ABSTRACT
In 2023, the NCCN Guidelines for Hepatobiliary Cancers were divided into 2 separate guidelines: Hepatocellular Carcinoma and Biliary Tract Cancers. The NCCN Guidelines for Biliary Tract Cancers provide recommendations for the evaluation and comprehensive care of patients with gallbladder cancer, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma. The multidisciplinary panel of experts meets at least on an annual basis to review requests from internal and external entities as well as to evaluate new data on current and emerging therapies. These Guidelines Insights focus on some of the recent updates to the NCCN Guidelines for Biliary Tract Cancers as well as the newly published section on principles of molecular testing.
Subject(s)
Bile Duct Neoplasms , Biliary Tract Neoplasms , Cholangiocarcinoma , Gallbladder Neoplasms , Liver Neoplasms , Humans , Biliary Tract Neoplasms/diagnosis , Biliary Tract Neoplasms/therapy , Gallbladder Neoplasms/diagnosis , Gallbladder Neoplasms/therapy , Cholangiocarcinoma/diagnosis , Cholangiocarcinoma/therapy , Liver Neoplasms/diagnosis , Liver Neoplasms/therapy , Bile Ducts, IntrahepaticABSTRACT
OBJECTIVE: Chronic pain is multidimensional, requiring expanded interventions for optimal management. Pain education, mindfulness training, and virtual reality (VR) are showing promise, but barriers remain for implementation by clinicians. The purpose of this study was to explore the experiences with a pain education and mindfulness intervention for patients with chronic low back pain and their treating clinicians. METHODS: This was a prospectively designed exploratory trial registered at ClinicalTrials.gov: NCT04777877. Patients were identified by study staff and consented. Baseline and follow-up questionnaires and surveys were collected with quantitative and qualitative data. Patients viewed five videos explaining key pain concepts and guided imagery nature videos using a VR headset. RESULTS: Twenty patients consented, and 15 patients completed the intervention. Patients and clinicians rated their experiences with the program as excellent; however, concerns were raised related to logistical challenges around use of the VR headset in busy clinic settings. Percentage changes in patient pain knowledge occurred in the desired direction in 8 out of 9 key concepts. CONCLUSIONS: Delivering educational and mindfulness content with a VR headset to patients with chronic low back pain was feasible and acceptable to patients and clinicians. Concerns remain regarding the increased time burden with use of this technology in a busy clinic setting weighed against potential benefits. Alternative delivery methods are needed to reduce logistical challenges and increase patient access to content outside of the clinic setting.