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Vienna, Austria

ESTRO 2023

Session Item

Sunday
May 14
16:45 - 17:45
Schubert
Patient perspectives
Danielle Fairweather, United Kingdom;
Elizabeth Forde, Ireland
Proffered Papers
Interdisciplinary
16:45 - 16:55
Barriers for inclusion in a proton therapy trial among Danish patients with head and neck cancer
Anne Kristensen, Denmark
OC-0589

Abstract

Barriers for inclusion in a proton therapy trial among Danish patients with head and neck cancer
Authors:

Anne Kristensen1, Jeppe Friborg2, Kenneth Jensen3, Jesper Grau Eriksen4, Christian Maare5, Mohammad Farhadi6, Jørgen Johansen7, Christian Rønn Hansen7, Maria Andersen8, Susanne Dalton9, Cai Grau3

1Aarhus University Hospital, Danish Centre for Particle Therapy, Aarhus , Denmark; 2Rigshospitalet, Department of Oncology, Copenhagen , Denmark; 3Aarhus University Hospital, Danish Centre for Particle Therapy, Aarhus, Denmark; 4Aarhus University Hospital, Department of Oncology, Aarhus, Denmark; 5Herlev Hospital, Department of Oncology, Herlev, Denmark; 6Zealand Hospital, Department of Oncology, Naestved, Denmark; 7Odense University Hospital, Department of Oncology, Odense, Denmark; 8Aalborg University Hospital, Department of Oncology, Aalborg, Denmark; 9Danish Cancer Society Research Center, Survivorship & Inequality in Cancer, Copenhagen, Denmark

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Purpose or Objective

In Denmark proton therapy (PT) is offered in one centralised treatment facility and for patients with head and neck cancer (HNC) only by participating in a randomized trial.

Candidates for this trial are identified in a model-based selection procedure where treatment plans with photons and protons are compared. Normal tissue complication probability (NTCP) are used as a biomarker for expected benefit of PT. If the treatment plan comparison indicates a difference in NTCP above 5% on the risk of dysphagia or xerostomia, the patient is eligible for the trial. This procedure results in one extra week before treatment start.

Purpose

  1. Investigate to which extent patients with HNC were evaluated for inclusion in a trial comparing radiotherapy with photons and protons.
  2. Explore patient - and physician related barriers to participate in the PT trial as well as the patient perspective regarding treatment in a centralised proton clinic.

Material and Methods

Study 1

Patients with larynx- and pharynx cancer referred to curative intended radiotherapy were prospectively registered on a screening log at six Danish radiotherapy clinics. The screening log contains data on the amount of performed and non-performed treatment plan comparisons and reasons for non-performed plans.

Study 2

Semi-structured interviews with HNC patients rejecting trial participation and physicians from the six Danish radiotherapy clinics are conducted. The interviews were audio-recorded, transcribed and will be analyzed based on Interpretive Description methodology.

Results

Study 1
From October 2020 to September 2022, 653 patients were screened for inclusion.

517 (79%) did not proceed to a dose plan comparison and thus the possibility of inclusion in the trial. The reasons were due to clinical barriers (23%), structural barriers (17%) or patients' rejection mainly due to distance to the treatment facility (39%).

136 patients (21%) had a comparative dose plan performed and, 80 of these comparisons showed a potential benefit of PT, leading to trial inclusion.

Study 2
During 2022, 19 interviews were conducted. The analysis is ongoing. Ready for presentation at ESTRO 2023.

The preliminary findings indicates the following  barriers to the PT trial.

  • Stay home with family nearby
  • Begin treatment immediately due to active cancer
  • Treatment effect seems more important to the patient's than late toxcicities
  • Once trust has been build up in the local clinic, patients prefer to stay here
  • Uncertainty regarding the randomization procedure and information material
  • Different ways in which physicians communicate clinical trials
  • Gatekeeping function in local clinics
  • Different perspectives on shared decision-making

Conclusion

The majority (79%) of patients screened for inclusion did not proceed to the treatment plan comparison.

A qualitative study are conducted to explore the underlying barriers for trial participation. Patients decide trial participation based on the feelings in the present situation and find it difficult to take future toxicities into account.