Time-action and patient experience analyses of locally advanced cervical cancer brachytherapy

Sharline M. van Vliet–Pérez*, Rosemarijn van Paassen*, Linda S.G.L. Wauben, Robin Straathof, Nick J.van de Berg, Jenny Dankelman, Ben J.M. Heijmen, Inger–Karine K. Kolkman–Deurloo, Remi A. Nout

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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BACKGROUND AND PURPOSE: Although MRI-based image guided adaptive brachytherapy (IGABT) for locally advanced cervical cancer (LACC) has resulted in favorable outcomes, it can be logistically complex and time consuming compared to 2D image-based brachytherapy, and both physically and emotionally intensive for patients. This prospective study aims to perform time-action and patient experience analyses during IGABT to guide further improvements. MATERIALS AND METHODS: LACC patients treated with IGABT were included for the time-action (56 patients) and patient experience (29 patients) analyses. Times per treatment step were reported on a standardized form. For the patient experience analysis, a baseline health status was established with the EQ-5D-5L questionnaire and the perceived pain, anxiety and duration for each treatment step were assessed with the NRS-11. RESULTS: The median total procedure time from arrival until discharge was 530 (IQR: 480–565) minutes. Treatment planning (delineation, reconstruction, optimization) required the most time and took 175 (IQR: 145–195) minutes. Highest perceived pain was reported during applicator removal and treatment planning, anxiety during applicator removal, and duration during image acquisition and treatment planning. Perceived pain, anxiety and duration were correlated. Higher pre-treatment pain and anxiety scores were associated with higher perceived pain, anxiety and duration. CONCLUSION: This study highlights the complexity, duration and impact on patient experience of the current IGABT workflow. Patient reported pre-treatment pain and anxiety can help identify patients that may benefit from additional support. Research and implementation of measures aiming at shortening the overall procedure duration, which may include logistical, staffing and technological aspects, should be prioritized.

Original languageEnglish
Pages (from-to)274-281
Number of pages8
Issue number3
Publication statusPublished - 2024


Disclosures: R.A. Nout has received research grants from the Dutch Cancer Society (KWF), the Dutch Research Council (NWO-LSH), Elekta, Varian, and Accuray. J. Dankelman has received research grants from the Dutch Cancer Society (KWF) and the Dutch Research Council (NWO-LSH). The remaining authors have no relevant conflicts of interest to disclose. This work was supported by the Dutch Cancer Society (KWF), the Dutch Research Council (NWO-LSH), Elekta and Oceanz (grant number 17921).


  • Anxiety
  • Brachytherapy
  • Duration of therapy
  • Pain
  • Uterine cervical neoplasms
  • Workflow


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