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Hay L, McLoone P, Campbell F, Reid H, James A, Lamb C, Schipani S, Grose D, Wilson C, Paterson C. How did the COVID-19 pandemic change patient experience during radiation therapy for head and neck cancer: A single centre survey. J Med Imaging Radiat Sci 2024; 55:101712. [PMID: 39128320 DOI: 10.1016/j.jmir.2024.101712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/07/2024] [Accepted: 06/18/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION/BACKGROUND Patients receiving treatment for head and neck cancer (HNC) with curative intent, will potentially undergo primary or adjuvant radiation therapy (RT). These patients require supportive management from an extended multi-disciplinary team, to manage the severe toxicities and distress that a course of treatment can bring. A survey was designed to determine if there were changes in the experience of HNC patients attending for radical RT, from the beginning to the end of their treatment course. During the conduct of the survey the COVID-19 pandemic began. As a result cancer services were adapted to keep patients receiving treatment protected from the virus, while continuing to treat their malignant disease. This enabled a comparison of HNC patient experiences pre-pandemic (PP) and during the pandemic (DP). The study aimed to assess the impact of changes in treatment logistics, implemented as a result of the COVID-19 pandemic, on the patient experience, analysing and comparing how well patients understood the information provided to them, their level of distress and anxiety during treatment, and their overall satisfaction with the experience. METHODS Eligible patients were receiving radical RT for HNC of any sub-site or histological type. Identical, anonymous surveys were distributed to patients at week 1 and the final week of RT. The initial PP questionnaire (distributed December 2019 to 11th March 2020) contained 22 questions with space for free text. The questionnaire was amended DP to include 6 additional COVID-19 related questions (distributed June to November 2020). RESULTS One hundred and eighty two surveys were returned; 95 (52%) PP and 87 (48%) DP. Patients were moderately distressed from wearing the immobilisation mask towards the end of treatment DP with a statistically significant difference in the final week, median (IQR) values of 1 (0-4) PP and 2 (1-6) DP, p=0.024. Patients reported increased distress by attending daily for treatment by the final week of RT DP, with a PP and DP median of 1 (0-3) and 2 (1-4) respectively, p=0.039. Patients reporting increased levels of distress about attending for RT also reported high levels of anxiety about COVID-19 (r=0.40, p=0.005). COVID-19 anxiety score displayed a weak inverse association with overall treatment satisfaction score (r=-0.28, p=0.008). CONCLUSION Despite the adapted COVID-19 working practices implemented and the challenges a course of head and neck RT entails, patients reported a positive experience attending for treatment, both PP and DP.
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Affiliation(s)
- Lisa Hay
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland.
| | - Philip McLoone
- School of Health & Wellbeing, Clarice Pears Building, University of Glasgow, G12 8TB Scotland
| | - Frances Campbell
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Heather Reid
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Allan James
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Carolynn Lamb
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Stefano Schipani
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Derek Grose
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Christina Wilson
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
| | - Claire Paterson
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, Scotland
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Gandhi B, Mihaylova L, Dogramadzi S. Head tracking using an optical soft tactile sensing surface. Front Robot AI 2024; 11:1410858. [PMID: 39045279 PMCID: PMC11264287 DOI: 10.3389/frobt.2024.1410858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/30/2024] [Indexed: 07/25/2024] Open
Abstract
This research proposes a sensor for tracking the motion of a human head via optical tactile sensing. It implements the use of a fibrescope a non-metal alternative to a webcam. Previous works have included robotics grippers to mimic the sensory features of human skin, that used monochrome cameras and depth cameras. Tactile sensing has shown advantages in feedback-based interactions between robots and their environment. The methodology in this paper is utilised to track motion of objects in physical contact with these sensors to replace external camera based motion capture systems. Our immediate application is related to detection of human head motion during radiotherapy procedures. The motion was analysed in two degrees of freedom, respective to the tactile sensor (translational in z-axis, and rotational around y-axis), to produce repeatable and accurate results. The movements were stimulated by a robot arm, which also provided ground truth values from its end-effector. The fibrescope was implemented to ensure the device's compatibility with electromagnetic waves. The cameras and the ground truth values were time synchronised using robotics operating systems tools. Image processing methods were compared between grayscale and binary image sequences, followed by motion tracking estimation using deterministic approaches. These included Lukas-Kanade Optical Flow and Simple Blob Detection, by OpenCV. The results showed that the grayscale image processing along with the Lukas-Kanade algorithm for motion tracking can produce better tracking abilities, although further exploration to improve the accuracy is still required.
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Affiliation(s)
- Bhoomika Gandhi
- School of Electrical and Electronic Engineering, The University of Sheffield, Sheffield, United Kingdom
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Keane M, Weitkamp N, Madani I, Day J, Dal Bello R, Zamburlini M, Schiess A, Moreira A, Perryck S, Tomuschat K, Spencer M, Tanadini-Lang S, Guckenberger M, Brown M. Randomized self-controlled study comparing open-face vs. closed immobilization masks in fractionated cranial radiotherapy. Radiother Oncol 2024; 196:110314. [PMID: 38677329 DOI: 10.1016/j.radonc.2024.110314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/01/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE To compare patient discomfort and immobilisation performance of open-face and closed immobilization masks in cranial radiotherapy. MATERIAL AND METHODS This was a single-center randomized self-controlled clinical trial. At CT simulation, an open-face and closed mask was made for each patient and treatment plans with identical dose prescription were generated for each mask. Patients were randomised to start treatment with an open-face or closed mask. Masks were switched halfway through the treatment course; every patient was their own control. Patients self-reported discomfort, anxiety and pain using the visual analogue scale (VAS). Inter- and intrafraction set-up variability was measured with planar kV imaging and a surface guided radiotherapy (SGRT) system for the open-face masks. RESULTS 30 patients with primary or metastatic brain tumors were randomized - 29 completed radiotherapy to a median total dose of 54 Gy (range 30-60 Gy). Mean discomfort VAS score was significantly lower with open-face masks (0.5, standard deviation 1.0) vs. closed masks (3.3, standard deviation 2.9), P < 0.0001. Anxiety and pain VAS scores were significantly lower with open-face masks (P < 0.0001). Closed masks caused more discomfort in infraorbital (P < 0.001) and maxillary (P = 0.02) areas. Two patients and 27 patients preferred closed or open-face masks, respectively. Interfraction longitudinal shifts and roll and yaw rotations were significantly smaller and lateral shifts were significantly larger with closed masks in combination with the laser system (P < 0.05) compared to open masks in combination with a SGRT system. Intrafraction variability did not differ between the masks. CONCLUSIONS Open-face masks are associated with decreased patient discomfort without compromising patient positioning and immobilisation accuracy.
