VERONA – A multidisciplinary approach for the management of patients with hepatocarcinoma. This is the strategy implemented by the University Hospital of Verona, which has structured a team of professionals, composed of hepatologists, surgeons, oncologists, radioologists, transplantologists, but also nutritionists, able to make an overall assessment of the case in order to then choose the best therapy for each patient. To take stock of the Veronese ‘model’, he stops in the city “United and close to patients with hepatocellular carcinoma“, The road show started by Roche with the patronage of EpaC Onlus.
The Verona stage is the third in a cycle of appointments in various Italian regions that will involve various reference centers at local and regional level, to reflect on the needs of patients with hepatocellular cancer, on best practices in the management of diagnosis and treatment pathways as in the centro veronese, on the priorities to strengthen multidisciplinary management and face current and future challenges.
ONE OF THE MOST AGGRESSIVE CANCERS
Hepatocarcinoma (Hcc) is one of the most aggressive cancers and one of the leading causes of cancer deaths worldwide. In Italy, in 2020 there were 13,000 new cases of liver cancer and hepatocarcinoma represents 75-85% of diagnoses. In Veneto, there are about 1,200 new cases per year, of which two thirds in men and about one third in women. However, only 50% of patients are diagnosed when the disease is still treatable. In any case, survival is increasing: at five years it is about 20%, at 10 years it is 10%. The approach to the treatment of this oncological pathology, moreover, is changing, because the factors that lead to its appearance are also changing.
Hepatocarcinoma mainly develops in people with cirrhosis, have contracted chronic hepatitis (B or C) or are suffering from metabolic syndromes, and have contracted it manifests itself in advanced stages. “The incidence of HCC is decreasing, above all thanks to the fact that the main cause of the disease, namely hepatitis C, is treatable”, explains David Sacerdoti, head of the ‘Liver’ operating unit of the integrated university hospital. of Verona. However, other risk factors emerge. 70-80% of Hcc cancers occur in liver affected by cirrhosis, but the share of patients in whom this disease develops from metabolic causes, associated with hypertension, diabetes and hypertension is increasing. If patients with liver cirrhosis are followed up and undergo periodic checks that can lead to an early diagnosis of the tumor, early diagnosis in other types of patients is more difficult. Furthermore, the pandemic could have slowed down screening activities.
“Unfortunately Covid has extended the follow-up time, which is usually done on a six-monthly basis, with the risk of facing a more advanced stage of cancer with, consequently, a higher future will ”, admonished Luca Frulloni, director of the Gastroenterology operating unit. Hence the need to structure a multidisciplinary team, precisely to provide patients with such a complex pathology the possibility of having a single point of reference.
VERONA’S INTEGRATED APPROACH
“It is therefore essential to evaluate the patient for the diagnosis in a multidisciplinary manner, the follow-up therapeutic choice, also given the absence of specific tests for this growing population. In Verona we have a multidisciplinary group that discusses the therapeutic choice in difficult cases, with hepatologist, surgeon, oncologist, radiologist, radiotherapist, and a multidisciplinary clinic has been set up with a hepatologist, oncologist, internist, surgeon ”, adds Sacerdoti. The team defines the personalized treatment for the patient, based on existing or previous pathologies, the conditions and morphology of the liver and tumor, comorbidities, hepatic functional reserves, the rapidity of growth from diagnosis, with the support of guidelines and regional paths or within the hospital structure, as happens in Verona.
“They speak to him with one voice with the patient, which is very reassuring, also because there is no longer the rebound from one specialist to another”, highlights the director of Oncology, Michele Milella, who during the day of study also took stock of therapeutic innovations, especially in the field of immunotherapies. The role of transplantation is important, although transplantation is the last therapeutic option, the one used when the others are no longer effective. “In some centers, up to 50% of patients listed for a transplant have hepatocellular carcinoma. It is essential that the transplantologist be involved quickly and that the patient’s indication for transplantation is made as soon as possible ”, highlights the head of the USD Hepatic Transplantation, Amedeo Carraro.
“Hcc is a complex disease, the medical treatment of which has made significant progress in recent years. The numerous treatment possibilities, especially in the initial stages, are the basis of the fragmentation that often characterizes many realities, even in Veneto, in the management of patients. Our thinking, as a group, is that the most effective strategy to treat these people is a close and constant cooperation between different figures ”, observes Alessandra Auriemma, oncologist and team member. “The integrated university hospital of Verona has been applying a multidisciplinary approach to patient care for years and has created a true clinical-care network dedicated to hepato-biliary diseases with an integrated clinic and specific care pathways”, reconstructs the health director , Matilde Carlucci.
“The epidemiological transition in the context of this pathology also places the accent on prevention and life corrections. Making an early diagnosis with timely intervention on the metabolic syndrome significantly reduces the risk of chronic hepatocellular carcinoma and hepatocellular carcinoma. The goal is to create health for our patients, understood as well-being, absence of disease, reduction of health costs, quality of care ”, assures Carlucci.
“Hepatocarcinoma is a pathology that has a significant social and economic impact not only on patients but also on their family unit. Recently, our association conducted a survey to highlight the needs, necessities and problems of patients with liver cancer: it emerged that 72% of patients indicated that they needed assistance from one or more people, often family members, and 8 , 6% said they were unaware of liver disease. This picture highlights the existence of patients unaware of their state of health or therefore uninformed, now difficult and sensitized, who often find themselves having to deal with an advanced stage of cancer and treatment ”, concludes Massimino Conforti, vice president of EpaC.
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