Oncological Disease in Metastatic Breast Neoplasia and Palliative Care: A Review (original) (raw)
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Research Square (Research Square), 2022
Background. "Ariadne's thread" is a psycho-educational intervention designed by the Clinical Psychology Unit of an Italian Comprehensive Cancer Center and aimed at promoting empowerment in patients with metastatic breast cancer. It consists of 8 online meetings led by a psycho-oncologist where informational parts discussed by all the doctors that care these patients alternate with moments of stress management. Aim. This case study aims to investigate: 1) the feasibility of the "Ariadne's thread" intervention; 2) the satisfaction and perception of e cacy of the pilot intervention by the participants. Method. We used a mixed method in which 1) it was detected: the number of acceptance to the intervention both of patients and professionals, the number of help requests by patients and the number of requests of date changing by the professionals; 2) semi-structured interviews to the professionals who participated at the intervention were conducted; 3) 2 focus groups with the patients were conducted and a questionnaire was submitted to each of them. Results. The intervention is sustainable for the organisation, professionals and patients point of view. In particular, the patients declare the perception of e cacy in many aspects: improvement of the relation with the doctors, acceptance of their illness, learning of a relaxing technique, possibility to look at the world with trust and hope, etc. The questionnaires show an improvement of empowerment and the satisfaction with the intervention. Conclusion. Even though other research are needed, the results are promising. majority of women with MBC that today live in Italy (about 37.000) have shown a recurrence of the disease after a treatment for an initial form of breast cancer (1). The clinical progression pattern of MBC is heterogeneous and patients can experience acute and stable phases at different time points (2). In Italy 30% of women with MBC is alive after 5 years from diagnosis. However, statistics change according to the number and the location of metastasis, to the molecular subtypes of cancer, to the age, to the presence of potential genetic mutations, to the course of treatment. The range of survival varies from less of a year to over 20 years (3). For this reason, the women with MBC will likely experience continuous uncertainty about their health and longevity (4). The treatment aims to extend survival, control symptoms and improve or maintain the patient's quality of life (QoL). Treatment often continues until the cancer starts growing again or until secondary effects become unacceptable. If this happens, other drugs might be tried (5). Anxiety, depression, loneliness, uncertainty about the future and a pervasive sense of limited time are common in these patients (6)(4)(7) (4). Recently, the literature has focused on the unmet needs of women with MBC, although contributions are still few. Research agrees that there is a lack of health information, especially in relation to treatments and prognosis; patients ask for psychological support, especially in groups; physical needs related to daily life also emerge (8)(9)(10)(11)(12)(4). A recent study conducted whit MBC women at the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan (INT) (8) identi ed the following unmet needs: 1) the need for clinical recognition, because this phase of the disease-even more than in the earlier stages-implies greater vulnerability, limitations in daily life, frequency of exams and duration of therapy; 2) the need for more attention by healthcare professionals: i.e. improving coordination between professionals, improving the quality and quantity of information, using empathy, not seeing the person only as a patient, being careful when communicating the diagnosis; 3) the need for more and better services to be available at the hospital: i.e. decreasing waiting times, creating recreational facilities, having a space for children, having a coordinating gure, doing all the exams in the hospital, possibility of having a psychological support and a social service, possibility of peer and group support meetings; 4) the need for speci c public health policies: i.e. support in knowledge of labor rights, more research into BMC. Not only the number of studies on the needs of MBC patients is limited, but also structured interventions that meet such needs are unknown. In the literature there are psychological (i.e. psychological support, psychotherapy, etc.), expressive (i.e. writing) or relaxing (i.e. yoga, mindfulness) interventions for patients with MBC (13)(14)(15). Although effective, nevertheless they only partially meet the multiplicity and complexity of the needs expressed by the patients.