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Affiliation(s)
- Michèle Keane
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Nienke Weitkamp
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Indira Madani
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Jonathan Day
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Mariangela Zamburlini
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Antonia Schiess
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Amanda Moreira
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Sophie Perryck
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Katja Tomuschat
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Marilyn Spencer
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Michelle Brown
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
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Glynn AM, Harwood R, Garrett B, Harper D, Dunne M, Nicholson J, Rangaswamy G, Duane F, Armstrong J, McArdle O, Brennan S. Unmasking anxiety: a head-to-head comparison of open and closed masks in head and neck cancer radiotherapy. Rep Pract Oncol Radiother 2024; 29:219-227. [PMID: 39143970 PMCID: PMC11321773 DOI: 10.5603/rpor.99905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/18/2024] [Indexed: 08/16/2024] Open
Abstract
Background Facemasks accurately immobilise patients with head and neck cancer (HNC) receiving radiotherapy (RT). However, such masks are associated with treatment related distress, a prognostic factor for poorer survival. Open masks offer increased comfort and patient satisfaction. We investigated whether open masks could immobilise patients without affecting treatment accuracy. Materials and methods Over an 18-month period, all HNC RT patients with anxiety were offered open masks. Once 30 patients had completed treatment, set-up data was compared to patients in closed masks. The mean displacement and one-dimensional standard deviations (SD) of the mean, systematic and random set-up errors were calculated for translational directions: anterior-posterior (x), superior-inferior (y), medial-lateral (z). The mean and SD of the mean was calculated for rotational displacements. Mann-Whitney U was used to determine any significant differences between set-up data. Results Sixty patients were included (30 open & 30 closed masks). There was no statistically significant difference found in the x (p = 0.701), y (p = 0.246) or z (p = 0.535) direction for the SD of the mean displacements between both masks. No statistically significant difference was found in the SD of means for rotational displacements. The calculated planning target volume (PTV) margin requirements were minimally less for the closed masks 3.5, 2.6, and 2.7 mm (x, y, z, respectively) versus 4.2, 3.2, and 3.7 mm, respectively, for open masks. Conclusion Our study demonstrates that open masks maintain accuracy at levels comparable to closed masks in patients with anxiety. The minor difference in the calculated PTV margin could be rectified with daily on-line imaging or surface guided imaging.
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Affiliation(s)
| | | | - Bill Garrett
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | - Dean Harper
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | - Mary Dunne
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | | | | | - Fran Duane
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | | | - Orla McArdle
- St. Luke's Radiation Oncology Network, Dublin, Ireland
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Forbes E, Clover K, Oultram S, Wratten C, Kumar M, Tieu MT, Carter G, McCarter K, Britton B, Baker AL. Situational anxiety in head and neck cancer: Rates, patterns and clinical management interventions in a regional cancer setting. J Med Radiat Sci 2024; 71:100-109. [PMID: 37888792 PMCID: PMC10920933 DOI: 10.1002/jmrs.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Research indicates that the immobilisation mask required for radiation therapy (RT) for head and neck cancers can provoke intense anxiety. However, little is known about the rates of this anxiety, whether it changes over a course of treatment and how it is managed in clinical practice. This study aimed to describe the rates and patterns of situational anxiety in patients undergoing RT for head and neck cancer and the use of anxiety management interventions in current clinical practice in a major regional cancer setting in New South Wales, Australia. METHODS Situational anxiety rates and patterns were assessed at five time points using the State-Trait Anxiety Inventory prior to treatment planning (SIM), the first three treatment sessions (Tx 1, Tx 2 and Tx 3) and treatment 20 (Tx 20). Sessions were observed to record the use of general supportive interventions (music and support person) and anxiety-specific interventions (break from the mask, relaxation techniques and anxiolytic medication). Sociodemographic and clinical information was extracted from the medical record. RESULTS One hundred and one patients were recruited. One-third had clinically significant anxiety at any of the first three time points (33.3-40%), and a quarter at Tx 3 (26.4%) and Tx 20 (23.4%). Of the sample, 55.4% had available data for categorisation into one of four pattern groups: 'No Anxiety' (46.4%); 'Decreasing Anxiety' (35.7%); 'Increasing Anxiety' (7.1%); and 'Stable High Anxiety' (10.7%). Most participants had social support present at SIM (53.5%) and listened to music during treatment (86.7-92.9%). Few participants received relaxation techniques alone (1.2-2.3%). Anxiolytic medication was provided for 10% of patients at some stage during the treatment journey and 5% required a break from the mask at SIM, with frequency decreasing throughout the treatment course. CONCLUSIONS In this regional cancer setting, situational anxiety was common, but generally decreased throughout treatment. Some patients experience persistent or increasing anxiety, with up to 10% of patients receiving specific anxiety management interventions.
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Affiliation(s)
- Erin Forbes
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Kerrie Clover
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- PsychoOncology Service, Department of Consultation Liaison PsychiatryCalvary Mater NewcastleWaratahNew South WalesAustralia
| | - Sharon Oultram
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Radiation Oncology DepartmentCalvary Mater NewcastleWaratahNew South WalesAustralia
| | - Chris Wratten
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Radiation Oncology DepartmentCalvary Mater NewcastleWaratahNew South WalesAustralia
| | - Mahesh Kumar
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Radiation Oncology DepartmentCalvary Mater NewcastleWaratahNew South WalesAustralia
| | - Minh Thi Tieu
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Radiation Oncology DepartmentCalvary Mater NewcastleWaratahNew South WalesAustralia
| | - Gregory Carter
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Department of Consultation Liaison PsychiatryCalvary Mater NewcastleWaratahNew South WalesAustralia
| | - Kristen McCarter
- School of Psychological Sciences, College of Science, Engineering and EnvironmentUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Ben Britton
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter New England Mental Health ServicesNewcastleNew South WalesAustralia
| | - Amanda L. Baker
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
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Ben Bouchta Y, Gardner M, Sengupta C, Johnson J, Keall P. The Remove-the-Mask Open-Source head and neck Surface-Guided radiation therapy system. Phys Imaging Radiat Oncol 2024; 29:100541. [PMID: 38327762 PMCID: PMC10847032 DOI: 10.1016/j.phro.2024.100541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Background and Purpose Surface Guided Radiotherapy (SGRT) for head and neck radiotherapy is challenging as obstructions are common and non-rigid facial motion can compromise surface accuracy. The purpose of this work was to develop and benchmark the Remove the Mask (RtM) SGRT system, an open-source system especially designed to address the challenges faced in radiotherapy of head and neck cancer. Materials and Methods The accuracy of the RtM SGRT system was benchmarked using a head phantom positioned on a robotic motion platform capable of sub-millimetre accuracy which was used to induce unidirectional shifts and to reproduce three real head motion traces. We also assessed the accuracy of the system in ten humans volunteers. The ground truth motion of the volunteers was obtained using a commercial motion capture system with an accuracy < 0.3 mm. Results The mean tracking error of the RtM SGRT system for the ten volunteers was of -0.1 ± 0.4 mm -0.6 ± 0.6 mm and 0.3 ± 0.2 mm, and 0.0 ± 0.2° 0.0 ± 0.1° and 0.0 ± 0.2° for translations and rotations along the left-right, superior-inferior and anterior-posterior axes respectively and we also found similar results in measurements with the head phantom. Forced facial motion was associated with lower tracking accuracy. The RtM SGRT system achieved submillimetre accuracy. Conclusion The RtM SGRT system is a low-cost, easy to build and open-source SGRT system that can achieve an accuracy that meets international commissioning guidelines. Its open-source and modular design allows for the development and easy translation of novel surface tracking techniques.
