have a diagnosis of CRNP or regular pain conversations with HCPs. CONCLUSION: CRNP remains under-recognised despite its substantial impact on patients' lives. Clinical practice may be improved by strengthening patient-HCP relationships around pain discussions and increasing the focus on pain management among cancer survivors.

Nutritional management of cancer patients in clinical practice in Spain: patients' and multidisciplinary health care professionals' perceptions.

BACKGROUND/OBJECTIVES: Malnutrition is a prevalent problem in patients with cancer and is associated with poor prognosis. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends the provision of nutritional support and evaluation. This study aims to describe the nutritional management of patients with cancer, including assessment of adherence, from the perspective of both patients and healthcare professionals (HCPs). SUBJECTS/METHODS: A cross-sectional descriptive observational study was carried out through two surveys addressed to patients and HCPs. RESULTS: A total of 230 cancer patients and 461 HCPs completed the questionnaire. The survey found 55.0% of patients experienced eating problems during treatment and 64.0% reported sequelae affecting nourishment. However, 60.1% of patients and 42.6% of HCPs indicated that nutritional status is not generally assessed. While 86.6% of HCPs stated that nutritional information is provided to patients, only 33.5% of patients reported having received it. Regarding nutritional adherence, 87.4% of HCPs stated that it is assessed whereas only 49.2% of patients receiving nutritional supplements confirmed this. General discomfort or gastrointestinal problems were the main issues hampering correct adherence perceived by both patients (41.8%) and HCPs (95.4%). CONCLUSIONS: Our study demonstrate that different perceptions exist between patients and HCPs about nutritional management in cancer and suggests that in Spain nutritional approach is suboptimal in terms of screening/assessment of malnutrition, nutritional information provided to the patient, nutritional intervention and assessment of adherence to nutritional support. Therefore, measure should be taken to foster the adoption of ESPEN recommendations in clinical practice and to promote nutritional education of HCPs.

[Opinions and experiences of healthcare professionals in the nutritional management of oncology patients: the ONA study]. / Opiniones y experiencias de profesionales sanitarios en el manejo nutricional del paciente oncológico: estudio ONA.

Introduction: Objectives: an inadequate approach to prevent malnutrition in cancer patients may worsen their quality of life and reduce their response to treatment. This study aims to describe the nutritional management of cancer patients in clinical practice, as well as the opinions of the healthcare professionals (HCPs) involved. Methods: this was an observational, descriptive, cross-sectional study addressed to HCPs in the Spanish healthcare setting. The online questionnaire was designed based on a literature review, one focus group of patients (n = 6), and the experience of the multidisciplinary scientific committee (n = 5), and was distributed by the scientific societies endorsing the study. Results: a total of 461 HCPs answered the survey. Most of them considered that a nutrition expert (95.0 %) is essential for the nutritional management of patients. However, 22.8 % of HCPs did not have access to this expert, and only 49.0 % had received training. Nutritional screening or patient referral for screening was performed by 58.4 % of HCPs. Of the total of HCPs, 86.6 % stated that nutritional information is provided to patients and considered them moderately satisfied with the information received. In malnourished patients or in those at risk of malnutrition, a complete nutritional assessment was performed by HCPs (73.1 %). Most HCPs (87.4 %) reported prescribing or recommending nutritional support if needed, and assessing adherence (86.8 %). Conclusions: despite malnutrition being a common problem in cancer patients, almost half of professionals do not perform any nutritional screening. In addition, patient information and assessment of nutritional adherence appear to be suboptimal.

