BackgroundThe COVID-19 pandemic has likely affected the most vulnerable groups of patients and those requiring time-critical access to healthcare services, such as patients with cancer. The aim of this study was to use time trend data to assess the impact of COVID-19 on timely diagnosis and treatment of head and neck cancer (HNC) in the Italian Piedmont region.MethodsThis study was based on two different data sources. First, regional hospital discharge register data were used to identify incident HNC in patients ≥18 years old during the period from January 1, 2015, to December 31, 2020. Interrupted time-series analysis was used to model the long-time trends in monthly incident HNC before COVID-19 while accounting for holiday-related seasonal fluctuations in the HNC admissions. Second, in a population of incident HNC patients eligible for recruitment in an ongoing clinical cohort study (HEADSpAcE) that started before the COVID-19 pandemic, we compared the distribution of early-stage and late-stage diagnoses between the pre-COVID-19 and the COVID-19 period.ResultsThere were 4,811 incident HNC admissions in the 5-year period before the COVID-19 outbreak and 832 admissions in 2020, of which 689 occurred after the COVID-19 outbreak in Italy. An initial reduction of 28% in admissions during the first wave of the COVID-19 pandemic (RR 0.72, 95% CI 0.62–0.84) was largely addressed by the end of 2020 (RR 0.96, 95% CI 0.89–1.03) when considering the whole population, although there were some heterogeneities. The gap between observed and expected admissions was particularly evident and had not completely recovered by the end of the year in older (≥75 years) patients (RR: 0.88, 0.76–1.01), patients with a Romano-Charlson comorbidity index below 2 (RR 0.91, 95% CI: 0.84–1.00), and primary surgically treated patients (RR 0.88, 95% CI 0.80–0.97). In the subgroup of patients eligible for the ongoing active recruitment, we observed no evidence of a shift toward a more advanced stage at diagnosis in the periods following the first pandemic wave.ConclusionsThe COVID-19 pandemic has affected differentially the management of certain groups of incident HNC patients, with more pronounced impact on older patients, those treated primarily surgically, and those with less comorbidities. The missed and delayed diagnoses may translate into worser oncological outcomes in these patients.

Study Type – Therapy (cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Published population‐based data related to recourse to cystectomy, adoption of partial instead of radical cystectomy, determinants of perioperative mortality, complications and length of stay, pelvic lymphadenectomy, and type of urinary diversion, have been largely investigated in the USA, whereas evidence from Western and Southern Europe is lacking. This first population‐based report on cystectomies for bladder cancer from continental Europe evidences a limited role of partial cystectomy, a high proportion of continent diversion, and a decreasing trend of length of stay and in‐hospital mortality. OBJECTIVE • To provide updated figures on urinary diversion, length of stay and mortality after cystectomy in two regions of northern Italy. PATIENTS AND METHODS • Discharge records of patients undergoing cystectomy for bladder cancer in 2000–2008 were extracted from the regional archives of hospital discharges. • Data on partial vs radical cystectomy and type of urinary diversion were obtained from intervention codes. • The influence of demographic characteristics, year of intervention, presence of comorbidities and hospital cystectomy volume on the adoption of a continent diversion and on in‐hospital mortality was assessed through multilevel models. RESULTS • The crude cystectomy rate was close to 10 per 100 000. • The share of partial cystectomies declined from 5.5% in 2000–2002 to 3.0% in 2006–2008. • A continent diversion was adopted in 35% of radical cystectomies, with higher rates in young male patients treated in high‐volume hospitals. • Median length of stay declined from 20 days in 2000–2002 to 18 in 2006–2008; in‐hospital mortality decreased from 3.2% to 2.2%. CONCLUSION • This first population‐based report on cystectomies for bladder cancer from continental Europe evidences a limited role of partial cystectomy, a high proportion of continent diversion and a decreasing trend of length of stay and in‐hospital mortality.

This is the first Italian study to attempt to quantify the injury economic burden in a cohort of children: the costs imposed on society by injuries, suggest how important it is to commit resources to injury prevention.

Adverse drug reactions (ADRs) are a major health problem in the primary care setting, particularly among the elderly population. While the high frequency of ADRs in the elderly has several causes, a major and common determinant is polypharmacy, which can in turn increase the risk of drug-drug interactions (DDIs). In this paper, we analyzed the drugs prescriptions dispensed to elderly outpatients, to assess changes in the prevalence of selected DDIs in the period 2013–2019. Overall, about 15% of the patients aged >65 years were poly-treated. Among them, a decreasing trend in prevalence was observed for the majority of DDIs during the study period. This trend was particularly noticeable for DDIs involving fluoroquinolones and vitamin K antagonists, where a sharp reduction of over 40% was observed. On the opposite, a small increase in prevalence was observed for the association of antidiabetics and beta-blocking agents and for that of clopidogrel and PPIs. While the occurrence of most of the considered DDIs among poly-treated elderly decreased over time, the prevalence of some of them is still worrying. The complexity of the national drug formularies, as well as the increased number of prescribing actors that are involved, further urges the update of DDI lists to be used to monitor drug appropriateness and reduce avoidable ADRs.