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Affiliation(s)
| | - Mark Gardner
- The University of Sydney, Camperdown, NSW 2050, Australia
| | | | - Julia Johnson
- The University of Sydney, Camperdown, NSW 2050, Australia
| | - Paul Keall
- The University of Sydney, Camperdown, NSW 2050, Australia
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Essers M, Mesch L, Beugeling M, Dekker J, de Kruijf W. Setup and intra-fractional motion measurements using surface scanning in head and neck cancer radiotherapy- A feasibility study. Phys Imaging Radiat Oncol 2024; 29:100563. [PMID: 38444887 PMCID: PMC10912619 DOI: 10.1016/j.phro.2024.100563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/30/2023] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
Background and purpose Surface-guided radiotherapy (SGRT) is applied to improve patient set-up and to monitor intra-fraction motion. Head and neck cancer (H&N) patients are usually fixated using 5-point thermoplastic masks, that are experienced as uncomfortable or even stressful. Therefore, the feasibility of irradiating H&N patients without a mask by using SGRT was examined. Material and methods Nineteen H&N patients were included in a simulation study. Once a week, before the standard treatment, a maskless treatment was simulated, using SGRT for setup and intrafraction motion monitoring. Initial patient setup accuracy and intrafraction motion was determined using ConeBeam CT (CBCT) images as well as SGRT before and after the (simulated) treatment. The clinical target volume to planning target volume (CTV-PTV) margin for intrafraction motion was calculated. Using patient questionnaires, the patient-friendliness H&N irradiation with and without mask was determined. Results Maskless setup with SGRT and CBCT was as accurate as with a mask. SGRT showed that intrafraction motion was gradual during the treatment. The CTV-PTV margin correcting for intrafraction motion was 1.7 mm for maskless treatment without interventions, and 1.2 mm if corrected for motions > 2 mm. For 19 % of fractions, the intrafraction motion, as detected by both SGRT and CBCT, was larger than 2 mm in at least one direction. Sixteen patients preferred maskless treatment, while 3 worried they would move too much. Conclusions Using SGRT and a standard head rest resulted in a patient-friendly treatment with accurate patient setup and acceptably small intrafraction motion for H&N patients.
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Affiliation(s)
- Marion Essers
- Institute Verbeeten, Medical Physics & Instrumentation, PO Box 90120, 5000 LA Tilburg, the Netherlands
| | - Lennart Mesch
- Institute Verbeeten, Radiotherapy, PO Box 90120, 5000 LA Tilburg, the Netherlands
| | - Maaike Beugeling
- Institute Verbeeten, Radiotherapy, PO Box 90120, 5000 LA Tilburg, the Netherlands
| | - Janita Dekker
- Institute Verbeeten, Medical Physics & Instrumentation, PO Box 90120, 5000 LA Tilburg, the Netherlands
| | - Willy de Kruijf
- Institute Verbeeten, Medical Physics & Instrumentation, PO Box 90120, 5000 LA Tilburg, the Netherlands
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Robertson I, Kortum P. The Usability of Face Coverings Used to Prevent the Spread of COVID-19. HUMAN FACTORS 2023; 65:1702-1717. [PMID: 34905433 DOI: 10.1177/00187208211051131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the perceived usability and usability problems associated with face coverings used to prevent the spread of COVID-19. BACKGROUND Since public health experts have now identified the appropriate use of facemasks as one of the critical elements in an effective COVID mitigation strategy, understanding how people use and care for them has become important. METHOD Data were collected via a survey that was shared on social media to which 2148 people responded. Participants were asked to identify the category class of the face covering they most often wear, rate its usability, answer demographic information, and questions about their mask use and hygiene, and identify issues they may suffer in relation to face cover use. RESULTS Overall, users appear to perceive their face coverings favorably from a usability and satisfaction standpoint, even though almost two-thirds of users indicated that they experienced discomfort and problems with glasses fogging with the most popular mask types. When considering demographic information, users' political party affiliation appears related to how they perceive the usability of their face covering. CONCLUSION Designers should work to improve the fit and comfort properties of protective masks; evidence suggests the System Usability Scale may be a useful tool in those efforts. APPLICATION Understanding mask design and behavioral issues related to their use can help in the development of masks and will maximize their acceptance and effectiveness in the field.
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Affiliation(s)
- Ian Robertson
- Department of Psychological Sciences, Rice University, Houston, TX, USA
| | - Philip Kortum
- Department of Psychological Sciences, Rice University, Houston, TX, USA
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Forbes E, Baker AL, Britton B, Clover K, Skelton E, Moore L, Handley T, Oultram S, Oldmeadow C, Gibberd A, McCarter K. A systematic review of nonpharmacological interventions to reduce procedural anxiety among patients undergoing radiation therapy for cancer. Cancer Med 2023; 12:20396-20422. [PMID: 37803922 PMCID: PMC10652309 DOI: 10.1002/cam4.6573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
Procedural anxiety is a concern for a number of patients undergoing radiation therapy. While procedural anxiety is often treated pharmacologically, there is a clinical need for effective alternative strategies for patients who are contraindicated from medication use, and those who prefer not to take unnecessary medications. OBJECTIVES The primary objective was to assess the efficacy of nonpharmacological interventions delivered to adults with cancer, in the radiation oncology department, just prior to, or during radiation therapy, in reducing levels of self-reported procedural anxiety. The secondary objectives were to assess the efficacy of these interventions in reducing physiological symptoms of procedural anxiety and anxiety-related treatment disruptions. DESIGN Systematic review. DATA SOURCES Electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials) were searched from inception up until February 2022. INCLUSION CRITERIA Population: Adult patients with cancer undergoing external beam radiation therapy. INTERVENTION Nonpharmacological interventions delivered within the radiation therapy department. Comparison: standard care controls, or standard care plus an alternative intervention. OUTCOMES level of self-reported procedural anxiety (primary), physiological symptoms of anxiety (secondary) and measures of anxiety-related treatment disruptions (secondary). DATA EXTRACTION AND ANALYSIS Two reviewers independently extracted data. A meta-analysis was originally planned but deemed not feasible as the studies could not be confidently pooled for meta-analysis, due to the variability in the interventions, study designs and the generally low number of studies. Therefore, a narrative synthesis is presented. RESULTS Screening of 2363 records identified nine studies that met inclusion criteria: six studies of music interventions, two of video-based patient education and one of aromatherapy. Overall, three studies received a global rating of strong methodological quality and low risk of bias. Three studies reported a significant effect of the intervention on reducing the primary outcome of self-reported procedural anxiety: two music interventions (both strong methodological quality), and one video-based patient education (moderate methodological quality). One of the studies (a music intervention) also reported a significant reduction in the secondary outcome of physiological symptoms of procedural anxiety (systolic blood pressure). CONCLUSIONS The evidence for nonpharmacological interventions delivered to adults with cancer just prior to, or during radiation therapy, in reducing levels of self-reported procedural anxiety is limited, with very few well-designed studies. There is a need for interventions for procedural anxiety during radiation therapy to be evaluated through rigorous randomised controlled trials.
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Affiliation(s)
- Erin Forbes
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanAustralia
| | - Amanda L. Baker
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanAustralia
| | - Ben Britton
- Hunter New England Mental Health ServicesNewcastleAustralia
| | - Kerrie Clover
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanAustralia
- Psycho‐Oncology Service, Department of Consultation Liaison PsychiatryCalvary Mater NewcastleWaratahAustralia
| | - Eliza Skelton
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanAustralia
| | - Lyndell Moore
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanAustralia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders UniversityBedford ParkAustralia
| | - Tonelle Handley
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanAustralia
| | - Sharon Oultram
- Department of Radiation OncologyCalvary Mater NewcastleWaratahAustralia
| | | | - Alison Gibberd
- Data Sciences, Hunter Medical Research InstituteNew LambtonAustralia
| | - Kristen McCarter
- School of Psychological Sciences, College of Engineering, Science and EnvironmentUniversity of NewcastleCallaghanAustralia
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Dhillon HM, Halkett GKB. Mask-related anxiety and distress during radiation therapy for head and neck cancer. J Med Radiat Sci 2023; 70:215-217. [PMID: 37328435 PMCID: PMC10500115 DOI: 10.1002/jmrs.695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023] Open
Abstract
Some patients experience mask-related anxiety and distress when undergoing radiation therapy for head and neck cancer. Building on the paper by Forbes et al (doi.org/10.1002/jmrs.658) this editorial discusses techniques to implement to improve the patient experience through education and support.
