The power of art and the powers of adolescents with cancer: Age-specific projects at Italian pediatric oncology centers.

This article describes the oncology programs developed in Italy for adolescents and young adults with cancer, with a specific focus on the local projects created in pediatric oncology centers. A common feature of such projects is the emphasis on creative and artistic activities and laboratories (involving music, photography, novel writing, fashion design, and so on) designed to give young patients innovative means of expression.This article highlights the amazing powers of adolescents involved in these projects: the power to produce beautiful things in a place that is not normally associated with the idea of beauty; the power to make their doctors smile and grasp the profound sense of life; the power to make hospitals become places for producing culture.

Age-appropriate multidisciplinary approach to young children with cancer undergoing radiotherapy: The SIESTA procedure.

A standardized multidisciplinary step-by-step approach to improve the compliance of young (or difficult) children having to undergo radiotherapy was described and applied. The procedure is called SIESTA, which stands for show-imagination-evaluation-support-treatment-anesthesia. Preliminary assessments suggest that the SIESTA approach was effective: the rate of young patients (≤6 years) requiring anesthesia decreased from 27% (14/52 cases) in 2011-2012 (before the procedure was adopted) to 13% (6/46) in 2018.

Illusionist techniques as a complement to psychological support for children with cancer.

Magic and illusionism may be a potentially valid resource for children with cancer, as a complement to more traditional psychological support approaches. This study considered the psychological interviews conducted with patients with cancer <10 years of age from January to December 2019. We classified the reasons why consultations were performed and the specific situations when psychologists adopted illusionist techniques. Overall, 96 children (age 4-10 years, median 7) received psychological interventions. Magic techniques were used in 30 patients: in 15 cases to support communication and relations, in 9 as a diversion, and in 2 each for physical therapy and rehabilitation, humour therapy, and psychotherapy. This preliminary descriptive experience suggests that the use of magic tricks might be helpful in providing support for communication and relations, as well for compliance and rehabilitation, for children with cancer. More analytical studies are needed to provide quantitative assessment of the efficacy of such an approach.

Experiencing Social Isolation (Even in the Era of COVID-19 Pandemic Lockdown): Teachings Through Arts from Adolescents with Cancer.

The article describes how adolescents with cancer utilized an artistic approach to discuss about their social isolation caused by disease and treatment. With the help of professionals, 17 young patients closed in their isolation room described their ideal room (a bit real, a bit of a fantasy place) producing texts and images, subsequently put together into a book. In these days when people are forced to social isolation by the lockdown related to corovavirus disease 2019 pandemic, young patients teach us meaningful life lessons: how social confinement can become an opportunity to focus on yourself, and what is really important in life.

Adolescents with Terminal Cancer: Making Good Use of Illusions.

The terminal stage of disease in teenagers is extremely complex to manage. In this study, we share some stories of terminally ill adolescent patients who made use of illusion as a way to overcome their anguish in their final stages of illness. These experiences show how young patients can cope better with terminal illness by resorting to a nonrational and fictional dimension that can serve them as a psychological compromise, helping them tolerate their real everyday life by suspending their critical senses for a while. Illusions can serve as a resource for young patients and a potentially useful tool for medical professionals.

Letter to the Editor: A New Video Tumorial by Young Cancer Patients Dedicated to COVID-19 Pandemic and Lockdown.

After the video tutorials created a few months ago and published in the Journal of Adolescent and Young Adult Oncology, Milan's Youth Project young cancer patients decided to record another video: a "special issue" dedicated to the coronavirus disease 2019 pandemic. The video addresses critical issues of the social isolation imposed by the lockdown and the fear the patients face in addition to their actual worries related to the disease. When many people across the world are forced to social distance for the imposed lockdown, the positive attitude and the advice of young cancer patients who experience social isolation regularly may be of great support and a fine example.

Tumorial: Video Tutorials Produced by Young Patients on the Youth Project to Voice Their Experiences.

Purpose: Adolescent and young adult patients of the Milan's Youth Project developed a new communication project aimed at young people with cancer: in a series of video tutorials called Tumorial, they talk about their day-to-day experiences, offering "survival tricks" to their peers. Methods: The project was developed during group meetings taking place every week in a dedicated room near the ward. Each meeting focused on a single topic and was led by the patients themselves, who talked about their experiences; staff members moderated the discussion and took notes, which was used as script for a video, recorded by one patient as a spokesperson. All the videos had English subtitles. Results: The project was implemented between March 2018 and June 2019 and involved 53 teenagers and young adults (15-27 years), 33 receiving treatment and 20 in follow-up when the project began. There were 23 video tutorials produced in all, with various topics, for example, school, sex, hair, privacy, social networks, fuck-ups to avoid, scars, ward companions. The videos are published on the Youth Project's YouTube channel (https://www.youtube.com/channel/UCR0EVeYMAjgJlN95tSc_iPA). Conclusion: This innovative approach to communication in the world of oncological disease in the young can be a useful tool as part of their course of care. It appears of great importance considering that social networks-and YouTube in particular-frequently provide unreliable or useless information. In making the project, patients told their innermost feelings, promoting cohesion among them. Patients and caregivers developed the project together in a significant example of cooperation.

