ESTRO 2024 - Abstract Book

S5632

RTT - Patient experience and quality of life

ESTRO 2024

53

Poster Discussion

Patient-reported outcomes and experience measures with online adaptive radiotherapy on MR-Linac

Amanda Moreira 1 , Winnie Li 1,2 , Alejandro Berlin 1,2 , Peter Chung 1,2 , Leigh Conroy 1,2 , Tim Craig 1,2 , Jennifer Dang 1 , Laura A Dawson 1,2 , Rachel Glicksman 1,2 , Ali Hosni 1,2 , Vickie Kong 1,2 , Patricia Lindsay 1,2 , Andrea Shessel 1 , Teodor Stanescu 1,2 , Edward Taylor 1,2 , Jeff Winter 1,2 , Michael Yan 1,2 , Michael Velec 1,2 1 Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada. 2 University of Toronto, Department of Radiation Oncology, Toronto, Canada

Purpose/Objective:

Online adaptive radiation therapy (ART) using an MR-linac poses new challenges compared to conventional radiation therapy for both patients and the multidisciplinary team to deliver high-quality care. This study evaluated patient-reported anxiety and experiences with cancer care involving treatment in the MR-linac facility

Material/Methods:

Patients treated on a 1.5T MR-linac (Unity, Elekta AB) were approached for a single-institution, observational study to collect clinical outcomes, experience measures and technical data for research (NCT04135794). Herein experience measures are reported. As part of standard care, patients were pre-screened for MR safety and claustrophobia prior to referral by their oncologist for MR-linac simulation to assess suitability for MR-guided ART. Radiation Therapists (RTTs) also performed pre-simulation patient education. Daily online ART was performed by a team of 3 RTTs, 1 physicist and 1 oncologist, and included patient set up, imaging, plan re-contouring and re optimization, review, verification and delivery. For research, patients completed two validated surveys. Immediately after the first treatment, the MR-anxiety questionnaire (MR-AQ) rated 15 items related to MR-related anxiety and relaxation as being “not at all”, “somewhat”, “moderately” or “very much so”. Higher total scores (possible range 15-60) indicate higher anxiety. After the last fraction, patients completed the EORTC outpatient cancer care satisfaction questionnaire that rated 40 items with Likert-type responses. The proportion of positive responses (“very good” or “excellent”) were evaluated with descriptive statistics. Differences between immobilization (abdominal compression vs. none), or tumor site (prostate vs. other) subgroups were explored using unadjusted Wilcoxon rank-sum tests at P<.05

Results:

Of the 238 patients who were approached, 210 patients consented to the study and the 205 who completed questionnaires were included in this analysis. The median age was 71 (range 27-94). Treated sites were prostate (n=119), lymph nodes (26), pancreas (26), liver (19), bone metastases (7), kidney (4) or other (4). All treatment fractions (median 6 per patient, range 1-7) were delivered using a full online ART workflow termed ‘adapt-to shape’. All patients were positioned supine with arms by side or on chest and 28% had abdominal compression to limit breathing motion. Following MR-linac simulation, no patient discontinued treatment on MR-linac for comfort or anxiety reasons. Median (range) patient time on the MR-linac couch per fraction was 46 (31-113) and 66 (38-114) minutes for pelvis and abdominal treatments respectively. Overall, patients rated individual MR related anxiety items as 87% “not at all”, 11% “somewhat”, 1% “moderately” and 1% as “very much so”. The median