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Affiliation(s)
- Haryana M. Dhillon
- Faculty of Science, School of Psychology, Psycho‐Oncology Cooperative Research GroupUniversity of SydneySydneyNew South WalesAustralia
- Centre for Medical Psychology & Evidence‐Based Decision‐MakingSydneyNew South WalesAustralia
| | - Georgia K. B. Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute (CHIRI), Faculty of Health SciencesCurtin UniversityBentleyWestern AustraliaAustralia
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Forbes E, Clover K, Baker AL, Britton B, Carlson M, McCarter K. 'Having the mask on didn't worry me until … they clamped my head down so I wouldn't move': A qualitative study exploring anxiety in patients with head and neck cancer during radiation therapy. J Med Radiat Sci 2023; 70:283-291. [PMID: 36724485 PMCID: PMC10500108 DOI: 10.1002/jmrs.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/11/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION More than 20% of patients undergoing radiation therapy for head and neck cancer report anxiety specifically related to the immobilisation mask, a tight-fighting mask patients are required to wear for the duration of each treatment session. However, limited research has investigated this from the patient perspective. The aim of this study was to better understand patient experiences of mask anxiety during head and neck cancer radiation therapy and to explore patient attitudes toward potential strategies that may reduce mask anxiety during this treatment. METHODS Five patients with head and neck cancer, who had self-reported mask anxiety during radiation therapy, participated in semi-structured, qualitative interviews exploring their experiences of anxiety and suggestions for reducing anxiety. A codebook thematic analysis was conducted. RESULTS Six main themes were identified: (1) triggers of anxiety; (2) adjusting to radiation therapy; (3) education about the mask; (4) coping; (5) motivation and (6) improving the patient experience. CONCLUSION Findings from these interviews provide valuable insight into how and when healthcare providers may be able to assist patients to manage mask anxiety. Recommendations include increased communication from health care providers; delivery of visual information to improve patient preparedness; exposure/opportunities to interact with the masks prior to treatment commencing and increased control of music/soundtrack selection. However, a limitation of this study is the small sample size and further research is warranted.
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Affiliation(s)
- Erin Forbes
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Kerrie Clover
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- PsychoOncology Service, Department of Consultation Liaison PsychiatryCalvary Mater NewcastleCallaghanNew South WalesAustralia
| | - Amanda L. Baker
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Ben Britton
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter New England Mental Health ServicesNewcastleNew South WalesAustralia
| | - Melissa Carlson
- School of Medicine and Public Health, College of Health Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Kristen McCarter
- School of Psychological Sciences, College of Science, Engineering and EnvironmentUniversity of NewcastleCallaghanNew South WalesAustralia
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12
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Goldsworthy S, Latour JM, Palmer S, McNair HA, Cramp M. Patient and therapeutic radiographer experiences of comfort during the radiotherapy pathway: A qualitative study. Radiography (Lond) 2023; 29 Suppl 1:S24-S31. [PMID: 36841685 DOI: 10.1016/j.radi.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/27/2023]
Abstract
INTRODUCTION There is little research regarding the experiences of patient comfort and how it is best managed in radiotherapy. The aim of this study was to explore the experiences of patient and therapeutic radiographer views of comfort during radiotherapy. METHODS This qualitative study involved semi-structured interviews, with cancer patients (n = 25) and therapeutic radiographers (n = 25), conducted between January-July 2019. Patients were recruited from one radiotherapy clinic and therapeutic radiographers were recruited from across the United Kingdom via specialist interest groups and social media. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data separately between both groups and shared themes were identified. RESULTS Four themes were identified of which two themes were shared among both the patients and therapeutic radiographer. Emotional Health was a shared theme highlighting experiences such as stress, vulnerability and privacy. The second shared theme, Positioning and Immobilisation Experiences, concerned how patients' experience being physically positioned and using immobilisation for accurate radiotherapy. The theme Information and Communication Experience was derived from patients highlighting concerns over sharing and provision of information and ways of communication. The last theme, Environmental Experience, emerged from the patient interviews and related to the first impressions of the radiotherapy environment such as reception or treatment rooms and how this effects the overall feelings of comfort. CONCLUSION This qualitative study has provided the shared voice of patients and therapeutic radiographers and their experiences of comfort during radiotherapy. These shared experiences emphasise the importance of considering comfort holistically and not just from a physical context. This information can be used by therapeutic radiographers to better understand their patients experiences and needs to provide better comfort during radiotherapy to improve patients' outcomes. IMPLICATIONS FOR PRACTICE The clinical implications of our study can encourage Therapeutic Radiographers to provide holistic care for their patients throughout the pathway and specifically to comfort patients while they are having treatment. In the short term this could be via simple adaptions to practice while in the long term, research is needed to develop comfort interventions for patients receiving radiotherapy.
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Affiliation(s)
- Simon Goldsworthy
- Beacon Radiotherapy, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, United Kingdom; Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom.
| | - Jos M Latour
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom; School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Shea Palmer
- Centre for Care Excellence, Coventry University and University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Helen A McNair
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Mary Cramp
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
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13
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Carmack CL, Agosta MT, Ann-Yi S, Bruera E. Treating Radiation Anxiety with Systematic Desensitization: Head and Neck Cancer Case Reports. J Palliat Med 2023. [PMID: 36730789 DOI: 10.1089/jpm.2022.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction: Head and neck cancer patients have high rates of psychological distress, which may be exacerbated by the treatments they receive. Many patients who undergo radiation therapy report significant anxiety associated with the thermoplastic mask required for immobilization during treatment. Case Description: This report presents two examples of head and neck cancer patients reporting high mask anxiety, along with a history of claustrophobia, who expressed concern about their abilities to initiate and adhere to treatment. Both were referred to supportive care psychology before radiation treatment initiation. With counseling and the use of systematic desensitization, they were successfully able to complete their treatments. Discussion: Results of these case reports highlight the value of integrating early supportive care in the treatment of head and neck cancer and support the need for further study in future randomized controlled trials.
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Affiliation(s)
- Cindy L Carmack
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Monica T Agosta
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sujin Ann-Yi
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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14
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Guo W, Wang B, Zhang LY, Sun YC, Xue T. Study on the application of 3D printing head film fixation technology in cranial radiotherapy. J Cancer 2023; 14:981-988. [PMID: 37151399 PMCID: PMC10158522 DOI: 10.7150/jca.82909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Objective: To investigate the use of 3D printing technology to customize individualized precise radiotherapy head masks for cranial radiotherapy patients. Through the comparison with thermoplastic head film, evaluate the effect of this material on deep dose attenuation and body surface dose, and evaluate its positioning accuracy and repeatability for clinical application. Methods: Thirty patients with head and neck radiotherapy were divided into the control group and the experimental group. The control group used the traditional thermoplastic head film fixation technique for body position fixation, and the experimental group used the 3D printing head film fixation technique. The patient setup was verified by kV-CBCT scanning to obtain the translational setup error and rotational setup error in the X, Y, and Z directions. Results: At a depth of 5 cm, both materials have a radiation attenuation rate of <1%. At the surface location, the body surface dose of control group increased by approximately 27%. With a 3D printing head film, the body surface dose increased by approximately 18%. The positioning of two groups of patients was verified by the kV-CBCT, and a total of 232 data sets were obtained. The average translation positioning errors in the X, Y, and Z direction of control group and experimental group were 1.29 mm, 1.42 mm, 1.38 mm and 1.16 mm, 1.24 mm, 1.16 mm, respectively. The average rotation positioning error in the X, Y, and Z direction of control group and experimental group were 1.29°, 1.02°, 1.01° and 1.08°, 0.96°, 1.00°, respectively. The translational setup errors in the Y and Z directions and rotational setup errors in the X direction significantly differed between the control and experimental groups (all p<0.05), but no statistical significance was found in the other directions (all p>0. 05). Conclusion: Compared to the traditional thermoplastic head membranes, 3D printing head membranes has shown a reliable and reproducible interactional positioning accuracy. Of course, further investigations are needed before the new technology can be used on a regular basis.
