The Patient’s Perspective on Breast Radiotherapy: Initial Fears and Expectations Versus Reality

Authors: Shaverdian, N. et. al.
Source: Cancer 2018;124:1673-81 https://www.ncbi.nlm.nih.gov/pubmed/29479673

Radiotherapy (RT) is instrumental in the treatment of breast cancer.  It reduces the risk of local recurrence and improves survival.  Breast conservation therapy (lumpectomy and RT) has repeatedly been shown to have equivalent outcomes compared to mastectomy.  In some cases, it improves recurrence and survival rates following mastectomy.

The authors noted that, despite many advances in the field of RT, many patients still do not perceive it as “modern” therapy and describe feelings of fear and anxiety about it.  They sought to determine what patients’ specific perceptions are, and if they hold true for the patients after treatment is complete.

Eligible patients were at least 6 months out from RT.  Over 320 participants answered questions about their baseline knowledge and fears of RT.  They also compared their short-term and long-term side effect experiences with their expectations.  Most of the respondents were white, married and college graduates.  The median age was 59 years.

Almost 70% of the women stated that they had little or no knowledge of RT at the time of their diagnosis.  Four percent of the women stated that they had a great deal of knowledge, and the most common source of this knowledge was friends and family.

Nearly half of the respondents recalled frightening stories of RT side effects, such as organ damage, skin burning, being radioactive, being unable to perform daily functions, having a damaged immune system, being in pain and feeling tired and weak.

Only 3% of participants found the negative stories they heard or read to be true based upon their own experiences.  About 85% of women noted that their RT experiences were “less scary” than expected.

Regarding short-term RT toxicity (severity of breast pain, sensitivity, skin changes, energy level, limits to activities, time feeling ill, disruption to family) and long-term RT toxicity (breast size change, lymphedema, bad breast appearance, body dissatisfaction), about 84% of respondents noted that their side effects were less than or as expected.  These experiences were the same regardless of the type of RT received (standard dose, hypofractionated, accelerated partial breast, post mastectomy RT).

This study suggests that most breast cancer patients who are recommended for RT may have negative preconceptions about the treatment.  This certainly can affect their experiences and may also influence the trend towards total mastectomy over breast conserving therapy.  If women are informed about first hand experiences with RT, and if they understand that the majority of breast cancer patients who shared their expectations had better outcomes than anticipated, their acceptance of RT could be improved.