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Survival of cancer and myeloma patients after diagnosis of medication-related Osteonecrosis of Jaws (ONJ) has not adequately been reported. ONJ is not rare in patients with bone metastatic cancer and myeloma patients, occurring mostly after prolonged treatment with antiresorptive drugs (zoledronic acid and other bisphosphonates, and/or denosumab). On the other hand, expected residual survival can influence the choice of ONJ treatment strategies (surgical versus conservative). We reviewed survival data after ONJ diagnosis time of 609 patients registered in the regional database of a cancer network in North-Western Italy (Rete Oncologica di Piemonte e Valle d’Aosta).  Main characteristics. Disease:  metastatic breast cancer 43%; myeloma 24.1%; prostate cancer 19.2%; lung cancer 5.7.% renal cancer 3.2% other cancer types 4.8%. Sex: 237 M, 372 F. Median age 69 (32-90) years. Main treatment: 79.1% zoledronic acid, 4.8% denosumab; 16.1 % other drugs or drug sequences.  Observed actuarial median survival after the registered ONJ diagnosis time was 29 (95% CI 26-35) months for breast cancer patients, 31 (95% CI 28-43) months for myeloma patients, 19 (95% CI 15-26) months for prostate cancer patients, 11 (95% CI 5-19) months for lung cancer patients, 30 (95% CI 13-57) months for renal cancer patients, 53 (95% CI 17-84) months for other cancer patients.  Two, three and four-year actuarial survival were respectively: 57.6%, 42.2%, 33.9% for breast cancer patients, 64.6%, 44.9%, 36% for myeloma patients, 42.7%, 27.3%, 19.6% for prostate patients; 28.5%, 14.3%, 11.4% for lung cancer patients; 57.8%, 36.8%, 26.3% for renal cancer patients; 62%, 58.6%, 58.6% for others cancer types.  In conclusion, expected survival after ONJ diagnosis is not really short (less than one year) in most of ONJ patients. Our data do not support generalized exclusion of jawbone surgery in ONJ patients due to expected short survival.

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Aims Data about long-term clinical outcomes of young patients experiencing an acute myocardial infarction (MI), along with the potential impact of gender on incidence and prognosis in such subset are scant and mostly including USA populations. Thus, there is a paucity of data about European patients suffering from a juvenile MI. Purpose. The purpose of the current study was to investigate temporal trends, survival, MI recurrence, and sex differences among subjects who experienced their first MI at young age in the Piedmont region (Italy) between 2007 and 2018. Methods and results Hospital Discharge Register records of Piedmont region (Italy) from 2007 to 2018 were interrogated to identify incident juvenile MI cases and MI recurrences (ICD-9-CM codes: ‘410’, ‘411’, and their subcodes). Patients were considered young if the first MI occurred before or at 47 years of age. Incidence of first Juvenile MI event and subsequent overall survival among patients who survived to hospital discharge were defined as primary outcomes of interest. Subgroup analysis were performed according to sex category, comorbidities and clinical intervention (obtained from the HDRs records). Incidence of MI recurrence among patients who survived to hospital discharge was defined as secondary outcome of interest. Lastly, we evaluated whether experiencing a MI recurrence was associated with a lower overall survival at follow-up. Out of 114 816 hospitalizations due to MI, 4482 occurred in people aged ≤47, with median age 44 years old. At baseline, men had more hypertension (13% vs. 9.4%, P < 0.006) and dyslipidaemia (18.2% vs. 9.9%, P < 0.001), while women more cardiac arrest at presentation (2.9% vs. 1.7%, P = 0.03), cardiogenic shock (2.1% vs. 1.3%, P = 0.06), and less likely to undergone PCI (53.9% vs. 74.3%, P < 0.001). More women (n = 14; 1.9%) than men (n = 33; 0.9%) died while in-hospital, adjusted OR: 2.12; 1.13–3.99. After a median follow-up was 7.2 years (IQR: 4.2–9.9), the survival rate after the first MI was 94.8%, without differences between men and women (HR: 1.05; 0.69–1.60). Age at first MI, year of hospitalization, hospitalization length, chronic kidney disease, cardiogenic shock, third degree atrio-ventricular block, and PCI were found independent predictors of long term survival. 348 (7.8%) experienced at least one MI recurrence and it was more common in men than women (adjusted HR: 0.72; 0.52–0.99). After multivariate adjustment, MI recurrence was associated with a significantly higher risk of death at follow-up as compared with a single MI episode (HR: 3.05; 1.9–4.80, all 95% CI). Conclusions In young patients with a MI, women had more in-hospital mortality compared to men, but among patients who survived to hospital discharge, overall long-term prognosis did not differ. MI recurrences were more common in men and were associated with lower long-term survival rate.