Preparation of the breast cancer patient for radiotherapy planning

Objective Approximately half of those patients who require surgery for breast cancer will be referred for a course of post-operative radiotherapy. In view of the increased risk of radiation dosage error associated with the inability to maintain the planning position when being prepared for radiotherapy, and the position of arm abduction and external rotation needed, this study was carried out to investigate the extent of patient preparation, and to identify factors that could influence that preparation.

Design Observational cohort study

Setting Outpatient radiotherapy planning clinic in South Wales oncology centre

Participants A convenience sample of 30 patients referred for radiotherapy following breast surgery

Main outcome measures Positioning standard assessed by therapeutic radiographers completing a questionnaire immediately after the planning session. Baseline data collection included functional deficit, shoulder joint range, type of surgery, compliance with the physiotherapy exercises and prior knowledge of radiotherapy planning routine.

Results Seven out of 30 patients (23%) did not achieve a satisfactory radiotherapy planning position. Satisfactory performance was associated with full range of abduction/elevation (Fisher’s exact test, P < 0.001) and compliance with the exercise regime (Fisher’s exact test, P = 0.048). Satisfactory planning position, coupled with the ability to maintain the position without visible signs of fatigue, was associated with prior knowledge of the planning routine (chi-square test, P = 0.002).

Conclusion Physiotherapy for the postoperative breast cancer patient should consider the radiotherapy planning position for appropriate candidates and develop strategies to improve compliance with an exercise regime.