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Rivera A, Barrios DM, Herbach E, Kahn JM, Williams VM, Mehta KJ, Wolfson A, Portelance L, Kamrava M. Analgesia and Anesthesia Practice Patterns for Gynecologic Brachytherapy Procedures and Potential Impact on Women's Procedural Experience: A National Survey. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)02973-0. [PMID: 39067485 DOI: 10.1016/j.ijrobp.2024.07.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/19/2024] [Accepted: 07/06/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE The purpose of this study was to determine the current U.S. practice patterns of analgesia (AG) and anesthesia (AS) for gynecologic brachytherapy (BT) procedures. METHODS AND MATERIALS A 27-item survey created with expertise from 5 brachytherapists was distributed electronically to 90 U.S. radiation oncology academic programs and publicized on social media and at 2 national meetings from June to October 2023. RESULTS Forty-one responses were received (46%). Fifty-four percent identified as female, 66% as Caucasian, and 85% as non-Hispanic/Latino ethnicity. Forty-nine percent use a BT suite ± computed tomography (CT) simulator alone, 39% the operating room ± BT suite or CT simulator or other location, 10% CT simulation room alone, and 2% clinic examination room. Thirty-four percent use general anesthesia alone (GA) for intracavitary BT (n = 41), 20% conscious sedation (CS) alone, 10% oral analgesia (OA) alone, 9% spinal or epidural AS alone, and 27% combination. Among those performing hybrid BT (n = 25), 40% use GA alone, 16% use CS alone, 12% epidural or spinal AS alone, 4% OA alone, and 28% combination. For template interstitial BT (n = 25), 44% use GA alone, 48% epidural alone or in combination with other AS, and 8% CS alone. Twenty-two percent of respondents provide AG or AS during applicator placement only, whereas 32% provide it during placement, planning, treatment, and removal. The most common reasons for not using CS or GA were the lack of AS resources and clinician preference. Seventy-three percent reported the belief that patients suffer from post-traumatic stress disorder symptoms after BT. However, 68% reported not using techniques to alleviate BT-related emotional distress. CONCLUSIONS Many U.S. brachytherapists report using GA, CS, or epidural AS; however, 10% are using only OA, and 22% offer AG/AS only during applicator placement. Furthermore, a majority of respondents believe post-traumatic stress disorder symptoms can occur after BT, but few offer any intervention. AS resources and clinician preferences should be targeted for the expansion of higher-quality care.
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Affiliation(s)
- Amanda Rivera
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | | | - Emma Herbach
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Jenna M Kahn
- Kaiser NW Permanente, Interstate Radiation Oncology Center, Portland, Oregon
| | | | - Keyur J Mehta
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Aaron Wolfson
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Lorraine Portelance
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
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Humphrey P, Dures E, Hoskin P, Cramp F. Patient Experiences of Brachytherapy for Locally Advanced Cervical Cancer: Hearing the Patient Voice Through Qualitative Interviews. Int J Radiat Oncol Biol Phys 2024; 119:902-911. [PMID: 38154511 PMCID: PMC11183299 DOI: 10.1016/j.ijrobp.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/26/2023] [Accepted: 12/15/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE Brachytherapy for gynecological cancer is reported to cause pain, anxiety, and distress with no clear guidance for optimizing patient experiences. The aim of this study was to explore patient experiences of brachytherapy and views on improvement. METHODS AND MATERIALS Semistructured interviews were undertaken with patients who had received brachytherapy for locally advanced cervical cancer. Two cohorts were recruited: cohort 1 had recently had brachytherapy, and cohort 2 was a year post brachytherapy. Four recruitment sites were selected, where brachytherapy is given in different ways, some with short day case procedures and others having 1 or 2 overnight stays with applicators in place. Consecutive patients were invited to interview. Participants were asked to retell their brachytherapy story, with views on their care and ideas for improvement. Interviews were audio recorded, transcribed, and data analyzed following Braun and Clarke's method for reflexive thematic analysis. RESULTS Thirty-five interviews were conducted (20 in cohort 1 and 15 in cohort 2). Participant's ages ranged from 28 to 87 years. The interview duration ranged from 22 to 78 minutes. Difficult and traumatic experiences were reported, including periods of severe pain and perceptions of poor care. However, some participants described positive experiences and what went well. Three themes were developed: (1) how the patient got through it, (2) unpleasantness, discomfort, and the aftermath, and (3) emotional consequences and trauma. Some aspects of medium and long duration brachytherapy were found to be more problematic compared with short duration brachytherapy. Exploring experiences at 1-year post brachytherapy has provided insights into the long-lasting impact of brachytherapy experiences. CONCLUSIONS Hearing the patient voice has demonstrated that further work is needed to improve patient care in modern brachytherapy techniques using different regimens and durations, to minimize difficult and traumatic patient experiences. Study insights will inform future work to develop clinical care recommendations.
