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.
Erasmus MC Cancer Institute, Department of Radiotherapy, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Brachytherapy. 2024 May-Jun;23(3):274-281. doi: 10.1016/j.brachy.2024.01.007. Epub 2024 Feb 28.
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.
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.
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.
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.
尽管基于 MRI 的图像引导自适应近距离放射治疗（IGABT）在局部晚期宫颈癌（LACC）中取得了良好的效果，但与二维图像引导近距离放射治疗相比，它在后勤方面更为复杂且耗时，对患者的身体和心理都有较大的负担。本前瞻性研究旨在对 IGABT 过程中的时间动作和患者体验进行分析，以指导进一步改进。
纳入接受 IGABT 治疗的 LACC 患者进行时间动作（56 例）和患者体验（29 例）分析。每个治疗步骤的时间均在标准化表格上报告。对于患者体验分析，采用 EQ-5D-5L 问卷确定基线健康状况，并使用 NRS-11 评估每个治疗步骤的感知疼痛、焦虑和持续时间。
从到达到出院的中位总治疗时间为 530 分钟（IQR：480-565）。治疗计划（勾画、重建、优化）所需时间最长，耗时 175 分钟（IQR：145-195）。应用器取出和治疗计划时感知疼痛最高，应用器取出时焦虑最高，图像采集和治疗计划时持续时间最长。感知疼痛、焦虑和持续时间呈正相关。治疗前疼痛和焦虑评分越高，感知疼痛、焦虑和持续时间越高。
本研究强调了当前 IGABT 工作流程的复杂性、持续时间和对患者体验的影响。患者报告的治疗前疼痛和焦虑程度有助于确定可能需要额外支持的患者。应优先研究和实施旨在缩短整体治疗时间的措施，包括后勤、人员配备和技术方面。
