From 13 to 21 March 2021, the National Week for Cancer Prevention (SNPO) is back, promoted throughout Italy by the Italian League for the fight against Tumors, (LITL) with the sole purpose of spreading the value of cancer prevention as a method of life, through the promotion of healthy lifestyles including an active and dynamic lifestyle and, in particular, healthy eating.
As stated by Prof. F. Schittulli National President of LITL “Today, in fact, thanks to prevention, the percentage of curable tumors has exceeded 65% and we can affirm that cancer is no longer scary, as it is a disease to be considered more and more chronic. So much so that, in the face of a constant annual increase in the incidence of cancer cases (over 1,000 per day in our country), there is a slower but continuous and progressive decrease in mortality “.

In Italy, cancers cause fewer deaths than the European average. In particular, from 2015 to date an overall decrease of 5% in cancer mortality in our country is estimated. In women, tumors of the stomach (-20%), of the thyroid gland (-15%) and of the esophagus (-12%) record the most important reductions, in men the neoplasms of the larynx (-28%), of the prostate (-15%) and stomach, colorectal and lung (-11%). The pandemic caused by Covid-19, however, is jeopardizing the continuity of care for people affected by cancer. In fact, it has certainly influenced the world of oncology, where during the first wave we witnessed the suspension for at least two months, on the national territory, of the oncological screening activity.

Screening, or the execution of certain tests that are proposed to anticipate the diagnosis of the onset of a tumor, are a fundamental moment in oncology since early diagnosis is still today one of the main factors that will influence the prognosis (i.e. evolution of the disease, and in other words long-distance survival). Unfortunately, most cases of cancer are still identified when, starting from some symptoms, it is considered appropriate to investigate further with diagnostic investigations, mainly hospital, to arrive at a diagnosis.

In the period of the lockdown, despite the extraordinary commitment of every human resource in all health facilities, there was unfortunately a significant reduction in access to hospitals and cancer diagnostics, partly forced by the differentiation of paths, but also due to fear of patients to approach the facilities. It is expected that the future will bring in evidence a greater number of cases of cancer patients not subjected to the usual screening, as well as from others who will arrive at a diagnosis in a more advanced stage of the disease.

This is the basic assumption that guided the discussion of the third interregional table of comparison on taking charge of the cancer patient at the time of Covid, which was attended by representatives from Marche, Lazio, Abruzzo and Tuscany. The online meeting, organized by Quotidiano Sanità was attended by many experts in the sector, prof. Francesco Saverio Mennini, Professor of Health Economics at Tor Vergata, whose main observation wants to point out the concept that: “From the point of view of the organization of the Health System and also from the point of view of the opportunities it can offer to the welfare system in its complex, the pandemic should be considered an opportunity “, or at least a turning point that stimulates the acceleration of certain activities, such as, for example, increasing the use of telemedicine, along the lines of the DAD, seen more and more as a useful complement and necessary for patient management, with particular reference to the follow up or planning of a territorial screening strategy. The ideal meeting point is the actual implementation of the regional cancer networks, which are actually present only in some regions; is the appeal launched by the Italian Association of Medical Oncology (AIOM) during the XXII National Congress of the scientific society, which took place in virtual form.

“Covid-19 has shown how necessary it is to make the regional oncological networks immediately operational throughout the territory – says Giordano Beretta, AIOM National President and Head of Medical Oncology Humanitas Gavazzeni of Bergamo -. Continuity of care has been ensured at the highest levels precisely in Regions with Networks, because access to treatments is also possible in peripheral locations on the basis of shared indications, thus limiting the movement of patients. Today the Networks are active in Piedmont and Valle d’Aosta, Veneto, Tuscany, Umbria, Liguria, the Autonomous Province of Trento, Puglia and Campania as well as in Lombardy and Emilia-Romagna, albeit with different configurations “.

A study published by the University College of London has in fact estimated that the percentage of deaths in the coming months in England could increase by 20%, reaching 18 thousand deaths caused by the postponement of treatment and the fear of the sick to go to the centers. “In order not to lose the ground gained so far, it must be considered that the Networks represent the tool for the real global care of the cancer patient, to obtain savings for the system and promote the quality and appropriateness of care with a multidisciplinary approach – he also says Saverio Cinieri, AIOM President-elect and Director of Medical Oncology and Breast Unit of the ‘Perrino’ Hospital in Brindisi -. With this type of organization it is also possible to guarantee more streamlined and uniform diagnostic-therapeutic assistance paths.

The theme was also the subject of the fourth National Congress of the Onda Foundation, held in virtual form at the end of September, which was attended by Professor Armando Santoro, Director of Humanitas Cancer Center, with a speech dedicated to the epidemiological framework: “The pandemic has made the management of cancer patients more difficult from all points of view: screening, early diagnosis, therapies and follow up “. However, a comforting fact emerged, namely that cancer patients do not run a greater risk of contracting the virus than others; that the presence of cancer does not influence the severity and prognosis of COVID-19 and that the cancer patients who contracted the virus and who died were mostly very elderly patients, suffering from multiple pathologies and cancers often at an advanced stage. “During the lockdown we continued to treat patients by providing them with anticancer treatments and non-postponable surgeries. However, we know that there has been a reduction in the number of new diagnoses in our country. A worrying fact, due to several factors: the interruption of screening programs, the difficulty of doctors to manage suspected cases of cancer and the fear of patients to return, from May onwards, to hospitals and clinics for screening and checks. ”, Continues prof. Santoro. Naturally, the issue does not concern only Italy. Norman E. Sharpless, Director of the National Cancer Institute (NCI), in an editorial published in Science last June asks what can be done to limit these consequences, also by virtue of the prediction of the increase in mortality – especially in cancer of the breast and colorectal – for failure to perform tests for early diagnosis. “In light of these considerations, it is important first of all to invite patients once again not to postpone treatment and to resume screening and controls: everything can be done in complete safety.

In fact, the task of all the institutions that deal with prevention and oncology is to keep prevention campaigns active. In fact, we cannot jeopardize the reduction in incidence and mortality that we have so far achieved thanks to the early identification of pre-cancerous lesions … “, concluded prof. Santoro. In this regard, CIPOMO (Italian College of Primary Medical Oncologists in Hospital), having acknowledged the possible negative effects caused by the SARS-Cov-2 pandemic on the survival and the possibility of recovery of cancer patients, asks the institutions responsible for a decisive change of strategy. in the management of the Pandemic: more preventive home care and fewer hospitalizations for patients with COVID-19 infection. The goal remains to ensure the preservation of an adequate number of medical and surgical beds – with the relative support of medical and nursing staff – for cancer patients who need them and to establish protected paths to be dedicated to them to avoid any risk of contagion in the hospital.