The Use of Virtual Care in Patients with Hematologic Malignancies: A Scoping Review

There is increasing interest from cancer patients and their healthcare providers in the use of virtual care in routine clinical practice. In the setting of hematologic malignancy, where patients often undergo complex and immunodepleting treatments, understanding how to use virtual care safely and effectively is critically important. We aimed to describe the use of virtual care in patients with hematologic malignancies and to examine physician- and patient-reported outcomes in the form of a systematic scoping review. An electronic search of PubMed, Ovid MEDLINE, Elsevier Embase, Scopus, and EBSCO CINAHL was conducted from January 2000 to April 2021. A comprehensive search strategy was used to identify relevant articles, and data were extracted to assess the study design, population, setting, patient characteristics, virtual care platform, and study results. Studies were included if they described the use of virtual care for patients with hematologic malignancies; commentaries were excluded. Fifteen studies met the inclusion criteria after abstract and full-text review. Three studies found that app-based tools were effective in monitoring patient symptoms and triggering alerts for more urgent follow-up. Four studies described the use of phone-based interventions. Five studies found that videoconferencing, with both physicians and oncology nurses, was highly rated by patients. Emerging themes included high levels of patient satisfaction across all domains of virtual care. Provider satisfaction scores were rated lower than patient scores, with concerns about technical issues leading to challenges with virtual care. Four studies found that virtual care allowed providers to promptly respond to patient concerns, especially when patients were experiencing side-effects or had questions about their treatment. Overall, the use of virtual care in patients with hematologic malignancies appears feasible, and resulted in high patient satisfaction. Further research is needed in order to evaluate the optimal method of integrating virtual care into clinical practice

Management of Marginal Zone Lymphoma: A Canadian Perspective

Marginal zone lymphomas (MZL) are a rare, heterogenous group of lymphomas, accounting for 5–17% of indolent non-Hodgkin lymphomas in the western world. They can be further divided into three subtypes: extranodal MZL, splenic MZL, and nodal MZL. These subtypes differ in clinical presentation and behavior, which influences how they are managed. There is currently no standard of care for the treatment of MZL, owing to the difficulty in conducting phase 3 randomized trials in MZL, and the fact that there are limited data on the efficacy of therapy in individual subtypes. Treatment practices are thus largely borrowed from other indolent lymphomas and are based on patient and disease characteristics, as well as access to therapy. This review summarizes the Canadian treatment landscape for MZL and how these therapies may be sequenced in practice

Evaluation of an educational program for the caregivers of persons diagnosed with a malignant glioma

Background: Caring for a loved one with a malignant glioma can be a formidable responsibility. The guarded prognosis, side effects of treatments, and changes in brain function, personality and behaviour pose unique challenges in care provision by family members. It is rare that institutions provide educational programs for caregivers. Purpose: To evaluate the impact of providing information in an educational program to caregivers of patients diagnosed with a malignant glioma. Methods: A structured educational program for caregivers of brain tumour patients was developed based upon multidisciplinary expert opinion and caregiver feedback. Twenty-four caregiver participants were enrolled in the program. Knowledge was assessed before, immediately following, and four to six weeks following the program. Open-ended questions were used to explore the caregivers’ experiences, as well as additional benefits derived from the program. Results: Knowledge scores on testing immediately after the program and four to six weeks following the program were statistically significantly improved from baseline testing, although there was a decline in scores four to six weeks after the program. These findings demonstrate effective knowledge transfer (recall of the information) immediately after the education program and four to six weeks later. Specific qualitative and quantitative data serve as a basis for understanding caregivers’ needs and experiences

Évaluation d’un programme d’éducation à l’intention des soignants des personnes diagnostiquées d’un gliome malin

Contexte : S’occuper d’un être cher atteint d’un gliome malin peut être une énorme responsabilité. Le pronostic réservé, les effets secondaires des traitements et les changements dans le fonctionnement cérébral, la personnalité et le comportement constituent des défis de taille dans la prestation de soins par des membres de la famille. Les établissements de santé offrant des programmes d’éducation à l’intention des soignants naturels de personnes atteintes d’un gliome malin sont rares. Objectif : Évaluer l’incidence d’un programme d’éducation offert aux soignants naturels de patients diagnostiqués d’un gliome malin. Méthodes : Nous avons mis au point un programme d’éducation structuré à l’intention des soignants naturels de patients atteints d’une tumeur cérébrale. Le programme était basé sur les opinions de spécialistes des domaines concernés et sur les commentaires de soignants naturels. Vingt-quatre soignants naturels ont participé au programme. Nous avons évalué leur niveau de connaissances à trois reprises : avant le programme, immédiatement après et de quatre à six semaines plus tard. Nous avons utilisé des questions ouvertes pour explorer les expériences des soignants naturels ainsi que d’autres avantages découlant du programme. Résultats : Les scores d’évaluation des connaissances affichaient une hausse statistiquement significative immédiatement après le programme (2e test) et de quatre à six semaines plus tard (3e test) par comparaison avec les scores de référence (1er test), avec un certain recul entre le 2e et le 3e test. Ces résultats démontrent l’existence d’un transfert efficace de connaissances (rappel de l’information) immédiatement après le programme d’éducation et de quatre à six semaines plus tard. Des données qualitatives et quantitatives particulières servent de base pour comprendre les besoins et les expériences des soignants

Combination of FDG PET/CT Radiomics and Clinical Parameters for Outcome Prediction in Patients with Hodgkin’s Lymphoma

Purpose: The aim of the study is to evaluate the prognostic value of a joint evaluation of PET and CT radiomics combined with standard clinical parameters in patients with HL. Methods: Overall, 88 patients (42 female and 46 male) with a median age of 43.3 (range 21–85 years) were included. Textural analysis of the PET/CT images was performed using freely available software (LIFE X). 65 radiomic features (RF) were evaluated. Univariate and multivariate models were used to determine the value of clinical characteristics and FDG PET/CT radiomics in outcome prediction. In addition, a binary logistic regression model was used to determine potential predictors for radiotherapy treatment and odds ratios (OR), with 95% confidence intervals (CI) reported. Features relevant to survival outcomes were assessed using Cox proportional hazards to calculate hazard ratios with 95% CI. Results: albumin (p = 0.034) + ALP (p = 0.028) + CT radiomic feature GLRLM GLNU mean (p = 0.012) (Area under the curve (AUC): 95% CI (86.9; 100.0)—Brier score: 3.9, 95% CI (0.1; 7.8) remained significant independent predictors for PFS outcome. PET-SHAPE Sphericity (p = 0.033); CT grey-level zone length matrix with high gray-level zone emphasis (GLZLM SZHGE mean (p = 0.028)); PARAMS XSpatial Resampling (p = 0.0091) as well as hemoglobin results (p = 0.016) remained as independent factors in the final model for a binary outcome as predictors of the need for radiotherapy (AUC = 0.79). Conclusion: We evaluated the value of baseline clinical parameters as well as combined PET and CT radiomics in HL patients for survival and the prediction of the need for radiotherapy treatment. We found that different combinations of all three factors/features were independently predictive of the here evaluated endpoints