Carolyn Giordano

A pilot study to determine if the use of a virtual reality education module reduces anxiety and increases comprehension in patients receiving radiation therapy

ObjectivesPre-treatment patient education has been shown to decrease anxiety and enhance comprehension. Our pilot study evaluates the impact of VERT™, a virtual environment education tool, on these endpoints.MethodsTwenty-two patients with prostate cancer being treated with radiotherapy completed a 16-question comprehension/anxiety survey. Patients proceeded to VERT™, modeled after a flight simulator using realistic sounds and views. The test was then repeated. A power analysis determined that enrolling 20 patients achieves 80% power to detect an effect size of 0.89 with a Bonferroni-adjusted significance level of 0.003125 using a one-sided one-sample paired t test to analyze differences between individual pre/post-test scores. Descriptive statistics were reported and effect size was computed.ResultsPre/post-test measures for all questions were statistically significant, favoring our hypothesis of improved education and reduced anxiety following virtual simulation except three measures of anxiety (low in both assessments). Baseline anxiety was highest for treatment precision, which also demonstrated the most significant pre/post-intervention improvement.ConclusionDecreased anxiety and improved comprehension influence patient-reported satisfaction and can contribute to quality assurance. Implementation of virtual simulation was successful in improving comprehension and reducing anxiety. Development of personalized, site-specific, clinic-based virtual modules is a long-term goal of this pilot study.

Brain Metastases in Patients with Gynecologic Cancers: A Single Institution Experience and Review of the Literature

Objective: Brain Metastasis (BM) from primary gynecologic cancers is a rare entity. The advances and successes in the treatment of primary gynecologic malignancies, have led to prolonged survival and, a higher incidence of BM. This study aims to report the experience at our institution in managing these patients, and provide possible data points that may be essential to note as prognostic factors, and see if our findings are consistent with the literature in this subject. We also aim to provide a brief literature review of patients with gynecologic cancers and BM. Methods: This is a small single institution retrospective study of 23 patients with a gynecologic malignancy and BM, identified between the years 2007–2015. Data were collected on variables including patient demographics, disease and treatment. Results: The median overall survival from the primary diagnosis was 28 months. Median time from diagnosis of BM to death was 9 months. Conclusion: The outcomes in our study are similar to what is stated in the current literature with regard to BM from gynecologic malignancies. Our literature search also revealed that the molecular analysis and treatment of the primary tumor remain important to prevent BMs. The tendency of tumors to metastasize varies for one tumor type to another for the same type of tumor. The tendency to develop BM may not only depend on risk factors such as stage, grade, and histology, but also on the genetic profile of the primary tumor. The study suggests that multimodal treatment of BM has better outcomes in managing BM from gynecologic cancers.