Comfort as a determiner of treatment position in radiotherapy of the male pelvis

A thematic exploration of patient and radiation therapist solutions to improve comfort during radiotherapy: A qualitative study

PURPOSE

Patients undergoing radiotherapy are positioned to restrict motion, ensuring treatment accuracy. Immobilisation can be uncomfortable which may impact treatment accuracy. Therapeutic radiographers (TR) are responsible for managing patient comfort, yet there is little evidence to guide practice. The objective was to explore patient and RT experience of comfort management during radiotherapy and identify solutions for how comfort may be managed.

MATERIALS AND METHODS

Twenty-five adult patients were purposefully recruited from Somerset NHS FT (SFT NHS) from those referred for, receiving or who had received radiotherapy within 3 months. Further criteria were that treatment delivery time on the couch exceeded 10 min (the time the patient was immobilised on the radiotherapy couch). 25 practicing TRs were recruited across the United Kingdom (UK) with experience of treatment delivery times exceeding 10 min. Semi structured interviews were conducted by the researcher at SFT NHS or in patients own homes and via telephone for TRs. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was performed by SG and after familiarisation with data, generation of codes, the themes defined were reviewed by researchers and patient partners.

FINDINGS

For patients, the three themes were: Supported Coping, Modification to Position or Immobilisation and Information Communication and Preparation. For TRs three main themes emerged: Supported Coping, Supporting and Adjusting Patients to Maintain Position and Preparational Approaches.

CONCLUSION

This qualitative paper provided a shared voice of how comfort can be best managed from the perspective of patients and TRs. Patient and TR views of how comfort is best managed has provided solutions that may be used during radiotherapy. The study has highlighted some of the positive and negative experiences of comfort solutions based on current UK practice. This information will be used to develop recommendations in a radiotherapy comfort intervention package.

Respiratory motion tracking of spine stereotactic radiotherapy in prone position

PURPOSE

The CyberKnife system is a specialized device for non-coplanar irradiation; however, it possesses the geometric restriction that the beam cannot be irradiated from under the treatment couch. Prone positioning is expected to reduce the dose to normal lung tissue in spinal stereotactic body radiotherapy (SBRT) owing to the efficiency of beam arrangement; however, respiratory motion occurs. Therefore, the Xsight spine prone tracking (XSPT) system is used to reduce the effects of respiratory motion. The purpose of this study was to evaluate the motion-tracking error of the spine in the prone position.

MATERIALS AND METHODS

Data from all 25 patients who underwent spinal SBRT at our institution between April 2020 and February 2022 using CyberKnife (VSI, version 11.1.0) with the XSPT tracking system were retrospectively analyzed using log files. The tumor motion, correlation, and prediction errors for each patient were examined. Furthermore, to assess the potential relationships between the parameters, the relationships between the tumor-motion amplitudes and correlation or prediction errors were investigated using linear regression.

RESULTS

The tumor-motion amplitudes in each direction were as follows: superior-inferior (SI), 0.51 ± 0.39 mm; left-right (LR), 0.37 ± 0.29 mm; and anterior-posterior (AP), 3.43 ± 1.63 mm. The overall mean correlation and prediction errors were 0.66 ± 0.48 mm and 0.06 ± 0.07 mm, respectively. The prediction errors were strongly correlated with the tumor-motion amplitudes, whereas the correlation errors were not.

CONCLUSIONS

This study demonstrated that the correlation error of spinal SBRT in the prone position is sufficiently small to be independent of the tumor-motion amplitude. Furthermore, the prediction error is small, contributing only slightly to the tracking error. These findings will improve the understanding of how to compensate for respiratory-motion uncertainty in the prone position.

Comparing patient acceptability of MR-guided radiotherapy to conventional CBCT on two Elekta systems: a questionnaire-based survey

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.

Reduced dose to small bowel with the prone position and a belly board versus the supine position in neoadjuvant 3D conformal radiotherapy for rectal adenocarcinoma

Introduction

No consensus exists regarding the optimal treatment setup for neoadjuvant radiotherapy of rectal cancer using a 3D conformal (3D CRT) technique. Positioning the patient prone with a belly board aims to reduce the amount of small bowel irradiated.

Methods

Twenty‐five patients with locally advanced rectal cancer underwent computed tomography (CT) planning for neoadjuvant chemoradiotherapy. Patients were simulated prone with a belly board and then in the supine position. Questionnaires rating the comfort of each position were completed. 3D CRT plans were generated for both positions to a prescribed dose of 50.4 Gy in 1.8 Gy daily fractions. Dose–volume parameters in 5 Gy increments for small bowel, large bowel and bladder wall were compared.

