Advertisement

“There’s no reason why”: a campaign to raise cancer awareness among adolescents

Abstract

Introduction

Adolescents with cancer often experience a longer diagnostic delay than children, mainly because they take longer to go to a doctor. The Italian Society for Adolescents with Oncohematological Diseases (SIAMO) has launched an information campaign focusing on raising adolescents’ awareness of the importance of diagnosing cancer early.

Methods

The concepts of the campaign were developed by a scientific committee of clinicians, cancer patients and their parents, and marketing experts. The title of the campaign is “There’s no reason why”. A video has been launched on TV channels and the Internet, and the final frame refers viewers to the SIAMO website, which provides advice to help adolescents interpret any symptoms they experience.

Results

The video has had 12,181 views. In the 6 months following the launch of the campaign, the SIAMO website page dedicated to the campaign was opened by 9,767 viewers for a total of 13,632 views.

Conclusions

Though it remains very difficult to judge the efficacy of this initiative, the value of a campaign focusing on improving the adolescent population’s cancer awareness is supported by the large number of studies published on the diagnostic delay in this age group. Our campaign goes to show the importance of ensuring cooperation between the different stakeholders involved in the global care of adolescents with cancer.

Tumori 2016; 102(3): 270 - 275

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/tj.5000493

Authors

Chiara Magni, Francesca Maggioni, Angelo Ricci, Elena Barisone, Momcilo Jankovic, Emma Sarlo Postiglione, Enrica Cargnel, Barbara Rita Barricelli, Stefano Valtolina, Laura Veneroni, Stefano Chiaravalli, Pietro Lapidari, Mirko Capelletti, Carlo A. Clerici, Andrea Biondi, Andrea Ferrari

Article History

Disclosures

Financial support: None.
Conflict of interest: The authors have no financial interests related to this work to disclose.

This article is available as full text PDF.

Download any of the following attachments:

Introduction

It has been variously reported that adolescent cancer patients often experience a longer diagnostic delay than children (1, 2). This may happen for numerous reasons. Some are patient related (the so-called “patient delay”), i.e., how patients interpret their signs and symptoms, and how promptly they report them to a doctor. Others depend on general practitioners’ ability to interpret cancer symptoms and consequently refer patients promptly to a specialist center for diagnosis and appropriate treatment (“doctor delay”). A previous study conducted at the Istituto Nazionale Tumori (INT) in Milan showed, however, that the main contributor to the diagnostic delay in this age group concerns the time it takes for adolescents to decide to see a doctor (2). The time to diagnosis can have a considerable impact on patients’ chances of cure (for some tumor types at least), even though the relationship between symptom interval and patient outcome remains a debated issue (3). An early diagnosis can also have some other, complementary advantages, reducing the apprehension and anxiety related to a cancer diagnosis (4). An information campaign was launched in Italy by the Italian Society for Adolescents with Oncohematological Diseases (Società Italiana Adolescenti con Malattie Onco-ematologiche; SIAMO) (5, 6) in an effort to address the problem of diagnostic delay in adolescents with cancer. SIAMO is a project organized by the Italian Pediatric Oncology Network (Associazione Italiana Ematologia Oncologia Pediatrica; AIEOP) and it was conceived in cooperation with the adult hematological and oncological scientific societies, with a view to ameliorating adolescents’ oncological care by focusing on the specific needs of this age group (7, 8). SIAMO is supported by the Federation of Associations of Parents of Children with Cancer (Federazione Italiana Associazioni Genitori Oncoematologia Pediatrica; FIAGOP).

Methods

The concepts of the information campaign were developed by a dedicated scientific committee consisting of clinicians, young cancer patients, and their parents; the campaign material was prepared by Ogilvy & Mather, one of the world’s largest marketing companies, in cooperation with the Dynamo Camp non-profit association (part of SeriousFun Children’s Network). Other societies involved in the project were PostAtomic and BlowUp Film. The fundamental aim was to generate a video that could draw attention to the importance of early cancer diagnosis. The campaign was entitled “There’s no reason why”. The campaign was addressed primarily to young people from 15 to 20 years old, and only secondarily to the community as a whole, families, clinicians and institutions. A famous Italian rapper, Jake la Furia, was asked to act as testimonial to attract the target population’s attention. His was the speaking voice of the campaign, talking directly to adolescents as if he were an older brother. A smiling patient cured of cancer also appeared at the end of the video.

