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Winners’ Cup: a national football tournament brings together adolescent patients with cancer from all over Italy

Abstract

Società Scientifiche Italiane Insieme per gli Adolescenti con Malattie Onco-ematologiche (SIAMO) is an Italian nationwide scheme that focuses on adolescent patients with cancer. Some of its activities include promoting dedicated local projects at the various oncology centers all over the country and organizing events to improve awareness regarding cancer in adolescence. It is with these aims in mind that it organized the Winners’ Cup, a football tournament between Italian adolescents who had (or had had) pediatric cancers. There were 144 young people 15 to 24 years old who arrived from 16 different treatment centers around the country to take part in the tournament and share their stories. Such an event had never been attempted before, in Italy at least. The Winners’ Cup was a great success and an opportunity to focus attention on the particular clinical, psychological, and social needs of cancer patients in this age group.

Tumori 2017; 103(4): e25 - e29

Article Type: SHORT COMMUNICATION

DOI:10.5301/tj.5000655

Authors

Matteo Silva, Marco Chisari, Stefano Signoroni, Alberto Bassani, Luca Tagliabue, Angelo Ricci, Mirco Daversa, Massimo Achini, Filippo Spreafico, Michele Murelli, Giuseppe Maria Milano, Gianni Bisogno, Luca Coccoli, Massimo Conte, Alberto Garaventa, Paolo Indolfi, Silverio Perrotta, Marco Spinelli, Federico Mercolini, Pietro Soloni, Marta Pierobon, Andrea Di Cataldo, Teresa Perillo, Maurizio Mascarin, Elisa Coassin, Laura Veneroni, Michela Casanova, Maura Massimino, Andrea Ferrari

Article History

Disclosures

Financial support: No financial support was received for this submission.
Conflict of interest: None of the authors has conflict of interest with this submission.

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Introduction

The last decade has seen a gradual increase in the international oncologic community in the awareness that adolescent cancer patients have special needs in comparison with children and adults (1) (Tab. I). Adolescents are neither children who have grown too big nor immature adults. All too often they are still seen as oversized patients in pediatric departments (“the ones who no longer fit into the beds”) or as youngsters in adult wards (“the ones afraid to speak to anyone” or the “poor things, so young”) (2). There have been various reports of how adolescents often have difficulty in accessing the most appropriate treatment (i.e., at centers of excellence and on clinical protocols), meaning that for many types of cancer adolescents have fewer chances of cure than children with the same disease (3-4-5). It is also undeniable that the onset of a disease such as cancer at this crucial time in an individual’s development means that adolescents are likely to have psychological and social needs that should be managed as part of their clinical care (6, 7).

Crucial issues in the clinical management of adolescents with cancer

- A particular distribution of the different types of tumor (adolescents may develop both pediatric and adult forms of cancer), with specific biological features vis-à-vis the same type of disease in other age groups
- An inadequate awareness that cancer can develop in this age group (not only among adolescents and their families, but also among doctors and nurses)
- Often complex diagnostic procedures (giving rise to diagnostic delays)
- Difficulty accessing the best treatments and clinical protocols
- Little improvement over the years in the chances of cure by comparison with other age groups
- A lower chance of cure than in children with the same disease (for many types of cancer)
- Specific psychological and social needs
- A lack of dedicated support services
- Fertility preservation issues
- The subsequent passage to adult care, after completing the treatments
- Limited dedicated resources
- Lack of appropriate training for health care personnel

In recent years, a variety of local and national projects have been dedicated to adolescents (and to young adults, who often share the same problems in terms of their clinical management) that have differed in various aspects, reflecting the diversity in the local medical culture and resources (8, 9).

