Due to the challenges and restrictions posed by COVID-19 pandemic, technology and digital solutions played an important role in the rendering of necessary healthcare services, notably in medical education and clinical care. The aim of this scoping review was to analyze and sum up the most recent developments in Virtual Reality (VR) use for therapeutic care and medical education, with a focus on training medical students and patients. We identified 3743 studies, of which 28 were ultimately selected for the review. The search strategy followed the most recent Preferred Reporting Items for Systematic Reviews and Meta-Analysis for scoping review (PRISMA-ScR) guidelines. 11 studies (39.3%) in the field of medical education assessed different domains, such as knowledge, skills, attitudes, confidence, self-efficacy, and empathy. 17 studies (60.7%) focused on clinical care, particularly in the areas of mental health, and rehabilitation. Among these, 13 studies also investigated user experiences and feasibility in addition to clinical outcomes. Overall, the findings of our review reported considerable improvements in terms of medical education and clinical care. VR systems were also found to be safe, engaging, and beneficial by the studies’ participants. There were huge variations in studies with respect to the study designs, VR contents, devices, evaluation methods, and treatment periods. In the future, studies may focus on creating definitive guidelines that can help in improving patient care further. Hence, there is an urgent need for researchers to collaborate with the VR industry and healthcare professionals to foster a better understanding of contents and simulation development.

(1) Background: Predicting the survival of patients in end-of-life care is crucial, and evaluating their performance status is a key factor in determining their likelihood of survival. However, the current traditional methods for predicting survival are limited due to their subjective nature. Wearable technology that provides continuous patient monitoring is a more favorable approach for predicting survival outcomes among palliative care patients. (2) Aims and objectives: In this study, we aimed to explore the potential of using deep learning (DL) model approaches to predict the survival outcomes of end-stage cancer patients. Furthermore, we also aimed to compare the accuracy of our proposed activity monitoring and survival prediction model with traditional prognostic tools, such as the Karnofsky Performance Scale (KPS) and the Palliative Performance Index (PPI). (3) Method: This study recruited 78 patients from the Taipei Medical University Hospital's palliative care unit, with 66 (39 male and 27 female) patients eventually being included in our DL model for predicting their survival outcomes. (4) Results: The KPS and PPI demonstrated an overall accuracy of 0.833 and 0.615, respectively. In comparison, the actigraphy data exhibited a higher accuracy at 0.893, while the accuracy of the wearable data combined with clinical information was even better, at 0.924. (5) Conclusion: Our study highlights the significance of incorporating clinical data alongside wearable sensors to predict prognosis. Our findings suggest that 48 h of data is sufficient for accurate predictions. The integration of wearable technology and the prediction model in palliative care has the potential to improve decision making for healthcare providers and can provide better support for patients and their families. The outcomes of this study can possibly contribute to the development of personalized and patient-centered end-of-life care plans in clinical practice.

The use of wearable devices (WDs) in healthcare monitoring and management has attracted increasing attention. A major problem is patients’ adherence and acceptance of WDs given that they are already experiencing a disease burden and treatment side effects. This scoping review explored the use of wrist-worn devices in the cancer population, with a special focus on adherence and clinical outcomes. Relevant articles focusing on the use of WDs in cancer care management were retrieved from PubMed, Scopus, and Embase from 1 January 2017 to 3 March 2022. Studies were independently screened and relevant information was extracted. We identified 752 studies, of which 38 met our inclusion criteria. Studies focused on mixed, breast, colorectal, lung, gastric, urothelial, skin, liver, and blood cancers. Adherence to WDs varied from 60% to 100%. The highest adherence was reported in the 12-week studies. Most studies focused on physical activity, sleep analysis, and heart vital signs. Of the 10 studies that described patient-reported outcomes using questionnaires and personal interviews, 8 indicated a positive correlation between the patient-reported and wearable outcomes. The definitions of the outcome measures and adherence varied across the studies. A better understanding of the intervention standards in terms of the clinical outcomes could improve adherence to wearables.

