[Acceptance of psychosocial bridging measures in dementia : Treatment observation during the COVID-19 pandemic]

BACKGROUND

In the event of a COVID-19-related absence from an outpatient treatment program, patients suffering from dementia and their caregivers were offered support from a distance. The aim was to examine the extent of the participants' burden as well as how the offer was accepted and evaluated.

MATERIAL AND METHODS

All participants (n = 63) were offered supportive telephone contact over a period of 8 weeks at varying frequencies (weekly, fortnightly). In addition patients received cognitive and physical tasks by mail every 2 weeks. In order to examine the acceptance of the support, data collected from clinical routine were included in a treatment observation. Additionally, all participants were asked to evaluate the support retrospectively.

RESULTS

Out of 63 contacted participants, 45 were included in the treatment observation. The telephone support was very well accepted and a tendency towards higher agreement could be ascertained by caregivers. The experience of burden remained stable at a moderate level for all participants; however, caregivers were significantly more burdened.

CONCLUSION

The present treatment observation shows the acceptance of a location-independent psychosocial treatment program for dementia for future pandemics or treatment failure as well as for the routine care, e.g. for patients with restricted mobility or those living in rural areas without direct hospital connection. In particular, our data strengthen the importance of programs for caregivers in order to alleviate their burden.

Feasibility of intensity-modulated radiation therapy (IMRT) with PET-defined simultaneous integrated boost (SIB) for distal rectal adenocarcinoma (DRA)

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Background: PET/CT guided preoperative IMRT is being used with increasing frequency in standard practice but reports of methods, efficacy, and toxicity are limited. We report the AGH experience from 2007-2010 of IMRT with SIB for DRA.

Methods: 22 pts with stage IB–IV DRA (8 with anal canal involvement) were treated with preoperative concurrent IMRT with SIB, 5FU-based chemotherapy. 15 received weekly oxaliplatin. All had PET/CT simulation. The planned target volume included PET-avid primary tumor and LNs with median margins of 3mm (range, 0–13), in a median of 24 fx (range, 20–28), a median dose of 2.25 Gy/fx (range, 1.9–2.4 Gy) to a median total dose of 53.3 Gy (range, 50.6–57.2 Gy). Clinical target volume included non PET-avid 1st echelon LNs with a median dose of 2.0 Gy/fx (range, 1.6–2.3 Gy) to a total median dose of 47 Gy (range, 40.7–54.04 Gy). Median follow-up was 18 mos (range, 4–35). Late toxicities were scored using CTCAE v. 3.0.

Results: 17 of 22 patients (TNM stages IB (3), IIA (3), IIB (1), IIIA (2), IIIB (7), IV (1)) were treated curatively. The remaining 5 pts were treated palliatively. The median length of time from completion of radiation to surgery was 81 days (range, 48–398). 5 pts did not have surgery due to advanced metastatic disease (3), death (1) or biopsy proven complete response (CR) (1). R0 resection was accomplished in 15 of 17 surgical pts including 13/14 curative and 2/3 palliative cases. R1 resection occurred in 2 pts; 1 with stage IIIB and 1 with stage IV. No pts had R2 resection. 6 pts (5 with T2 lesions and 1 with a T4 lesion) had a pathologic CR. 2 of 3 non-surgical pts with metastatic disease had LRF at 5 and 11 mos. 9/22 pts had no late toxicity, 9/22 ≤ grade 2 and 4/22 had grade 3 late toxicity. No patients with T2 tumors had grade 3 late toxicity, and this appeared to be related to lower GTV. Kaplan-Meier freedom from grade 3late toxicity was 85% at 18 mos.

Conclusions: IMRT with SIB is an accurate targeting technique in pts with DRA that showed a pathologic CR in 100% of T2 lesions. Advanced T stage and larger GTV were possible risk factors for grade 3 late toxicity.

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No significant financial relationships to disclose.