3268 - A Systematic Approach to Improving Patient Compliance and Experience for Breath-Hold Radiotherapy in Breast Cancer

Purpose/Objective(s):

Respiratory-gated radiotherapy (RGRT) is recommended by the National Comprehensive Cancer Network (NCCN) to mitigate cardiac and pulmonary toxicities. Deep inspiration breath-hold (DIBH) techniques can reduce mean heart dose by 40%-60%. Despite established RGRT protocols at our institution, patient compliance, defined as the proportion of patients successfully completing RGRT among those referred, was only half. The present study aimed to improve adherence and optimize patient experience through a structured quality-improving project.

Materials/Methods:

A baseline assessment in August 2022 found a RGRT compliance rate of 56% (49/88 patients). A retrospective analysis identified multiple factors: inconsistencies in radiation therapists’ guidance, subjective physician judgments, difficulties in patient comprehension, instability in breath-holding due to exertion, anxiety, discomfort from immobilization, insufficient educational materials, lack of self-practice, muscle fatigue, and immediate scheduling post-surgery.

Multi-disciplinary interventions using the Plan-Do-Check-Act (PDCA) cycle were implemented. We focused on three key domains: (1) optimize clinical operations through standardized training for radiation therapists and systematic handover mechanisms, (2) improve patient engagement via instructional videos, structured home-based respiratory training, and enhanced educational resources, and (3) increase patient comfort by refining immobilization techniques and integrating adaptive supportive measures. These interventions were systematically monitored for adherence and effectiveness.

Results:

Following these interventions, the RGRT compliance rate improved from 56% (49/88) to 82% (23/28) by December 2023 (P < 0.01). A follow-up analysis in December 2024 confirmed sustained improvement, with patient compliance rates maintained at 83% (84/101; P < 0.0001). In addition, patient comprehension of breath-hold techniques increased from 85.9% to 92.9% (P = 0.17), and treatment-related anxiety decreased from 23.4% to 10.7% (P = 0.08). Overall patient satisfaction improved significantly, rising from 47% to 90% (P < 0.001), with comfort levels increasing from 46% to 92% (P < 0.001).

Conclusion: Using medical quality-improving interventions enhances the healthcare team's work efficiency and healthcare quality, improves patient treatment stability and comfort, and then increases patient compliance with RGRT. Treatment side effects may be therefore reduced. Moreover, these results support ongoing efforts to refine RGRT protocols and extend best practices across multiple institutions for broader clinical adoption.