Evaluation of the Geographical Accessibility of Genome-Matched Clinical Trials on a National Experience.

BACKGROUND: Molecular-driven oncology allows oncologists to identify treatments that match a cancer's genomic profile. Clinical trials are promoted as an effective modality to deliver a molecularly matched treatment. We explore the role of geographical accessibility in Italy, and its impact on patient access to clinical trials. MATERIAL AND METHODS: We retrospectively reviewed molecular data from a single-institutional case series of patients receiving next-generation sequencing testing between March 2019 and July 2020. Actionable alterations were defined as the ones with at least one matched treatment on Clinicaltrials.gov at the time of genomic report signature. We then calculated the hypothetical distance to travel to reach the nearest assigned clinical trial. RESULTS: We identified 159 patients eligible for analysis. One hundred and one could be potentially assigned to a clinical trial in Italy, and the median distance that patients needed to travel to reach the closest location with a suitable clinical trial was 76 km (interquartile range = 127.46 km). Geographical distribution of clinical trials in Italy found to be heterogeneous, with Milan and Naples being the areas with a higher concentration. We then found that the probability of having a clinical trial close to a patient's hometown increased over time, according to registered studies between 2015 and 2020. CONCLUSIONS: The median distance to be travelled to the nearest trial was generally acceptable for patients, and trials availability is increasing. Nevertheless, many areas are still lacking trials, so efforts are required to increase and homogenize the possibilities to be enrolled in clinical trials for Italian patients with cancer.

Presence and mobility of the population during the first wave of Covid-19 outbreak and lockdown in Italy.

The non-medical policies implemented by many countries to "flatten the curve" during the COVID-19 outbreak has people stranded in their homes and some, out of their homes unable to return due to the disruptions in the mobility network. The availability of rich datasets (in our case, Facebook) has made it possible to study the mobility dynamics and spatial distribution of people during lockdown in Italy. Our interpretation is an effort to look deeper, describing the movements occurred during lockdown, including the territorial differences. We observe that, initially, tourists left the country and later Italians abroad managed to return, thereby, stabilising the population. With regards to internal mobility, the earliest affected regions see higher number of stationary users in the initial days of the outbreak while this is less significant for the central/southern regions until the decree for the official lockdown on the 9th of March 2020, due 2 days later. Just before lockdown, there was not a significant exodus of people from the North to the rest of the country, instead, relocation of people between cities and their urban belts, but not towards remote areas. This will be elaborated in conclusions shedding light on possible changes in future cities.