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Affiliation(s)
- Wei Guo
- Department of Radiation Oncology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou Hebei, 061000, China
| | - Bin Wang
- Department of Radiation Oncology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou Hebei, 061000, China
| | - Li-Yuan Zhang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yun-Chuan Sun
- Department of Radiation Oncology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou Hebei, 061000, China
| | - Tao Xue
- Department of Radiation Oncology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou Hebei, 061000, China
- ✉ Corresponding authors: Li-Yuan Zhang, Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China. . Yun-Chuan Sun, Department of Radiation Oncology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou Hebei, 061000, China.
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15
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Forbes E, Clover K, Baker AL, McCarter KL, Oultram S, Kumar M, Wratten C, Tieu MT, Nixon J, Britton B. Biofeedback Enabled CALM (BeCALM)-the feasibility of biofeedback on procedural anxiety during radiation therapy: study protocol for a pilot randomised controlled trial. BMJ Open 2022; 12:e062467. [PMID: 36600369 PMCID: PMC9730381 DOI: 10.1136/bmjopen-2022-062467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Patients undergoing treatment for cancer who require radiation therapy (RT) report anxiety specifically relating to the RT procedure. Procedural anxiety can be detrimental to treatment delivery, causing disruptions to treatment sessions, or treatment avoidance. Acute procedural anxiety is most commonly managed with anxiolytic medication. There is a need for effective, non-pharmacological interventions for patients not suitable for, or who prefer to avoid, anxiolytic medication. The primary objectives of this pilot trial are to evaluate the: (1) feasibility of conducting the Biofeedback Enabled CALM (BeCALM) intervention during RT treatment sessions; (2) acceptability of the BeCALM intervention among patients; and (3) acceptability of the BeCALM intervention among radiation therapists. The secondary objective of this pilot trial is to examine the potential effectiveness of the BeCALM intervention delivered by radiation therapists to reduce procedural anxiety during RT. METHODS AND ANALYSIS This is a pilot randomised controlled trial. A researcher will recruit adult patients with cancer (3-month recruitment period) scheduled to undergo RT and meeting eligibility criteria for procedural anxiety at the Calvary Mater Hospital, Newcastle (NSW), Australia. Participants will be randomly assigned to receive treatment as usual or the BeCALM intervention (biofeedback plus brief breathing techniques). The primary outcomes are feasibility (measured by recruitment, retention rates and percentage of treatment sessions in which the intervention was successfully delivered); radiation therapists perceived feasibility and acceptability (survey responses); and patient perceived acceptability (survey responses). Secondary outcome is potential effectiveness of the intervention (as measured by the State Trait Anxiety Inventory-State subscale; the Distress Thermometer; and an analysis of treatment duration). ETHICS AND DISSEMINATION The study protocol has received approval from Hunter New England Health Human Research Ethics Committee (2021/ETH11356). The results will be disseminated via peer-reviewed publications, as well as presentation at relevant conferences. TRIAL REGISTRATION NUMBER ACTRN12621001742864.
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Affiliation(s)
- Erin Forbes
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kerrie Clover
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- PsychoOncology Service, Department of Consultation Liaison Psychiatry, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kristen Louise McCarter
- School of Psychological Sciences, College of Science, Engineering and Environment, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Sharon Oultram
- Radiation Oncology Department, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Mahesh Kumar
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Radiation Oncology Department, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Chris Wratten
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Radiation Oncology Department, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Minh Thi Tieu
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Radiation Oncology Department, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Jodie Nixon
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Ben Britton
- Mental Health Services, Hunter New England Health, New Lambton, New South Wales, Australia
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16
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Robar JL, Kammerzell B, Hulick K, Kaiser P, Young C, Verzwyvelt V, Cheng X, Shepherd M, Orbovic R, Fedullo S, Majcher C, DiMarco S, Stasiak J. Novel multi jet fusion 3D-printed patient immobilization for radiation therapy. J Appl Clin Med Phys 2022; 23:e13773. [PMID: 36052990 DOI: 10.1002/acm2.13773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/25/2022] [Accepted: 08/11/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Thermoplastic immobilizers are used routinely in radiation therapy to achieve positioning accuracy. These devices are variable in quality as they are dependent on the skill of the human fabricator. We examine the potential multi jet fusion (MJF) 3D printing for the production immobilizers with a focus on the surface dosimetry of several MJF-printed PA12-based material candidates. Materials are compared with the goal of minimizing surface dose with comparison to standard thermoplastic. We introduce a novel metamaterial design for the shell of the immobilizer, with the aims of mechanical robustness and low-dose buildup. We demonstrate first examples of adult and pediatric cranial and head-and-neck immobilizers. METHODS Three different PA12 materials were examined and compared to fused deposition modeling-printed polylactic acid (PLA), PLA with density lowered by adding hollow glass microspheres, and to perforated or perforated/stretched and solid status quo thermoplastic samples. Build-up dose measurements were made using a parallel plate chamber. A metamaterial design was established based on a packed hexagonal geometry. Radiochromic film dosimetry was performed to determine the dependence of surface dose on the metamaterial design. Full cranial and head-and-neck prototype immobilizers were designed, printed, and assessed with regard to dimensional accuracy. RESULTS Build-up dose measurements demonstrated the superiority of the PA12 material with a light fusing agent, which yielded a ∼15% dose reduction compared to other MJF materials. Metamaterial samples provided dose reductions ranging from 11% to 40% compared to stretched thermoplastic. MJF-printed immobilizers were produced reliably, demonstrated the versatility of digital design, and showed dimensional accuracy with 97% of sampled points within ±2 mm. CONCLUSIONS MJF is a promising technology for an automated fabrication of patient immobilizers. Material selection and metamaterial design can be leveraged to yield surface dose reduction of up to 40%. Immobilizer design is highly customizable, and the first examples of MJF-printed immobilizers demonstrate excellent dimensional accuracy.
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Affiliation(s)
- James L Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada.,Nova Scotia Health, Halifax, Nova Scotia, Canada.,Adaptiiv Medical Technologies, Halifax, Nova Scotia, Canada
| | | | - Kevin Hulick
- HP, Vancouver, Washington, USA.,HP, Corvallis, Oregon, USA
| | - Pierre Kaiser
- HP, Vancouver, Washington, USA.,HP, Corvallis, Oregon, USA
| | - Calvin Young
- HP, Vancouver, Washington, USA.,HP, Corvallis, Oregon, USA
| | | | - Xin Cheng
- HP, Vancouver, Washington, USA.,HP, Corvallis, Oregon, USA
| | | | | | - Sara Fedullo
- Adaptiiv Medical Technologies, Halifax, Nova Scotia, Canada
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17
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Comparing patient acceptability of MR-guided radiotherapy to conventional CBCT on two Elekta systems: a questionnaire-based survey. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background and Purpose:
The magnetic resonance linear accelerator system (MR Linac) is a novel piece of radiotherapy (RT) equipment allowing the routine application of daily MR-guided treatment adaptation. The hardware design required for such technical capabilities and the increased complexity of the treatment workflow entails a notable departure from cone beam computed tomography (CBCT)-based RT. Patient tolerability of treatment is paramount to RT practice where high compliance is required. Presented is a comparative analysis of how such modality specific characteristics may ultimately impact the patient experience of treatment.
