PO-1125 Evaluation of the clinical practice of vaginal dilator therapy for women receiving curative pelvic radiotherapy

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S610 3rd ESTRO Forum 2015
Materials and Methods: Ten consecutive patients with
pancreas tumor treated on EDGE platform (Varian) by SBRT
with 10FFF beam and volumetric modulated arc therapy
(VMAT) were evaluated. The schedule was: 6 fractions of
7.5Gy prescribed at mean dose to PTV. During the simulation
CT, two surface transponders were positioned under the
abdominal compression. Calypso was used to monitor the
transponders position before the treatment in a free
breathing mode and during the patient treatment with the
abdominal compressor.
Results: Sixty treatment sessions were analyzed. Abdominal
compressor resulted in important reduction of breathing
excursion, in particular in anterior posterior (AP) direction. In
detail, irregular breathing cycle up to 25 mm in AP was found
without abdominal compressor. In all but one patients
outlined shifts lower than 2 mm during beam on time using
the abdominal compression. One patient resulted in residual
motion greater than 10 mm and a new simulation CT with
another abdominal compressor was developed after which
the motion was reduced to 4 mm in AP. Figure 1 shows an
usual free breathing abdominal monitoring with and without
abdominal compressor.
Figure 1: Breathing monitoring with Calypso superficial
transponders.
Conclusions: Abdominal compressor was shown to reduce
diaphragmatic breathing motion with important benefit for
patient positioning. Calypso superficial transponders can help
in increasing treatment precision confidence and abdominal
compression efficacy.
Poster: RTT track: Patient care
PO-1124
Impact of ethnic diversity on the management of African
patients in radiotherapy departments
C. MacBride1, C. Gillham2, A. Craig1
1Trinity College Dublin, ARTT. Discipline of Radiation
Therapy, Dublin, Ireland Republic of
2St Luke's Radiation Oncology Network, St. James Hospital,
Dublin 8, Ireland Republic of
Purpose/Objective: The 2011 census recorded that
approximately 58,967 persons of an African ethnic/cultural
background live in Ireland. As immigrant populations age,
cancer levels in this population will increase. Culture can
significantly impact healthcare, influencing behaviour whilst
on treatment or in preparation for treatment. Barriers to
effective healthcare can arise when there are cultural
differences between health care professionals and patients.
The primary aim of this study was to gain a better
understanding of the impact of African Cultures on patient
management in Radiotherapy Department. A secondary aim
was to devise a set of recommendations to help overcome
any identified obstacles.
Materials and Methods: A qualitative approach was used in
this exploratory research. Six focus groups were conducted
with 29 Radiation Therapists (RTT's,) from 5 Radiotherapy
Departments in Ireland. The Transcultural Assessment Model
(TAM) developed by Giger and Davidhizar , was used as the
theoretical framework for this study. Following an initial
brainstorming in each focus group, this validated model was
used to structure topics for discussion. A thematic longtable
approach was used to analyse the data and generate themes
related to aspects of African culture.
Results: Language barriers, communication, modesty,
religion, skin reactions and tattoos, and accessing support
services were the themes identified in relation to the TAM
topics of communication, time, space, social organisation,
biological variations and environmental control, respectively.
These themes were established as cultural barriers in the
management of African Patients in the Radiotherapy
Department.
Conclusions: African cultural and ethnic diversity has
implications in the Radiotherapy Department. Giger and
Davidhizar’s Transcultural Assessment Model established the
aspects which cause barriers to providing culturally sensitive
care to ethnically diverse patients. This study shows that
RTT's are not fully informed about some aspects of cultural
diversity which in turn can affect the management of African
Patients in Radiotherapy Departments. Cultural training,
advocacy, use of the TAM questionnaires and other resources
are recommended to help overcome these obstacles.
PO-1125
Evaluation of the clinical practice of vaginal dilator
therapy for women receiving curative pelvic radiotherapy
K. Olling1
1Vejle Hospital, Radiotherapy Dep. of Oncology, Vejle,
Denmark
Purpose/Objective: In studies examining the effect of
vaginal dilation therapy after pelvic radiotherapy, frequent
practice has been associated with lower rates of self
reported stenosis. The primary outcome of the current study
was dilator use within our clinical practice. Other relevant
outcomes were reasons for not using a dilator, whether
women felt well-informed about dilator use and if there was
preference for one type of dilator. The purpose of the study
was to develop and assure the quality of our clinical practice.