Background: This study aimed to identify the risk factors for permanent stoma (PS) in patients who underwent sphincter-saving operations for rectal cancer.Methods: We retrospectively reviewed 597 consecutive patients with rectal cancer from January 2012 to December 2020 at Taipei Medical University Hospital. Univariate and multivariable analyses were used to analyze risk factors for PS.Results: After a mean follow-up of 47.3 months (range 7-114 months), 59 patients (15.1%) were alive with a PS, including 46 patients who did not undergo reversal surgery and 13 patients who underwent stoma re-creation after reversal surgery. The mean period between primary surgery and stoma reversal was 6.0 months. Multivariate analysis revealed that the risk factors for PS were local recurrence [odd ratio (OR), 25.58; 95% confidence interval (CI), 4.428-147.761; p < 0.001], perirectal abscess [OR, 154.34; 95% CI, 15.806 ->999; p < 0.001], anastomosis site stenosis [OR, 187.081; 95% CI, 22.193 ->999; p < 0.001], perineural invasion [OR, 4.782; 95% CI, 1.22-18.736; p = 0.025], and operation time (min) [OR, 1.008; 95% CI, 1.002-1.014; p = 0.01]. Conclusions: Local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, and operation time were independent risk factors for PS. Therefore, before a patient undergoes surgery for rectal cancer, surgeons should consider the possibility of the need for a PS, and patients should be informed before the operation that closure of the temporary stoma may not always be possible.(c) 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Background: Smartphones and wearable devices have become a part and parcel of the healthcare industry. The use of wearable technology has already proved its potentials in improving healthcare research, clinical work, and patient care. The real time data allows the care providers to monitor the patients’ symptoms remotely, prioritize the patients’ visits, assist in decision-making, and carry out advanced care planning. Objectives: The primary objective of our study was to investigate the potential use of wearable devices as a prognosis tool among patients in hospice care and palliative care, and the secondary objective was to examine the association between wearable devices and clinical data in the context of patient outcomes, such as discharge and deceased at various time intervals. Methods: We employed a prospective observational research approach to continuously monitor the hand movements of the selected 68 patients between December 2019 and June 2022 via an actigraphy device at hospice or palliative care ward of Taipei Medical University Hospital (TMUH) in Taiwan. Results: The results revealed that the patients with higher scores in the Karnofsky Performance Status (KPS), and Palliative Performance Scale (PPS) tended to live at discharge, while Palliative Prognostic Score (PaP) and Palliative prognostic Index (PPI) also shared the similar trend. In addition, the results also confirmed that all these evaluating tools only suggested rough rather than accurate and definite prediction. The outcomes (May be Discharge (MBD) or expired) were positively correlated with accumulated angle and spin values, i.e., the patients who survived had higher angle and spin values as compared to those who died/expired. Conclusion: The outcomes had higher correlation with angle value compared to spin and ACT. The correlation value increased within the first 48 h and then began to decline. We recommend rigorous prospective observational studies/randomized control trials with many participants for the investigations in the future.

For treating hepatocellular carcinoma (HCC), local therapies and surgery, including liver transplant, are the first line treatment options; however, several contraindications limit their clinical use. The improvement of radiotherapy (RT) established RT in treating HCC contraindicated against local therapies, including transarterial chemoembolization and radiofrequency ablation. For HCC that recurs after RT and still contradicts against local therapies, there is a need to investigate the use of reirradiation. This study recruited patients receiving two courses of RT for recurrent HCC between January 2007 and December 2019. The result suggested that patients who experienced tumor regression after reirradiation had better survival over those with a stable form of the disease, with the mean overall survival (OS) as 30.0 and 4.0 months, respectively (p < 0.001). The analysis also revealed that systemic therapy had no benefit on both the OS and controlling distant metastasis; the result was limited to a small study number and diversity of drugs. Considering systemic therapy and portal vein tumor thrombosis, which are commonly viewed to affect prognosis, multivariate analysis suggested that the Child–Pugh score and local control were the only two independent factors for the OS, with p = 0.017 and p = 0.028, respectively. Our findings suggested that reirradiation could be the choice for treating recurrent HCC.

