The Effect of Measured Radiotherapy Dose on Intrathecal Drug Delivery System Function

Example Radiation Oncology Policy for Managing Patients With Implanted Electronic Devices Other Than Implantable Cardiac Pacemakers or Defibrillators

PURPOSE

This article describes a community-based hospital's policy for the management of patients with medical implanted electronic devices other than pacemakers or implanted cardiac defibrillators (ICDs). The policy may be adapted as needed for other radiation oncology groups requiring a practical solution for managing the care of patients with implanted devices, noting the need for changes for departments offering proton, neutron, heavy ion, or magnetic resonance-guided linear accelerator (MR-linac) treatment modalities.

METHODS AND MATERIALS

The policy was developed using a risk-based approach, with each patient's risk level determined based on the patient's dependence on the device, the anticipated dose to the device, and the type of treatment used. A similar approach is used for patients with pacemakers or ICDs, but this policy was designed to accommodate patients with other types of devices with care managed outside the department. Such devices include, but are not limited to, hepatic pumps, intrathecal pain pumps, neurostimulators, cochlear implants, and loop recorders.

RESULTS

The resulting definitions, guidelines, and proposed workflow were presented at the institution's multidisciplinary radiation oncology quality assurance committee monthly meeting and adopted as department policy in 2022. Recommendations incorporated in the policy include levels of patient monitoring and timing of device interrogation to minimize the risk of device malfunction.

CONCLUSIONS

The policy was written to guide the management of treatment of patients with a range of medical implanted electronic devices. This policy is currently in operation at a community-based hospital.

The American Society of Pain and Neuroscience (ASPN) Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain

Moderate to severe pain occurs in many cancer patients during their clinical course and may stem from the primary pathology, metastasis, or as treatment side effects. Uncontrolled pain using conservative medical therapy can often lead to patient distress, loss of productivity, shorter life expectancy, longer hospital stays, and increase in healthcare utilization. Various publications shed light on strategies for conservative medical management for cancer pain and a few international publications have reviewed limited interventional data. Our multi-institutional working group was assembled to review and highlight the body of evidence that exists for opioid utilization for cancer pain, adjunct medication such as ketamine and methadone and interventional therapies. We discuss neurolysis via injections, neuromodulation including targeted drug delivery and spinal cord stimulation, vertebral tumor ablation and augmentation, radiotherapy and surgical techniques. In the United States, there is a significant variance in the interventional treatment of cancer pain based on fellowship training. As a first of its kind, this best practices and interventional guideline will offer evidenced-based recommendations for reducing pain and suffering associated with malignancy.