Development of recommendations to improve patient experiences of brachytherapy for locally advanced cervical cancer

Abstract

Brachytherapy is a type of internal radiation treatment where a radioactive source is placed close to a tumour. For locally advanced cervical cancer (LACC), too advanced to be cured by a hysterectomy, radiotherapy with chemotherapy is the standard treatment. Typically, brachytherapy follows five weeks of daily external beam radiotherapy alongside weekly chemotherapy. Brachytherapy requires patients to have applicators/needles positioned inside them in an operating theatre and to remain lying flat and still on a bed for the planning and treatment delivery. Currently, the way the brachytherapy is given is not standardised. It may be given as three or four day case procedures, or one or two inpatient stays for up to three days where the applicators stay in place for this duration. Brachytherapy is a highly invasive procedure and is known to cause pain, anxiety and distress. Currently there is no consensus on how to minimise this in the context of a rapidly developing technique with wide variations in delivery. This research was undertaken to better understand patient experiences of brachytherapy for LACC, to identify areas needing improvement and ways to reduce distress caused by brachytherapy. A total of three studies were carried out. The first study was a survey to ascertain current UK brachytherapy service provision, including pain management and procedures to provide patient care and support. This found that many different treatment regimens were in use, confirming the lack of standardisation of procedures. The second study was a qualitative interview study, to explore patient experiences of brachytherapy across a number of UK centres where brachytherapy is delivered in different ways. This showed that some women had difficult and traumatic experiences with periods of severe pain and a perception of poor nursing care on the wards. Others described more positive experiences, with some having had no pain. Aspects of what had gone well were identified as well as suggestions for how the treatment could be improved. In the final stage of the research, study data were used to develop potential patient care recommendations. These were discussed and ranked by service providers and service users meeting together in nominal group technique workshops. Some recommendations were amended to improve clarity and a few new recommendations were created in the workshops. From the workshops a list of potential recommendations was produced to be taken forwards for future development, with the aim of improving standards and consistency of care in brachytherapy for LACC