Bones are one of the most common sites of cancer metastasis, which usually causes pain and impairs quality of life. Radiation therapy combined with opioids is the standard treatment for painful bone metastases. This treatment achieves effective pain control in 60-74% of patients, but limited treatment choices with limited benefits are available for recurrent or residual painful bone metastases after radiotherapy. More than 40% of patients still experience moderate to severe bone pain after reirradiation. Magnetic resonance-guided focused ultrasound (MRgFUS) combines high-intensity focused ultrasound, which achieves thermal ablation of bone metastases and subsequent pain reduction, with real-time magnetic resonance (MR) thermometry to monitor the temperature of anatomic MR images, with an accuracy of 1 °C, spatial resolution of 1 mm, and temporal resolution within 3 s. As well as being increasingly used clinically for controlling metastatic bone pain, the use of MRgFUS for other diseases has also been tested. However, the use of MR software as a thermometer is the only technique available to verify the accuracy of the software and assure energy delivery. Here, we describe an efficient method of quality assurance we developed for thermal detection and energy delivery before each MRgFUS treatment and also propose a modified workflow to expedite the treatment course as well as to reduce patients' pain during the procedure.

Survival prediction is highly valued in end-of-life care clinical practice, and patient performance status evaluation stands as a predominant component in survival prognostication. While current performance status evaluation tools are limited to their subjective nature, the advent of wearable technology enables continual recordings of patients' activity and has the potential to measure performance status objectively. We hypothesize that wristband actigraphy monitoring devices can predict in-hospital death of end-stage cancer patients during the time of their hospital admissions. The objective of this study was to train and validate a long short-term memory (LSTM) deep-learning prediction model based on activity data of wearable actigraphy devices. The study recruited 60 end-stage cancer patients in a hospice care unit, with 28 deaths and 32 discharged in stable condition at the end of their hospital stay. The standard Karnofsky Performance Status score had an overall prognostic accuracy of 0.83. The LSTM prediction model based on patients' continual actigraphy monitoring had an overall prognostic accuracy of 0.83. Furthermore, the model performance improved with longer input data length up to 48 h. In conclusion, our research suggests the potential feasibility of wristband actigraphy to predict end-of-life admission outcomes in palliative care for end-stage cancer patients. Clinical Trial Registration: The study protocol was registered on ClinicalTrials.gov (ID: NCT04883879).

A 62-year-old woman visited the radiation oncology clinic of Taipei Medical University Hospital (Taipei, Taiwan) in December, 2018, with a 2-week history of progressive dyspnoea. 1 year previously, she had undergone surgery for leiomyosarcoma in the left calf and had also received adjuvant radiotherapy (66 Gy in 30 fractions); she had refused adjuvant chemotherapy and her progress was lost to follow-up.

Stereotactic body radiotherapy (SBRT) has been increasingly used for hepatic oligometastasis which is not suggested for surgery and other local ablative therapy. Although burgeoning literature has been discussing SBRT for liver metastasis, there is no evidence comparing the outcome between SBRT and conventional radiotherapy (RT). Moreover, the patients with oligometastasis would continue systemic therapy, how to compare the effect and how to combine radiotherapy with systemic therapy are still under investigation. Therefore, we report our experience comparing SBRT to conventional RT for hepatic metastasis from colorectal carcinoma. Between 2009 June to 2018 December, 11 patients with oligometastatic hepatic nodules from colorectal carcinoma, which were not suggested for resection or other local therapy after multidisciplinary review, received SBRT to their liver metastases. In the comparing subgroup, 21 patients with metastatic hepatic nodules from colorectal carcinoma accepted palliative RT with conventional dose during the same period. Both SBRT and conventional RT were under same protocol for daily image guidance. With mean follow-up as 15.8 months, overall survival was 14.0 months for conventional RT subgroup and 19.2 months for SBRT subgroup. The mean of maximum diameter of hepatic metastasis for both groups was 3.2 cm (range: 1.5 ∼ 5.8cm). Prescribed dose for conventional RT ranges 35 to 50Gy in 10 to 25 fractions while dose for SBRT was 25 to 50Gy in 3 or 5 fractions. Mean biologically effective doses for conventional RT and SBRT was 68.1Gy and 87.1Gy (α/β=5), 56.3Gy and 60.0Gy (α/β=10), respectively. For the best response outcome, by RECIST 1.1, 1 patient had complete remission (CR), 6 patients had partial response (PR), another 6 patients remained stable disease (SD) and the other 8 patients had progressive disease (PD) in conventional RT subgroup; for SBRT subgroup with 11 patients, 2 patients were CR, 6 patients had PR, and 3 patients remained SD. In-field progression-free survival for conventional RT and SBRT was 8.5 and 10.5 months. Out-field (not irradiated area or other organs) progression-free survival for conventional RT and SBRT was 8.8 and 8.8 months, respectively. None of these 32 patients developed ≥grade 3 side effects during or within 1 month after radiotherapy. For liver metastasis not indicated for operation and other local therapy, SBRT offers an ablative but non-invasive option. From our preliminary comparison, SBRT seems to have higher biological equivalent dose and better local control comparing to conventional RT. Further rigorous research comparing conventional RT and SBRT, as well as investigating confounding effect from systemic therapy, would be needed in future.

