Communicating the External Beam Radiotherapy Experience (CEBRE) Discussion Guides: Real World Implementation and Evaluation

PURPOSE/OBJECTIVE(S)

Communicating about the radiotherapy treatment process can be difficult for patients and healthcare professionals. The "Communicating the External Beam Radiotherapy Experience" (CEBRE) and Communicating the Gynecologic Brachytherapy Experience (CoGBE) discussion guides use graphic narrative to explain external beam radiotherapy and gynecologic high-dose rate brachytherapy, respectively. The CEBRE, CoGBE, and CEBRE en Español guides have been available for free download since 10/2018, 6/2020, and 8/2021, respectively. This study aims to characterize how the guides are being implemented and used in practice.

MATERIALS/METHODS

Global downloads of the CEBRE, CoGBE, and CEBRE en Español guides were analyzed. Email addresses submitted at the time of download were used to contact study subjects. Duplicate emails, fake addresses, and expired emails were removed resulting in 500 individuals being invited to participate in the survey. A data collection web application survey was distributed on 1/27/23. Two reminders were sent prior to the survey closing on 2/13/23. The survey addressed how physicians or other radiotherapy team members use the CEBRE guides, where they are used, and how the guides can be improved. Likert-type data (1 = strongly disagree, 5 = strongly agree) are reported as median [interquartile range].

RESULTS

As of 10/16/22, the CEBRE guides (English) had been downloaded 602 times, CoGBE 86 times, and CEBRE en Español 63 times. 42/500 individuals responded to the survey for an 8% response rate. 40/42 (95%) of participants were healthcare providers with 35/40 (87.5%) radiation oncologists. 16/40 (40%) have used the CEBRE guides in some way. 6/16 (37.5%) "always use," 2/16 (12.5%) "often use," and 3/16 (18.8%) "sometimes use" the guides during consultation. 8/16 (50%) report using the guides for education of medical students, residents, and fellows. The 16 respondents that use the guides felt the guides were useful overall (5[5-5]), felt "very confident" using the guides (4.5[4-5]), and felt the guides "help patients prepare for their treatment" (5[4-5]). 40 respondents provided suggestions on additional language translations with 19/40 (48%) recommending translation into Mandarin, 6/40 (15%) into Cantonese, Portuguese, French and Arabic, and 5/40 (12.5%) into Haitian, Hindi, and Vietnamese.

CONCLUSION

The majority of respondents did not use the CEBRE guides which may be due to difficulty with implementation. However, respondents who use the guides are confident using them and rate them as useful for patients. These data, although limited by the low response rate, suggest that the CEBRE guides have accomplished the goal of facilitating patient-physician conversations. Moreover, there is an interest in translating the guides into additional languages other than Spanish. Due to the low response rate, definitive conclusions cannot be made from these data. Therefore, further research such as interviews and focus groups may be beneficial.

Patient Education Practices and Preferences of Interprofessional Radiation Oncology Providers

PURPOSE/OBJECTIVE(S)

Patient understanding of radiotherapy (RT) processes and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. Our objective was to evaluate PE practices and preferences of interprofessional RO providers to inform recommendations for delivering inclusive, accessible, and patient-centered education.

MATERIALS/METHODS

An anonymous 17-item online survey, approved by an ethics review board, was administered to all members of the Radiation Oncology Education Collaborative Study Group (ROECSG) between 10/5/22 to 11/23/22. Respondent demographics, provider practices/preferences, and institutional practices were collected. Qualitative items explored key strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. Fisher's exact test compared PE practices by provider role and PE timing. Thematic analysis was used for qualitative responses.

RESULTS

A total of 123 ROECSG members, including RO attendings (64%), RO trainees (21%), medical physicists (7%), physician assistants/nurses (2%), and radiation therapists (2%), completed the survey (31% response rate). Most practiced in an academic setting (86%) in North America (82%). The most common PE resources used were custom created institution-specific (61%) and electronic health system generated materials (38%). PE was delivered primarily by one-on-one teaching (72%), paper handouts (69%), and organizational websites (21%) (e.g., RTanswers.org). Almost half (41%) reported that PE practices differed based on type of clinical encounter, for example paper handouts for in-person visits and multimedia for virtual visits. The majority (86%) stated that their institution has disease site-specific PE materials, with nearly all having breast cancer materials (91%). Only 58% reported access to non-English PE materials. RO attendings/trainees were more likely than other team members to deliver PE at consultation (98% vs 71%, p = 0.03). PE practices amongst radiation oncologists differed according to the timing along the RT care path (consultation vs simulation vs first fraction, respectively): one-on-one teaching: 89% vs 49% vs 56%, p<0.01 and paper handouts: 69% vs 28% vs 16%, p<0.01. Key PE strategies included incorporating multimedia resources, personalizing delivery, and repetition at multiple timepoints by the interprofessional team. Limited time, inadequate administrative support, and lack of customized resources were identified as challenges in PE delivery.

CONCLUSION

Interprofessional RO providers engage in PE, with most utilizing institution-specific materials. PE practices differ according to the type of clinical encounter and timing in the RT care path. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources based on language, learning styles, and cultural preferences are needed to foster high-quality, patient-centered PE delivery.

Outcomes of definitive chemoradiation for squamous cell carcinoma of the anus and the effect of radiation technique on hematologic parameters

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Background: Chemotherapy-radiation (CRT) is an established therapy for squamous cell carcinoma of the anus. A limiting factor in the successful completion of CRT is bone marrow toxicity. The effect of intensity modulated radiation therapy (IMRT) on marrow toxicity is not well defined. We evaluated the effect of IMRT on the severity of cytopenias for patients receiving CRT. We also explored the influence of cytopenias on disease outcome both pre-CRT or during CRT.

Methods: 43 patients were treated with CRT between 1994-2010. The median delivered dose was 50.4 Gy (range, 32.4-59.4). 31 patients (72%) were treated with IMRT. All patients received concurrent chemotherapy, usually 5FU and mitomycin-C (n = 34, 79%). White blood cell (WBC), hemoglobin (Hg), and platelet counts were recorded pre- CRT, weekly during CRT, and within 7 days post-CRT. Hematologic values were analyzed according to type of RT and for association with treatment outcome.

Results: 2-year locoregional failure (LRF) and distant failure were 14% and 14%, respectively. 21 patients required a treatment break due to any cause. In 9 (43%) patients the break was due to hematologic toxicity. 34 patients had complete blood values available. IMRT did not affect the rate of ≥ grade 2 cytopenia (p = 0.64) or median treatment nadirs; Hg (9.1 vs. 8.3 g/dL, p = 0.24), WBC (1.7 vs. 1.2 K/uL, p = 0.95), or platelets (90.5 vs. 61.5 k/uL, p = 0.88). Median time to nadir was not different for WBC (7 vs. 7 days, p = 0.36) or Hg (36 vs. 22 days, p = 0.29), but patients treated with IMRT did have a delayed platelet nadir (33 vs. 14 days, p = 0.01). Hg nadir ≤ 9 g/dL was associated with a higher rate of 2- year LRF (> 9 g/dL 100% vs. ≤ 9 g/dL 73%, p = 0.03). No other hematologic values were associated with LRF.

Conclusions: In this cohort of patients, nearly 50% of patients required a treatment break, which was related to a cytopenia 43% of the time. IMRT did not appear to have significant impact on acute marrow toxicity, although sample size may limit our power to detect a difference. Low Hg during CRT appears to influence LRF. More detailed dose volume histogram analysis will be useful to further explore how IMRT might influence acute hematologic toxicity, and therefore treatment outcomes.

No significant financial relationships to disclose.