Anxiety at the first radiotherapy session for non-metastatic breast cancer: key communication and communication-related predictors.

BACKGROUND AND PURPOSE: Patients may experience clinically relevant anxiety at their first radiotherapy (RT) sessions. To date, studies have not investigated during/around the RT simulation the key communication and communication-related predictors of this clinically relevant anxiety. MATERIAL AND METHODS: Breast cancer patients (n=227) completed visual analog scale (VAS) assessments of anxiety before and after their first RT sessions. Clinically relevant anxiety was defined as having pre- and post-first RT session VAS scores ⩾4 cm. Communication during RT simulation was assessed with content analysis software (LaComm), and communication-related variables around the RT simulation were assessed with questionnaires. RESULTS: Clinically relevant anxiety at the first RT session was predicted by lower self-efficacy to communicate with the RT team (OR=0.65; p=0.020), the perception of lower support received from the RT team (OR=0.70; p=0.020), lower knowledge of RT-associated side effects (OR=0.95; p=0.057), and higher use of emotion-focused coping (OR=1.09; p=0.013). CONCLUSIONS: This study provides RT team members with information about potential communication strategies, which may be used to reduce patient anxiety at the first RT session.

Anxiety and its time courses during radiotherapy for non-metastatic breast cancer: a longitudinal study.

PURPOSE: To our knowledge, no study has specifically assessed the time course of anxiety during radiotherapy (RT). The objective of this study was to assess anxiety time courses in patients with non-metastatic breast cancer. MATERIAL AND METHODS: This multicenter, descriptive longitudinal study included 213 consecutive patients with breast cancer who completed visual analog scales (VASs) assessing state anxiety before and after the RT simulation and the first and last five RT sessions. RESULTS: Pre- and post-session anxiety mean levels were highest at the RT simulation (respectively, 2.9±2.9 and 1.6±2.5) and first RT session (respectively, 3.4±2.9 and 2.0±2.4), then declined rapidly. Clinically relevant mean differences (⩾1cm on the VAS) between pre- and post-simulation/session VAS scores were found only for the RT simulation (-1.3±2.7; p<0.001) and first RT session (-1.4±2.4; p<0.001). Five percent to 16% of patients presented clinically relevant anxiety (pre- and post-simulation/session VAS scores⩾4cm) throughout treatment. CONCLUSIONS: To optimize care, RT team members should offer all patients appropriate information about treatment at the simulation, check patients' understanding, and identify patients with clinically relevant anxiety requiring appropriate support throughout RT.

Is it possible to improve radiotherapy team members' communication skills? A randomized study assessing the efficacy of a 38-h communication skills training program.

BACKGROUND AND PURPOSE: Optimizing communication between radiotherapy team members and patients and between colleagues requires training. This study applies a randomized controlled design to assess the efficacy of a 38-h communication skills training program. MATERIAL AND METHODS: Four radiotherapy teams were randomly assigned either to a training program or to a waiting list. Team members' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient were the primary endpoints. These encounters were scheduled at the baseline and after training for the training group, and at the baseline and four months later for the waiting list group. Encounters were audiotaped and transcribed. Transcripts were analyzed with content analysis software (LaComm) and by an independent rater. RESULTS: Eighty team members were included in the study. Compared to untrained team members, trained team members used more turns of speech with content oriented toward available resources in the team (relative rate [RR]=1.38; p=0.023), more assessment utterances (RR=1.69; p<0.001), more empathy (RR=4.05; p=0.037), more negotiation (RR=2.34; p=0.021) and more emotional words (RR=1.32; p=0.030), and their self-efficacy to communicate increased (p=0.024 and p=0.008, respectively). CONCLUSIONS: The training program was effective in improving team members' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient. Future study should assess the effect of this training program on communication with actual patients and their satisfaction. Moreover a cost-benefit analysis is needed, before implementing such an intensive training program on a broader scale.

A qualitative and a quantitative analysis of an auto-segmentation module for prostate cancer.

