The impact of psychological factors on interfractional motion in breast cancer radiotherapy

Uvod: Rak dojke je heterogena bolezen in je po pojavnosti drugi najpogostejši rak pri ženskah v Sloveniji. Zdravljenje raka dojke z obsevanjem je eden izmed temeljnih načinov zdravljenja. Sodobne obsevalne tehnike zahtevajo ustrezne verifikacijske procese, ki zagotavljajo, da se tarčni volumen obseva, kot je predvideno v obsevalnem načrtu. Vsakodnevna nastavitev bolnika v položaj za obsevanje obsega več faktorjev negotovosti, najpomembnejši pa so intrafrakcijski in interfrakcijski premiki. Interfrakcijski premiki so premiki med posameznimi obsevanji in prikazujejo dnevna odstopanja od načrtovanega izocentra. Rak dojke je iz različnih psiholoških in psihosocioloških vidikov bolezni ena najbolj raziskanih bolezni. Psihološko neugodje pri bolnicah, ki se zdravijo zaradi raka dojke, je povezano z depresijo, tesnobo, strahom, jezo, nizkim samospoštovanjem in nizko čustveno oporo. Namen: Ugotoviti, kako psihološki dejavniki (strah, tesnoba, negotovost) vplivajo na interfrakcijske premike pri dopolnilnem pooperativem obsevanju raka dojke. Metode dela: Na Onkološkem inštitutu Ljubljana smo izvedli presečno prospektivno raziskavo. Raziskava se je izvajala od januarja 2020 do maja 2021. Kot merski instrument smo uporabili beleženje interfrakcijskih premikov v x, y in z smeri (v mm) in anketiranje bolnic z rakom dojke z dvema anketnima vprašalnikoma. V raziskavo smo vključili 40 bolnic, ki so se adjuvantno obsevale s tehniko 3D CRT ali IMRT/VMAT v prostem dihanju in v anteroposteriornem položaju. Bolnice so bile obsevane na linearnem pospeševalniku proizvajalca Elekta, model Synergy. Podatke smo analizirali s programom za statistično analizo. Rezultati: S statističnimi testi povezanosti demografskih dejavnikov in interfrakcijskih premikov nismo potrdili (p > 0,05), prav tako nismo potrdili statistično značilne povezanosti interfrakcijskih premikov in seznanjenostjo o zdravljenju z obsevanjem. Na podlagi statistične analize smo prišli do zaključkov, da psihološki dejavniki niso statistično značilno bolj izraženi pred prvim obsevanjem kot pred petnajstim obsevanjem, prav tako ni statistično značilnih razlik med interfrakcijskimi premiki, merjenimi od 1. do 3. obsevanja in od 13. do 15. obsevanja. Na podlagi rezultatov statistične analize smo prišli do zaključka, da psihološki dejavniki statistično značilno ne vplivajo na velikost interfrakcijskih premikov. Razprava in zaključek: Na podlagi beleženja interfrakcijskih premikov od 1. do 3. obsevanja in od 13. do 15. obsevanja ter na podlagi rezultatov anketnih vprašalnikov smo ugotovili, da psihološki dejavniki (strah, tesnoba, negotovost) niso imeli statistično značilnega vpliva na interfrakcijske premike.Introduction: Breast cancer is a heterogeneous disease and it is the second most common cancer in Slovenian female population. It is fundamentally treated with radiation therapy. Modern irradiation techniques require appropriate verification processes which ensure that the target volume is irradiated as provided in the irradiation plan. The daily positioning of the patient to the irradiation position involves several uncertainties, the most important being intrafractional and interfractional motion. Interfractional shifts are shifts between individual irradiations and show daily deviations from the planned isocenter. Breast cancer is one of the most researched diseases due to various psychological and psychosociological aspects of the disease. Psychological discomfort in patients treated for breast cancer is associated with depression, anxiety, fear, anger, low self-esteem and low emotional support. Purpose: To determine how psychological factors (fear, anxiety and uncertainty) affect interfraction motion in complementary postoperative irradiation of breast cancer. Methods: From January 2020 to May 2021 we conducted a survey within a cross-sectional prospective study at the study at the Ljubljana Oncology Institute. As a measuring instrument, we used the recording of interfractional motion in x, y, z directions (in mm) and a patient survey with two questionnaires on the influence of psychological factors on interfraction motion in complementary postoperative iradiation of patients with breast cancer. The study included 40 patients who underwent adjuvant radiation therapy with 3D CRT or IMAT/VMAT technique in free breathing and in the antero-posterior position. The patients were irradiated on a linear accelerator manufactured by Elekta, model Synergy. The data was analyzed with a statistical analysis program. Results: We were not able to confirm the correlation of demographic factors and iterfraction motion with statistical tests, nor did we confirm the statistical characteristics of the correlation between interfraction motion and patient awareness of radiation therapy. Furthermore, we came to the conclusion that psychological factors are not statistically more significant before the first irradiation than before the fifteenth irradiation, nor are there statistically significant differences between interfraction motion measured from 1st to 3rd irradiation and from 13th to 15 irradiation. Based on the statistical analysis results, we came to the conclusion that psychological factors do not statistically significantly affect the magnitude of interfraction motion. Discussion and conclusion: Based on the recording of interfraction motion from 1st to 3rd and from 13th to 15th irradiation and based on the results of the questionnaires, we conducted that psychological factors (fear, anxiety, uncertainty) did not have a statistically significant effect on interfractional motion