The Medical Oncology Unit of the University Hospital “Policlinico S.Orsola-Malpighi” in Bologna, Italy is directed by Prof. Andrea A. Martoni. Founded in February 1972, it was one of the first hospital divisions exclusively dedicated to the diagnosis and treatment of cancer patients in Italy and was directed by Prof. Franco Pannuti for 25 years. Since 2002 a Palliative Care section has been created within the Medical Oncology Unit with the attribution of responsibility to a component of the medical staff of the Unit (Dr. Antonia Cricca).
The Unit comprises:
- one inpatient ward with 27 beds, 3 of them in single rooms
- an outpatient clinic (day-hospital) with 24 beds dedicated to anti-tumour treatments
- an outpatient consultation office (ambulatories for surveillance of NED patients with prior diagnosis of breast, gynaecological, gastrointestinal, thoracic and urological cancer).
About 1000 new cancer patients are seen yearly and about 2000 patients are treated in the inpatients and/or outpatient wards every year at the Center. The medical staff consists of the Director, 10 medical oncologists, 2 psychologists, 3 data-managers and 35 nurses. The Unit is a reference site for the School of Oncology of the University of Bologna, and 4 medical doctors are currently doing their oncological professional training there. The Medical Oncology Unit is a part of the Department of Haematology & Oncology that also includes the Haematology Unit, 2 other smaller medical Oncology Units for outpatients, one dedicated to breast and gynaecology tumours, the other one prevalently to rare tumours, 2 Pathology Units, Radiology Unit and Nuclear Medicine Unit.
At the Medical Oncology Unit, the monitoring of physical and psychological symptoms is a standard practice. A simple and reproducible three-grade scale was adopted by 1975 to monitor the typical symptoms of cancer patients such as pain, asthenia, anorexia and other frequent organ-specific symptoms. Since 2005 the twelve-hour monitoring of pain intensity by NRS for all patients admitted to the inpatients’ ward is carried out by the nurses and reported in the clinical chart. From 2010, the monitoring of pain intensity was extended to the outpatients’ clinic through the use of a daily diary. Patient and/or their relatives are referred to psycho-oncological consultation when psychological symptoms are particularly distressing. In addition to individual visits, a monthly meeting with a group of 25-30 people including patients, relatives, long-term survivors, doctors and nurses is held and coordinated by an expert psychologist. The aim of these meetings is to face together the psychological and existential distress associated to the disease. This meeting is called “Se ne parli” (in English ‘Let’s talk).
Palliative and Supportive Care
The Palliative Care section is a part of the Medical Oncology Unit and the staff are composed by 2 oncologists, 1 psychologist 1 case-manager nurse. As this section is a structural part of the Medical Oncology Unit, an integrated approach and management of complex needs is allowed and favoured.
This organisation model allows the connection and integration between the Medical Oncology Unit and the Network of Palliative Care outside the hospital. This network hinges on primary care doctor who is joined by an expert and a high quality home care programme for advanced cancer patients set up by the non-profit ANT Italia Foundation since 1985 and by 2 Hospices managed by the MT Chiantore Seragnòli Foundation since 2002 that provide high quality inpatient care for terminally ill cancer patients. These linkages allow and foster continuity of care and integration between anti-tumour treatments and palliative care (simultaneous care) for patients charged to the Medical Oncology Unit. This Centre has the expertise in treating the symptoms of cancer inpatients both among the medical oncological staff and within the Hospital. Cancer patients with severe uncontrolled symptoms or toxicity are admitted to the inpatients’ ward with high priority. A weekly meeting in the hospital between personnel of the Palliative Care section, primary care doctor, medical doctor and psychologist of ANT Foundation and/or MT Chiantore Seragnòli Foundation is held in order to discuss continuity of care and share care planning for “complex” patients.