Materials and Methods:
Forty patients undergoing RT for prostate cancer (PCa) on either the MR Linac (n = 20) or a CBCT-based linac (n = 20) were provided with a validated patient reported outcomes measures (PROM’s) questionnaire at fraction 1 and fraction 20. The 18-item questionnaire provided patient responses recorded using a 4-point Likert scale, 0 denoting a response of ‘Not at all’, 1 ‘Slightly’, 2 ‘Moderately’ and 3 signifying ‘Very’. The analysis provided insight into both comparisons between modalities at singular time points (fractions 1 and 20), as well as a temporal analysis within a single modality, denoting changing patient experience.
Results:
Patients generally found the MR Linac treatment couch more comfortable, however, found the increase in treatment duration harder to tolerate. Responses for all items remained stable between first and last fraction across both cohorts, indicating minimal temporal variation within a single modality. None of the responses were statistically significant at the 0·01 level.
Conclusion:
Whether radiotherapy for PCa is delivered on a CBCT linac or the MR Linac, there is little difference in patient experience with minimal experiential variation within a single modality.
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18
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Burns M, Campbell R, French S, Dhillon HM, Butow PN, Pritchard A, Sundaresan P. Trajectory of anxiety related to radiation therapy mask immobilization and treatment delivery in head and neck cancer and radiation therapists’ ability to detect this anxiety. “Anxiety during radiation therapy with mask”. Adv Radiat Oncol 2022; 7:100967. [PMID: 36148368 PMCID: PMC9486416 DOI: 10.1016/j.adro.2022.100967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/28/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Receiving radiation therapy treatment with an immobilization mask is a source of anxiety in people with head and neck cancer (HNC). This study aimed to document the trajectory of situational anxiety during HNC treatment delivery and explore radiation therapists’ (RTs’) ability to identify it. Methods and Materials Participants with HNC commencing radiation therapy completed the state-trait anxiety inventory at their mask-making session, and once each week immediately before and after their radiation treatment. Treating RTs independently rated their perception of participant's anxiety at the same time points. Participant- and RT-rated anxiety scores were calculated at each time point together with the proportion of participants reporting clinically significant anxiety (state-trait anxiety inventory ≥ 40). Intraclass correlations were calculated to assess concordance between participant- and RT-ratings. Results Sixty-five participants and 16 RTs took part in this study. Participants were classified into 1 of 5 trajectory groups: stable high (16%), increasing (19%), decreasing (27%), fluctuating (19%), and no anxiety (19%). Nearly half (43%) of participants reported clinically significant anxiety before their mask-making session, and between 30% and 43% across trajectories reported significant anxiety immediately before treatments. Intraclass correlation values indicated poor agreement between participant- and RT-ratings. Conclusions Situational anxiety is prevalent in people receiving HNC radiation therapy with mask immobilization. RTs did not reliably capture patients’ situational anxiety. There is no single best time point to provide intervention, suggesting people should be screened for anxiety regularly throughout their treatment. Resources and education should also be available to improve RT skills in providing psychosocial support.
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19
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Adeberg S, Sauer C, Lambert L, Regnery S, Windisch P, Zaoui K, Freudlsperger C, Moratin J, Farnia B, Nikendei C, Krauss J, Ehrenthal JC, El Shafie R, Hörner-Rieber J, König L, Akbaba S, Lang K, Held T, Rieken S, Debus J, Friederich HC, Maatouk I. Screening and Psycho-Oncological Support for Patients With Head and Neck Cancer and Brain Malignancies Before Radiotherapy With Mask Fixation: Results of a Feasibility Study. Front Psychol 2021; 12:760024. [PMID: 34975651 PMCID: PMC8716729 DOI: 10.3389/fpsyg.2021.760024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
This single-center, single-arm trial investigates the feasibility of a psycho-oncological care program, which aims to reduce psychological distress and improve compliance with radiotherapy with mask fixation in patients with head and neck cancer or brain malignancies. The care program comprised (1) a screening/needs assessment and (2) the provision of a psycho-oncological intervention using imaginative stabilization techniques for distressed patients (distress due to anxiety ≥5) or in a case of subjective interest in the psycho-oncological intervention. Another allocation path to the intervention was directly through the radiation oncologist in charge who classified the patient as: in need of support to tolerate the immobilization device. Of a total of 1,020 screened patients, 257 (25.2%) patients indicated a distress ≥5 and 141 (13.8%) patients reported panic attacks. 25% of the patients reported a subjective interest in psycho-oncological support. A total of 35 patients received the psycho-oncological intervention, of which 74% were assigned by radiation oncologists. In this small patient cohort, no significant pre-post effects in terms of depression, anxiety, distress, and quality of life (mental and physical component scores) could be detected. Our results indicate a good feasibility (interdisciplinary workflow and cooperation, allocation by physicians in charge) of the psycho-oncological care program for this cohort of patients before radiotherapy with mask fixation. The screening results underline the high psychological distress and demand for psycho-oncological support. However, since the utilization of our intervention was low, future studies should reduce the barriers and improve compliance to psycho-oncological services by these patients.Clinical Trial Registration: https://www.drks.de/drks_web/setLocale_EN.do #DRKS00013493
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Affiliation(s)
- Sebastian Adeberg
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Heidelberg (UKHD), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), UKHD and DKFZ, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christina Sauer
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg (UKHD), Heidelberg University, Heidelberg, Germany
| | - Lena Lambert
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg (UKHD), Heidelberg University, Heidelberg, Germany
| | - Sebastian Regnery
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Heidelberg (UKHD), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), UKHD and DKFZ, Heidelberg, Germany
| | - Paul Windisch
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Karim Zaoui
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Julius Moratin
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Benjamin Farnia
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg (UKHD), Heidelberg University, Heidelberg, Germany
| | - Juergen Krauss
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Rami El Shafie
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Heidelberg (UKHD), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), UKHD and DKFZ, Heidelberg, Germany
| | - Juliane Hörner-Rieber
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Heidelberg (UKHD), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), UKHD and DKFZ, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laila König
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Heidelberg (UKHD), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), UKHD and DKFZ, Heidelberg, Germany
| | - Sati Akbaba
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Heidelberg (UKHD), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), UKHD and DKFZ, Heidelberg, Germany
| | - Kristin Lang
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Heidelberg (UKHD), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), UKHD and DKFZ, Heidelberg, Germany
| | - Thomas Held
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Heidelberg (UKHD), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), UKHD and DKFZ, Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, Goettingen University Hospital, Goettingen, Germany
| | - Juergen Debus
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Heidelberg (UKHD), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), UKHD and DKFZ, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg (UKHD), Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg (UKHD), Heidelberg University, Heidelberg, Germany
| | - Imad Maatouk
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg (UKHD), Heidelberg University, Heidelberg, Germany
- Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian University Würzburg, Würzburg, Germany
- *Correspondence: Imad Maatouk,
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20
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Individual 3D-printed fixation masks for radiotherapy: first clinical experiences. Int J Comput Assist Radiol Surg 2021; 16:1043-1049. [PMID: 34021859 PMCID: PMC8166668 DOI: 10.1007/s11548-021-02393-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022]
Abstract
Purpose To show the feasibility of 3D-printed fixation masks for whole brain radiation therapy in a clinical setting and perform a first comparison to an established thermoplastic mask system. Methods Six patients were irradiated with whole brain radiotherapy using individually 3D-printed masks. Daily image guidance and position correction were performed prior to each irradiation fraction. The vectors of the daily position correction were compared to two collectives of patients, who were irradiated using the standard thermoplastic mask system (one cohort with head masks; one cohort with head and neck masks). Results The mean systematic errors in the experimental cohort ranged between 0.59 and 2.10 mm which is in a comparable range to the control groups (0.18 mm–0.68 mm and 0.34 mm–2.96 mm, respectively). The 3D-printed masks seem to be an alternative to the established thermoplastic mask systems. Nevertheless, further investigation will need to be performed. Conclusion The prevailing study showed a reliable and reproducible interfractional positioning accuracy using individually 3D-printed masks for whole brain irradiation in a clinical routine. Further investigations, especially concerning smaller target volumes or other areas of the body, need to be performed before using the system on a larger basis.