PURPOSE: This work describes the clinical validation of an automatic segmentation algorithm in CT-based radiotherapy planning for prostate cancer patients. MATERIAL AND METHODS: The validated auto-segmentation algorithm (Smart Segmentation, version 1.0.05) is a rule-based algorithm using anatomical reference points and organ-specific segmentation methods, developed by Varian Medical Systems (Varian Medical Systems iLab, Baden, Switzerland). For the qualitative analysis, 39 prostate patients are analysed by six clinicians. Clinicians are asked to rate the auto-segmented organs (prostate, bladder, rectum and femoral heads) and to indicate the number of slices to correct. For the quantitative analysis, seven radiation oncologists are asked to contour seven prostate patients. The individual clinician contour variations are compared to the automatic contours by means of surface and volume statistics, calculating the relative volume errors and both the volume and slice-by-slice degree of support, a statistical metric developed for the purposes of this validation. RESULTS: The mean time needed for the automatic module to contour the four structures is about one minute on a standard computer. The qualitative evaluation using a score with four levels ("not acceptable", "acceptable", "good" and "excellent") shows that the mean score for the automatically contoured prostate is "good"; the bladder scores between "excellent" and "good"; the rectum scores between "acceptable" and "not acceptable". Using the concept of surface and volume degree of support, the degree of support given to the automatic module is comparable to the relative agreement among the clinicians for prostate and bladder. The slice-by-slice analysis of the surface degree of support pinpointed the areas of disagreement among the clinicians as well as between the clinicians and the automatic module. CONCLUSION: The efficiency and the limits of the automatic module are investigated with both a qualitative and a quantitative analysis. In general, with efficient correction tools at hand, the use of this auto-segmentation module will lead to a time gain for the prostate and the bladder; with the present version of the algorithm, modelling of the rectum still needs improvement. For the quantitative validation, the concept of relative volume error and degree of support proved very useful.

Predictors of the risk of fibrosis at 10 years after breast conserving therapy for early breast cancer: a study based on the EORTC Trial 22881-10882 'boost versus no boost'.

The EORTC 22881-10882 trial in 5178 conservatively treated early breast cancer patients showed that a 16 Gy boost dose significantly improved local control, but increased the risk of breast fibrosis. To investigate predictors for the long-term risk of fibrosis, Cox regression models of the time to moderate or severe fibrosis were developed on a random set of 1797 patients with and 1827 patients without a boost, and validated in the remaining set. The median follow-up was 10.7 years. The risk of fibrosis significantly increased (P<0.01) with increasing maximum whole breast irradiation (WBI) dose and with concomitant chemotherapy, but was independent of age. In the boost arm, the risk further increased (P<0.01) if patients had post-operative breast oedema or haematoma, but it decreased (P<0.01) if WBI was given with >6 MV photons. The c-index was around 0.62. Nomograms with these factors are proposed to forecast the long-term risk of moderate or severe fibrosis.

The use of magnetic sensors to monitor moderate deep inspiration breath hold during breast irradiation with dynamic MLC compensators.

BACKGROUND AND PURPOSE: To reduce the dose to the heart during left breast irradiation, a moderate deep breath hold technique (MDIBH) was introduced. Originally, verification of the MDIBH was performed with portal images acquired in movie loop during the treatment delivery. However, this verification method is not compatible with the use of dynamic MLC compensation, recently introduced because of its often superior dose distribution. Magnetic sensors were evaluated as an additional/alternative method to monitor the breath hold. MATERIAL AND METHODS: In a first phase, the reproducibility of MDIBH for breast patients was evaluated by investigating for 19 patients the set-up errors derived from portal images in cine loop acquisition during MDIBH. In a second phase, for 10 patients, the breathing curves recorded by magnetic sensors were used to monitor beam-on and beam-off while portal images were simultaneously recorded in movie loop. In a third phase, breast patients treated with dynamic MLC compensation were trained for MDIBH and monitored with magnetic sensors. RESULTS: The interfraction reproducibility of MDIBH for the initial 19 patients was recorded: the mean set-up error, the systematic and the random deviations are all smaller than 4mm in the anterior-posterior direction and in the cranio-caudal direction and smaller than 2 degrees along the rotation axis. Magnetic sensors provided a reproducible breathing curve: while the mean amplitude recorded for 10 patients varied substantially between patients, the individual standard deviation of the amplitude for each session was smaller than 3mm. For these 10 patients, the intrafraction set-up variation between the first portal image of two consecutive breath holds and the intra-breath hold set-up variation between the first and last portal image of each breath hold is smaller than 2mm in the anterior-posterior direction, smaller than 3mm in the cranio-caudal direction and smaller than 1.5 degrees along the rotation axis. CONCLUSION: Using magnetic sensors to record the breathing curve of left breast patients in MDIBH, a verification method was developed, suitable for combining MDIBH with dynamic MLC compensation.