How young patients with cancer perceive the COVID-19 (coronavirus) epidemic in Milan, Italy: Is there room for other fears?

The rapid spread of coronavirus disease 2019 epidemic in Italy, in particular in the Milan focal point, required drastic measures and led to panic in the population. While in our center we did not change our approach to the treatment of our young patients with cancer, we developed a qualitative survey to assess their perception of the risk and level of stress. The survey showed that a relatively large proportion of young patients felt personally at risk of severe complications. We believe that we need to adequately inform our patients, focusing on hygienic measures and personal protection and prompt reporting of any suspicious symptoms.

Cannabinoids use in adolescents and young adults with cancer: a single-center survey.

OBJECTIVE: To present an investigation into the intake of cannabinoids in a population of adolescents and young adults with cancer. METHODS: Sixty-six patients took part in the research: 27 reported having used cannabinoids, 21 before diagnosis; among the latter, 10 increased use during treatment. RESULTS: Benefits were reported by 19% of responders regarding anxiety control, 24% for nausea, 29% for pain control and improvement of sleep, and 48% for appetite improvement. CONCLUSIONS: Cannabis use by patients may often be unknown to caregivers. Studying this subject may help to better define important therapeutic aspects of these substances.

[Healing magic. Illusionistic techniques supporting communication and relationship between children and adolescents.] / Magie che curano. Tecniche illusionistiche a supporto della comunicazione e della relazione tra clinici e pazienti bambini e adolescenti.

In the training of the doctors, even specialists, training courses are generally not available for communication and for the relationship with patients in developmental age. Some techniques such as illusionistic techniques are increasingly described in the scientific literature as tools that can be used in the areas of care and rehabilitation. In this work, clinical experiences are presented on the use of illusionism techniques in clinical consultation with patients suffering from organic pathologies, based on a review of the scientific literature.

Spirituality and Sustaining Hope in Adolescents with Cancer: The Patients' View.

Purpose: The trauma of the diagnosis of cancer during adolescence may affect the young people's spiritual sphere. Projects aiming to the global care of adolescents with cancer should consider also their spiritual needs: at our center, the dedicated multidisciplinary team of professionals includes a chaplain with a specific training. This article describes, throughout the patients' dialogs, how a chaplain can help patients to give voice to their emotions and thoughts about their sense of life and illness. Methods: From January 2016 to December 2017, 33 adolescent patients with solid tumors had from 2 to 12 one-to-one talks with the chaplain. We selected six specific clinical cases in which some important topics were discussed between the chaplain and the patients. Results: Patients' own voices were reported to describe some specific spiritual issues, particularly as regards how spirituality could sustain them in their need to continue to hope. Examples of specific questions during talks were as follows: "Why doesn't God do something?"; "What is the point of all this pain?"; "Why have I become ill? Why me?"; "What do you think will happen to me after I die?" Conclusions: This experience underlines the importance of the inclusion of the spiritual assistant within the multidisciplinary team dedicated to young people with cancer. The daily and constantly available presence of the chaplain in the ward, from the beginning of any treatment, can permit a good relationship with patients and help them to keep hope and move forward.

[Continuity and school reentry support of patients with serious diseases: experiences in pediatric oncology.] / Il supporto alla continuità scolastica nella cura multidisciplinare dei pazienti con patologie gravi: esperienze in oncologia pediatrica.

Dealing with a serious illness always implies, and particularly for a child, important physical and psychological stresses. If on the one hand, the adult could have adaption's resources which allow him to deal with the illness's implications, on the other hand, for a child, the interference of the disease with growing steps may cause serious problems. For this reason, the clinicians and the family have to support the educational and social continuity of the child's interactions. The school experience, in fact, helps and supports the psychological and social development of the patient. This article has the aim of describing the experiences of the authors considering the Italian legislation, discussing the scientific literature and the approaches and resources which can be used in order to maintain the children within their school career. The experiences of the authors have been collected in the Paediatric Unit of an oncology's hospital. However, these experiences may be useful also in other contexts where children are being treated for different diseases.

