Recenti progressi in medicina最新文献

Scientific literature and daily experience highlight two worrying phenomena: on the one hand, in the very advanced or even terminal stages of cancer, anticancer therapies are administered with dubious or insufficient and ethically disproportionate indications; on the other, the initiation of palliative care, whether simultaneous or end-of-life, is often too late. Moreover, this occurs despite the opposing recommendations of international and italian scientific societies, indicating the need to forgo (withholding or withdrawing) anticancer treatments that lack solid clinical indications and are ethically disproportionate. The problem can be addressed by removing the factors that hinder proper clinical practice, in compliance with the multiple oncology guidelines described in detail in the article by Rossi "The impact of cancer treatments at the end of life: a clinical, ethical and organizational problem" contained in this issue. The main strategies useful for overcoming these obstacles are a better and constant collaboration between oncology teams and palliative care teams in which shared decision-making processes are built that are more responsive to the global needs of the patient and more respectful of the criteria of therapeutic appropriateness and ethical proportionality. In this regard, it is essential to strengthen shared prognostic communication between the two teams to allow patients to make more informed decisions about which therapeutic options to accept in a situation of increasing uncertainty about efficacy due to disease progression.

There is growing recognition that mucus and mucin biology have a considerable impact on respiratory health, and subsequent global morbidity and mortality. Mucins play a critical role in chronic lung disease, not only by providing a physical barrier and clearing pathogens, but also in immune homeostasis. Mucoactive drugs are commonly used to clear the airway in mucus hypersecretory diseases, which can alleviate mucus hypersecretion and increase the efficiency of expectoration. Theoretically, inhaled medications can be directly and rapidly delivered to the lower respiratory tract and exert therapeutic effects, with fewer systemic adverse effects. Ambroxol is a widely used mucoactive drug to treat respiratory diseases associated with abnormal mucus secretion and impaired mucus transport. Moreover, ambroxol stimulates the synthesis of pulmonary surfactant, which, in addition to increasing lung compliance, preventing end-expiratory atelectasis, and facilitating the recruitment of collapsed airways, has anti-inflammatory, anti-infective, and immunoregulatory properties. Ambroxol inhalation represents an efficient way to reduce sputum viscosity, increase expectoration without increasing adverse events.

The use of cancer treatments in the terminal stages of life is an increasingly important clinical, ethical, and organizational issue. Despite recommendations from major scientific organizations to reduce active treatments for patients with a limited life expectancy, significant evidence shows that these therapies continue to be used even during the final days or weeks of life. This trend raises important questions regarding the quality of care, the appropriate balance between risks and benefits, the effective use of healthcare resources, communication between physicians and patients, and the incorporation of palliative care into the overall oncological treatment plan. Given these considerations, it is essential to analyze the clinical and organizational factors that influence these decisions. The goal is to develop effective strategies that promote more appropriate care, encourage the earlier integration of palliative care, and reduce the use of unnecessary or potentially harmful treatments during the terminal phases of illness.

The Compassionate communities paradigm proposes an integrated model of end-of-life care, in which social, relational, and community dimensions complement medical intervention. Developed within the framework of public health, the model entails the active involvement of citizens, institutions, and volunteers in local support networks. International evidence indicates benefits in terms of perceived quality of life, reduced isolation, and more appropriate use of healthcare services. In Italy, the "InVita" project has launched a pilot implementation in the province of Reggio Emilia, based on co-design, needs assessment, and both educational and cultural initiatives. The experience suggests the potential for local policies grounded in a renewed literacy around death and care.

Anticancer treatments at the end of life are considered inappropriate and are used as a quality indicator of clinical behaviours in oncology. However, given the changing of disease trajectories and the availability of new, active treatments, it can no longer be considered synonymous of "useless or ineffective treatment". The distance from death is not sufficiently predictable, and treatment choices should ignore this factor. We propose a decision-making process that takes into account the person's wishes and prioritizes the best treatment options in every circumstance.