Interdisciplinary Research health psychology are integrated to promote an active, unbiased and deliberate participation of patients in the therapeutic process representing the core activity of this newly-created Unit. Integrating academic interests with clinical purposes, the present Unit will promote a multidisciplinary approach aimed at developing new training and treatment strategies as well as continually monitoring the cognitive-psycho-social processes which arise from the time of diagnosis communication through to oncology treatment. In particular, the Unit will perform, but will not be limited to, the following activities: - creation of a counseling unit for clinical decisionmaking strategies - administration of periodic and standardized surveys of needs and quality of life of oncology patients - implementation and standardization of advanced instruments for measuring and promoting the patients’ empowerment and health - assessment and evaluation of patients’ cognitive and emotional needs and preferences - implementation and standardization of advanced instruments to develop efficient communication strategies between doctor and patient - implementation of instruments to evaluate and enhance resilience in the patients and their families - creation of a counseling and training unit for patient management. All the activities developed by the Unit will be carried out using a rigorous scientific method applied to the oncologic clinical setting, striving to obtain the best possible integration between academic and clinical expertise. Ongoing researches Within the framework of the FP7 “P-Medicine” project, working together with medical oncologists, Research Unit for Early Diagnosis and Prevention of Lung Cancer, our research group is developing a decision-making tool which offers an active knowledge resource using patients’ personal data and needs to generate case-
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specific advice in support of decision making about individual patients by health professionals, by the patients themselves or by others concerned about them. The tool is designed to aid health professionals and/or oncology patients in the clinical decision making process based on a personalized medicine approach. Within the framework of the “Cosmos” project, we are collaborating with the Research Unit for Early Diagnosis and Prevention of Lung Cancer) to create a cognitive and personality profile of heavy smokers in order to help clinicians understand the possible psychological causes and mental effects of smoking addiction and find the most effective approaches to increase the patients’ compliance to the proposed treatment. The Unit is also very interested in the topic of food choices, considering the considerable bearing it has on cancer-related diseases. Collaborating with oncologists, biologists and nutritionists, we are developing protocols and tools to analyze the way in which healthy people and patients make their choices about food, what factors are involved in such choices and how, if at all possible, to modify “unsafe” habits. In this regard, we have recently been awarded a grant sponsored by Working Capital, to develop a tool to help people to track their eating behaviors and to modify them according to their personal needs and health profile.
Activities 2012.
In 2012 the Psycho-Oncology Unit continued the close collaboration with the Division of Gynaecology and its Ovarian Cancer Center with an ongoing study aimed at assessing the psychosocial needs and the psychological distress of patients recently diagnosed with an ovarian cancer (42 patients have been interviewed by psychologists of the Unit). Eight hundred and twelve (N=812) new patients, from all Departments, Divisions and Units, were referred to the Psycho-Oncology Unit. Three thousand three hundred fifty five (N=3355) consultations were performed during 2012.
After the patient’s discharge, a telephone follow-up is performed by the psychologist of the Unit on a regular basis. In order to improve the psychological support to cancer patients and their families after discharge, we also created a link with the national Foundation Gigi Ghirotti which provides psychological support by phone, performed by external psychologists/psychotherapists. Research interests The main research interests of the Psycho-Oncology Unit are the evaluation of the psychological impact of breast cancer and breast surgery on patients and their partners, patients’ quality of life (QoL) and sexuality (paper is being draft). A particular attention is paid to the impact of very breast conservative surgery on Quality of life but also to the patient’s satisfaction and Quality of life after breast reconstruction in close collaboration with the EORTC QoL Group. In close collaboration with the Divisions of Senology, Reconstructive Plastic Surgery, and the Department of Medicine we studied the psychological and body image impact of breast loss, satisfaction with cosmetic results of breast reconstruction, with a specific attention to nipple-sparing mastectomy which is now included in the routine of the Breast Division and we assessed the motivations of patients for accepting a NSM or the nipple reconstruction when NSM was not possible. Because of the stressful psychological impact of a breast cancer diagnosis, and the possible role of stress and the role of immunological factors in tumor growth, in 2011, thanks to a Grant from the Umberto Veronesi Foundation, we commenced psychosocial study to determine whether psychosocial stress, in the form of adverse life events and social difficulties, depressive illness, or lack of confiding relationships, shortens the postoperative disease-free interval in breast cancer patients. A prospective follow-up was conducted of a cohort of newly diagnosed breast cancer patients for 60 months after primary surgical treatment: 140 patients
have been interviewed at baseline, for a total of 420 interviews performed by psychologists. Another study aimed at assessing the psychological stressful impact of the breast diagnosis and being on the waiting list, on women who are candidates for mastectomy has been terminated. 91 patients have been interviewed for a total of 183 interviews performed by psychologists. Publications Lucchiari, C., and G. Pravettoni. Cognitive Balanced Model: A Conceptual Scheme of Diagnostic Decision Making. J Eval Clin Pract 2012; 18 (1): 82-8. Gorini A, Miglioretti M, Pravettoni G. A new perspective on blame culture: an experimental study. J Eval Clin Pract. 2012, 18(3): 671-675. Cropley M, Michalianou G, Pravettoni G, Millward LJ. The relation of post-work ruminative thinking with eating behaviour. Stress Health. 2012, 28(1):23-30. Gorini A, Pravettoni G. An overview on cognitive aspects implicated in medical decisions. Eur J Intern Med. 2011;22(6):547-53. doi: 10.1016/j. ejim.2011.06.008. Didier F, Arnaboldi P, Gandini S, Maldifassi A, Goldhirsch A, Radice D, Minotti I, Ballardini B, Luini A, Santillo B, Rietjens M, Petit JY. Why do women accept to undergo a nipple sparing mastectomy or to reconstruct the nipple areola complex when nipple sparing mastectomy is not possible? Breast Cancer Research Treatment. 2012. DOI: 10.1007/s10549012-1983-y
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