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

Published online by Cambridge University Press:  21 July 2022

Lee Whiteside Open the ORCID record for Lee Whiteside [Opens in a new window] ,
Claire Nelder ,
Eleanor Pitt ,
Clare Hodgson ,
Ananya Choudhury  and
Cynthia L. Eccles Open the ORCID record for Cynthia L. Eccles [Opens in a new window]
Lee Whiteside
Affiliation:
The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, UK
Claire Nelder
Affiliation:
The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, UK
Eleanor Pitt
Affiliation:
The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, UK
Clare Hodgson
Affiliation:
Digital Services, The Christie NHS Foundation Trust, Manchester, UK
Ananya Choudhury
Affiliation:
Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
Cynthia L. Eccles*
Affiliation:
The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, UK Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
*
Author for correspondence: Dr Cynthia Eccles, Radiotherapy Department (39), Research Office, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK. E-mail: cynthia.eccles1@nhs.net
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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.

Keywords

MRgRTMR-Linacpatient acceptabilitypatient experiencePROMSradiotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e50
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Ocloo, J, Matthews, R. From tokenism to empowerment: progressing patient and public involvement in healthcare improvement. BMJ Qual Saf 2016; 25: 626–632.CrossRefGoogle ScholarPubMed
Hugon, A, Roustit, M, Lehmann, A et al. Influence of intention to adhere, beliefs and satisfaction about medicines on adherence in solid organ transplant recipients. Transplantation 2014; 98: 222–228 CrossRefGoogle ScholarPubMed
Jacobs, J M, Pensak, N A, Sporn, N J et al. Treatment satisfaction and adherence to oral chemotherapy in patients with cancer. J Oncol Pract 2017; 13: e474–e485 CrossRefGoogle ScholarPubMed
Prinsen, C A C, Mokkink, L B, Bouter, L M et al. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res 2018; 27: 1147–1157.CrossRefGoogle ScholarPubMed
Basch, E, Deal, A M, Kris, M G et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol 2016; 34: 557–565.CrossRefGoogle ScholarPubMed
Nipp, R, Temel, J. Editorial: the patient knows best: incorporating patient-reported outcomes into routine clinical care. JNCI 2017; 109: djx044.CrossRefGoogle Scholar
Cheng, F, Wang, W. Factors influencing comfort level in head and neck neoplasm patients receiving radiotherapy. Int J Nur Sci 2014; 1: 394–399.Google Scholar
Olausson, K, Holst Hansson, A, Zackrisson, B, Edvardsson, D, Östlund, U, Nyholm, T. Development and psychometric testing of an instrument to measure the patient’s experience of external radiotherapy: the radiotherapy experience questionnaire (RTEQ). Tech Innov Patient Support Radiat Oncol 2017; 3: 7–12.CrossRefGoogle ScholarPubMed
Malinowski, A, Stamler, L L. Comfort: exploration of the concept in nursing. J Adv Nurs 2002; 39: 599–606.CrossRefGoogle ScholarPubMed
Wensley, C, Botti, M, Mckillop, A, Merry, A. A framework of comfort for practice: an integrative review identifying the multiple influences on patients’ experience of comfort in healthcare settings. Int J Qual Health Care 2017; 29: 151–162.Google ScholarPubMed
Goldsworthy, S, Palmer, S, Latour, J M, McNair, H, Cramp, M. 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 2020; 26: 314–324.CrossRefGoogle ScholarPubMed
Cobben, D, de Boer, H, Tijssen, R et al. Emerging role of MRI for radiation treatment planning in lung cancer. Technol Cancer Res Treat 2015; 15: 47–60.CrossRefGoogle ScholarPubMed
Bainbridge, H, Salem, A, Tijssen, R et al. Magnetic resonance imaging in precision radiation therapy for lung cancer. Transl Lung Cancer Res 2017; 6: 689–707.CrossRefGoogle ScholarPubMed
Society and College of Radiographers MRI guided radiotherapy. The Society and College of Radiographers (online) 2020. https://www.sor.org/getmedia/3be2a7d1-2d57-4d6b-b4ef-60368a3b7eae/mri_guided_radiotherapy-1.pdf_2. Accessed on 22th April 2022.Google Scholar
Van Herk, M, McWilliam, A, Dubec, M, Faivre-Finn, C, Choudhury, A. Magnetic resonance imaging-guided radiation therapy: a short strengths, weaknesses, opportunities, and threats analysis. Int J Radiat Oncol Biol Phys 2018; 101: 1057–1060.CrossRefGoogle Scholar
Merchant, S, O’Connor, M, Halkett, G. Time, space and technology in radiotherapy departments: how do these factors impact on patients’ experiences of radiotherapy? Eur J Cancer Care 2017; 26: e12354 (1–10).CrossRefGoogle ScholarPubMed