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21
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Effeney LC, Nixon JL, Pigott AE. Occupational therapy for people with mask anxiety undergoing radiotherapy. Aust Occup Ther J 2021; 68:374-383. [PMID: 33966280 DOI: 10.1111/1440-1630.12734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Up to one third of people with head and neck cancer undergoing radiation therapy experience mask anxiety. However, there is limited literature guiding the role of health professionals, including occupational therapists, in managing mask anxiety. This study aimed to explore the content of occupational therapy interactions with people who have identified mask anxiety. METHODS A cohort of 20 participants with identified mask anxiety engaged in semi-structured interviews with occupational therapists. Theoretical thematic analysis and the framework provided by the Canadian Model of Occupational Performance and Engagement (CMOP-E) were employed to explore the content of occupational therapy interactions with people experiencing mask anxiety. RESULTS Theoretical thematic analysis identified 13 relevant themes with 49 codes relating to the interaction between participants and occupational therapists. Analysis of these interactions identified the occupational therapy role to be holistic and multifaceted. The cognitive, affective, and institutional components of the CMOP-E were dominantly explored by the occupational therapists with participants. Occupation, spirituality, and the cultural environment were either not addressed or minimally discussed with participants. CONCLUSION The management of mask anxiety during radiation therapy is a novel area of practice for occupational therapists. The results of this study suggest that the occupational therapy profession explores a range of factors with the person undergoing radiation therapy with mask anxiety, and that the CMOP-E model can be used to guide these interactions. Future research is required to further define this role and its efficacy in managing mask anxiety.
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Affiliation(s)
- Lauren C Effeney
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Jodie L Nixon
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia.,Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Amanda E Pigott
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia.,Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
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22
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Goldsworthy S, Zheng CY, McNair H, McGregor A. The potential for haptic touch technology to supplement human empathetic touch during radiotherapy. J Med Imaging Radiat Sci 2020; 51:S39-S43. [PMID: 32981887 PMCID: PMC7515610 DOI: 10.1016/j.jmir.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022]
Abstract
Radiotherapy for cancer is an effective treatment but requires precise delivery. Patients are required to remain still in the same position during procedure which may be uncomfortable. This combined with high anxiety experienced by patients, and feelings of isolation, have indicated a need for comfort interventions. Care conveyed through empathetic touch promotes comfort, individual attention and presence and provides both psychological and physical comfort at the same time. Evidence in nursing and care literature showed that empathetic touch interventions have a significant role in promoting comfort, facilitating communication between care recipients and caregivers. However, the application of empathetic touch interventions may be challenging to administer due to the safety concern in the radiotherapy environment. The emergence of haptic technologies that enable the communication of touch remotely may have a potential to fill this gap. We take inspiration from both clinical empathetic touch in radiotherapy practice, as well as affective haptic technologies to envision the opportunities for haptic technologies as a complimentary comfort intervention to supplement human empathetic touch during radiotherapy.
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Affiliation(s)
- Simon Goldsworthy
- Radiotherapy, Beacon Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, United Kingdom; Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom.
| | - Caroline Yan Zheng
- Information Experience Design & Fashion, Royal College of Art, London, United Kingdom
| | - Helen McNair
- Radiotherapy Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison McGregor
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
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23
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Forbes E, Baker AL, Britton B, Clover K, Skelton E, Oultram S, Oldmeadow C, McCarter K. Non-pharmacological approaches to procedural anxiety reduction for patients undergoing radiotherapy for cancer: systematic review protocol. BMJ Open 2020; 10:e035155. [PMID: 33039983 PMCID: PMC7549444 DOI: 10.1136/bmjopen-2019-035155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Procedural anxiety relates to an affective state of anxiety or fear in relation to a medical procedure. Various treatment-related factors may elicit anxiety among oncology patients, including fear of diagnostic imaging (such as MRI scans) and impending treatment and medical procedures (such as chemotherapy and radiotherapy). It is common in oncology settings to manage acute anxiety relating to medical procedures with anxiolytic medication. However, pharmacological approaches are not suitable for many patients. Despite this, non-pharmacological interventions are infrequently used. The aim of this systematic review is to determine whether non-pharmacological interventions delivered prior to, or during, radiotherapy are effective in reducing procedural anxiety. METHODS AND ANALYSIS Data sources will include the bibliographic databases CINAHL, MEDLINE, EMBASE, PsycINFO and Cochrane Central Register of Controlled trials (CENTRAL) (from inception onward). Eligible studies will include adult patients with cancer undergoing radiotherapy treatment. Included studies will be those which employ a non-pharmacological intervention, delivered within existing radiotherapy appointments, with the aim of reducing procedural anxiety related to radiotherapy. All research designs with a control or other comparison group will be included. The primary outcome will be change in levels of self-reported procedural anxiety. Secondary outcomes will be changes in scores on physiological measures of anxiety and/or changes in treatment completion and/or changes in treatment duration and/or changes in psychological distress. Two investigators will independently complete title and abstract screening, full-text screening, data extraction and assessment of methodological quality. If appropriate, a meta-analyses will be performed. Any important amendments to this protocol will be updated in the PROSPERO registration and documented in the resulting review publication. ETHICS AND DISSEMINATION No ethical issues are anticipated from this review. The findings will be disseminated through peer-reviewed publication and at conferences by presentation. SYSTEMATIC REVIEW REGISTRATION CRD42019112941.