The campaign used images and language likely to be familiar to young people, trying to match actual moments of their lives, but also their worries and anxiety. The aim of the campaign was to deliver an inclusive message: “We understand your fears, but we are here with you.” The final message on the video referred viewers to the SIAMO website (www.progettosiamo.it), which provides information to help adolescents interpret any symptoms they experience with a view to reducing the diagnostic delay.

The Ogilvy & Mather company provided its services free of charge (pro bono), while insurance, filming and out-of-pocket costs amounting to €15,000 were covered by FIAGOP.

The video was launched on several TV channels and on YouTube and was also the object of numerous online and printed press articles.

Results

Figures 1-2-3-4 show some frames from the video, e.g., a girl with wings crouching in the rain, a girl standing under a burning umbrella, a young man holding a metronome. The rapper says, “Some people in the world are born rich and some aren’t. There’s no reason why. Someone will win the next Ballon d’Or, and someone else will spend his whole life on the sidelines. One day you fall for a girl who doesn’t even know you exist. There’s no reason why. You are born with your dad’s nose and your mom’s hips. Some people roll in a Lamborghini and you go on foot. There’s no reason why. And there’s no reason why some people get cancer in high school… but there is a reason why some of them get better.”

A frame from the video “There’s no reason why”. The text says, “There’s no reason why some people get cancer in high school… but there is a reason why some of them get better. Early diagnosis is up to you. Go to progettosiamo.it.”

A frame from the video “There’s no reason why”.

A frame from the video “There’s no reason why”.

A frame from the video “There’s no reason why”.

The last frame of the video refers viewers to the SIAMO website, which opens on a page dedicated to the campaign, showing the following text: “Early diagnosis is important and it’s up to you. If you feel a pain that has no known cause and that keeps coming back; if you have a swelling/lump and don’t know where it comes from, and it doesn’t heal for several weeks; if you’ve been feeling tired for a long time, for no apparent reason; if you often bleed; if you have been losing a lot of weight in recent weeks; if you have a mole that has changed in shape or size, or color; if you are experiencing any persistent symptoms that you don’t understand; don’t panic. There may be lots of explanations for these signs and symptoms, but – just to be on the safe side – we suggest you see your doctor.”

The video was launched on September 1, 2014 in 2 different versions, one for television lasting 30 seconds and the other lasting 45 seconds, uploaded to the Web (https://www.youtube.com/watch?v = jKc7Tt-LgRk), which included the link to the SIAMO website. The video was broadcast about 300 times on SKY television in the first 2 weeks (September 1-14, 2014), then for another 2 weeks on the national La7 TV network (September 21-October 4), and for 1 week (September 28-October 4) on the national Mediaset TV network. All the above-mentioned broadcasting companies offered their services free of charge.

The campaign circulated on the Web and social media with the hashtag #nonceunperche using various communication channels, particularly Facebook and Twitter. The campaign was launched not only on the FIAGOP pages (and those of numerous parents’ associations forming part of the federation), but also on Jake la Furia’s pages and those of the companies that contributed to the preparation of this awareness campaign.

On the Internet the video received 12,181 views. In the 6 months following the launch of the campaign (September 1, 2014 to March 1, 2015) the SIAMO website page dedicated to the campaign was viewed by 9,767 single visitors for a total of 13,632 views. In addition, the diffusion of the video was supported by a press release and it was the object of several articles in national mass media and websites focusing on young people. It was also broadcast by numerous radio channels.

Finally, the campaign was launched on the website of the Italian Health Ministry at the time of the 13th International Childhood Cancer Day (February 15, 2015). This international day was also celebrated with a conference entitled “Io, adolescente, l’ospedale che vorrei” (“The hospital that I, as an adolescent, would like”) held in Milan and organized by FIAGOP, AIEOP and SIAMO, with the support of the Italian Health Ministry, where several of the mass media relaunched the campaign as a “breaking news” item.

Discussion

This paper describes the development and dissemination of an information campaign to raise cancer awareness among adolescents. The campaign focuses particularly on the importance of diagnosing cancer early in this age group, and on making young people realize which signs and symptoms should be considered a potential cause for concern and prompt them to seek a doctor’s advice.