Diary of a journey to a faraway galaxy.

This article describes a brief account written by a girl treated with chemotherapy and surgery for an ovarian germ cell tumor. The brief novel was conceived in the context of the Youth Project of Milan, dedicated to helping adolescent and young adult cancer patients socialize and express themselves through group activities that focus on art and creativity. It describes the scenery of a new galaxy and is replete with images and metaphors that recall the experience of receiving anticancer treatment, touching on emotional themes including desire, isolation, fear, and hope.

"Summer is you": Adolescents and young adults with cancer sing about their desire for summer.

Creative spirit and art are used as part of the Youth Project in Milan, a program dedicated to adolescents and young adults (AYA) with cancer. The "Summer is you" music project involved 45 patients (15-26 years old): with professional help, the patients wrote music and lyrics, sang their song, and recorded a video clip, sharing with us not only their hopes and fears, but also their romantic encounters and their urge to travel (https://youtu.be/Q5FSCMUVg0E). This project exploited the power of music to bring young people with cancer together in a novel form of support that can complement the more conventional psychological approaches.

[About the good use of illusions in oncology. End-of-life experiences and communications in adolescent patients.] / Sul buon uso delle illusioni in oncologia. Esperienze e comunicazioni di fine vita in pazienti adolescenti.

The issue of quality of life, particularly of patients affected by cancer, is very controversial, especially with adolescent patients who have no prospects of recovery. This article aims to describe the psychological mechanisms, which affect teenage patients with terminal cancer, in order to allow the best quality of life possible. The adaptation of teenager patients suffering from terminal illnesses is also related to other non-medical issues such as psychological, legal and ethical considerations. A correct and balanced communication with such patients is needed, in order of maintaining a positive mental approach ("hope") so that the teens are able to come to terms with the hard reality. Several case studies are presented, that according to the authors show the importance of developing an area of illusion, which allows patients to face up to the extreme distress and anxiety of their reality, without completely denying the reality itself. These hypotheses at the moment need more empirical evidences but they demonstrate the complex mental process involved with terminally ill adolescent patients coming to terms with their situations and show the importance of considering such process in all aspects of clinical care and treatment, in order to best address their physical and psychological well-being.

Dreams and illusions in adolescents with terminal cancer.

Being diagnosed with cancer in adolescence generally has important emotional consequences: adolescent cancer patients need to be seen as special cases with particular medical and psychosocial needs. This is especially true when a young patient is faced with a progressive, incurable disease. Herein, we report the story of a 17-year-old girl with a metastatic refractory soft tissue sarcoma who tells her dream to the psychologist of the ward. Telling this narrative is the opportunity to discuss the complex topic of how adolescent cancer patients adapt to the terminal stage of their disease; for example, the patient needs to talk to someone about their fear of dying; the healthcare operators need to be able properly listen and communicate; the patient's trust in the future despite their clinical condition; the necessity to leave space for hope; the useful role of the imagination sphere; the issue of whether and how to tell a person who is terminally ill the truth about their condition.

An investigative study into psychological and fertility sequelae of gestational trophoblastic disease: the impact on patients' perceived fertility, anxiety and depression.

OBJECTIVES: Gestational Trophoblastic Disease (GTD) comprises a group of disorders that derive from the placenta. Even if full recovery is generally expected, women diagnosed with GTD have to confront: the loss of a pregnancy, a potentially life-threatening diagnosis and delays in future pregnancies. The aim of the study is to evaluate the psychological impact of GTD, focusing on perceived fertility, depression and anxiety. METHODS: 37 patients treated for GTD at San Raffaele Hospital, Milan, took part in the study. The STAI-Y (State-Trait Anxiety Inventory), the BDI-SF (Beck Depression Scale-Short Form) and the FPI (Fertility Problem Inventory) were used. Patients were grouped on the basis of presence of children (with or without), age (< or ≥35) and type of diagnosis (Hydatidiform Mole, HM, or Gestational Trophoblastic Neoplasia, GTN). Differences in the values between variables were assessed by a t-type test statistic. Three-way ANOVAs were also carried out considering the same block factors. RESULTS: The study highlights that women suffering from GTN had higher depression scores compared to women suffering from HM. A significant correlation was found between anxiety (state and trait) and depression. Younger women presented higher Global Stress scores on the FPI, especially tied to Need for Parenthood and Relationship Concern subscales. Need for Parenthood mean scores significantly varied between women with and without children too. CONCLUSIONS: We can conclude that fertility perception seems to be negatively affected by GTD diagnosis, particularly in younger women and in those without children. Patients should be followed by a multidisciplinary team so as to be supported in the disease's psychological aspects too.