Historically, there have been 2 organizations promoting action of this kind in Italy: the Area Giovani (www.areagiovanicro.it) at the Centro di Riferimento Oncologico (CRO) in Aviano (10), which is part of a medical oncology center for the treatment of adults, and the Progetto Giovani (Youth Project) (www.ilprogettogiovani.it) at the Pediatric Oncology Department of the Istituto Nazionale Tumori (National Cancer Institute) in Milan (11, 12). These 2 projects are organized in much the same way (based on a multidisciplinary cooperation between the 2 worlds of pediatric and adult oncology), and share much the same cultural approach to adolescent cancer patients (the need to promote a degree of normality in their lives and give them opportunities to tell their stories) (13-14-15-16-17-18). With only 2 centers in Italy running dedicated projects for adolescents and young adults with cancer, there was clearly a need to develop a coordinated action on a national scale. The aim was partly to offer the same services to adolescent patients treated elsewhere in Italy, and partly to promote the proposed model. The first draft of a national-scale project was developed by the Italian Scientific Society of Pediatric Oncology (Associazione Italiana Ematologia Oncologia Pediatrica [AIEOP]). From 2007 to 2010, a work group concentrated primarily on dealing with the problem of adolescents’ limited access to clinical protocols and the barriers posed by age limits for admissions to pediatric oncology departments (19-20-21-22). What subsequently emerged, however, was the need for a broader project, capable of involving all the different stakeholders: the scientific associations interested in adult medical oncology (Associazione Italiana di Oncologia Medica [AIOM], Società Italiana di Ematologia [SIE]), the nurses, psychologists, and social workers working with adolescent cancer patients, the help groups of parents and relatives (particularly the Federazione Italiana delle Associazioni Genitori di Oncoematologia Pediatrica [FIAGOP]), and the groups of adolescents cured of cancer and their peers. Complex actions were promoted on various levels, reaching out to the media, universities, family physicians, cooperative groups, and national and international scientific societies. In January 2014, this effort gave birth to the Società Scientifiche Italiane Insieme per gli Adolescenti con Malattie Onco-ematologiche (SIAMO) (www.progettosiamo.it) (23). This organization has obtained the official support of the Italian Ministry of Public Health, and established an important partnership with a major charity, the Fondazione Umberto Veronesi (FUV). One of the goals of SIAMO is to promote the political and institutional initiative of the AIEOP and adult oncologic scientific societies to define the functional and structural characteristics that a center should have in order to manage adolescent cancer patients effectively. This means, for instance, treating a sufficient number of cases every year; imposing no age limits that restrict a patient’s access; assuring a multidisciplinary management that directly involves both pediatric and adult oncologists; adopting clinical protocols for the treatment of all the neoplasms that may develop in this age group; having a dedicated staff of psychologists, social workers, and educators; providing age-specific spaces within the hospital; and offering a fertility preservation program. Meeting these requirements should lead to the creation of a network of dedicated centers around the country.

Another of the goals set by SIAMO concerns the cultural sphere. It focuses on providing and disseminating information, improving people’s awareness of the problems that adolescents with cancer face, in the general population and among people working in the field. In 2015 and 2016, 2 campaigns were undertaken to promote the early diagnosis of cancer that specifically targeted young people: “Non c’è un perché” (“There is no reason why”) (24) and #fattivedere” (this latter Italian term has a dual meaning: “Don’t hide!” and “Get a checkup”) (25). Another project focused on the problem of providing appropriate spiritual support for adolescents in pediatric oncology centers (26).

In cooperation with the FUV and FIAGOP, SIAMO has been active in promoting and supporting local projects for adolescent cancer patients that can operate in parallel with those in Milan and Aviano. The first steps have been taken to set up such local projects in Rome, Monza, Padova, Bari, and Palermo. Implementing these various local projects all over the country is seen as a fundamental step forward, and it is with this in mind that the Winners’ Cup was conceived.

Winners’ Cup

The Winners’ Cup was a football tournament for Italian adolescents with pediatric cancer. The SIAMO was able to organize the tournament owing to the cooperation of stakeholders such as the FIAGOP parents’ associations, the FC Internazionale Milano professional football club and its sponsor Pirelli, and the Milan committee of the Centro Sportivo Italiano (CSI) (a national body for sports and social promotion), under the auspices of the Comitato Olimpico Nazionale Italiano (The National Olympic Sports Committee). The basic idea of SIAMO was to induce its various pediatric cancer treatment centers to form a group of adolescents, starting with a football team. This could then prompt the development of other local projects dedicated to these adolescents with cancer being treated at the various Italian oncology units. The football tournament was held on April 22, 2017, in Milan, at the Centro Sportivo di Formazione Suning in Memoria di Giacinto Facchetti, owned by the FC Internazionale. There were 12 teams involved, representing a total of 16 different pediatric oncology centers from all over Italy (some teams were formed in cooperation by several centers): Milan, Monza, Genova, Padova, Rome, Bologna, Modena, Napoli, Bari, Pisa/Firenze, Aviano/Udine/Trieste, and Palermo/Catania. The tournament was held from 8 AM until late in the evening, with 3 rounds of 4 teams each, semifinals, and finals, for a total of 22 matches (Figs. 1 and 2). Each team consisted of 12 players from 15 to 24 years old (mainly male, but also female), all patients who were being treated for cancer or had already completed their therapies. The teams were accompanied by 4 adults (generally physicians or nurses, or members of parents’ associations). The Winners’ Cup thus involved 144 adolescent patients who met in Milan to play football together and share their stories (Fig. 3). The teams stayed 2 nights in hotels near the football field and this made it easier for participants to socialize. The players were also followed by numerous supporters from all over Italy, in many cases other patients who could not play themselves for various reasons. About 600 people watched the matches.