It is obviously impossible to assess the campaign’s efficacy in terms of reducing the diagnostic delay in adolescent cancer patients. The figures mentioned in this paper, such as the number of times the online video was viewed, can only give an idea of how successful the campaign has been in attracting attention to the issue. It is only with time, and only if this campaign is followed up by other such schemes, that it will be possible to say whether Italian teenagers have become more aware of the fact that cancer can involve their age group too, and what symptoms might lead to an early diagnosis.

The value of our campaign stems from many previously published reports of adolescent cancer patients often experiencing considerable diagnostic delay. Table I (1-2-3-4, 9-10-11-12-13-14-15-16-17-18-19-20) lists some of these studies with their key findings. It has been said that an inadequate awareness at all levels (among patients, families, general practitioners and medical specialists) that adolescents can develop cancer too may at least partially explain the longer time to diagnosis seen in this particular age group (21-22-23). Cancers often present with nonspecific symptoms and their diagnostic pathways are frequently nonlinear. Corrective action to reduce the diagnostic delay for adolescents with cancer needs to be taken at all possible levels and with differentiated aims. An information campaign directed specifically at adolescents can certainly play a prominent part because it can contain the patient delay. One of numerous possible causes of patient delay is young people’s limited awareness that cancer may develop at their age too (1, 15). In addition, adolescents’ appraisal of any symptoms they experience (and understanding that some bodily changes might need to be discussed with a health-care professional) can be influenced by the peculiar behavioral traits typical of adolescence (24, 25). In addition to the emotional factors (anxiety and worry) that influence an individual’s symptom appraisal at any age, adolescents may also experience mechanisms of denial and a sense of invincibility (26). As adolescents become increasingly independent, they may feel invulnerable, and this can easily make them underestimate any unusual symptoms they experience. Now that they are no longer children (whose bodies are touched more frequently by their parents), they also experience a new sense of embarrassment about their own nudity and their bodily changes underway. Adolescents demonstrate their newly acquired independence by establishing a greater distance in their relations with their parents, and they may feel that a doctor’s questioning about any bodily symptoms would invade their privacy (27). Our “There’s no reason why” campaign aimed to influence these attitudes in some way. The campaign also demonstrates the importance of getting different stakeholders to cooperate. FIAGOP had a crucial role in implementing the campaign, and the direct involvement of patients in its conception and development was fundamentally important. For instance, the patients or ex-patients involved in the Youth Project of the INT Milan (a project dedicated to adolescents with cancer) (28-29-30) discussed the form and content not only of the video but also of the SIAMO website page. Most of these adolescents on the Youth Project had themselves experienced a delay in their cancer diagnosis. Some of them had told their stories in a video recorded at the INT (available on YouTube and the Youth Project website http://www.ilprogettogiovani.it/index.php/video-main/2-non-categorizzato/56-in-their-own-words; Tab. II), describing how their cancer came to be diagnosed and cured. That video had provided some useful background for the “There’s no reason why” campaign.

