Patient expectation and experience of MR-guided radiotherapy using a 1.5T MR-Linac

Abstract

Background and purpose: Online adaptive MR-guided radiotherapy (MRgRT) is a relatively new form of radiotherapy treatment, delivered using a MR-Linac. It is unknown what patients expect from this treatment and whether these expectations are met. This study evaluates whether patients' pre-treatment expectations of MRgRT are met and reports patients' on-table experience on a 1.5 T MR-Linac.

Materials and methods: All patients treated on the MR-Linac from November 2020 until April 2021, were eligible for inclusion. Patient expectation and experience were captured through questionnaires before, during, and three months after treatment. The on-table experience questionnaire included patient' physical and psychological coping. Patient-expected side effects, participation in daily and social activity, disease outcome and, disease related symptoms were compared to post-treatment experience.

Results: We included 113 patients who were primarily male (n = 100, 89 %), with a median age of 69 years (range 52-90). For on-table experience, ninety percent of patients (strongly) agreed to feeling calm during their treatment. Six and eight percent of patients found the treatment position or bed uncomfortable respectively. Twenty-eight percent of patients felt tingling sensations during treatment. After treatment, 79 % of patients' expectations were met. Most patients experienced an (better than) expected level of side effects (75 %), participation in daily- (83 %) and social activity (86 %) and symptoms (78 %). However, 33 % expected more treatment efficacy than experienced.

Conclusion: Treatment on the 1.5 T MR-Linac is well tolerated and meets patient expectations. Despite the fact that some patients expected greater treatment efficacy and the frequent occurrence of tingling sensations during treatment, most patient experiences were comparable or better than previously expected.

Keywords: MR-Linac; MRgRT; Patient reported experience measures (PREM); Patient reported outcomes.

Fig. 1

Flowchart of patients included for analysis after in- and exclusion criteria.Abbreviations: MOMENTUM = the The Multi-OutcoMe EvaluatioN of radiation Therapy Using the Unity MR-Linac Study, MRL = MR-Linac, QoL = Quality of Life.A Q1 Expectation: Questionnaire capturing pre-treatment expectation of patients.B Q2 On-Table Experience: Questionnaire capturing on-table experience of patients after 3rd fraction.C Q3 Total experience: Questionnaire capturing the totals experience of the treatment 3 months after treatment.D Q1 vs Q3: patients that completed Q1 and Q3 questionnaires.^# Patients who had their first fraction and before receiving the first questionnaire were considered screen failure.

Fig. 2

Patient on-table experience of their MR-Linac treatment stratified into positive and negative answers.1 = 82 patients answered the questions (n = 82)0.2 = 83 patients answered the questions (n = 83)0.3 = 73 patients listened to music and answered the question (n = 73) Questions are ranked from smallest to most amount of ‘most positive’ patients.

Fig. 3

Flow of patient expectation and experience of their high field MR-Linac treatment.Flow for 59 patients from expectation before MR-Linac treatment on the right to experience after MR-Linac treatment on the left. Fifty-seven, nine, and fifty eight patients responded to the questions on disease course, disease related symptoms and social activities respectively.

Fig. 4

Expectation versus experience for 59 patients treated on an MR-Linac.Fifty-seven, nine, and fifty eight patients responded to the questions on disease course, disease related symptoms and social activities, respectively.