Discussion
nonverbal behaviors, dyspnea, fatigue, breast cancer, cancer
REGRESSION, CANCER, BREAST CANCER
The integrated approach proposed in the FRIPOS project seems to be an adequate response to the claims that appear in the literature related to the concept of holistic management [Indeed, the inclusion of the psycho-oncologist in the treatment has brought significant benefits or at least a state of stability in many areas (in contrast to what happened in the group TAU), especially in relation to several aspects highlighted in the literature: the development of symptomatic manifestations related to psychopathology as a result of or during the journey against cancer and the indices of psychological functioning, especially at the emotional level [In addition, the results show the effectiveness of the integrated intervention in terms of quality-of-life scales, especially in terms of fatigue, dyspnea, and sleep disturbances. This result can be taken as an indication of the importance of assessing not only the level of distress, but a more comprehensive picture of the person (including the assessment of unmet needs), taking into account in particular nonverbal behaviors as part of a holistic approach that can be of greater use for interventions in breast cancer patients. One of the advantages of the FRIPOS personalized approach is that it can be adapted to the specific needs of the patient. The psycho-oncologist throughout the oncological path can therefore implement psychological support on the basis of the particular psychological functioning of the person. In line with the literature [In nine of ten regression models for psychological symptomatology (all except the somatization subscale), membership in the FRIPOS group together with the quality-of-life subscales significantly contributed to the prediction of the mean score of the respective subscale at T2. These results suggest that the FRIPOS program was effective, confirming the hypothesis and joining the ranks of studies demonstrating the importance of integrated approaches [Further studies on the cost-effectiveness of an integrated approach are needed, especially for health systems such as the Italian one, which faces an increasing demand for integrated psycho-oncology services but also dwindling financial resources, especially for psychosocial care.Despite methodological limitations such as the relatively small sample size, the use of self-reports, and a possible implicit influence of the greater participation in the FRIPOS group (in which the women who completed all three surveys were more numerous), this study may provide important general insights for the clinical setting, including various health situations in which the presence of a parallel psychological support network in conjunction with medical interventions could significantly affect the quality of life and psychophysiological balance of those involved in the treatment process. Another limitation is that due to the pioneering and exploratory nature of this project, there is not yet a manualization of the integrative interventions. For this reason, the intervention was planned using information from the scientific literature on actual difficulties reported by cancer patients (especially breast cancer patients), but no measures were taken to ensure consistency of treatment. This problem needs to be addressed in the future. Potential psychological variables that would be useful to examine in future research involve perceived support by family and partner and specific personality traits.