The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For inoperable patients, local ablation therapies, such as stereotactic body radiotherapy (SBRT), can provide effective local tumor control with minimal toxicity. Because of its high precision and accuracy, SBRT delivers a higher radiation dose per fraction, is more effective, and targets smaller irradiation volumes than does conventional radiotherapy. In addition, steep dose gradients from target lesions to surrounding normal tissues are achieved using SBRT; thus, SBRT provides more effective tumor control and exhibits fewer side effects than conventional radiotherapy. The use of SBRT is prevalent for treating intracranial lesions (known as stereotactic radiosurgery); however, it is now also used for treating spinal and adrenal metastases. Because of advancements in image-guided assistance and respiratory motion management, several studies have investigated the use of SBRT for treating lung or liver tumors, which move as a patient breathes. The results of these studies have suggested that SBRT favorably controls tumors in the case of moving lesions. Four-dimensional computed tomography (4D-CT) with an abdominal compressor (AC) is clinically convenient for effective respiratory motion management. Because this method is noninvasive and allows free breathing, its use reduces complications. Furthermore, patients consider this method convenient. Moreover, it is considered more efficient than other methods of respiratory motion management by physicians and therapists. The use of 4D-CT with an AC for treating pulmonary lesions has also been widely investigated, and the technique is gaining acceptance for treating hepatic lesions. However, the protocols for using 4D-CT with an AC for treating hepatic lesions are different from those used for treating pulmonary lesions. In this article, we describe a new protocol for SBRT with 4D-CT and an AC for treating liver metastases.

Few data are available on the tolerance of reirradiation in patients with hepatocellular carcinoma (HCC). This study determined the clinical parameters contributing to the development of radiation-induced liver disease (RILD).

In patients with unresectable hepatocellular carcinoma (HCC), radiotherapy is considered for patients with a large tumor burden or tumors with portal vein tumor thrombosis, which is not indicated for operation or transarterial chemoembolization. Sorafenib has proved to be effective as a first-line treatment for locally advanced and metastatic HCC. Preclinical and clinical studies have shown the efficacy of the combined therapeutic effects of radiotherapy (RT) with sorafenib used either concurrently or sequentially. We presented a patient with multiple recurrent HCCs successfully treated with combined RT and sorafenib.

Gene sequencing may be a feasible means of individualizing cancer treatment. By investigating the correlation between genetic profiles and treatment outcomes of chemotherapy, it may be possible to determine effective treatment strategies according to individual genotypes in cancer patients. Despite great advances in drugs for cancer treatment, treatment outcomes may be improved by analyzing genetic markers that indicate treatment efficacy. We report the treatment for a patient with metastatic colon cancer in which gene sequencing was used for the selection of an effective chemotherapy regimen. In addition, we describe the entire course of treatment, including the combination of surgical resection for local control and radiotherapy to eradicate distant metastases. This is a pilot report of the clinical use of gene sequencing for determining a treatment regimen. Further clinical trials are needed to optimize the personalization of cancer treatment.