Background: Breaking bad news (BBN) may be associated with increasing risk of burnout in practising physicians. However, there is little research on the association between the way bad news is broken and burnout. We investigated the association between physicians' self-efficacy regarding communication to patients and risk of burnout. Methods: We performed a cross-sectional study by proposing an ad-hoc survey exploring attitudes and practice regarding BBN and the Maslach Burnout Inventory-Human Service Survey to 379 physicians from two University Hospitals in Italy. Associations were assessed by multivariable logistic regression models. Results: Two-hundred twenty-six (60%) physicians returned the questionnaires. 76% of physicians acquired communication skills by observing mentors or colleagues, 64% considered BBN as discussing a poor prognosis, 56% reported discussing prognosis as the most difficult task, 38 and 37% did not plan a BBN encounter and considered it stressful. The overall burnout rate was 59%. Considering BBN a stressful task was independently associated with high risk of burnout (OR 3.01; p = 0.013). Planning the encounter (OR = 0.43, p = 0.037), mastering communication skills (OR = 0.19, p = 0.034) and the self-evaluation as good or very good at BBN (OR 0.32; 0.15 to 0.71; p = 0.0) were associated with low risk of burnout. Conclusions: Our findings suggest that some physicians' BBN attitudes and knowledge of conceptual frameworks may influence the risk of burnout and support the notion that increasing knowledge about communication skills may protect clinicians from burnout. Further research is needed in this area.

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Background: Breaking bad news (BBN) may be associated with increasing risk of burnout in practising physicians. However, there is little research on the association between the way bad news is broken and burnout. We investigated the association between physicians' self-efficacy regarding communication to patients and risk of burnout.Methods: We performed a cross-sectional study by proposing an ad-hoc survey exploring attitudes and practice regarding BBN and the Maslach Burnout Inventory - Human Service Survey to 379 physicians from two University Hospitals in Italy. Associations were assessed by multivariable logistic regression models.Results: Two-hundred twenty-six (60%) physicians returned the questionnaires. 76% of physicians acquired communication skills by observing mentors or colleagues, 64% considered BBN as discussing a poor prognosis, 56% reported discussing prognosis as the most difficult task, 38% and 37% did not plan a BBN encounter and considered it stressful. The overall burnout rate was 59%. Considering BBN a stressful task was independently associated with high risk of burnout (OR 3.01; p=0.013). Planning the encounter (OR=0.43, p=0.037), mastering communication skills (OR=0.19, p=0.034) and the self-evaluation as good or very good at BBN (OR 0.32; 0.15 to 0.71; p=0.0) were associated with low risk of burnout.Conclusions: Our findings suggest that some physicians' BBN attitudes and knowledge of conceptual frameworks may influence the risk of burnout and support the notion that increasing knowledge about communication skills may protect clinicians from burnout. Further research is needed in this area.

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MEITL is a very rare and highly aggressive peripheral T-cell lymphoma with poor prognosis and for which there is no standard treatment. Patients with relapsed/refractory disease have few treatment options and many still die of disease progression. Here we report the case of a 65-year-old woman affected by MEITL, progressing after initial treatment with an anthracycline-based chemotherapy and surgery, who received single-agent PEG-asparaginase salvage therapy at our institution. The treatment proved to be rapidly effective in controlling the disease and its associated paraneoplastic features. Nevertheless, toxicity was high and the patient died due to a treatment-related complication. The case we described brings new evidences on the effectiveness of PEG-asparaginase therapy in MEITL patients. Whether PEGasparaginase should be included in the treatment course of MEITL patients could be the subject of future studies.

