Single-Fraction Palliative High-Dose-Rate Brachytherapy for Symptom Management in a 97-Year-Old Patient With Dementia.
Ken YoshidaKohiro AkitaAsami YoshidaMidori YuiKazuki HirotaHideki TakegawaYusuke AnetaiYuhei KoikeYoko HarimaToshiko ShigaNaomi NakajimaNobukata KazawaAtsushi KomemushiKeita UtsunomiyaNoboru TanigawaReiko NoborioSatoaki NakamuraPublished in: Journal of palliative medicine (2024)
Background: Delivering cancer treatment to elderly patients with dementia is often challenging. We describe performing palliative surface mold brachytherapy (SMBT) in an elderly patient with advanced dementia for pain control using music therapy to assist with agitation. Case Description: The patient was a 97-year-old Japanese woman with advanced dementia. Exudate was observed from her tumor, and she complained of Grade 2 severity pain using Support team assessment schedule (STAS), especially when undergoing would dressings. Given her advanced dementia, she was not considered a candidate for radical surgery or external beam radiotherapy. We instead treated her with high-dose-rate (HDR) SMBT. Due to her advanced dementia associated with agitation, she could not maintain her position. She was able to remain calm while listening to traditional Japanese enka music, which enables our team to complete her radiation without using anesthetics or sedating analgesics. Her localized pain severity decreased ≤21 days and the exudate fluid disappeared ≤63 days after HDR-SMBT. Her tumor was locally controlled until her death from intercurrent disease 1 year after HDR-SMBT. Discussion: Single fraction palliative HDR-SMBT was useful for successful treatment of skin cancer in an elderly patient. Traditional Japanese music helped reduce her agitation to complete HDR-SMBT. For elderly patients with agitation associated with dementia, we should consider using music and music therapy to facilitate radiation therapy.
Keyphrases
- mild cognitive impairment
- high dose
- radiation therapy
- cognitive impairment
- case report
- palliative care
- chronic pain
- low dose
- stem cell transplantation
- pain management
- locally advanced
- radiation induced
- neuropathic pain
- early stage
- skin cancer
- stem cells
- squamous cell carcinoma
- advanced cancer
- community dwelling
- bone marrow
- newly diagnosed
- rectal cancer
- acute coronary syndrome
- smoking cessation