Players in one of the teams taking part in the Winners’ Cup egg each other on before the match. Picture by Pietro Ferrari.

An action during one of the Winners’ Cup matches. Picture by Pietro Ferrari.

After the prize-giving, the adolescents and the adults accompanying them gather in the field for a group photograph. Picture by Pietro Ferrari.

An event of this kind had never been attempted before in Italy. Bringing together such a large group of patients from all over the country for such a festive occasion, to play sports and swap their experiences of cancer, proved an extraordinary success, also arousing the interest of the mass media, including the national television channels. This gave SIAMO a chance to bring these young people into the spotlight, telling the stories of their courage and of their ability to carry on normally. It was also an opportunity to speak about the special needs of these patients, who live in a no man’s land between the worlds of pediatric and adult oncology, and who are entitled to their own spaces and to dedicated projects.

The attention of the media was facilitated partly by the popularity of football as a sport in Italy, but also by the Winners’ Cup anthem, which was circulated on the web. The song—“Uniti per vincere” (United to win) —was written by the adolescents on the Youth Project in Milan and the musician Stefano Signoroni (the same team produced a successful Christmas carol called “Palle di Natale”) (15, 16). The video of the song (https://www.youtube.com/watch?v=OuwQckowZxw) also features contributions from patients in Bari, Genova, and Padova. The lyrics (Tab. II) repeatedly say “we are,” which in Italian reads exactly the same as the acronym SIAMO.

Lyrics for “Uniti si vince” (United to win), the Winners’ Cup anthem

Written by Stefano Signoroni, Jacopo Sarno, Giacomo Ruggeri, and Tommaso Ruggeri, together with adolescent cancer patients involved in the Youth Project at the National Cancer Institute in Milan, Italy. Patients in Bari, Genova, and Padova also contributed to the video, visible online at https://www.youtube.com/watch?v=OuwQckowZxw.
In a dream we can go
up over the roofs or down in the city.
We can fall in love
or change reality.
In a dream we can win.
Nobody loses here.
We’re ready for this match
that’ll make you want to cheer.
Here we are, this is us, (we are) the heroes. (we are)
Here we are, this is us, (we are) united to win.
Here we are, this is us, (we are) we make a great team. (we are)
We are all for one and that’s the rule.
No one can stop us.
We’re here to change reality

Sport as a medicine to help combat disease

The adolescents want to “change reality.” They are “united to win.” By coming together, and playing sports together, they want to combat the reality of their disease. For young cancer patients coping with all the problems of oncologic therapies and their sequelae, sport can be more than a pastime. Sport becomes an ally at such times as when adolescents are faced with a diagnosis of cancer, and have to cope with its treatment at a delicate time in their individual development. Sport provides a way for them to be in touch with others in the same predicament and to make friends. Sport enables them to feel that their body is still functioning; they can feel “normal,” like everyone else; it helps them to manage their emotions, discover their limits, combat their pain, and rediscover joy (27).

In Italy, the idea of sports for young cancer patients stemmed from the experience of the Youth Project in Milan, which includes a clearly defined and independent Progetto Sport (Sports Project). The aim of the Sports Project is to promote physical activities for patients during and after their oncologic treatments, particularly for those who can benefit from regular physical exercise but have particular difficulties due to personal characteristics and/or their disease or disability. In-hospital physical activities are organized at the pediatric oncology department’s own gym (a well-equipped 30 m² room 10 meters down the corridor from the bedrooms), where patients can sweat and laugh with their trainers, physiotherapists, and roommates.

The trainers agree on fitness programs with the physicians, tailoring workouts to patients’ individual needs. Exercises focus on muscle tone, cardiovascular efficiency and breathing, body weight control, and rehabilitation. It is wonderful to see these young people returning to the hospital to carry on using the gym even when they are not scheduled for any treatment. The gym becomes a place where these young patients feel at home.

