PRO in assessment of new radiotherapy technology

With an MR-Linac, the cancer node and the surrounding organs are visualised with high-quality MR scans. This makes it possible to adapt the radiation treatment to the cancer node and minimise the area that receives rays by reducing the safety margins around the tumor.

The goal was to optimise treatment but reduce the side effects patients experience during and after treatment. In order to evaluate this, it was important to assess the side effects in a timely and accurate manner. Previous studies have shown that by involving the patients in weekly digital patient-reported outcomes (PRO), the symptoms are detected earlier, and the uninterpreted patient-experienced symptoms are recorded more precisely. Actively involving patients in symptom monitoring has also been shown to improve communication between patient and staff and improve the quality of life for patients.

AIM

This PhD project aimed to develop, test and use a targeted scheme for the assessment of acute side effects in the treatment of prostate cancer with MR-Linac. Likewise, to evaluate the importance of integrating and using PRO in a radiotherapy course against prostate cancer.

The aim of the studies is:

1. Identify, select and validate symptoms for patient reporting compiled into a digital PRO form covering the most frequent acute side effects of radiotherapy for pelvic cancer.
2. Investigate the feasibility, usability and patients’ acceptance of weekly digital PRO during and 4 weeks after radiotherapy with a half-year follow-up.
3. Investigate acute side effect profiles over time, the greatest symptom burden and the duration of acute side effects in patients with prostate cancer treated with the MR-Linac.
4. Explore the clinical effect of integrating weekly PRO into a radiation treatment course, where the staff actively monitors the patient’s symptoms and uses it as dialogue support with feedback to the patient.

RESULTS

A targeted PRO questionnaire has been developed and validated for patients with pelvic cancer and integrated into clinical radiotherapy.

The pilot study confirmed that it was feasible, applicable and accepted by patients. In patients with prostate cancer treated on the MR-Linac, the weekly PRO mapped acute side effect profiles with real-time improvements and worsening of symptoms over time. Digital PRO with active symptom monitoring was integrated in all prostate cancer patients with high clinician and patient compliance. Patients felt their symptom reports were used by staff and improved the quality of their care.

PARTNERS

The project was carried out at the Department of Oncology, OUH in collaboration with:

• Professor Karin Brochstedt Dieperink, Department of Oncology, OUH
• Asst. Professor Uffe Bernchou, Radiophysics Laboratory, Oncology Department, OUH
• Professor Tine Schytte, Department of Oncology, OUH
• Professor Helle Pappot, Department of Oncology, Rigshospitalet

The project was a PhD project by Pia Krause Møller. View Pia’s publications.

The project defense was held on 27 January 2023.

EXTERNAL FUNDING

The project was financed by the Novo Nordisk Foundation and AgeCare (Academy of Geriatric Cancer Research).