The Oncology Unit was funded in 1958 and is one of the oldest in Italy, possibly in Europe. In 2004 the Department of Medical Oncology originates from the merging of two pre-existing units: the “historical” Oncology Unit of the Hospital Santa Maria della Misericordia and the Cancer Clinic that has been established by the University of Udine within the University Hospital. In 2008 the Palliative Care Unit, sited close to the Oncology Ward, was opened. Currently the Department of Oncology is part of the University Hospital of Udine, recently re-accreditated by Joint Commission International as Academic Teaching Hospital.
Since 2015 the Medical Oncology Department is located in a new building, known as “New Udine Hospital”: on the second floor are located the Day Hospital Unit and the Visiting Rooms for out-patients and on the third floor are situated both the Oncology Ward and the Palliative Care Unit.
In the Day Hospital there can be found two rooms with twelve armchairs and two rooms with height day-beds for chemotherapy infusion, supportive treatments, blood transfusions and observation/monitoring after minor procedures such as biopsies or paracentesis. There are also two single bed rooms dedicated to the visit of outpatients requiring isolation (eg. with neutropenia or with infections) or have urgent needs, together with five ambulatory rooms for pre-therapy visits and two rooms dedicated to psychologist and dietitian counseling. There is also a consultation room dedicated to unplanned medical assessments, most of them are related to treatment side effects or disease complications. This is an everyday service covered by a medical oncology trainee, a dedicated nurse and a medical oncology consultant.
In the Oncology Ward are admitted the patients that must undertake chemotherapy or radiotherapy treatments but also supportive care, diagnostic and palliative procedures (eg peritoneal drainage, paracentesis, thoracentesis). The Oncology Ward is made of sixteen rooms with twenty-two beds (single or double occupancy rooms) whereas the Palliative Care Unit has six single rooms.
There is a separate nursing staff for each area: eighteen nurses and three health care assistants work in the Day Hospital and sixteen nurses together with eleven health care assistants work in both the Oncology Ward and the Palliative Care Unit. The nursing and medical teams devoted to the palliative care are trained in palliation of symptoms.
Globally, the medical staff is composed of twenty medical oncology consultants and ten trainees in medical oncology.
There are also six psychologists, three available for out-patients, two dedicated to in-patients and one more dedicated to patients’ children; there are also a welfare worker, a physiotherapist, a dietician and a spiritual assistant working both in the Oncology Ward and in the Palliative Care Unit. All these professionals, together with the Radiotherapists, participate to bi-weekly ward meetings, where all clinical and psyco-social situations of in-patients are discussed.
The Ward can also claim a little gym for rehabilitation, with an exercise bike and other tools. Moreover, there is a space dedicated to the relax of in-patients and their familiars.
In both the Ward and the DH meetings of musicotherapy have been organized for the patients.
Each patient starting an oncology therapy is provided with a leaflet explaining the principal treatment side effects and how to manage them, together with phone numbers useful in case of urgencies. Other guides with all the information about services, facilities and assistance available, both in hospital and local areas, are distributed in collaboration with volunteers’ associations.
A project called “HUCARE”, sponsored by the Italian Association for Medical Oncology (AIOM), has been activated in the last years. This project planned to put into practice some initiatives aimed at favoring an improved first approach towards patients undergoing an oncological therapy for the first time; it has consisted of previous training sessions dedicated to the improvement of doctors’ and nurses’ communication, and actually of: a distress screening for patients’ anxiety and depression, a screening of the basic social needs, the designation of a reference nurse for each of the patients, a list of questions provided to patients in order to favor the doctor-patient information transfer and a structured path with the purpose of giving to patients and caregivers correct information.
In our department, medical oncology consultants and all trainees in medical oncology are subdivided into subspecialty groups, each one dedicated to the main tumor types: breast, gastro-intestinal, thoracic and genitourinary. There are also other professionals dedicated to treatment of head & neck cancer, central nervous system, gynecological and skin & melanoma cancers. Over the last years, we have created, as well, two new team dedicated respectively to precision oncology and to immunotherapy from research to management of the related adverse events. As clinical research is one of the main interests and objective of our department, our institute is an active recruiting center for several national and international, sponsored and spontaneous, clinical trials with almost fifty trials currently ongoing. Both clinical and research meetings are regularly held: the weekly multidisciplinary teams (MDTs) for each subspecialty and oncology professionals’ meetings to discuss specific clinical cases twice a week. Twice a month we hold a management meeting, monthly a research group meeting and every week a journal club. Seminars and conferences are also periodically organized in our institute, frequently in collaboration with other cancer centers.
Palliative and Supportive Care
The Palliative Care Unit is provided with sofa beds available for relatives. Its facilities are designed to assure a comfortable and private place for patients, host caregivers and relatives during night and day. A medical oncology consultant and a trainee in medical oncology examine the patients during the daily ward round; a medical oncologist is present during the night as well. In the hospital there is a protocol called “the end of life” and other for the treatment of the main symptoms related to it; psychosocial problems are identified and dealt with during multi-professional ward meetings; regular discussion about these problems are conducted among doctors, the patient and/or his/her family, in the presence of nurses, welfare worker and psychologist. The welfare worker, with the aid of a dedicated nurse, helps to find the best continuing care at home by the time the patient is discharged, and is constantly in contact with the community team; weekly meetings with the home palliative care team are finalized to enhancing the simultaneous and continuum care during the re-admission at home. Our psychologist offers psychological support to care givers during all the disease phases and during the grief. Finally, a great help comes from volunteers affiliated to cancer charities. A written document (called “Carta dei Servizi”) provides all information for supporting patients at home.
Unfortunately, the present pandemic emergency has interrupted the initiation of a project, sponsored by a Volunteers’ Association that kindly support us, aimed at training the volunteers in the field of assistance to cancer patients.
Last, it is our intention to activate a clinic for Simultaneous Care carried out together with the Colleagues that are committed to Home Palliative Care and the ones who deal with the Hospice.
Last update: December 2020