Authors (including presenting author) :
Ng AFT(1), Lau TTS(2), Wong TWL(3)(4), Yuen JPM (1), Leung CYY (1)
Affiliation :
(1)Physiotherapy Department, Princess Margaret Hospital, (2)Department of Oncology, Princess Margaret Hospital, (3)Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, (4)School of Public Health, LKS Faculty of Medicine, The University of Hong Kong
Introduction :
Post-surgery radiation therapy (RT) has been shown to significantly reduce locoregional recurrence and improves survival for breast cancer patients compared with surgery alone. Despite its benefits, RT to the breast can result in complications. Solid evidence has shown cardiac mortality and morbidity to be a long-term complication of left breast irradiation. One of the treatment techniques, which can reduce the radiation dose to the heart, is called Deep Inspiration Breath Hold (DIBH) technique. During inspiration, lungs fill with air and move the heart away from the chest wall, which can locate the heart in a more favorable position. The success of DIBH is therefore depended on the fully understanding of the procedure and mastering of the technique by the patient. Collaboration between the Physiotherapy and Oncology Departments in Princess Margaret Hospital is introduced in March 2019 to facilitate DIBH training for Left breast cancer patients.
Objectives :
To review service of early Physiotherapy training on the DIBH technique to Left breast cancer patients at the Princess Margaret Hospital.
Methodology :
A service review was performed between March to December 2019 at the Princess Margaret Hospital. Patients with Left breast cancer required RT and also have one of the moderate to severe cardiac comorbidities, including significant myocardial insufficiency, congestive heart failure, ischaemic heart disease, cardiomyopathy, severe valvular heart disease, high-risk uncontrolled arrhythmias, poorly controlled hypertension, were referred to Physiotherapy by Oncology doctors. To facilitate early appointment, a dedicated Physiotherapist was responsible to ensure training can be provided before start of RT planning. During individual training session, DIBH technique was taught in a simulated position and educational material was given to encourage home practice. Other Physiotherapy intervention, such as mobilization exercise, use of incentive spirometer, and visual feedback, was also included to facilitate performance of deep inspiration.
Result & Outcome :
In total, twenty patients were referred, with the age range from 36 to 78 years old (mean=58, SD=12.79 years). All patients had their DIBH training before the start of their RT planning. Two patients are still waiting to have their RT planning done. Out of the eighteen patients who have their RT planning completed, thirteen patients (72.2%) were successful in using DIBH technique during RT and five patients (27.8%) failed. The reasons for failure included predisposed irritable airway, enlarged heart that is too closed to the chest wall, and restricted lung expansion.
A 5-point likert scale of patient satisfaction survey was used to collect feedback post training. The level of satisfaction is categorized into five levels: very satisfied, satisfied, neutral, dissatisfied, very dissatisfied. The result indicated very high level of satisfaction on the service. All patients were either very satisfied or satisfied with the duration of treatment time, explanation and practicing on the DIBH technique, teaching of other shoulders mobilization exercise and method to improve deep breathing and also overall increased their confidence on performing DIBH during RT.
In conclusion, patient coaching before RT could enhance the success of using DIBH for Left breast cancer patients. It can also increase the cost-effectiveness (reduce the simulation time and increase the number of patients) on the simulation procedure.