Munn, Z, Jordan, Z. The patient experience of high technology medical imaging: a systematic review of the qualitative evidence. JBI Libr Syst Rev 2011; 9: 631–678.CrossRefGoogle ScholarPubMed
Watt, L. Evaluating patient experience in magnetic resonance imaging (MRI). J Med Imaging Radiat Oncol 2014; 58: 335 Google Scholar
Davids, M, Guerin, B, Endt, A, Schad, L R, Wald, L. Prediction of peripheral nerve stimulation thresholds of MRI gradient coils using coupled electromagnetic and neurodynamic simulations. Magn Reson Med 2018; 81: 686–701 CrossRefGoogle ScholarPubMed
Brunnquell, C L, Hoff, M N, Balu, N, Nguyen, X V, Oztek, M A, Haynor, D R. Making magnets more attractive. Top Magn Reson Imaging 2020; 29: 167–174.Google ScholarPubMed
Tetar, S, Bruynzeel, A, Bakker, R et al. Patient-reported outcome measurements on the tolerance of magnetic resonance imaging-guided radiation therapy. Cureus 2018; 10: e2236.Google ScholarPubMed
Winkel, D, Bol, G H, Werensteijn-Honingh, A M et al. Target coverage and dose criteria based evaluation of the first clinical 1.5T MR Linac SBRT treatments of lymph node oligometastases. Radiother Oncol 2020; 146: 118–125.CrossRefGoogle ScholarPubMed
Chin, S, Eccles, C L, McWilliam, A et al. Magnetic resonance-guided radiation therapy: a review. J Med Imaging Radiat Oncol 2019; 64: 1–15.Google ScholarPubMed
Boda-Heggemann, J, Mai, S, Fleckenstein, J et al. Flattening-filter-free intensity modulated breath-hold image-guided SABR (stereotactic ablative radiotherapy) can be applied in a 15-min treatment slot. Radiother Oncol 2013; 109: 505–509 CrossRefGoogle Scholar
Peguret, N, Dahele, M, Cuijpers, J P, Slotman, B J, Verbakel, W. Frameless high dose rate stereotactic lung radiotherapy: intrafraction tumor position and delivery time. Radiother Oncol 2013; 107: 419–422 CrossRefGoogle ScholarPubMed
Datta, A, Aznar, M C, Dubec, M, Parker, G J M, O’Connor, J P B. Delivering functional imaging on the MRI-Linac: current challenges and potential solutions. Clin Oncol 2018; 30: 702–710.CrossRefGoogle ScholarPubMed
Bangard, C, Paszek, J, Berg, F et al. MR imaging of claustrophobic patients in an open 1.0T scanner: motion artifacts and patient acceptability compared with closed bore magnets. Eur J Radiol 2007; 64: 152–157 CrossRefGoogle Scholar
McWilliam, A, Rowland, B, van Herk, M. The challenges of using MRI during radiotherapy. Clin Oncol 2018; 30: 680–685.CrossRefGoogle ScholarPubMed
Bayley, A J, Catton, C N, Haycocks, T et al. A randomized trial of supine vs. prone positioning in patients undergoing escalated dose conformal radiotherapy for prostate cancer. Radiother Oncol 2004; 70: 37–44.CrossRefGoogle ScholarPubMed
Gill, S, Dang, K, Fox, C, Bressel, M, Kron, T, Bergen, N. Seminal vesicle intrafraction motion analysed with cinematic resonance imaging. Radiat Oncol 2014; 9: 174 CrossRefGoogle ScholarPubMed
Napp, A, Enders, J, Roehle, R et al. Analysis and prediction of claustrophobia during MR imaging with the claustrophobia questionnaire: an observational prospective 18-month single-center study of 6500 patients. Radiology 2017; 283: 148–157 CrossRefGoogle ScholarPubMed
Dewey, M, Schink, T, Dewey, C F. Claustrophobia during magnetic resonance imaging: a cohort study in over 55,000 patients. J Magn Reson Imaging 2007; 26: 1322–1327.CrossRefGoogle ScholarPubMed
Ahlander, B M, Årestedt, K, Engvall, J, Maret, E, Ericsson, E. Development and validation of a questionnaire evaluating patient anxiety during magnetic resonance imaging: the magnetic resonance imaging-anxiety questionnaire (MRI-AQ). J Adv Nurs 2016; 72: 1368–1380.CrossRefGoogle ScholarPubMed
Barnes, H, Alexander, S, Bower, L et al. Development and results of a patient-reported treatment experience questionnaire on a 1.5 T MR Linac. Clin Transl Radiat Oncol 2021; 30: 31–37.CrossRefGoogle ScholarPubMed
Kao, C-Y, Aranda, S, Krishnasamy, M, Hamilton, B. Identifying essential information to support patient decision-making regarding participation in cancer clinical trials: a Delphi study. Eur J Cancer Care 2018; 27: e12954.CrossRefGoogle ScholarPubMed
Covvey, J R, Kamal, K M, Gorse, E et al. Barriers and facilitators to shared decision-making in oncology: a systematic review of the literature. Support Care Cancer 2019; 27: 1613–1637.CrossRefGoogle ScholarPubMed
Klüter, S, Katayama, S, Spindeldreier, C K et al. First prospective clinical evaluation of feasibility and patient acceptance of magnetic resonance-guided radiotherapy in Germany. Strahlenther Onkol 2020; 196: 691–698.CrossRefGoogle ScholarPubMed