Results

Small bowel V5 Gy, V10 Gy, V15 Gy and V20 Gy values were significantly higher in the supine position (398, 366, 245, 151 cm³ for supine vs. 243, 213, 161, 122 cm³ for prone respectively; P < 0.001, <0.001, <0.001 and 0.025). Large bowel V5 Gy, V10 Gy and V15 Gy values were significantly higher in the supine position (266, 209, 147 cm³ supine, 175, 139, 108 cm³ prone respectively; P = 0.001, <0.001, 0.003). There was a significant difference in comfort scores favouring the supine position (P = 0.015).

Conclusion

A significant increase in small and large bowel dose was seen in the supine plans. Treatment in the prone position with a belly board may reduce toxicity when using a 3D CRT technique. Whilst both setup positions were tolerable the supine was more comfortable.

A focus group consultation round exploring patient experiences of comfort during radiotherapy for head and neck cancer

Purpose

The aim of this study was to consult patients about their experiences of comfort while wearing a thermoplastic mask during head and neck radiotherapy before designing a study to develop a comfort scale for radiotherapy.

Methods

A qualitative method using a focus group of patients receiving radiotherapy for head and neck cancer was deployed. Five patients were invited and agreed to participate. Semi-structured questions guided the focus group interview. Thematic analysis was used to identify themes.

Findings

Three patients participated in the focus group. Three main themes were identified: Physical comfort, Mental perception, Passivity. Physical comfort derived from feelings of pressure, unpleasantness, and generally being uncomfortable. Mental perception derived from how the physical comfort was perceived and derived from feelings of shock, anxiety, indifference and sensory systems. Passivity arose from feelings such as the ‘doctor knows best’, ‘putting up with it’, and ‘being taken for a ride’.

Conclusion

The insight of patient’s comfort and experiences are valuable for clinicians to provide patient-centred care. Findings of this study implicate further investigation of how the themes of patient comfort can be measured in radiotherapy to improve the patient experience.

A pain survey to support role development for Radiation Therapists in Ghana

A research study was conducted at the radiation oncology department of a large teaching hospital in Ghana, to determine whether the use of a pain questionnaire would facilitate a contribution by the radiation therapists (RTs) to the management of pain in the patients undergoing external beam radiotherapy. The rationale for the study was to test the pain questionnaire as a tool for routine use by RTs and to increase the knowledge and skill of the RTs with regard to pain assessment in order that they could have an effective role in the multidisciplinary approach to pain management.

The pain questionnaire for administration by RTs was adapted as a tool for assessing pain. The tool and the process were tested in a prospective study of 90 participants who willingly consented to participate. The data was analysed as a means of evaluating the questionnaire and learning about pain in this group of cancer patients. The results of this analysis were integrated with the findings from textual data published in a previous paper.

Findings revealed that RTs could administer a limited pain questionnaire and use this for clinical assessment of patients with pain, refer patients who need urgent medical attention to the doctors, monitor the patients receiving radiotherapy and adjuvant chemotherapy as well as provide meaningful suggestions to the multidisciplinary team on the management of pain.

Through this reflective process it is recommended that because RTs have daily contact with patients during external beam radiotherapy treatment and because the majority of cancer patients in the study population experience pain, the RTs should enhance their knowledge of pain and participate in routine pain assessment. Through engagement in this role development the quality of care to the patient population in Ghana will be improved.

A prospective randomised controlled clinical trial to evaluate three immobilisation devices for intra-thoracic radiation therapy

Purpose: To determine the optimal of three immobilisation devices for lung radiotherapy in terms of set-up reproducibility, patient comfort, radiation therapists’ (RTs) satisfaction and cost-effectiveness.

Materials and methods: A total of 30 lung CRT patients were randomised to one of three immobilisation techniques – Arm A, headsponge; Arm B, BreastBoard dedicated immobilisation device; and Arm C, LungBoard dedicated immobilisation device.

Results: Random errors were larger for Arm A versus C in all directions (p < 0.05). Random errors were larger for Arm A versus B for y and z directions (p < 0.05). When the data for the immobilisation devices (Arms B+C) were pooled and compared with Arm A (no dedicated device), the systematic errors were larger in the z direction for A (p < 0.05). Arm C was cheaper and was more comfortable for patients. Therapists preferred this device (Arm C) and treatment times were less (p < 0.05).

Conclusion: This is the first prospective randomised controlled lung immobilisation trial, based on 3-DCRT, that takes into account treatment accuracy, users satisfaction and resource implications. It suggests that the LungBoard immobilisation device is optimal.