ABSTRACT
The ESTRO vision statement for 2030 is “Radiation Oncology. Optimal Health for All, Together”. It is becoming increasingly clear that optimal health for all should include the health of caregivers, too. This is exemplified by the high level of burnout amongst radiation oncology professionals across the disciplines, as published recently by Franco et al. (1) Sadly, the COVID pandemic has had a negative impact on mental health of these professionals. (2) The young ESTRO committee (yESTRO) has aligned its activities to the ESTRO vision by setting up an ESTRO mentoring program in order to increase professional well-being for its young members. Mentorship benefits both mentor and the mentee. A review on mentorship in the medical field reported it to have an ‘important influence on personal development, career guidance, career choice, and research productivity, including publication and grant success’. (3) For mentors the benefits lie in enhancement of knowledge, leadership skills, educational skills and increased job satisfaction. With the yESTRO mentoring pilot program, yESTRO specifically aims to satisfy unmet needs for mentorship among young ESTRO members. Fifteen young members were selected as mentees based on their curriculum and personal motivation. The program had its official kickoff at ESTRO 2021 in Madrid with an onsite and an online speed dating session between mentors and mentees. Matches were made and mentor-mentee couples committed to meet at least every three months for the duration of one year. We will present the mid-term evaluation of the pilot at ESTRO 2022. The final evaluation takes place one year after the program started, after which it will be decided whether the program will continue. Yet the ambition of yESTRO is larger. This session will also provide practical advice for those considering to set up a mentoring program at their own institute. Or those seeking a mentor. In this ambition, we will be helped by the experiences shared by Daniel Portik, one of the mentees in the yESTRO mentoring program pilot.
ABSTRACT
BACKGROUND AND PURPOSE: Covid-19 is a novel respiratory disease leading to high rates of acute respiratory distress syndrome (ARDS) and causes adverse effects on both the peripheral and respiratory muscles. Despite optimal medical management some patients with severe Covid-19 develop irreversible lung injury. Patients who cannot be weaned from mechanical ventilation (MV) or extracorporeal life support, lung transplantation (LTX) may be the only life-saving option. Inspiratory muscle training (IMT) has been extensively studied in a variety of non-LTX population with results indicating improvements in exercise capacity, diaphragmatic thickness, reduced dyspnea with ADL's and improved quality of life. Several previous studies found that IMT is a feasible and safe modality in ICU patients. A recent study showed significant improvements in the dyspnea index and quality of life following 2 weeks of IMT in Covid-19 patients after weaning from MV. To the best of our knowledge, no studies have investigated the use of IMT immediately after lung transplantation due to Covid-19 in addition to physical therapy intervention. This report describes the effects of IMT on inspiratory muscle strength, perceived dyspnea and physical performance over the course of 22 weeks in two patients post lung transplantation. CASE DESCRIPTION: Two males (45 ± 9 yr, BMI 33.6 ± 0.1 kg/m2) admitted to the hospital with ARDS secondary to Covid-19 underwent double lung transplantation and performed IMT (2 sessions/day;30 breathes, 50% maximal inspiratory pressure, (MIP);5 days/week) in addition to physical therapy immediately following surgery. Inspiratory muscle strength (MIP), perceived dyspnea (Modified Borg Dyspnea Scale, MBS) and physical performance (4- meter walking speed and 5 times sit to stand) were assessed at baseline and weekly for a total of 22 weeks. Length of hospital stay (LOS) was 58 ± 22 days and both patients participated in a 12 week Pulmonary Rehab Program upon hospital discharge. OUTCOMES: There were no adverse events associated with the intervention. IMT resulted in an increase MIP from -25.7 ± 13 cmH2O to -79.8 ± 7 cmH2O (22% to 66% of predicted normal). MBS improved 4 and 2, to 3 and 0 respectively. Baseline physical performance: 4-meter walking speed and 5-time sit to stand test were 0.40 ± 0.3 m/sec and 60 seconds, and improved to 1.28 ± 0.1 m/s and 7 ± 3 seconds, respectively, after IMT. Activity Measure for Post-Acute Care mobility score (AM-PAC) 7 improved from 7.5 ± 0.7 at evaluation to 18 ± 6.4 upon discharge. DISCUSSION: The present case report describes the integration of IMT to physical therapy intervention in two patients immediately following double lung transplantation due to Covid-19. Improvements in inspiratory muscle strength, perceived dyspnea and functional performance following IMT were present in both cases after a 22 week intervention. These results indicate that IMT program should be encouraged in the rehabilitation of patients post Covid-19. Further research is needed to investigate the benefits of IMT for patients requiring lung transplantation and/or post-Covid-19.
ABSTRACT
Purpose or Objective A questionnaire among 543 radiation oncology (RO) professionals involved in research demonstrated that approximately half of them were forced to work full-time from home due to the COVID-19 pandemic (Dhont et al, ctRO, 2020). At the same time, those still working on location had to adjust to a new working environment. Both groups and especially early-career researchers experienced a substantial impact on mental health and work productivity. The aim of the current qualitative study was to assess in-depth the specific challenges faced by young researchers in RO and what constitutes helpful support in case of continuing or future adverse situations. Materials and Methods This study was conducted jointly by researchers in the field of RO and experts in qualitative research. Data was collected using online Focus Groups (oFGs) facilitated by qualitative research experts. Three oFGs were held with 7-11 young RO professionals (total N=25), in which data saturation was reached. Invitations to participate in the oFGs were sent out 30 days prior through the ESTRO newsletter, social media and personal networks. Inclusion criteria to participate were (1) working in RO, (2) in a European institution, and (3) with less than 10 years of research experience. Efforts were made to ensure a diverse panel. The design of the oFGs (Figure 1) comprised two main steps: (1) Deepening the understanding of experienced impacts during the COVID-19 pandemic, and (2) formulating solutions that could positively address the identified impacts. The oFGs were recorded and transcribed verbatim. Transcripts were analyzed via the qualitative analysis software Atlas (2019) through inductive coding. The coded segments were then translated into themes. $Φg Results In addition to years of research experience, seven other variables were identified as potentially impacting on the work or personal sphere in a positive and/or negative manner. In total ten main impacts were identified in the personal (2) and work sphere (8), which were either affected directly by the variables or indirectly through other impacts. It was for example found that job title could negatively impact the type of work the researcher had to perform during the pandemic, which in turn negatively impacted his/her mental health. All variables, impacts and how they relate are illustrated in Figure 2. Proposed solutions were mostly technical, illustrating that the most pressing issue was to ensure the possibility to perform one's work. Proposed solutions for social isolation (e.g. virtual social events) were often countered by the presence of “zoom fatigue”. $Φg Conclusion Different variables, their impacts and a complex interplay between them have been identified to determine how early-career RO professionals experienced working during the COVID-19 pandemic. Beyond technical solutions to enable remote working, the distinct personal situations must be considered when proposing solutions to support mental health in these situations.