Background: The majority of practising physicians experience burnout. One of the factors most frequently advocated to increase such risk is breaking bad news (BBN). Several reports, by showing alteration of physiological indices, have empirically suggested that BBN may stress physicians, ultimately contributing to burnout. However, the association between the way serious news is broken and burnout has not been explored yet. In this study we investigated the correlation between burnout and physicians' self-efficacy regarding communication to patients. Methods: A 23-item questionnaire exploring attitudes and practice regarding BBN and the Maslach Burnout Inventory test were administered to 379 physicians from two University Hospitals. Associations were assessed by means of logistic regression models. Results: 226 (60%) returned the questionnaires. 76% of physicians acquired communication skills by observing mentors or colleagues, 64% considered BBN as discussing a poor prognosis, 56% reported discussing prognosis as the most difficult task, 38% and 37% did not plan a BBN encounter and considered it stressful. The overall burnout rate was 59%. At the multivariable analysis considering BBN as discussing a poor prognosis and a stressful task were related to high level of burnout (OR 2.42, p=0.042; OR 3.56, p=0.005); whereas planning the encounter and mastering communication skills even by just by means of reading relevant literature were correlated to low level of burnout (OR=0.43, p=0.037; OR=0.19, p=0.034). Conclusions: Our study identifies some physicians' BBN attitudes and knowledge of conceptual frameworks which may influence the risk of burnout and support the notion that increasing knowledge about communication skills may protect clinicians from burnout.

Study question Does ovarian reserve, measured with antimullerian hormone (AMH) and antral follicle count (AFC) diminish in BRCA, CHEK2, PALB2, RAD50, RAD51D, ATM, TP53 pathogenic variants carriers? Summary answer Ovarian reserve, measured with antimullerian hormone (AMH) and antral follicle count (AFC) doesn’t diminish in women with increased risk for hereditary breast and ovarian cancer What is known already Besides the concerns for increased cancer risk, women carrying a predisposing mutation for breast and ovarian cancer face several non-oncological issues that affect the quality of their reproductive lives. Particularly, in recent literature, it remains controversial whether carriers of these mutations, in comparison with non-carrires, have lower ovarian reserve, tendencies to experience premature menopause and lower ovarian response to ovarian stimulation Study design, size, duration This was the first prospective single-center study and was performed between July 2020 and December 2021. All women carrying a germline mutation of BRCA 1/2, CHEK2, PALB2, RAD50, RAD51D, ATM, TP53 under the age of 42 with no history of previous chemotherapy and/or ovarian surgery were eligible. We enrolled 55 women with these germline mutations Participants/materials, setting, methods On the day in which patients were recruited, a blood sample was obtained by venipuncture to determine the antimullerian hormone (AMH) level, independent from the last menstrual cycle. Serum AMH was measured by the new automated Access AMH assay (Beckman Coulter). Thereafter, a transvaginal ultrasound was performed by a single operator to evaluate antral follicle count (AFC) Main results and the role of chance We defined low ovarian reserve as having AMH<1 ng/ml and AFC<7. Only 5/55 (9%) of the study group had an AMH<1 ng/ml and only 4/55 (7.3%) had an AFC<7. In our study population the distribution of AMH percentiles was as follows: only 3/55 (5.5%) had an AMH< 10th percentile by age, 5/55 (9.1%) had AMH values between 10th and 25th percentile, 12/55 (21.8%) between 25th and 50th percentile, 14/55 (25.5%) between 50th and 75th percentile, 13/55 (23.6%) between 75th and 90th percentile and 8/55 (14.5%) above 90th percentile. This means that 47.3% (26/55) of the women had an AMH between the 25th and 50th percentile and 32.7% (18/55) had an AFC between the 25th and 50th percentile. Most of the women studied had an ovarian reserve above the median: 35/55 (corresponding to 63.6%) for AMH and 44/55 (corresponding to 80%) for AFC. The results obtained are consistent with the normal curves of the general population, showing that ovarian reserve in women with germline mutations of BRCA 1/2, CHEK2, PALB2, RAD50, RAD51D, ATM, TP53 is not reduced compared to that of the general population. Limitations, reasons for caution The limitation of the study is the small sample size. Further prospective studies should be done to confirm the finding that women with germline mutation of BRCA 1/2, CHEK2, PALB2, RAD50, RAD51D, ATM, TP53 have a normal ovarian reserve. Wider implications of the findings Women with germline mutations of BRCA 1/2, CHEK2, PALB2, RAD50, RAD51D, ATM, TP53 should be advised that their ovarian reserve is normal. However, there is still a need for adequate counselling to encourage women to have their pregnancies at an early stage, before any potential disease onset and/or prophylactic surgery. Trial registration number GR-2018-12367239