There is increasing evidence that early liver transplantation (eLT), performed within standardized protocols can improve survival in severe alcoholic hepatitis (sAH). The aim of the study was to assess outcomes after eLT for sAH in four Italian LT centres and to compare them with non-responders to medical therapy excluded from eLT. Patients admitted for sAH (2013 – 2019), according to NIAAA criteria, were included. Patients not responding to medical therapy were placed on the waiting list for eLT after a strict selection. Histological features of explanted livers were evaluated. Post-transplant survival and alcohol relapse were evaluated. 93 patients with severe AH were evaluated (65.6% male, median [IQR] age: 47 [42-56] years). 45/93 patients received corticosteroids, 52/93 were non-responders and amongst these, 20 patients were wait-listed. Sixteen patients underwent LT. Overall, 6, 12 and 24-month survival rates were 100% significantly higher compared with non-responders to medical therapy who were denied LT (45%, 45% and 36%; p<0.001). 2/16 patients resumed alcohol intake, one at 164 days and one at 184 days. Early LT significantly improves survival in sAH non-responding to medical therapy, when a strict selection process is applied. Further studies are needed to properly assess alcohol relapse rates.

Cancer patients are at risk of several comorbid conditions, including nutritional issues and mental health illnesses. The objective of the current study was to estimate the prevalence, upon hospital admission, of depression and malnutrition among adults with cancer. A retrospective chart review was conducted using health information collected as part of routine assistance. Nutritional status was measured through structured tools, including body mass index (BMI), Nutrition Risk Screening (NRS) 2002, and dietary intake needs. Depression was assessed with the Hospital Anxiety and Depression Scale (HAD). Cancer site, disease stage, length of hospitalization, age, and sex were also considered. Multivariate analyses were used to investigate the association between malnutrition and depression. In summary, our study reveals that malnutrition increases the risk of depression among cancer patients. The findings can also be used in clinical oncology for the implementation of appropriate prevention and treatment interventions in order to reduce the extent of depression and thus improve cancer patients’ quality of life and survival rate.

Benefits of early palliative care referral in oncology are well-validated. At the Veneto Institute of Oncology-IRCCS, a simultaneous-care outpatient clinic (SCOC) has been active since 2014, where patients with advanced cancer are evaluated by an oncologist together with a palliative care team. We prospectively assessed SCOC patients’ characteristics and SCOC outcomes through internal procedure indicators. Data were retrieved from the SCOC prospectively maintained database. There were 753 eligible patients. The median age was 68 years; primary tumor sites were gastrointestinal (75.2%), genitourinary (15.0%) and other sites (9.8%). Predominant symptoms were psychological issues (69.4%), appetite loss (67.5%) and pain (65.9%). Dyspnea was reported in 53 patients (7%) in the referral form, while it was detected in 226 patients (34.2%) during SCOC visits (p < 0.0001). Median survival of patients after the SCOC visit was 7.3 months. Survival estimates by the referring oncologist were significantly different from the actual survival. Psychological intervention was deemed necessary and undertaken in 34.6% of patients, and nutritional support was undertaken in 37.9% of patients. Activation of palliative care services was prompted for 77.7% of patients. Out of 357 patients whose place of death is known, 69.2% died at home, in hospice or residential care. With regard to indicators’ assessment, the threshold was reached for 9 out of 11 parameters (81.8%) requested by the procedure. This study confirmed the importance of close collaboration between oncologists and palliative care teams in responding properly to cancer patients’ needs. The introduction of a procedure with indicators allowed punctual assessment of a team’s performance.

Background: Comprehensive Geriatric Assessment (CGA) is essential for evaluating older cancer patients, but significant gaps persist in both research and clinical practice. This study aimed (I) to identify the CGA elements that most influence anti-cancer treatment decisions in older patients and (II) to explore the predictive value of CGA components for mortality. Methods: This observational study included older patients with newly diagnosed, histologically confirmed solid or hematological cancers, recruited consecutively from 2003 to 2023. Participants were followed for four years. The data collected included CGA measures of functional (Activities of Daily Living-ADL), cognitive (Mini-Mental State Examination-MMSE), and emotional (Geriatric Depression Scale-GDS) domains. Patients were categorized into frail, vulnerable, or fit groups based on Balducci’s criteria. Statistical analyses included decision tree modeling and Cox regression to identify predictors of mortality. Results: A total of 7022 patients (3222 females) were included, with a mean age of 78.3 ± 12.9 years. The key CGA factors influencing treatment decisions were ADL (first step), cohabitation status (second step), and age (last step). After four years, 21.9% patients had died. Higher GDS scores (OR 1.04, 95% CI 1.01–1.07, p = 0.04) were independently associated with survival in men and living with family members (OR 1.67, 95% CI 1.35–2.07, p < 0.001) in women. Younger patients (<77 years) showed both MMSE and GDS as significant risk factors for mortality. Conclusions: Functional capacity, cohabitation status, and GDS scores are crucial for guiding treatment decisions and predicting mortality in older cancer patients, emphasizing the need for a multidimensional geriatric assessment.

The following article proposes a reflection on the experience of Narrative Therapy of a group of cancer patients, non-homogeneous for sites and stages of disease, participating to a therapeutic writing path, in order to process the trauma reactive to cancer and to reflect on themselves. Taking inspiration from the assumption that “writing helps when people are faced with a stumble”, facilitating the process of distancing from life-events, each writer establishes either context, in a more intimate and true way, or memories and emotions connected to it, in order to express them to the group and to themselves too, and to identify new adaptation styles. The therapeutic path lasted eight meetings, during which some themes were chosen to guide the written reflection, which was carried out at home, and then shared with the group. The therapeutic path is an opportunity to adjust the perspective with which the specialist accompanies patients during the adaptation process to the disease, moving from the “explanation” to “comprehension”; from symptom to “sense”. The group narration is based on a relational perspective of co-construction of the meaning of experiences, highlighting the different roles and relevance of the factors involved.

Background/Objectives: Although they differ in terms of epidemiological incidence, melanoma and sarcoma are rare, aggressive cancers with a substantial impact on patients’ quality of life and that of their caregivers. Caregivers, who are often family members, experience high levels of stress, anxiety, and caregiving burden, leading to significant psychological, social, and economic repercussions. The aim of this scoping review was to identify the assessment tools used to study the quality of life and psychological well-being of caregivers of patients with melanoma and/or sarcoma, and to highlight the main areas of difficulty. Methods: A systematic search of PubMed, Embase, and PsycINFO databases identified 325 studies, of which 16 met the inclusion criteria. Eligible studies were English language publications focusing on caregivers of adult patients (>18 years) with melanoma or sarcoma. Reviews, case reports, animal studies, or clinical trials, abstracts, books or book chapters, and studies without clear information on assessment tools or involving the pediatric population were excluded. Results: The studies included (2007–2024) involve 3464 caregivers in all, 211 of whom were caring for patients with melanoma or sarcoma. Caregivers were predominantly female (women-to-men ratio of 2:1) with an average age of 50 years. Caregivers presented severely impaired quality of life, high psychological distress, economic and work difficulties, and limited access to emotional support. Conclusions: Cancer caregiving emerges as a complex process influenced by individual, relational, and contextual factors that affect psychological well-being. Despite limitations related to the small number of studies, the predominance of melanoma-focused research, limited sample diversity, and heterogeneous designs and assessment tools, this review highlights the need for a theoretically grounded and clinically integrated approach that recognizes caregivers as active yet vulnerable participants within the care system.