Probst, Heidi

Sheffield Hallam University Research Archive

Support, Positioning and Organ Stabilisation during Breast Cancer Radiation Therapy : SuPPORT 4 All StudyPROBST, HeidiAvailable from Sheffield Hallam University Research Archive (SHURA) at:http://shura.shu.ac.uk/13199/This document is the author deposited version.  You are advised to consult the publisher's version if you wish to cite from it.Published versionPROBST, Heidi (2016). Support, Positioning and Organ Stabilisation during Breast Cancer Radiation Therapy : SuPPORT 4 All Study. In: UK Radiation Oncology Conference, Liverpool, 6-8 June 2016. (Unpublished) Repository use policyCopyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in SHURA to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.Sheffield Hallam University Research Archivehttp://shura.shu.ac.ukSupport, Positioning and Organ Stabilisation during Breast Cancer Radiation Therapy: SuPPORT 4 All Study Professor Heidi Probst  On behalf of the SuPPORT 4 All Project Team This work is funded by the National Institute for Health Research (NIHR) Invention for Innovation Programme (programme grant number: II-LA-0214-20001)  DISCLOSURE   • I have no financial relationships to declare. Photo by pfala - Creative Commons Attribution License  http://www.flickr.com/photos/21313845@N04 Created with Haiku Deck Today in the UK 125 women will be told they have breast cancer Photo by glokbell - Creative Commons Attribution License  http://www.flickr.com/photos/11715835@N08 Created with Haiku Deck Globally around 1.5 million are diagnosed with the disease annually Photo by garryknight - Creative Commons Attribution-ShareAlike License  http://www.flickr.com/photos/8176740@N05 Created with Haiku Deck Around 80% will survive the disease beyond 5 years, survival projected to reach 1.7 million by 2040  • Patient positioning has changed little with improvements in technology.  • Patient remains naked from the waist upwards. • Tattoos are the mainstay of treatment set up. Why is breast immobilisation needed now? • Greater use of IMRT/3D conformal, SIB or partial breast irradiation techniques are used where greater precision is needed. • Use of IMN irradiation requiring  movement of the non-irradiated breast out of the field. •  Concerns over dose to organs at risk (specifically heart in those treated for a left breast cancer) and • Unsatisfactory techniques for women with large, pendulous or relaxed breasts.  Mahe MA, Classe JM, Dravet F, Cussac A, Cuilliere JC. Preliminary results for prone-position breast irradiation. International Journal of Radiation Oncology*Biology*Physics 2002 Jan 1;52(1):156-60.   To refine, produce and test a support bra for immobilising breast tissue during breast irradiation for women that have been diagnosed with breast cancer (and have undergone removal of the tumour leaving an intact breast).  The primary endpoint is a support bra that is technically acceptable to health-care professionals (HCPs) and aesthetically acceptable to patients.  Key requirements 1. Accuracy 2. Reproducibility 3. Reducing side effects of RT 4. Improve dignity Aim of the study Work programme Workpackage 3 Work package 1 Work package 2 Work package 4 • Stakeholder engagement  • Product design refinement • Linac testing • Healthy volunteer study • Phantom studies • Clinical feasibility trial Health Economics, Service Integration and Commercialisation Work programme Workpackage 3 Work package 1 Work package 2 Work package 4 • Stakeholder engagement  • Product design refinement • Linac testing • Healthy volunteer study • Phantom studies • Clinical feasibility trial Health Economics, Service Integration and Commercialisation User and HCP Participatory Co-Design Workshops (n=19) • Participants were sent a diagram of the radiotherapy pathway and asked to write on it their experiences-this formed the focus of the discussions in the first part of each co-design workshop. • Design images were used to promote discussion. • Physical prototypes to promote free discussion. • Audio recorded (7 hours of audio recorded discussions). cc: symphony of love - https://www.flickr.com/photos/85608594@N00 Tell us about your radiotherapy Journey cc: symphony of love - https://www.flickr.com/photos/85608594@N00 Categories from users Sub Categories Information needs  Knowledge of Treatment Mis-information Timing of Information Preconceptions of RT Exposure Issues of Modesty Wearing a gown in a public place Emotional experience Feeling embarrassed Interactions with HCPs Staff attitudes Feeling a burden Finding your voice Being listened to Disempowered Technology focused care Impersonal Systems and processes including having confidence in staff and the process  Improving the efficiency of practice Choice Communication issues Feeling oppressed Having to have tattoos Fear Fear about treatment accuracy, minimising errors Feeling frightened The waiting room experience Inappropriate entertainment Getting to radiotherapy Physically getting there to the radiotherapy centre The emotional journey-what has come before (including chemotherapy, surgery the end of a long process)  Impact of side effects Skin reactions  Finding a comfortable bra to wear during RT period The changed self Lost self confidence Change to personal image/body image Wanting to feel normal Finding your voice-Being Listened to cc: Maryam Abdulghaffar ميرم رافغلادبع - https://www.flickr.com/photos/47910063@N06 Finding your voice being listened to cc: Maryam Abdulghaffar ميرم رافغلادبع - https://www.flickr.com/photos/47910063@N06 ͞I had the same experience actually and I noticed that it ǁas sǁelliŶg aŶd I ǁas told it’s a Ŷorŵal reaĐtioŶ that it ǁas lǇŵphedeŵa aŶd theŶ I didŶ’t aĐtuallǇ realise uŶtil three years later when I got really bad cellulitis septicaemia actually as a result of it and was totally being igŶored aŶd it ǁasŶ’t disĐussed as a side effeĐt iŶ the iŶitial iŶforŵatioŶ giǀiŶg.͟   Exposure cc: midwestnerd - https://www.flickr.com/photos/20553990@N06 Exposure cc: midwestnerd - https://www.flickr.com/photos/20553990@N06 ͞Ǉou go for the sessioŶs Ǉou kŶoǁ it ǁas a ďit of a shoĐk the first time when there were four people in the room, you know and Ǉou'ǀe got ŶothiŶg oŶ. ͞ ͞Ǉou're Ŷaked areŶ’t Ǉou aŶd Ǉou’ǀe also, Ǉou're kiŶd of ŵaiŵed areŶ’t Ǉou Ǉou’ǀe had surgerǇ so it’s Ŷot just the eǆposiŶg yourself, you're exposing yourself with a new not so pleasant aspeĐt of it, ďeĐause Ǉou haǀeŶ’t got used to it haǀe Ǉou aŶd Ǉou're differeŶt.͟   Categories Sub categories Feedback on the prototype Bra design Bra challenges HCP worries  Reference to other immobilisation methods Bra changing the patient experience Technical Challenges Delays to treatment start Differences between patient types Impact of a non-standard approach to  RT Lateral beam difficulties for women with larger breasts Reproducibility of existing technique Technical issues with positioning on board Treating IMN Treating photon boosts Use of bolus Technical challenges cc: Kaptain Kobold - https://www.flickr.com/photos/95492938@N00 Technical challenges ͞We found with some of the casts if you mould it too tight it pushes the breast tissue up and it ends up going above as well.͟   ͞We can't do deep inspiration with Orfit because the board, they can't take the deep breath in because we are restricting them already ͞   ͞If you're wearing a bra and there's identifying skin changes, infection, changes in seroma I guess, things like that could be an issue.͟   cc: Kaptain Kobold - https://www.flickr.com/photos/95492938@N00 cc: symphony of love - https://www.flickr.com/photos/85608594@N00 The power of joint working cc: symphony of love - https://www.flickr.com/photos/85608594@N00 RTOG Patient skin scoring SizE, Look, FeeL- SELF assessment Breast Oedema cc: Erik Schepers - https://www.flickr.com/photos/47423064@N00 1. Currently- Healthy Volunteer 3D Surface scanning 2. Clinical Feasibility Study cc: Erik Schepers - https://www.flickr.com/photos/47423064@N00 Support Positioning and Organ Registration during Breast cancer Radiation Therapy: The SuPPORT 4 ALL study  www.support4all.org.uk        follow us on twitter @SuPPORT4A  cc: julianrod - https://www.flickr.com/photos/17513020@N00 Any questions? cc: Derek Bridges - https://www.flickr.com/photos/84949728@N00 

Support, Positioning and Organ Stabilisation during Breast Cancer Radiation Therapy : SuPPORT 4 All Study

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