Session Item

Patients with breast cancer have unmet informational needs and anxiety during radiotherapy. To address this gap, a person-centered service was designed through Radiation Therapist (RTT)-led education and continuity-of-care over the whole radiotherapy pathway. The aim of this study was to determine if the person-centered model was more effective at reducing anxiety compared to standard care.

Breast cancer patients requiring locoregional radiotherapy were prospectively accrued and randomized (1:1) to the intervention or standard care arm. The intervention was a 1-on-1 pre-CT education session led in-person by an RTT with expertise in breast radiotherapy who subsequently performed CT, planning, treatment delivery and support for the same patient. Standard care had no dedicated RTT-led education session and was usually delivered by many different RTTs over the care pathway. Patient-reported endpoints collected using validated questionnaires were changes relative to baseline in anxiety (HADS-A) as the primary endpoint, and self-efficacy (PROMIS), treatment concerns (CaTS) and health engagement (PHE) as secondary endpoints. Changes over time and between arms were evaluated using linear mixed-effects models. Post-treatment satisfaction items (EORTC PATSAT) were compared using unadjusted Wilcoxon rank sum tests. Optional semi-structured interviews were conducted post-treatment to thematically analyze patients’ experiences using qualitative methods.

Patients (109 total) were randomized to the intervention (54) or standard care (55). Median age overall was 51 (28-81), and the majority were treated with 40 Gy/15 fractions (94%) using a 4-field technique (93%) in active breath-hold (57%). Anxiety was significantly reduced post-treatment (Figure) although the magnitude was similar between arms (p=0.682). Procedural concerns were significantly reduced prior to the 1st fraction in the intervention arm (p=0.001). Other secondary outcomes were similar between arms (Table). Satisfaction improved with the intervention for provision of information (p=0.042), identifying care team roles (p=0.042) and overall hospital care (p=0.024). Thematic interview analysis (20 intervention, 21 standard care) demonstrated that patients highly valued pre-treatment RTT-led education, and appreciated having one consistent RTT (or a small, consistent team of RTTs) particularly at the start of treatment course, when intimidated by the breath-hold technique or for especially vulnerable individuals.

Compared to standard care for breast radiotherapy, the person-centered RTT model significantly improved patients’ procedural concerns, overall satisfaction and experience with care. Future refinements in education content or RTT-patient communications should be considered in an effort to resolve patients’ psychological concerns and anxiety. In addition, having one or a few RTTs specialized in person-centered practice could facilitate an individualized approach to patients most in need.