A selection of published studies on time to diagnosis in adolescents with cancer

Authors Characteristics of the study Major findings
TtD = time to diagnosis; CNS = central nervous system; STS = soft tissue sarcomas; RMS = rhabdomyosarcoma; PFS = progression-free survival; OS = overall survival; EFS = event-free survival.
Fajardo-Gutiérrez et al 2002 (9) Retrospective analysis of 4,940 patients aged 0-14 years with malignant tumors TtD positively correlates with age and tumor type. No correlation found between TtD and tumor stage. Tumor biology influences TtD
Haimi et al 2004 (10) Retrospective analysis of 315 patients aged 0-20 years with solid tumors TtD positively correlates with age and tumor type. TtD is predictive of survival. The relationship between TtD and prognosis is very complex and related to tumor biology
Goyal et al 2004 (11) Retrospective analysis of 103 patients aged 4-22 years with bone tumors TtD positively correlates with age (<12 years 2.7 months vs. 4.2 months in patients >12 years). Older patients also experience longer patient delay (1.7 months vs. 0.5 months)
Dang-Tan et al 2008 (12) Retrospective analysis of 2,896 patients aged 0-19 years with malignant tumors TtD positively correlates with age. Median patient delay positively correlates with age (p = 0.0001). TtD is also associated with tumor type
Kukal et al 2009 (13) Retrospective analysis of 315 patients aged 0-16 years with CNS tumors TtD positively correlates with age: parental delay is smaller in younger patients (<4 years, 31 days; 4-8 years, 63 days; 8-12 years, 79 days; >12 years, 106 days). TtD is also associated with tumor type and site. TtD inversely correlates with PFS and OS probability. The effect of tumor biology on survival overwhelms any effect on survival of a delay in diagnosis
Ferrari et al 2010 (1) Retrospective analysis of 575 patients aged 0-21 years with STS TtD positively correlates with age. Significant association between TtD and tumor size and histology. Positive correlation found between TtD and outcome
Cecen et al 2011 (14) Retrospective analysis of 329 patients aged 0-19 years with malignant tumors TtD positively correlates with age. In older patients, referral delay is longer. TtD is also associated with tumor type. TtD inversely relates to metastatic stage at presentation
Bisogno et al 2012 (15) Prospective analysis of 643 patients aged 0-19 years with RMS TtD positively correlates with age (4.6 weeks in children vs. 8 weeks in adolescents). RMS presents with more aggressive features in adolescents and this may have an impact on their survival, though no correlation was found between TtD and prognosis
Loh et al 2012 (16) Retrospective analysis of 390 patients aged 0-18 years with malignant tumors TtD positively correlates with age. No association with disease stage at presentation. Symptom interval is inversely related to disease stage and survival. TtD is not significantly predictive of EFS
Brasme et al 2012 (17) Review of 98 studies The belief that a long delay before diagnosis of pediatric cancers leads to worse prognosis is often untrue. For most pediatric cancers TtD probably depends most on the tumor’s biology
Lethaby et al 2013 (18) Review of 32 studies on TtD Cancer TtD varies between diagnostic groups and with age at diagnosis in the majority of studies. Specific criteria identifying circumstances in which delay has occurred should accompany a defined timeline to diagnosis or treatment in every study
Veneroni et al 2013 (2) Prospective analysis of 425 patients aged 0-25 years with malignant solid tumors TtD positively correlates with age (47 days in patients aged 0-14 years vs. 137 days in those aged ≥15 years; p<0.001). Patient delay in adolescent patients accounts for 63.3% of the total symptom interval
Launay et al 2014 (19) Review of 50 studies on TtD Weaknesses in the quality of reporting of studies of TtD. Need for development of new (or refinement of existing) guidelines for reporting this type of study
Barr 2014 (20) Review The assumption that the longer the TtD the poorer the prospect of survival Is not supported by evidence. The biology of the tumor is the most important determinant of outcome. Shortening TtD in order to minimize anxiety
Brasme et al 2014 (4) Prospective analysis of 436 patients aged 0-21 years with Ewing sarcoma TtD positively correlates with age. TtD is also associated with tumor site. The study did not show a significant relationship between longer TtD and unfavorable outcome in Ewing sarcoma
Ferrari et al 2015 (3) Prospective analysis of 351 patients aged 0-25 years with solid malignancies At least a subset of patients can benefit from an earlier diagnosis in terms of survival. For others, intrinsic aggressiveness may mask the potential effect of diagnostic delays

Adolescent patients involved in the Youth Project at the Istituto Nazionale Tumori in Milan talk about how they came to be diagnosed with cancer (http://www.ilprogettogiovani.it/index.php/video-main/2-non-categorizzato/56-in-their-own-words)

Elisa, 16 years old: “After 4 weeks the pain got more intense. My arm was bruised and I thought, once again, that I must have been sleeping on it. I really didn’t want to see a doctor, as I didn’t like going to the doctor’s, so I went to a drugstore and was given an ointment to put on my arm. We thought it was just an infection.”
Camilla, 14 years old: “I had trouble sleeping. I would wake up at night because of the pain I felt. My mother was worried and started consulting doctors and taking me to be examined, and this went on for 6 months. Then one day at the hospital lots of doctors came into my room.”
Angelo, 20 years old: “I started taking antibiotics for a bad sore throat. At first we thought it was a cyst or an inflamed salivary gland. The oncologist said that he had never treated cancer in a 20-year-old, and that is why he referred me to the INT.”
Davide, 16 years old: “It was a small mass and I was told not to worry, that I could relax and wait and see. Then the mass got bigger, but still the doctors didn’t understand what it was. They finally realized it was a brain tumor and that it had to be removed. … Why me? … There’s a problem, but there’s a solution too.”
Elisabetta, 20 years old: “My diagnosis took rather a long time. It was agreed with my general practitioner that I could wait and see. The swelling was there for 6 months. Because of the rarity of the condition, the doctors were caught unprepared too. They thought I’d have to go abroad to obtain a diagnosis and a cure.”

