Journey in the Academic and Research world of Italy Anna Maria Fioretti

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1 Journey in the Academic and Research world of Italy Anna Maria Fioretti The Regina Elena National Cancer Institute (I.R.E.) part of the Italian network of the LR. C CS. (Istituti di Ricovero e Cura a Carattere Scientifico). The Regina Elena Institute, founded in 1939, operates in the most advanced fields of clinical research dealing with the comprehensive care of cancer. The Ifistitute's activities, well endowed, within national and international projects, aim at research in the field of cancer aetiology, neoplastic transformation and progression, and experimental therapies. The Institute also runs programmes on applied research in bio-molecular and instrumental diagnostics, epidemiology and early detection of cancer. It develops standard and experimental protocols for the treatment and rehabilitation of cancer patients. The I.R.E. is a member of various organizations such as the Union International Centre le Cancer (U.I.C.C.), the European Organization of Cancer Institutes (O.E.C.I.) and the European Organization for Research and Treatment of Cancer (E.O.R.T.C. - Early Clinical Trial Group). It is also a World Health Organization Reference Centre for the diagnosis and treatment of stomach cancer and one of the subscribers of the Chart of Paris signed on February 4, The Institute is also collaborating with the Ministry of Foreign Affairs' in a programme for medical cooperation with Tunisia by sending experts and hosting post-graduate scholarship holders. The Institute participates in the international campaign sponsored by the International Digestive Cancer Alliance (I.D.C.A.), and is among the promoters of the Italian public awareness campaign for the Screening of Colorectal Cancer sponsored by the Italian Federation of Digestive Diseases and the Italian League against Cancer. Since 1982 the Institute's Service of Epidemiology coordinates and runs the Cancer Registry of the Latina Province - the only one in Central and Southern Italy - which represents an information and reference source for Italian and foreign researchers in analytic and descriptive epidemiology. As to the administration, the Institute is managed by the public institution named I.F.O. (Istituti Fisioterapici Ospitalieri), which is also running the San Gallicano Institute, specialized in Dermatology. I.F.O.'s Administrative Chairman is Prof. Luigi Giusto Spagnoli, while, I.R.E.'s Scientific Director is Prof. Francesco, Cognetti, with Dr. Patrizio Valeri as General Medical Director and Dr. Costanza Cavuto as Medical Director. The Experimental Oncology Department implements studies of oncogenesis, tumour oncosuppressor genes, genic therapy, biological drugs (also called 'intelligent'), immunology and resistance to chemotherapy. For what concerns complementary surgical techniques, -the Institute aims at optimizing the use of hyperthen-nia in the control of neoplastic growth (melanoma, sarcoma) and uses intra-surgical radiotherapy (IORT), which.allows to supply higher dose of radiotherapy during the surgical operation, thus avoiding to affect the healthy organs, reducing the treatment's toxicity. Other special clinical research activities concern the treatment of head and neck, breast, ovary and central nervous system cancers, the control of neoplastic pain and 100

2 the chromo-modulated chemotherapy. The Institute has a special expertise in breast cancer, which represents one of its historical areas of intervention. The inter-departmental structure ensures a specialised multidisciplinary approach to diagnosis and treatment that improves and integrates the different diagnostic and therapeutic alternatives, tailored on the individual patient. To that aim I.R.E. adopts preset therapeutic and diagnostic protocols, codified and accepted by all doctors, ensuring an approach in line with national and international guidelines. The Institute's innovative services for cancer patients are the following ones: house-treatment, guest-rooms for patients' relatives and palliative cares (hospice) at the 'Sacro Cuore' nursing home in Rome. The I.R.E. is also a promoter of the actions adopted by the Region in the field of oncology, such as the participation in the Regional Oncologic Committee, with special emphasis in tumour prevention and screening of uterine-cervix, breast, colon-rectal, and skin cancer. Furthermore, there is a full experimental activity for the early detection with spiral TC of minimal lesions in those patients with higher risk to develop lung cancer. I.R.E. is also one of the three Italian Institutes authorized to perform liver transplant on AIDS seropositives. The latest media news report the first mandibular transplant from a dead man in the world as a surgical operation realized by the Institute. As a matter of the fact, the Institute's professional specialities are very often exploited within the Scientific Oncologic Societies and involved in the definition of those guidelines and principles to be applied in the national medical Practice. As to medical and public education, the I.R.E. has been carrying out for about 30 years clinical activities in the field of prevention through the Cancer Prevention Centre. In - addition, the prevention of skin cancer among school-age children is a recently started medical educatton project which has been implemented not only at a city and regional, but also at a wider national and international level. The Clinical Pathology Laboratory has been among the first ones to receive the "Vision 20OW Certification, which represents the best recognition of a general system which aims at quality and certification. The Institute Congress Centre hosts meetings for the constant training of operators, as well congresses and multidisciplinary national and international conferences and symposia. The Regina Elena in numbers and structure The I.R.E. is structured into the following departments: -Experimental Oncology (Research) -Medical Oncology -Surgical Oncology -Critical Area -Neurosciences and Head, Neck and Facial pathologies -Oncological Prevention and Diagnosis -Institutional Affairs 1. Number of hospital beds (at present):