Andratschk, N, Day, J, Schüler, et al. Initial clinical experience with the MR Linac system – patient perspective 2020. Poster presentation. In: ESTRO 28th Nov – 1st Dec 2020. Session code: 934Google Scholar
Munn, Z, Moola, S, Lisy, K, Riitano, D, Murphy, F. Claustrophobia in magnetic resonance imaging: a systematic review and meta-analysis. Radiography 2015; 21: e59–e63.CrossRefGoogle Scholar
Sharp, L, Lewin, F, Johansson, H, Payne, D, Gerhardsson, A, Rutqvist, L E. Randomized trial on two types of thermoplastic masks for patient immobilization during radiation therapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2005; 61: 250–256.CrossRefGoogle ScholarPubMed
Mullaney, T, Pettersson, H, Nyholm, T, Stolterman, E. Thinking beyond the cure: a case for human-centered design in cancer care. Int J Design 2012; 6: 27–39 Google Scholar
Nixon, J L, Cartmill, B, Turner, J et al. Exploring the prevalence and experience of mask anxiety for the person with head and neck cancer undergoing radiotherapy. J Med Radiat Sci 2018; 65: 282–290 CrossRefGoogle ScholarPubMed
Nixon, J L, Brown, B, Pigott, A E et al. 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 CrossRefGoogle ScholarPubMed
Sutton, E, Lane, J A, Davis, M et al. Men’s experiences of radiotherapy treatment for localized prostate cancer and its long-term treatment side effects: a longitudinal qualitative study. Cancer Causes Control 2021; 32: 261–269 CrossRefGoogle ScholarPubMed
Clover, K, Oultram, S, Adams, C, Cross, L, Findlay, N, Ponman, L. Disruption to radiation therapy sessions due to anxiety among patients receiving radiation therapy to the head and neck area can be predicted using patient self-report measures. Psychoncology 2011; 20: 1334–1341 CrossRefGoogle Scholar
Cox, J, Davison, A. Comfort as a determiner of treatment position in radiotherapy of the male pelvis. Radiography 2005; 11: 109–115.CrossRefGoogle Scholar
Nutting, C M, Khoo, V S, Walker, V et al. A randomised study of the use of a customised immobilisation system in the treatment of prostate cancer with conformal radiotherapy. Radiother Oncol 2000; 54: 1–9.CrossRefGoogle Scholar
Grassi, L, Johansen, C, Annunziata, M A et al. Screening for distress in cancer patients: a multicenter, nationwide study in Italy. Cancer 2013; 119: 1714–1721.CrossRefGoogle ScholarPubMed
Cardoso, G, Graca, J, Klut, C, Trancas, B, Papoila, A. Depression and anxiety symptoms following cancer diagnosis: a cross-sectional study. Psychol Health Med 2016; 21: 562–570.CrossRefGoogle ScholarPubMed
Couper, J, Bloch, S, Love, A, Macvean, M, Duchesne, G M, Kissane, D. Psychosocial adjustment of female partners of men with prostate cancer: a review of the literature. Psycho-Oncology 2006; 15: 937–953.CrossRefGoogle ScholarPubMed
Goldsworthy, S D, Tuke, K, Latour, J M. A focus group consultation round exploring patient experiences of comfort during radiotherapy for head and neck cancer. J Radiother Pract 2016; 15: 143–149.CrossRefGoogle Scholar
McCaughan, E, Prue, G, McSorley, O, Northouse, L, Schafenacker, A, Parahoo, K. A randomized controlled trial of a self-management psychosocial intervention for men with prostate cancer and their partners: a study protocol. J Adv Nurs 2013; 69: 2572–2583 CrossRefGoogle ScholarPubMed
Oliffe, J L, Ogrodniczuk, J, Bottorff, J L, Hislop, T G, Halpin, M. Connecting humor, health, and masculinities at prostate cancer support groups. Psycho-Oncology 2009; 18: 916–926.CrossRefGoogle ScholarPubMed
Hedden, L, Pollock, P, Stirling, B, Goldenberg, L, Higano, C. Patterns and predictors of registration and participation at a supportive care program for prostate cancer survivors. Support Care Cancer 2019; 27: 4363–4373 CrossRefGoogle Scholar
Smith, M, Casey, L, Johnson, D, Gwede, C, Riggin, O. Music as a therapeutic intervention for anxiety in patients receiving radiation therapy. Oncol Nurs Forum 2001; 28: 855–862.Google ScholarPubMed
Barry, P, O’Callaghan, C, Wheeler, G, Grocke, D. Music therapy CD creation for initial pediatric radiation therapy: a mixed methods analysis. J Music Ther 2010; 47: 233–263.CrossRefGoogle ScholarPubMed
O’Callaghan, C, Sproston, M, Wilkinson, K et al. Effect of self-selected music on adults’ anxiety and subjective experiences during initial radiotherapy treatment: a randomised controlled trial and qualitative research. J Med Imaging Radiat Oncol 2012; 56: 473–477.CrossRefGoogle ScholarPubMed