Introducción: Objetivos: un abordaje inadecuado de la desnutrición en el paciente con cáncer puede conducir a un empeoramiento de su calidad de vida y una respuesta deficiente al tratamiento. El estudio ONA (Oncología, Nutrición y Adherencia) tiene como objetivo describir el manejo nutricional del paciente con cáncer en la práctica clínica, así como las opiniones de los profesionales sanitarios involucrados en el mismo. Métodos: estudio observacional, descriptivo y transversal dirigido a profesionales sanitarios españoles. El cuestionario online fue diseñado a partir de una revisión bibliográfica, un grupo focal de pacientes (n = 6) y un comité científico multidisciplinar (n = 5), y distribuido por las sociedades científicas que avalan el estudio. Resultados: de los 461 profesionales sanitarios participantes, el 95,0 % consideraron fundamental la figura del profesional sanitario con formación específica en nutrición, pero el 22,8 % no tenían acceso a ella y solo el 49,0 % habían recibido formación. El 58,4 % afirmaron realizar el cribado nutricional o derivar al paciente para este fin. El 86,6 % de los participantes indicaron que se informa al paciente sobre aspectos nutricionales y consideraron que este estaba moderadamente satisfecho con la información recibida. En caso de detectarse desnutrición o riesgo de desnutrición, los profesionales afirmaron realizar una evaluación nutricional completa (73,1 %) y, de necesitarse soporte nutricional, este se prescribiría/recomendaría (87,4 %), evaluándose la adherencia al mismo (86,8 %). Conclusiones: a pesar de que la desnutrición es un problema común en el paciente con cáncer, casi la mitad de los profesionales no realizan un cribado nutricional. Además, el proceso de información y evaluación de la adherencia nutricional es subóptimo.

Impact of the COVID-19 pandemic on the diagnosis and treatment of onco-hematologic patients: a discussion paper / Impacto de la pandemia de COVID-19 en el diagnóstico y tratamiento de los pacientes onco-hematológicos: un documento de opinión

We do not know the precise figure for solid organ tumors diagnosed each year in Spain and it is therefore difficult to calculate whether there has been a decrease in cancer diagnoses as a consequence of the pandemic. Some indirect data suggest that the pandemic has worsened the stage at which some non-hematological neoplasms are diagnosed. Despite the lack of robust evidence, oncology patients seem more likely to have a poor outcome when they contract COVID-19. The antibody response to infection in cancer patients will be fundamentally conditioned by the type of neoplasia present, the treatment received and the time of its administration.In patients with hematological malignancies, the incidence of infection is probably similar or lower than in the general population, due to the better protective measures adopted by the patients and their environment. The severity and mortality of COVID-19 in patients with hematologic malignancies is clearly higher than the general population. Since the immune response to vaccination in hematologic patients is generally worse than in comparable populations, alternative methods of prevention must be established in these patients, as well as actions for earlier diagnosis and treatment.Campaigns for the early diagnosis of malignant neoplasms must be urgently resumed, post-COVID manifestations should be monitored, collaboration with patient associations is indisputable and it is urgent to draw the right conclusions to improve our preparedness to fight against possible future catastrophes. (AU)

No conocemos con precisión la cifra nacional de tumores sólidos diagnosticados en España anualmente y por tanto se hace difícil calcular si ha habido una disminución de diagnósticos de cáncer como consecuencia de la pandemia. Algunos datos indirectos permiten sospechar que la pandemia ha empeorado el estadio en que se diagnostican algunas neoplasias no hematológicas. A pesar de no existir una evidencia robusta, los pacientes oncológicos presentan una mayor tendencia a tener una mala evolución cuando contraen COVID-19. La respuesta de anticuerpos frente a la infección en pacientes con cáncer va a estar condicionada fundamentalmente por el tipo de neoplasia presente, el tratamiento recibido y el momento de su administración.En pacientes con hemopatías malignas la incidencia de infección es probablemente similar o inferior a la de la población general, debido a las mejores medidas de protección adoptadas por los pacientes y su entorno. La gravedad y letalidad de la COVID-19 en pacientes con hemopatías malignas es claramente más elevada que en la población general. Dado que la respuesta inmune a la vacunación es peor que en poblaciones comparables, hay que establecer métodos alternativos de prevención en estos pacientes, así como planes de diagnóstico y tratamiento precoces.Hay que retomar las campañas de diagnóstico precoz de neoplasias malignas con urgencia, vigilar las manifestaciones post-COVID, colaborar con las asociaciones de pacientes y hacer planes urgentes para hacer frente con más eficiencia a potenciales catástrofes futuras. (AU)