Patient Perspectives on Reirradiation for Recurrent Cancer, to Inform Future Clinical Trial Design.

Abstract

AIMS: There is increasing interest in the potential benefits of reirradiation for recurrent or new primary cancers close to or within a previously irradiated region, but there is a need for high-quality studies to evaluate this approach. This study aimed to understand patient and carer perspectives regarding reirradiation, future clinical trial design, and the potential role of advanced technologies.

MATERIALS AND METHODS: Semi-structured interviews were conducted with patients who underwent reirradiation, and their carers. Patients were in follow-up and were approached about the study by their oncologist. Analysis was informed by principles of thematic analysis.

RESULTS: Interviews involving 11 patients and 5 carers were conducted and analysed. Five themes were developed: 1. Considerable psychological impact from a diagnosis of recurrent cancer; 2. Influences on decision making for reirradiation; 3. Experience of reirradiation; 4. Considerations for future clinical trial design; 5. Considerations regarding advanced technologies in reirradiation. Patients and carers described the impact they had experienced from a recurrent cancer diagnosis, the strong influence of their treating oncologists on decision making regarding reirradiation, and absence of decision regret. In terms of future clinical trial design, study arms without reirradiation, especially if these contain no active treatment, may be less acceptable to patients. Some patients would be prepared to travel or temporarily relocate for reirradiation using advanced technologies such as proton beam therapy, but for others the family/social/financial impact would make this challenging.

CONCLUSION: This study has provided important insights from patients and their carers regarding reirradiation for recurrent cancer. Perspectives regarding clinical trials and advanced technologies will help to shape future study design.