3 The wards are all structured in 2 bed rooms with annex services Number of Day Hospital beds: Supplied Medical Assistance These data refer to standard hospitalization in 2002: - Hospitalization days in medical wards: 8,373 - Hospitalization days in surgical wards: 4,013 - Hospitalization days in day hospital: 16,000 - Patients from outside Lazio Region: 22,7% The more frequently treated cancers are, in rank order, the following ones: 1) breast 2) lung 3) digestive tract 4) female reproductive apparatus 5) head and neck 6) bladder and prostate Surgery, chemotherapy and combined treatments (radio-chemotherapy, etc... are also provided for all the other cancers. 3. Out-patient-activities Out-patient-visits in 2001 were 436,895. The waiting list for visits is on average three days, except for non-urgent instrumental examinations (where 20 days are needed). The emergencies, on the contrary, follow preferential channels and are worked out in a very short time. 4. Divisions and Services (all covered by the National Health Service) Anaesthesiology and Intensive Care Cardiology General and Breast Surgery Oncologic Digestive Surgery Thoracic Surgery Oncologic Gynaecologic Surgery Urologic Surgery Plastic and reconstructive Surgery Oncologic Dermatology Hematology Histo-cytopathology and Cytodiagnostic Endocrinology Gastroenterology and Digestive Endoscopy Pulmonary Physiopathology Nuclear Medicine Neurosurgery Neurology Neurorehabilitation Medical Oncology Otorhinolaryngology 102

4 Clinical Pathology Mammary Pathology Cancer Detection and Prevention Radiology and Diagnostic Imaging Radiotherapy Pain Therapy Urology and Urodynamics 5. Medical and paramedical Staff Graduates in Medicine employed as permanent staff at the I.R.E. are in total 224. There are also several doctors under temporary contract, scholarship holders, and so on. The personnel of the Institute includes 334 nurses, and medical technicians with a ratio between paramedical staff and beds of 1.4. The I.R.E. being a specialistic Cancer Centre has no emergency service. 6. Advanced diagnostic and therapeutic apparatus I.R.E. Services are equipped with modem radio-diagnostic technologies, such as TC-spiral, high resolution MRT and interventional radiology. In addition there are: The Radiotherapy Service Furnished with 4 linear accelerators, a CT for virtual simulation, a traditional simulator and'an information net where processing and computational stations are able to direct and control a 11 the activities. The Nuclear Medicine Service Furnished with 4 traditional scintillation scanning diagnostic sections, a mineralometry bone section (MOC) and a ward with 8 hospital beds. The Clinical Pathology Laboratory~ Beside traditional diagnostics there is a division of molecular diagnostics implementing experimental studies and the evaluations of familiar predisposition to tumors (genetic testing). 7. Experimental Oncology Department It is organized into the following laboratories: -Biochemistry -Preclinical and Experimental Chemoterapy -Medical Physics and Expert Systems -Molecular Oncogenesis -Virology -Immunology -Cell Metabolism and Pharmacology -Molecular Pathology The Department is located in separate buildings of the Institute located in Via delle Messi D'Oro, 156 -Rome. 8. Other services and activities Library 103

5 Journals Subscriptions106 Volumes 7,300 Computerized access for bibliographic research: Medlars System, Medline Workbench (developed by the Institute). Tumour Registry The Tumour Registry of the Latina Province (RTP.L.T.), the only one in Central and Southern Italy, is run by the Epidemiology Division. The Registry's activities are published by the International Agency on Cancer Research, the World Health Organization and the European Union (Eurocare and Eurocim). It also collaborates as a reliable instrument for oncologic epidemiology with the Italian Ministry of Health, the National Institute of Health and the Epidemiological Observatory of the Lazio Region. Education and Training The Institutes hosts scholarships and provides post-graduate professional training for the staff physicians (Data Club, Journal Club, lectures and seminars by national and foreign researchers, video conferences). It participates in the Regional courses of the Hospital Medical School. It carries out a two-year course in Oncologic Psychology for medical operators. By an agreement with the Universities of Rome La Sapienza and Tor Vergata, L'Aquila, Urbino and Chieti participates in the teaching of long and short-term post-graduate courses, as well as Doctorates. It carries out a short- term graduation course in Nursery Sciences titled 'P. Nazzaro' at the University of Rome La Sapienza. The Institute is a European Community Training Site for young European scholarship holders of 'Marie Curie Fellowships' under the Fifth European Research and Technological Development Framework Programme (within the specific programme 'Improving Human Potential and Socio-economic Knowledge Base'). 104