When and how can I request a visit to CNAO?

When and how can I request a visit to CNAO?

At CNAO, we can treat some types of cancer that are resistant to traditional radiotherapy and surgically inoperable. The complete list of these pathologies is available on the home page of our website www.cnao.it

The request to get access to treatment can be made by the general practitioner or the specialists who treat the patient. Or the patient himself may choose to contact us. The patient or his caregivers can receive support from trained health personnel, who will tell patients on the chances to have a first visit, or will explain the reasons why the hadrontherapy cannot be used for the patient's case. Patients may be also required to send documentation in advance in order to evaluate their medical history in detail. Afterwards, it will be decided if they have or do not have a chance to see the radiotherapist specialists.

The telematic medical service, letters received via regular mail service or via fax are also handled by duly trained health personnel working at various levels.
Once received, the documentation undergoes a thorough evaluation. If the pathology is not treatable with hadrontherapy, an email will be sent stating the impossibility to get access to the treatment. Otherwise, the case will be analysed together with the doctors, and the patient will be contacted for a first visit.

There is also a channel dedicated to patients residing abroad that is managed by the International Patients Office. The initial documentation required for the preliminary evaluation is the same for all patients: recent medical report with medical history, histological test or radiological diagnosis of the disease, report and images of recent radiological studies (CT scans, MRI, CT-PET) and any previous radiation treatment plan if the patient has received any other radiotherapy in the past on the area of disease for which treatment is being requested now. It is also important that the patient have a recent medical report, so that all the necessary information can be found in the medical history.

An evaluation of a clinical case must be requested when you actually have the histopathological test or, in case a biopsy is not feasible, the radiological diagnosis determined by radiological tests such as nuclear magnetic resonance or a computed tomography scan and scintigraphy.
Together with the diagnosis, which is essential to determine the therapeutic process, staging tests are also necessary as they will tell doctors that the clinical case can be cured.
Each pathology follows a separate clinical procedure so that as soon as your disease is diagnosed, you must contact the medical services and you are given instructions on how to act in the moments immediately following the diagnosis.

The common standard for all pathologies is linked to the impossibility of treating an area that has already undergone radiation therapy in the previous 6 months: that is, when local recurrence or progression of a disease occurs, the clinical documentation can be assessed for the purpose of a hadrontherapy treatment only if at least 6 months have elapsed since the end of the previous radiation treatment, and with recent radiological studies for that specific moment.

Who should you call?

The telephone medical service is available on weekdays, from Monday to Friday, from 9am to 4pm, at 00390382078963.
The e-mail address is serviziomedico@cnao.it

In our website you will find all the useful references to request the preliminary evaluation and send the clinical documentation https://cnao.it/it/how-to-get-access-to-treatment

In this section you will find the instructions to submit your clinical case for a preliminary evaluation by the health personnel. Reception of clinical cases: from Monday to Friday, weekdays, from 8am to 9pm.
Once the documentation is sent, you will receive a answer within 10 working days. If due to its clinical characteristics the pathology is among those that can be treated, your case will be accepted and our office will contact you to schedule an appointment for the first visit.
Times for an appointment varies according to the agendas, usually, you will not have to wait more than 2 weeks through the National Health Service, thus, with a red prescription made out by the GP and a request for a First radiotherapy visit.

The first visits are at the expense of the National Health Service for all patients residing in Italy.
After the first visit, if the case is treatable, the patient will be called for a simulation process in order to create the treatment plan. Therefore, it will take approximately 15 days to perform the simulation CT and MRI scans in order to make the therapy mask. When the treatment plan is ready, the patient will be contacted to start the treatment; waiting time is approximately 15 days.

What are treatments are fully covered by the National Health Service?

The National Health Service provides all citizens residing in Italy with some services free of charge or by paying a fixed fee, called a ticket. This is the Italian Basic Benefit Package (LEA), and hadrontherapy has been included in it for the treatment of certain oncological pathologies.
With the approval of Italian Leg. Decree of 12 January 2017, the Basic Benefit Package was amended and updated, and published in the Official Journal on 18 March 2017.

Although the decree is not yet implemented, the treatments are still provided free of charge for all patients. For residents in Emilia Romagna and Lombardy, it will only suffice for the physician to submit a demanding request for a full hadrontherapy treatment. Patients residing in other regions must go in person to the office in charge of authorisations at the Local Health Authority carrying with them the visit letter prescribing hadrontherapy, and then, wait until the authorisation to pay for the treatment is issued.

The pathologies that will therefore fall within these eligibility conditions are: chordomas and chondrosarcomas of the skull base and spine; brain stem neoplasms (excluding diffuse intrinsic pontine gliomas) and spinal cord tumours; cervical-cephalic region, paraspinal, retroperitoneal and pelvic sarcomas; extremity sarcomas with radio-resistant histology (osteosarcoma, chondrosarcoma); intracranial meningiomas in critical locations (close to the optic tract and the brain stem); orbital and periorbital tumours (e.g. paranasal sinuses), including ocular melanoma; adenoid cystic carcinoma of salivary glands; paediatric solid tumours; tumours in patients with genetic syndromes and collagen diseases associated with increased radiosensitivity; recurrences that require re-treatment in an area that has previously undergone radiation.