Outdoor activities also are organized as part of the Sports Project. In addition to the football team, which trains routinely and takes part in various tournaments, there are sailing trips (managed by the Association Il Progetto del Vento), and some patients took part in an international regatta, the Course Croisière EDHEC at La Rochelle in France, in 2015.

Such experiences demonstrate the feasibility and the validity of practicing sports even while receiving cancer treatments. Such activities can give patients a sense of well-being and autonomy, benefit their relationship with their bodies, and let them feel a shared sense of healthy fatigue and pleasure in striving to improve alongside their peers. Sports can help these young people live through the diagnosis and treatment of their cancer more positively, enabling them to cope better with the trauma of disease and the side effects of therapies. Sports can also facilitate a rapid and effective return to normal life for patients who have completed their treatments.

Conclusion

The Winners’ Cup gave our adolescent cancer patients a chance to tell their stories. Channeled through Italy’s favorite sport, they could talk about their disease and how they had returned to life. It was a very special opportunity for these young people to meet and share their experiences, while also having fun in the fresh air.

The best way to sum up the sense of this event is in their own words.

One of the 144 players, Riccardo, said in a TV interview: “For all of us this is a great comeback after the terrible experience we’ve been through.” Marco said: “We look each other in the eye, with all these other kids who’ve been down the same road as us, and we recognize each other. Our hearts have been branded with the mark of the tempest. But we’re here today. It’s a marvelous thing.” Cristian said: “As a team we play for each other, we make a real team. Just as we need a team to succeed in overcoming the challenge against the disease. We need everybody’s help.”

Many of the adolescents said the football team created for the Winners’ Cup would not just dissolve. The group that had formed planned to carry on and become part of a project on a larger scale, which is what SIAMO was aiming for when it organized the tournament.

Finally, there is a comment from Bonvi (one of the players) on his Facebook page: “The results don’t matter, the number of goals scored or conceded, the league table and the prizes, the sore feet and the sunburnt faces. All my friends were there. There were those who’ve been through adventures like mine, those who’ve shared them with me, those who work to save other people’s lives, and the presence of those who’ve gone was stronger than ever. For me, having been there is already like having won everything.”

The Winners’ Cup was won by the team from Tuscany (Pisa/Firenze), which beat the team from Modena after a penalty shoot-out. But this time, it would be fair to say that everybody won.

Acknowledgment

The authors and SIAMO thank all the people who helped to make the Winners’ Cup possible: all the various parents’ associations belonging to the FIAGOP, the FC Internazionale Milano football club and its sponsor Pirelli, the Milan committee of the Centro Sportivo Italiano (CSI), all the volunteers, the Comitato Olimpico Nazionale Italiano (CONI), the Fondazione Umberto Veronesi (FUV) for supporting SIAMO, and the Associazione Bianca Garavaglia, which supports the Youth Project and the Sports Project in Milan; Jacopo Sarno, Giacomo Ruggeri, Tommaso Ruggeri, and Cloverthree (especially Ernesto Giuntini) for the song “Uniti per vincere”; and the adolescent patients who took part in the Winners’ Cup and the others who were unable to be there.

Disclosures

Financial support: No financial support was received for this submission.
Conflict of interest: None of the authors has conflict of interest with this submission.
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Authors

Affiliations

  •  Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy
  •  Unit for Hereditary Digestive Tract Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy
  •  S.p.A. Community Relations, FC Internazionale Milano, Milan - Italy
  •  Centro Sportivo Italiano (CSI), Rome - Italy
  •  Federazione Italiana Associazioni Genitori Oncoematologia Pediatrica (FIAGOP), Modena - Italy
  •  Hematology/Oncology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome - Italy
  •  Pediatric Hematology and Oncology Division, University of Padua, Padua - Italy
  •  Pediatric Hematology-Oncology Department, Azienda Ospedaliero-Universitaria Pisana, Pisa - Italy
  •  Department of Pediatric Hematology/Oncology, Giannina Gaslini Children’s Hospital, Genoa - Italy
  •  Pediatric Oncology Service, Department of Pediatrics, Second University, Naple - Italy
  •  Pediatric Hematology-Oncology Department and “Tettamanti” Research Center, Milano-Bicocca University, “Fondazione MBBM,” San Gerardo Hospital, Monza - Italy
  •  Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, Policlinico, University of Catania, Catania - Italy
  •  Pediatric Hematology-Oncology Division, Department of Pediatrics, University of Bari, Bari - Italy
  •  Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano (Pordenone) - Italy

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