Implementing an Integrative Oncology Paradigm in Cancer Care: The Tuscan Regional Healthcare System.

Introduction: Recent cancer research highlighted specific patient needs, with a growing interest in integrative oncology (IO). Design: This is a narrative review concerning the Tuscan Healthcare System, which represents a virtuous example of progressive integration of complementary medicine in conventional cancer care. Results: The main steps of the process are described, with a specific focus on the 2021 Diagnostic and Therapeutic Care Pathway on Integrative Oncology. Conclusions: Implementing an IO service may contribute to respond to patients' demand for complementary therapies, also providing safety and equity of therapeutic access within public health care systems.

Complementary and Integrative Medicine to Reduce Adverse Effects of Anticancer Therapy.

BACKGROUND: To address the side effects of anticancer treatments, the Clinic for Complementary Medicine and Diet in Oncology was opened, in collaboration with the oncology department, at the Hospital of Lucca (Italy) in 2013. AIM: To present the results of complementary medicine treatment targeted toward reducing the adverse effects of anticancer therapy and cancer symptoms, and improving patient quality of life. Dietary advice was aimed at the reduction of foods that promote inflammation in favor of those with antioxidant and anti-inflammatory properties. METHODS: This is a retrospective observational study on 357 patients consecutively visited from September 2013 to December 2017. The intensity of symptoms was evaluated according to a grading system from G0 (absent) to G1 (slight), G2 (moderate), and G3 (strong). The severity of radiodermatitis was evaluated with the Radiation Therapy Oncology Group (RTOG) scale. Almost all the patients (91.6%) were receiving or had just finished some form of conventional anticancer therapy. RESULTS: The main types of cancer were breast (57.1%), colon (7.3%), lung (5.0%), ovary (3.9%), stomach (2.5%), prostate (2.2%), and uterus (2.5%). Comparison of clinical conditions before and after treatment showed a significant amelioration of nausea, insomnia, depression, anxiety, fatigue, mucositis, hot flashes, joint pain, dysgeusia, neuropathy, and all symptoms. Moreover, in a subgroup of 17 patients in radiotherapy undergoing integrative treatment, the level of toxicities and the severity of radiodermatitis were much lower than in the 13 patients without integrative treatment. Twenty-one cancer patients (6.2%) either refused (18) or discontinued (3) conventional anticancer treatment against the recommendation of their oncologist; after the integrative oncology (IO) visit, 7 (41.2%) out of 17 patients with follow-up decided to accept standard oncologic treatments. CONCLUSIONS: An IO clinic may contribute to reducing the adverse effects of anticancer therapy and improving the quality of life of cancer patients.

Patient Safety in Complementary Medicine through the Application of Clinical Risk Management in the Public Health System.

Aim: To develop a systematic approach to detect and prevent clinical risks in complementary medicine (CM) and increase patient safety through the analysis of activities in homeopathy and acupuncture centres in the Tuscan region using a significant event audit (SEA) and failure modes and effects analysis (FMEA). Methods: SEA is the selected tool for studying adverse events (AE) and detecting the best solutions to prevent future incidents in our Regional Healthcare Service (RHS). This requires the active participation of all the actors and external experts to validate the analysis. FMEA is a proactive risk assessment tool involving the selection of the clinical process, the input of a multidisciplinary group of experts, description of the process, identification of the failure modes (FMs) for each step, estimates of the frequency, severity, and detectability of FMs, calculation of the risk priority number (RPN), and prioritized improvement actions to prevent FMs. Results: In homeopathy, the greatest risk depends on the decision to switch from allopathic to homeopathic therapy. In acupuncture, major problems can arise, mainly from delayed treatment and from the modalities of needle insertion. Conclusions: The combination of SEA and FMEA can reveal potential risks for patients and suggest actions for safer and more reliable services in CM.

Homeopathic therapy in pediatric atopic diseases: short- and long-term results.

AIM: To study the outcomes of atopic diseases in children treated with homeopathy at the Homeopathic Clinic of Lucca (Italy) and related long-term results after approximately an 8-year period. MATERIALS AND METHODS: Our data derive from an observational longitudinal study carried out on 857 pediatric patients who consecutive visited from 1998 to 2014. Children with atopic diseases were 325 (37.9%), 126 (39%) suffered from atopic dermatitis, 72 (22%) from allergic rhinitis, and 127 (39%) from asthma. Moreover, a long-term study was conducted on a subset of 107/165 patients, consecutively visited from 1998 to 2006, and with ≥5 years follow-up. The study also investigated the evolution of overall symptoms in those patients with a complex atopic symptomatology. RESULTS: 75.8% of atopic children had moderate or major improvement (67.1% with asthma as the primary disease; 84.2% rhinitis; 84.2% dermatitis). At re-evaluation after 5-10 years, complete remission of atopic symptoms was obtained in 70.1% of the children: 84.2% in dermatitis; 48.1% in allergic rhinitis; 71.4% in asthma. Children with two or three atopic diseases at the first visit were completely cured in 40% of cases. CONCLUSION: The results seem to confirm that homeopathic medicine produces positive therapeutic response in atopic children.

The homeopathic choice for children: a qualitative research on the decision making process of the families.

AIM: To explore the experiences of parents who chose homeopathic treatment for their children, with particular regard to the decision-making process within the family and the availability of conventional and homeopathic healthcare services. METHODS: Semi-structured interview with parents immediately after or before the homeopathic visit at the Homeopathic Clinic of Campo di Marte Hospital of Lucca (Italy) from1st March, 2012 to 18 July 2012. Answers were analyzed by frequency of response and grouped into main areas: 1. Choice of homeopathy. 2. Intra-family dynamics. 3. Behaviour in emergency situations. 4. The relationship with the homeopathic doctor. 5. The role of friends and acquaintances. 6. The 'cut off' of use of homeopathy. RESULTS: Parents who choose homeopathic treatments for their children are strongly influenced by context. The choice of homeopathy is usually made by mothers and is rarely hindered by fathers, grandparents or friends, whose approval is important and encourages parents to use homeopathy for their children, both for prevention and treatment. Easy access to the homeopathic doctor was frequently requested, especially for acute situations. CONCLUSION: This research confirms the importance of context in decision making processes. Other characteristics of families which use homeopathy, such as level of education, personal coping strategies and family context should be investigated.

Putting E-government to work in healthcare environment: a multiregional project funded by the Italian Innovation & Technology Ministry.

In 2002, the Italian Ministry of Innovation promoted a national bid for e-government projects. Specifically it allocated a budget of 120 M euro. One of the four project approved in healthcare sector was the "Information, Care ("Assistenza" in Italian) and healthcare Education by the Web" (IAEW), with a global budget of 2580 k euro, partially financed by Ministry with a quota of 830 k euro. The project involves 12 medical structures (both national excellences centers and local regional hospitals) located in two different Region of North Italy, dealing with two different healthcare regional systems (Lombardia and Emilia-Romagna), with potentially 3 millions of users.