Deep Inspiration Breath Hold for left-sided breast cancer: experience from the patient’s perspective

Abstract

IntroductionThe dosimetric benefits of Deep Inspiration Breath Hold (DIBH) in reducing cardiac dose are well documented, however reports on the patient’s personal experience with this technique are limited. The purpose of this research is to investigate DIBH from the patient’s perspective and to provide recommendations to further improve the patient experience.Materials and methodsA questionnaire was used to record the patient’s comprehension of DIBH instructions and preparation for treatment. Levels of comfort, confidence and technical challenge were also recorded and an open-format question allowed patients to provide suggestions to improve the DIBH experience.ResultsThe majority of patients do not find it difficult to hold their breath at the correct level during DIBH and confidence levels regarding ability to follow instructions are good. Comprehension of instructions, preparation to perform DIBH and treatment position comfort levels were universally graded positively.ConclusionThe majority of patients reported a strong level of comprehension and preparation that allows them to confidently perform DIBH as planned. Establishment of a dedicated treatment team, consistent patient instructions, regular feedback and an opportunity to rehearse DIBH can help increase patient confidence and reduce anxiety.

Deep inspiration breath hold in breast cancer: Development and analysis of a patient experience questionnaire

“…The increased risk is proportional to the mean dose of radiation delivered to the heart. The addition of potentially cardiotoxic chemotherapy is a further complication to many of these patients and thus it is recommended that the radiation dose delivered to the heart be kept as low as reasonably possible . DIBH treatment has been developed to facilitate reduction in cardiac dose, by achieving the maximum separation between the treatment target area and heart, without compromise on the target volume coverage …”

Prolonging deep inspiration breath-hold time to 3 min during radiotherapy, a simple solution

“…All participants understood the technique, they could execute it well and felt satisfied afterwards. During the examinations we focused on creating a safe and repeatable environment with clear and simple instructions, since previous research has shown this improves the patient experience [18] , [39] . To create this environment, appropriate monitoring of the patients is required.…”

“…multi-beam intensity modulated radiotherapy (IMRT) for whole breast with lymph node irradiation, beam-on time can be extended to up to 5 min, especially in combination with hypofractionated schedules [15] , [16] . Therefore, a high number of consecutive short DIBHs are required, leading to stress for the patient, position changes and the inability of treatment in DIBH due to exhaustion for many patients [17] , [18] . Also, previous research has shown a moderate correlation between positional errors, mostly in the superior-inferior direction, and the number of DIBHs required, especially when treating the lymph node regions.…”