Patient experience preparing for prostate cancer radiotherapy

Abstract

Introduction

Bladder and rectal preparation regimes for prostate cancer (PCa) radiotherapy (RT) can heighten anxiety before and during RT. Patient’s perception of RT preparation is under-represented in the literature. To address this gap, patient’s experience of preparation with respect to understanding, comfort, anxiety, effectiveness and impact on daily life was examined.

Materials and methods

A novel patient preparation survey was created and validated, it contained 12 original questions related to general, bladder and rectal preparation. Plus, the Patient Health Questionnaire 4 (PHQ4) and question 15 of the Expanded Prostate Cancer Index Composite (EPIC).

Eligible patients were individuals referred for prostate or prostate bed +/− pelvic lymph node RT from March-May 2024. Surveys were issued immediately after the patient’s planning scan, those completing the survey at this timepoint were asked to repeat it in their first and final weeks of RT.

Results

The survey was completed by 103/125 eligible patients at their planning scan, 47/103 in the first and 52/103 in the final week of RT. Perception of preparation was largely positive. For general and bladder preparation positive question response rate ranged from 55 to 98 % and negative from 0 to 26 %. Rectal preparation response rate was 59–100 % positive and 0–35 % negative. Difficulty maintaining a full bladder and using enemas was greatest at the end of RT.

No significant difference in experience was found for participants using or not using enemas for preparation. Anxiety and depression (PHQ4) affected 12–13 % of respondents, and significantly more patients reported bowel toxicity (EPIC), in the last week of RT compared to earlier timepoints.

Conclusion

The authors conclude that the preparation needs of their patients are well met. However, a considerable number did find preparation difficult, disruptive and ineffective, more so at the end of treatment. Further qualitative analysis of patient’s experience is needed to better understand why individuals experience varies.