The campaign is one of many schemes implemented by SIAMO as part of a comprehensive Italian program dedicated to adolescents with cancer. SIAMO aims to be a cultural movement as well as a project of the scientific societies dedicated to pediatric and adult medical oncology, and correlated with cooperative groups running clinical trials (8). In Italian, the word “siamo” means “we are”, but the acronym can also be read as “sì amo”, meaning “yes, I love”. We believe that its name perfectly represents what lies behind the “There’s no reason why” campaign, i.e., the will to focus with passion on providing genuine support for young people with cancer.

Acknowledgment

The authors thank the Associazione Bianca Garavaglia for supporting the Youth Project at the Pediatric Oncology Unit at the Istituto Nazionale Tumori, Milan, Italy.

Disclosures

Financial support: None.
Conflict of interest: The authors have no financial interests related to this work to disclose.
References
  • 1. Ferrari A Miceli R Casanova M et al. The symptom interval in children and adolescents with soft tissue sarcomas. Cancer 2010 116 1 177 183 Google Scholar
  • 2. Veneroni L Mariani L Lo Vullo S et al. Symptom interval in pediatric patients with solid tumors: adolescents are at greater risk of late diagnosis. Pediatr Blood Cancer 2013 60 4 605 610 Google Scholar
  • 3. Ferrari A Lo Vullo S Giardiello D et al. The sooner the better? How symptom interval correlates with outcome in children and adolescents with solid tumors: regression tree analysis of the findings of a prospective study. Pediatr Blood Cancer 2016 63 3 479 485 doi:10.1002/pbc.25833. Google Scholar
  • 4. Brasme JF Chalumeau M Oberlin O Valteau-Couanet D Gaspar N Time to diagnosis of Ewing tumors in children and adolescents is not associated with metastasis or survival: a prospective multicenter study of 436 patients. J Clin Oncol 2014 32 18 1935 1940 Google Scholar
  • 5. Ferrari A The challenge of access to care for adolescents with cancer in Italy: national and local pediatric oncology programs. International perspectives on AYAO, part 2. J Adolesc Young Adult Oncol 2013 2 3 112 117 Google Scholar
  • 6. Ferrari A SIAMO: Italian pediatric oncologists and adult medical oncologists join forces for adolescents with cancer. Pediatr Hematol Oncol 2014 31 6 574 575 Google Scholar
  • 7. Zebrack B Isaacson S Psychosocial care of adolescent and young adult patients with cancer and survivors. J Clin Oncol 2012 30 11 1221 1226 Google Scholar
  • 8. Morgan S Davies S Palmer S Plaster M Sex, drugs, and rock ‘n’ roll: caring for adolescents and young adults with cancer. J Clin Oncol 2010 28 32 4825 4830 Google Scholar
  • 9. Fajardo-Gutiérrez A Sandoval-Mex AM Mejía-Aranguré JM Rendón-Macías ME Martínez-García MC Clinical and social factors that affect the time to diagnosis of Mexican children with cancer. Med Pediatr Oncol 2002 39 1 25 31 Google Scholar
  • 10. Haimi M Peretz Nahum M Ben Arush MW Delay in diagnosis of children with cancer: a retrospective study of 315 children. Pediatr Hematol Oncol 2004 21 1 37 48 Google Scholar
  • 11. Goyal S Roscoe J Ryder WDJ Gattamaneni HR Eden TO Symptom interval in young people with bone cancer. Eur J Cancer 2004 40 15 2280 2286 Google Scholar
  • 12. Dang-Tan T Trottier H Mery LS et al. Delays in diagnosis and treatment among children and adolescents with cancer in Canada. Pediatr Blood Cancer 2008 51 4 468 474 Google Scholar
  • 13. Kukal K Dobrovoljac M Boltshauser E Ammann RA Grotzer MA Does diagnostic delay result in decreased survival in paediatric brain tumours? Eur J Pediatr 2009 168 3 303 310 Google Scholar
  • 14. Cecen E Gunes D Mutafoglu K Sarialioglu F Olgun N The time to diagnosis in childhood lymphomas and other solid tumors. Pediatr Blood Cancer 2011 57 3 392 397 Google Scholar
  • 15. Bisogno G Compostella A Ferrari A et al. Rhabdomyosarcoma in adolescents: a report from the AIEOP Soft Tissue Sarcoma Committee. Cancer 2012 118 3 821 827 Google Scholar
