«Cancer, a word linked to incurability and death. Luckily that's not the case anymore."

Journeys of health, of hope, medical pilgrimages: a thousand ways to call them, but all are united by one element, that of illness.

From Sardinia, thousands of people cross the sea to reach centers of excellence on the peninsula - or even abroad - to find a cure, to get a second opinion . And there are many who turn to the Scientific Hospitalization and Treatment Institute of Candiolo , in the Turin area, of which Dr. Piero Fenu is the medical director. 63 years old, originally from Banari (Sassari), graduated in Medicine and Surgery in the Piedmontese capital.

Sardinia is his fixed stop at least four times a year, especially the small town from which his parents emigrated: «A welcoming place, on a human scale, I have many friends there, I am viscerally linked to the island ».

In his work he has had the opportunity to meet many Sardinians, to give some data: « On average in a year we have about 500 patients who arrive from the island , of which about a hundred are hospitalized, the rest for visits. A number that is increasing and does not consider the emigrants who therefore live in other regions".

For which pathologies in particular?

«Colonrectal or breast cancer, but this certainly does not mean that Sardinia has a particular incidence. In general, they are the most common types of cancer among the population.

Do you remember any particular story?

«A Sardinian patient, who has been with us for a few years, with otolaryngological cancer, and had arrived after receiving a poor short-term prognosis. Well, it's been 7 years and he periodically comes for checkups. I am always very happy to see him again, our professionals have done a great job. But there are many other stories of Sardinians who come to seek a "second opinion" to cling to hope and I see that they respond well to therapy".

Do you follow the families of the sick in any way?

«We try to ensure that the costs for those who come here for treatment are not unsustainable. For example, we issue free meal vouchers, for the internal restaurant, for patients and carers. In addition, we have agreements with residential facilities where rooms are available for which no compensation is required from the patient. And yet other agreements with hotels at modest prices. However, there is no time limit, if the patient has a complex clinical process, he can stay as long as necessary".

There is another Sardinian surname among your managers.

«Yes, the administrative director: Salvatore Nieddu, parents of Silanus».

How many employees does the Institute have?

«We are a structure where clinics and research coexist, in all we have around 750 operators between assistance and researchers. There is a single building with laboratories, hospitalizations, clinics, the major technologies sector – radiotherapy, nuclear medicine, radiodiagnostics -, the surgical sector, to name a few ».

Do you have special machines?

«A robotic surgery platform, which allows less demolitive interventions than in the past with early resignations and a faster return to social-family activities».

Has there been any major progress in the last five years?

«In terms of surgery, in particular the minimally invasive one, including laparoscopic and laser surgery, ways of trying to act on the tumor mass while sparing the surrounding tissues with various devices and techniques have become very popular».

What weight does the psychological aspect have for you in relation to the patient?

«It is fundamental, it is about treating people who have received a terrible diagnosis, tumors are mentally linked to incurability and death, fortunately this is no longer the case but psychological trauma is normal. So the environment must be humanized with staff available and sympathetic to the disease, it is important to have mental health professionals. In fact, we have an active psychology service with three professionals who take care of the patients either at their express will or when, during the clinical procedure, the doctor notices some problems and proposes the advice of a psychologist. Discomfort must be countered with grace, solidarity, kindness and constant understanding in the relationship with patients but also through psychologists who are the most suitable to interact to find the mental resources that allow you to face the path ".

Are waiting lists a sore point for you too?

"In our case we are able - having only oncology - to have adequate expectations with respect to the urgency of the pathology, a cancer patient must be treated quickly, it is indispensable".

As medical director, what are the most frequent critical issues to detect?

«Covid could represent an enormous risk for cancer patients, which is why we have implemented particularly strict prevention measures thanks to which we have, among other things, offered "hospitality" to local health authorities who had had to close wards and, for example, not could perform surgery. We hosted them in our halls. In short, the coronavirus was an important training ground ».

What is your element of excellence?

«A management model that integrates research. Let me explain: we have doctors and researchers, the patient receives personalized treatment based on the genetic analysis of his own tumor, at a therapeutic level he is included in a protocol, even experimental, suitable for his clinical characteristics".

International collaborations?

"Different. We are part of a network with scientific societies, we often have international guests, congresses and meetings, a continuous exchange».

How important is prevention instead?

“Extremely important. It is said with an apparently incorrect expression that it is the best cure, instead it allows to be able to avoid a large number of pathologies, or at least surprise the tumor when it is still curable".

Primary, secondary and tertiary prevention: what do they mean?

«The primary includes adhering to healthy lifestyles, moderating alcohol, not sunbathing too much, no tanning lamps, not working in unhealthy environments or in which carcinogenic pollutants exist. In the secondary, identifying the tumor at an early stage: when we carry out a colonoscopy - and it is very important to do it periodically - or a screening mammogram, the goal is precisely to identify the tumor in an initial stage, the one in which the interventions can give the better results, with more chances of recovery. I therefore recommend that you always respond to the screening when calling the ASL, an exam can save your life. Finally, the tertiary sector concerns patients who have already had a tumor and must avoid recurrences, with a healthy lifestyle, some sporting activity, no smoking, drinking alcohol in moderation".

Research sector, are you at highly relevant levels?

«I would say yes, in particular for the study of the molecular characterization of the neoplasm. Each neoplasm is distinguished by genetic and molecular characteristics, therefore targeted and personalized therapies can be created. There is also the part of immunogenomics, ie the relationship between cancer and the immune system, the goal is to enhance the immune system to make it more "intelligent". And, again, artificial intelligence in particular in the field of diagnostics with projects intended to identify diagnostic systems which, through a computerized system of data, guide us in diagnostic accuracy in a way superior to the subjective diagnosis of an individual. In other words: in a computer there are thousands of data, we analyze an X-ray and the computer knows if in that case the diagnostic continuation will lead to a tumor ».