Integration of art and technology in personalized radiation oncology care: Experiences, evidence, and perspectives

Cancer diagnoses expose patients to traumatic stress, sudden changes in daily life, changes in the body and autonomy, with even long-term consequences, and in some cases, to come to terms with the end-of-life. Furthermore, rising survival rates underline that the need for interventions for emotional wellbeing is in growing demand by patients and survivors. Cancer patients frequently have compliance problems, difficulties during treatment, stress, or challenges in implementing healthy behaviors. This scenario was highlighted during the COVID-19 emergency. These issues often do not reach the clinical attention of dedicated professionals and could also become a source of stress or burnout for professionals. So, these consequences are evident on individual, interpersonal, and health system levels. Oncology services have increasingly sought to provide value-based health care, considering resources invested, with implications for service delivery and related financing mechanisms. Value-based health care can improve patient outcomes, often revealed by patient outcome measures while seeking balance with economical budgets. The paper aims to show the Gemelli Advanced Radiation Therapy (ART) experience of personalizing the patients' care pathway through interventions based on technologies and art, the personalized approach to cancer patients and their role as “co-stars” in treatment care. The paper describes the vision, experiences, and evidence that have guided clinical choices involving patients and professionals in a co-constructed therapeutic pathway. We will explore this approach by describing: the various initiatives already implemented and prospects, with particular attention to the economic sustainability of the paths proposed to patients; the several pathways of personalized care, both from the patient's and healthcare professional perspective, that put the person's experience at the Gemelli ART Center. The patient's satisfaction with the treatment and economic outcomes have been considered. The experiences and future perspectives described in the manuscript will focus on the value of people's experiences and patient satisfaction indicators, patients, staff, and the healthcare organization

Patients’ Satisfaction by SmileInTM Totems in Radiotherapy: A Two-Year Mono-Institutional Experience

Background: Patient’s satisfaction is recognized as an indicator to monitor quality in healthcare services. Patient-reported experience measures (PREMs) may contribute to create a benchmark of hospital performance by assessing quality and safety in cancer care. Methods: The areas of interest assessed were: patient-centric welcome perception (PCWP), punctuality, professionalism and comfort using the Lean Six Sigma (LSS) methodology. The RAMSI (Radioterapia Amica Mia SmileINTM (SI) My Friend RadiotherapySI), project provided for the placement of SI totems with four push buttons using HappyOrNot technology in a high-volume radiation oncology (RO) department. The SI technology was implemented in the RO department of the Fondazione Policlinico Universitario A. Gemelli IRCCS. SI totems were installed in different areas of the department. The SI Experience Index was collected, analyzed and compared. Weekly and monthly reports were created showing hourly, daily and overall trends. Results: From October 2017 to November 2019, a total of 42,755 votes were recorded: 8687, 10,431, 18,628 and 5009 feedback items were obtained for PCWP, professionalism, punctuality, and comfort, respectively. All areas obtained a SI-approved rate ≥ 8.0 Conclusions: The implementation of the RAMSI system proved to be doable according to the large amount of feedback items collected in a high-volume clinical department. The application of the LSS methodology led to specific corrective actions such as modification of the call-in-clinic system during operations planning. In order to provide healthcare optimization, a multicentric and multispecialty network should be defined in order to set up a benchmar

Issues related to the pharmacological management of patients with brain tumours and epilepsy

The patient affected by epilepsy related to brain tumours presents certain features linked to the summation of his cancer-related problems and his epilepsy-related problems. Furthermore, epilepsy in brain tumour patients is often refractory to pharmacological treatments and can complicate the therapeutic management of these patients due to the increased incidence of pharmacological interactions and adverse effects. Analysis of the data in the literature suggests that it is opportune, when planning antiepileptic therapy in these cases, to choose the new-generation drugs, as these show a lower incidence of pharmacological interactions with the therapies used in brain tumour patients (chemotherapies, radiotherapy and support therapies), have fewer adverse effects, and have less impact on neuropsychological functions, all factors that strongly influence the patient’s quality of life. Of the new antiepileptic drugs, the following seem to be promising in the treatment of cancer-related epilepsy: oxcarbazepine, topiramate and levetiracetam (the latter as an add-on therapy). The pharmacokinetic features of these drugs, their effectiveness in controlling seizures, and the reduced incidence of adverse effects make them useful in this particular group of patients

Radiotherapy during the COVID-19: a review about management and treatment strategies

Background: The administration of radiotherapy should be encouraged despite the emergency of COVID-19; therefore, our aim is to analyze management and therapeutic interventions to be implemented in a Radiotherapy department to allow patients to continue their treatment and health professionals to continue their work safely. Material and methods: A Pubmed search was performed, in which all articles specific to Radiotherapy and COVID-19 were included. Those articles that were too specific about the COVID-19, surgery and chemiotherapy, were excluded. Results: 315 articles were selected, of which 35 were about therapeutic strategies and 25 about management strategies. In the first category, 5 articles were about how radiotherapy could be a weapon to be used for COVID-19 positive patients with important lung problems. While 30 articles described priorities and new treatment plans for oncology patients who have to undergo radiotherapy during the pandemic. In the second category, almost all the articles explained how triage can be a preventive and monitoring way against COVID-19 in an operating unit with many patients and professionals, and other articles developed a telemedicine system, too, which allows patients to make scheduled visits without coming to the hospital and also for the staff, who can work remotely. In addition, 5 articles concerning psychological aspects of both patients and health care providers were included. Conclusion: This document can be used as a summary in the coming months/years, during the recovery phase from COVID19 pandemic outbreak and as a starting point to be used in case of further pandemic break-out

Efficacy of an eye movement desensitization and reprocessing (EMDR) intervention for a head and neck cancer patient with intolerable anxiety undergoing radiotherapy

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"A Lion Sleeping Next to Me": Preliminary Considerations on the Psychological Consequences of Surviving COVID-19

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Ipsilateral sequential arm movements after unilateral subthalamic deep-brain stimulation in patients with Parkinson's disease

Unilateral STN-DBS significantly improves the performance of contralateral sequential arm movements. Whether unilateral STN-DBS also improves ipsilateral sequential movement is unclear. In this Study in unmedicated parkinsonian patients. we tested the effect of unilateral STN-DBS on the performance of ipsilateral sequential movements and compared it with the performance of contralateral sequential movements. Three-dimensional movements were recorded with the ELITE system and three kinematic variables were considered: total movement time (TMT), total inter-onset latency (IOL), and spatial accuracy. Unilateral STN-DBS significantly decreased TMT in the contralateral arm and only tended to do so also in the ipsilateral arm, whereas it significantly decreased IOL and worsened spatial accuracy only on the contralateral side. Before unilateral STN-DBS a positive correlation was present between the clinical impairment and the TMTs in the contralateral and ipsilateral sides. After unilateral STN-DBS the UPDRS scores improved in the contralateral and to a lesser extent also in the ipsilateral side. Correlation analysis between clinical and kinematic data showed no differences between the contralateral and ipsilateral sides. Our kinematic findings show that after STN-DBS parkinsonian patients' performance of a sequential motor task improves significantly on the contralateral but only tended to do so on the ipsilateral side. Ipsilateral changes can be explained by the observation that the output structures of the basal ganglia send large ipsilateral and less dense contralateral projections to the thalamus. (C) 2008 Movement Disorder Society