  • 16. Loh AH Aung L Ha C Tan AM Quah TC Chui CH Diagnostic delay in pediatric solid tumors: a population based study on determinants and impact on outcomes. Pediatr Blood Cancer 2012 58 4 561 565 Google Scholar
  • 17. Brasme JF Morfouace M Grill J et al. Delays in diagnosis of paediatric cancers: a systematic review and comparison with expert testimony in lawsuits. Lancet Oncol 2012 13 10 e445 e459 Google Scholar
  • 18. Lethaby CD Picton S Kinsey SE Phillips R van Laar M Feltbower RG A systematic review of time to diagnosis in children and young adults with cancer. Arch Dis Child 2013 98 5 349 355 Google Scholar
  • 19. Launay E Morfouace M Deneux-Tharaux C Gras le-Guen C Ravaud P Chalumeau M Quality of reporting of studies evaluating time to diagnosis: a systematic review in paediatrics. Arch Dis Child 2014 99 3 244 250 Google Scholar
  • 20. Barr RD “Delays” in diagnosis: a misleading concept, yet providing opportunities for advancing clinical care. J Pediatr Hematol Oncol 2014 36 3 169 172 Google Scholar
  • 21. Kyle RG Macmillan I Rauchhaus P et al. Adolescent Cancer Education (ACE) to increase adolescent and parent cancer awareness and communication: study protocol for a cluster randomised controlled trial. Trials 2013 14 1 286 Google Scholar
  • 22. Dommett RM Redaniel MT Stevens MCG Hamilton W Martin RM Features of cancer in teenagers and young adults in primary care: a population-based nested case-control study. Br J Cancer 2013 108 11 2329 2333 Google Scholar
  • 23. Stark D Bielack S Brugieres L et al. Teenagers and young adults with cancer in Europe: from national programmes to a European integrated coordinated project. Eur J Cancer Care (Engl) 2015 August 4 [Epub ahead of print]. doi:10.1111/ecc.12365. Google Scholar
  • 24. Bleyer A Budd T Montello M Adolescents and young adults with cancer: the scope of the problem and criticality of clinical trials. Cancer 2006 107 7 Suppl 1645 1655 Google Scholar
  • 25. Fern LA Campbell C Eden TO et al. How frequently do young people with potential cancer symptoms present in primary care? Br J Gen Pract 2011 61 586 e223 e230 Google Scholar
  • 26. Bleyer WA Cancer in older adolescents and young adults: epidemiology, diagnosis, treatment, survival, and importance of clinical trials. Med Pediatr Oncol 2002 38 1 1 10 Google Scholar
  • 27. Magni MC Veneroni L Clerici CA et al. New strategies to ensure good patient-physician communication when treating adolescents and young adults with cancer: the proposed model of the Milan Youth Project. Clinical Oncology in Adolescents and Young Adults 2015 5 63 73 Google Scholar
  • 28. Ferrari A Clerici CA Casanova M et al. The Youth Project at the Istituto Nazionale Tumori in Milan. Tumori 2012 98 4 399 407 Google Scholar
  • 29. Veneroni L Clerici CA Proserpio T et al. Creating beauty: the experience of a fashion collection prepared by adolescent patients at a pediatric oncology unit. Tumori 2015 101 6 626 630 Google Scholar
  • 30. Ferrari A Veneroni L Clerici CA et al. Clouds of oxygen: adolescents with cancer tell their story in music. J Clin Oncol 2015 33 2 218 221 Google Scholar

Authors

Affiliations

  • Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy
  • Associazione Dynamo Camp Onlus, Limestre (Pistoia) - Italy
  • Federazione Italiana Associazioni Genitori Oncoematologia Pediatrica FIAGOP, Modena - Italy
  • Pediatric Onco-Hematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children’s Hospital, Turin - Italy
  • Pediatric Hematology-Oncology Department and Tettamanti Research Center, Milano-Bicocca University, Fondazione MBBM, San Gerardo Hospital, Monza - Italy
  • Ogilvy and Mather Italia, Milan - Italy
  • Department of Computer Science, University of Milan, Milan - Italy
  • Clinical Psychology, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy

Article usage statistics

The blue line displays unique views in the time frame indicated.
The yellow line displays unique downloads.
Views and downloads are counted only once per session.

No supplementary material is available for this article.