Exploring patient perceptions of the current breast radiotherapy pathway and a future upright radiotherapy solution

Abstract

Introduction: Breast cancer remains a major global health challenge. Around 60 % of patients receive radiotherapy as part of their treatment, typically in the supine position. Upright positioning offers an alternative, potentially reducing treatment room costs. This study explored patient perceptions of (i) conventional supine treatments and (ii) upright positioning.

Methods: Women with lived experience of breast radiotherapy joined a participatory co-design workshop with healthcare practitioners, academics, and industry researchers. The workshop included three stages: 1) Sharing Experiences, participants discussed lying-down radiotherapy, including positioning aids and in-room experience; 2) Improving Experience, the group explored ideas to enhance patient experience; 3) Upright Experience, participants sat for 10 min in a demonstrator upright radiotherapy chair, provided comfort scores, comments, and completed short questionnaires comparing it to supine treatment. Discussions were audio-recorded, transcribed, and analysed using framework analysis. A live-drawing artist captured key themes. Participants sense-checked reported themes to ensure trustworthiness.

Results: Ten women aged 37-69 years participated; 80 % were white British and 20 % mixed heritage. Time since radiotherapy ranged from 9 months to 4 years. Six themes emerged: 1) Everyone has a different journey, 2) The whole journey is hard, 3)"Radiotherapy will be a breeze", 4) Understanding positioning and environment, 5) The 'worst' radiotherapy service: what might that look like? 6) The 'best' radiotherapy service: what might that look like? Overall, upright positioning was viewed favourably: 77.8 % of participants found the upright demonstrator chair comfortable, compared with 11.1 % for supine position experienced for treatment (n = 9).

Conclusion: This study reinforces previous research findings on the emotional and physical experiences of supine radiotherapy; new insights were patient-determined service improvements.

Implications for practice: Upright radiotherapy may improve comfort and emotional well-being, offering new opportunities for patient-centred radiotherapy.

Keywords: Breast cancer; Patient experience; Radiotherapy; Upright radiotherapy.