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Affiliation(s)
- Erin Forbes
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
| | - Ben Britton
- Department of Consultation Liaison Psychiatry, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Kerrie Clover
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
- Psycho-Oncology, Calvary Mater Newcastle, Hunter Region Mail Centre, New South Wales, Australia
| | - Eliza Skelton
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
| | - Sharon Oultram
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Christopher Oldmeadow
- CREDITSS-Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Kristen McCarter
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
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24
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A systematic review of effectiveness of interventions applicable to radiotherapy that are administered to improve patient comfort, increase patient compliance, and reduce patient distress or anxiety. Radiography (Lond) 2020; 26:314-324. [PMID: 32245711 DOI: 10.1016/j.radi.2020.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this review was to search existing literature to identify comfort interventions that can be used to assist an adult patient to undergo complex radiotherapy requiring positional stability for periods greater than 10 min. The objectives of this review were to; 1) identify comfort interventions used for clinical procedures that involve sustained inactivity similar to radiotherapy; 2) define characteristics of comfort interventions for future practice; and 3) determine the effectiveness of identified comfort interventions. The Preferred Reporting Items for Systematic Reviews and meta-analyses statement and the Template-for-Intervention-Description-and Replication guide were used. KEY FINDINGS The literature search was performed using PICO criteria with five databases (AMED, CINAHL EMBASE, MEDLINE, PsycINFO) identifying 5269 titles. After screening, 46 randomised controlled trials met the inclusion criteria. Thirteen interventions were reported and were grouped into four categories: Audio-visual, Psychological, Physical, and Other interventions (education/information and aromatherapy). The majority of aromatherapy, one audio-visual and one educational intervention were judged to be clinically significant for improving patient comfort based on anxiety outcome measures (effect size ≥ 0.4, mean change is greater than the Minimal-Important-Difference and low-risk-of-bias). Medium to large effect sizes were reported in many interventions where differences did not exceed the Minimal-Important-Difference for the measure. These interventions were deemed worthy of further investigation. CONCLUSION Several interventions were identified that may improve comfort during radiotherapy assisting patients to sustain and endure the same position over time. This is crucial for the continual growth of complex radiotherapy requiring a need for comfort to ensure stability for targeted treatment. IMPLICATIONS FOR PRACTICE Further investigation of comfort interventions is warranted, including tailoring interventions to patient choice and determining if multiple interventions can be used concurrently to improve effectiveness.
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25
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Klug N, Butow PN, Burns M, Dhillon HM, Sundaresan P. Unmasking Anxiety: A Qualitative Investigation of Health Professionals; Perspectives of Mask Anxiety in Head and Neck Cancer. J Med Imaging Radiat Sci 2019; 51:12-21. [PMID: 31759941 DOI: 10.1016/j.jmir.2019.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND To ensure precision of treatment, patients requiring radiation therapy for treatment of head and neck cancer (HNC) are stabilized using a fitted thermoplastic immobilization mask. Despite evidence that many patients experience significant anxiety when restrained in the mask, there is a lack of proven interventions to prevent or manage mask-related anxiety. The Promoting Action on Research Implementation in Health Services implementation framework promotes consideration of context and culture when developing interventions to ensure successful implementation if proven effective. Health professionals (HPs) play a crucial role in the management of patients' psychological concerns, yet no studies have explored their perspectives of mask anxiety and how it should be managed. The aim of this study, therefore, was to elicit and analyse HPs' perspectives of mask anxiety, using the Promoting Action on Research Implementation in Health Services framework, to guide the development of implementation-ready interventions to reduce mask anxiety. METHODS Semistructured interviews were conducted with 20 HPs involved in the care of HNC patients, including radiation oncologists, radiation therapists, nurses, and psychologists, from nine hospitals in NSW, Australia. Framework analysis methods were used. RESULTS Participants were on average 40 years old (range, 27-56), the majority were female (75%), and they had worked from 1 to 22 years with HNC patients. Six emergent themes were identified: (1) Mask anxiety is a significant problem but is easily missed; (2) Context matters; (3) Trust is critical; (4) Choice and control facilitate adjustment; (5) Psychological strategies are valued; and (6) Culture matters. Subgroup analysis also highlighted differences in perspectives between specialties. CONCLUSIONS Participants identified key principles underlying successful intervention. Two significant barriers to mask-anxiety intervention were identified: (1) a lack of empirical evidence surrounding its prevalence and predictors and (2) contextual and systematic hurdles making the health system potentially unresponsive to change. These data suggest a need for further descriptive studies and careful development of interventions which will address these hurdles.
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Affiliation(s)
- Natalie Klug
- Centre for Medical Psychology & Evidence-Based Decision-Making School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology & Evidence-Based Decision-Making School of Psychology, University of Sydney, Sydney, New South Wales, Australia; Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, New South Wales, Australia.
| | - Melissa Burns
- Radiation Oncology Network, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making School of Psychology, University of Sydney, Sydney, New South Wales, Australia; Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, New South Wales, Australia
| | - Purnima Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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26
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Nixon JL, Brown B, Pigott AE, Turner J, Brown E, Bernard A, Wall LR, Ward EC, Porceddu SV. A prospective examination of mask anxiety during radiotherapy for head and neck cancer and patient perceptions of management strategies. J Med Radiat Sci 2019; 66:184-190. [PMID: 31343118 PMCID: PMC6745384 DOI: 10.1002/jmrs.346] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Distress related to wearing an immobilisation mask for radiotherapy treatment (RT) is a common experience for the person undergoing RT for head and neck cancer (HNC). Described as 'mask anxiety', there is little known about the patterns of this distress through the course of the treatment or what strategies are being used by people to help alleviate mask anxiety. METHODS The study used a prospective cohort design to examine the patterns of patient-reported mask anxiety during the course of RT, using a modified Distress Thermometer (DT) and a survey to explore strategies patients used to assist their mask anxiety. RESULTS Thirty-five participants, who identified as experiencing mask anxiety, were followed throughout RT treatment. At baseline, females were more likely to experience higher mask anxiety (P = 0.03). Across the course of treatment, mask anxiety significantly (P < 0.001) reduced within the total cohort. In 72% of participants, the level of initial distress was found to reduce over time. Only 22% experienced mask anxiety that remained constant. Few (6%) experienced an increase in mask anxiety across the course of RT. Participants reported relying on intervention from health professionals, self-taught strategies, music, visualisation and medication to manage their mask anxiety. CONCLUSIONS Due to its high prevalence and variable patterns over time, it is recommended that routine screening for mask anxiety be implemented as standard care throughout the course of RT for HNC. Multiple, diverse strategies are being used by patients and studies are needed to develop effective interventions for managing mask anxiety.
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Affiliation(s)
- Jodie L. Nixon
- Occupational Therapy DepartmentPrincess Alexandra HospitalBrisbaneAustralia
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
| | - Bena Brown
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
- Speech Pathology DepartmentPrincess Alexandra HospitalBrisbaneAustralia
- Centre for Functioning and Health ResearchMetro South Hospital and Health ServiceWoolloongabbaAustralia
| | - Amanda E. Pigott
- Occupational Therapy DepartmentPrincess Alexandra HospitalBrisbaneAustralia
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
| | - Jane Turner
- Faculty of MedicineThe University of QueenslandBrisbaneAustralia
| | - Elizabeth Brown
- Radiation Oncology DepartmentPrincess Alexandra HospitalBrisbaneAustralia
| | - Anne Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, The University of QueenslandBrisbaneAustralia
| | - Laurelie R. Wall
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
- Centre for Functioning and Health ResearchMetro South Hospital and Health ServiceWoolloongabbaAustralia
| | - Elizabeth C. Ward
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
- Centre for Functioning and Health ResearchMetro South Hospital and Health ServiceWoolloongabbaAustralia
| | - Sandro V. Porceddu
- Faculty of MedicineThe University of QueenslandBrisbaneAustralia
- Radiation Oncology DepartmentPrincess Alexandra HospitalBrisbaneAustralia
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27
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Dinapoli L, Massaccesi M, Colloca G, Tenore A, Dinapoli N, Valentini V. Efficacy of an eye movement desensitization and reprocessing (EMDR) intervention for a head and neck cancer patient with intolerable anxiety undergoing radiotherapy. Psychooncology 2019; 28:647-649. [PMID: 30664291 DOI: 10.1002/pon.5000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Loredana Dinapoli
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Mariangela Massaccesi
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Giuseppe Colloca
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Angela Tenore
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Nicola Dinapoli
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Vincenzo Valentini
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia
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