3rd ESTRO Forum 2015 S611
Materials and Methods: This practice changing study was
done in two phases. In phase 1, 17 women prescribed to
curative radiotherapy for rectal or anal cancer were asked to
complete a simple questionnaire about the vaginal dilator
therapy at a routine follow-up after their radiotherapy
course. Our findings led to modification of our clinical
practice such as written patient information, increased
clinician and nursing skills as well as improved patient-nurse
communication. In phase 2, 25 new women were enrolled in
a repeat study with an updated questionnaire. This assessed
the effects of the changes in our clinical practice. The
answers were transcribed in to an electronic survey system,
to ensure correct data analysis.
Results: All 43 women completed the questionnaire. In phase
1, we excluded 1/17 that did not receive a dilator. 1/16 did
not use the dilator due to having regular intercourse and
6/16 women regularly used a dilator 1-2 times a week. In
phase 2, 80 % of women felt well informed about reasons and
outcomes of using a dilator. We excluded 1/25 women that
did not receive a dilator. 5/24 women did not use the dilator
due to having regular intercourse and 11/24 regularly used a
dilator 1-2 times per week. The proportion of women
regularly using a dilator was not statistically different
between the two groups. A larger proportion of women 8/11
(73 %), used a specific dilator compared to 3/13 (23%) with
other types of dilator (p < 0.05).
Conclusions: Phase 1 results showed that clinical practice
was neither sufficient nor satisfactory. Modifying clinical
practice, led to more women regularly using a dilator at the
time of check up, but was not statistically significant due to
at small study size. Focusing patient information on the
importance of regular intercourse, rather than dilator use,
appeared to have increased the reported frequency of
woman having a regular sex life. Besides regular intercourse,
major reasons for lack of dilator use were pain,
anxiety/discomfort and misinformation. Current results
suggest (i) structured nursing interventions may be required
to control pain, (ii) nurses have an essential role in explaining
dilator use and addressing feelings of anxiety/discomfort,
(iii) further refinement to our patient information procedure
is needed because misinformed women only used a dilator for
a short period after radiotherapy, (iv) women do appear to
show preference for using a particular dilator type.
PO-1126
A pilot study using a computer simulation tool for
patient/carer education of radiotherapy
M. Hughes1, V.A. Sykes1, A. Jessop2, A.W. Beavis3
1Queens Centre for Oncology and Haematology Castle Hill
Hospital, Radiotherapy Department, Cottingham, United
Kingdom
2Sheffield-Hallam University, Faculty of Health and Well
Being, Sheffield, United Kingdom
3Queens Centre for Oncology and Haematology Castle Hill
Hospital, Radiation Physics Department, Hull, United
Kingdom
Purpose/Objective: The improvement of public knowledge of
radiotherapy is a global objective; specifically we believe
that if patients have a more thorough understanding of the
processes and issues then they may be more compliant to
preparatory instructions and have reduced anxiety regarding
treatment. Information is often more efficiently absorbed
when presented in a novel manner, in this study we utilised a
computer simulation of a Linear Accelerator.
Materials and Methods: PEARL is a commercially available PC
based tool that provides a realistic and functional 3D model
of a Linear Accelerator and, using a DICOM interface, can
visualise treatment plans. We staged 'drop-in' sessions in the
waiting room of our clinic. Patients, that were under
treatment and their carers, were offered demonstrations and
explanations of the treatment process by two treatment
radiographers (RTTs) using PEARL; no specific treatment site
was targeted. Immediately following the discussion,
comments were invited and captured using a 'free text'
questionnaire. Post processing split these responses into
common themes and where appropriate, multiple comments
were scored per patient.
Results: Over three sessions 116 patients viewed the
demonstration and 64 patients (or carers) returned feedback;
139 individual comments were identified in the post
processing of the free text written responses. In general the
recorded comments were all positive and reflected that the
use of the computer simulation tool had been useful in
communicating the information imparted. After reviewing
the responses, 5 common themes emerged from the recorded
comments: 1) 'around patient expectations' (24 comments
recorded, of these 12 recorded it helped reduce anxiety); 2)
'demonstration was helpful and informative' (43 comments
recorded, of these 6 related to carers); 3) 'understanding the
need for compliance in bladder and bowel preparation' (6
comments recorded); 4) 'around understanding the
technology' (25 comments recorded); and 5) 'recommendation
regarding the timing of information delivery' (41 comments
recorded, of these 35 stated they would have preferred to
have seen PEARL before their treatment commenced). 48% of
the patients were prostate patients and many gave verbal
comments as to the usefulness in understanding their bowel
and bladder preparation instructions although not all left
written feedback.