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Affiliation(s)
- Pauline Humphrey
- College of Health, Science & Society, University of the West of England, Bristol, United Kingdom; Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
| | - Emma Dures
- College of Health, Science & Society, University of the West of England, Bristol, United Kingdom
| | - Peter Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Fiona Cramp
- College of Health, Science & Society, University of the West of England, Bristol, United Kingdom
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van Vliet-Pérez SM, van Paassen R, Wauben LSGL, Straathof R, Berg NJVD, Dankelman J, Heijmen BJM, Kolkman-Deurloo IKK, Nout RA. Time-action and patient experience analyses of locally advanced cervical cancer brachytherapy. Brachytherapy 2024; 23:274-281. [PMID: 38418362 DOI: 10.1016/j.brachy.2024.01.007] [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: 05/11/2023] [Revised: 10/31/2023] [Accepted: 01/18/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND AND PURPOSE Although MRI-based image guided adaptive brachytherapy (IGABT) for locally advanced cervical cancer (LACC) has resulted in favorable outcomes, it can be logistically complex and time consuming compared to 2D image-based brachytherapy, and both physically and emotionally intensive for patients. This prospective study aims to perform time-action and patient experience analyses during IGABT to guide further improvements. MATERIALS AND METHODS LACC patients treated with IGABT were included for the time-action (56 patients) and patient experience (29 patients) analyses. Times per treatment step were reported on a standardized form. For the patient experience analysis, a baseline health status was established with the EQ-5D-5L questionnaire and the perceived pain, anxiety and duration for each treatment step were assessed with the NRS-11. RESULTS The median total procedure time from arrival until discharge was 530 (IQR: 480-565) minutes. Treatment planning (delineation, reconstruction, optimization) required the most time and took 175 (IQR: 145-195) minutes. Highest perceived pain was reported during applicator removal and treatment planning, anxiety during applicator removal, and duration during image acquisition and treatment planning. Perceived pain, anxiety and duration were correlated. Higher pre-treatment pain and anxiety scores were associated with higher perceived pain, anxiety and duration. CONCLUSION This study highlights the complexity, duration and impact on patient experience of the current IGABT workflow. Patient reported pre-treatment pain and anxiety can help identify patients that may benefit from additional support. Research and implementation of measures aiming at shortening the overall procedure duration, which may include logistical, staffing and technological aspects, should be prioritized.
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Affiliation(s)
- Sharline M van Vliet-Pérez
- Erasmus MC Cancer Institute, Department of Radiotherapy, University Medical Center Rotterdam, Rotterdam, The Netherlands; Delft University of Technology, Department of BioMechanical Engineering, Delft, The Netherlands.
| | - Rosemarijn van Paassen
- Erasmus MC Cancer Institute, Department of Radiotherapy, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Linda S G L Wauben
- Delft University of Technology, Department of BioMechanical Engineering, Delft, The Netherlands
| | - Robin Straathof
- Erasmus MC Cancer Institute, Department of Radiotherapy, University Medical Center Rotterdam, Rotterdam, The Netherlands; Delft University of Technology, Department of BioMechanical Engineering, Delft, The Netherlands
| | - Nick J van de Berg
- Delft University of Technology, Department of BioMechanical Engineering, Delft, The Netherlands; Erasmus MC Cancer Institute, Department of Gynaecological Oncology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jenny Dankelman
- Delft University of Technology, Department of BioMechanical Engineering, Delft, The Netherlands
| | - Ben J M Heijmen
- Erasmus MC Cancer Institute, Department of Radiotherapy, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Inger-Karine K Kolkman-Deurloo
- Erasmus MC Cancer Institute, Department of Radiotherapy, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Remi A Nout
- Erasmus MC Cancer Institute, Department of Radiotherapy, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Chekrine T, Bellefkih FZ, Hatim G, Bouchbika Z, Benchakroun N, Jouhadi H, Tawfiq N, Sahraoui S. Patterns of practice survey for cervical cancer brachytherapy in Morocco. Brachytherapy 2024; 23:154-164. [PMID: 38311545 DOI: 10.1016/j.brachy.2023.12.006] [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: 08/28/2023] [Revised: 12/25/2023] [Accepted: 12/30/2023] [Indexed: 02/06/2024]
Abstract
PURPOSE This study surveyed radiation oncologists in Morocco to explore current practices and perspectives on brachytherapy for cervix cancer. METHODS AND MATERIALS A 37-question survey was conducted in April 2023 among 165 Moroccan radiation oncologists using Google Forms. RESULTS Of the 93 respondents, 39% treated over 20 patients in 2022 using 3D image-guided brachytherapy (BT) through the HDR technique; 2D techniques were not reported in the last five years. Intracavitary BT is uniformly applied with a tandem and ovoid applicator. Only 14% utilized interstitial needles for hybrid BT. Iridium-192 was the primary radioactive source (63%), followed by cobalt (37%). Ultrasound-guided 47% of applicator insertions. All used CT scans for planning, but only 6% used MRI fusion due to limited availability. Guidelines for target volume and dose prescription were mostly based on GEC-ESTRO recommendations (74%), followed by Manchester Point A (30.4%) and ABS (11%). Over 90% delineated CTV-HR and CTV-IR; 30% delineated GTV. All marked the bladder and rectum, while 52% marked the sigmoid, 5% the small bowel, and 3% the recto-vaginal point. For dosimetry, 12% used ICRU 89 points, 54% used dose-volume histograms (DVH), and 36% used both. Most reported EQD2cc for OARs for the rectum and bladder, with nine still using ICRU point doses. The most common fractionation schema was 7 Gy in four fractions (60%) and 7 Gy in three fractions (55%). CONCLUSIONS Brachytherapy remains essential for treating cervical cancer in Morocco. Key areas for improvement include MRI fusion-guided brachytherapy, access to advanced applicators, expanding interstitial techniques, and professional training and national referential.
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Affiliation(s)
- Tarik Chekrine
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Fatima Zahra Bellefkih
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Ghita Hatim
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Zineb Bouchbika
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Nadia Benchakroun
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Hassan Jouhadi
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Nezha Tawfiq
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Souha Sahraoui
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
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