Jodi Waugh
Calvary Mater Newcastle Department of Radiaton Oncology
Radiation Therapist/ Clinical Specialist Brachytherapy

Geetha Govindarajulu
Senior Staff Specialist Radiation Oncology/Conjoint Lecturer
Calvary Mater Newcastle/University of Newcastle

Annette Skov
Treatment Supervisor/ARIA Administrator
Calvary Mater Newcastle

Background and Purpose

The Calvary Mater Newcastle (CMN) is the only New South Wales Radiation Oncology Treatment Centre outside of the Sydney metropolitan area offering High Dose Rate (HDR) brachytherapy for the management of gynaecological cancers. In 2016, 50% of the patients referred to the CMN were from the local area and 50% were from regional NSW centres. Follow-up of patients is dependent on the type of brachytherapy received, the referring specialist and the patient’s willingness to travel to Newcastle for appointments. Often, patients are lost to follow-up; hence, the CMN does not receive information regarding treatment outcomes or chronic toxicities. In 2014, the CMN commenced a telephone follow-up study to collect patient reported toxicity data.

Methods

All patients receiving HDR brachytherapy for endometrial, cervical and vaginal cancers were invited to participate in the study. Patients received a letter outlining the purpose of the study, the frequency of contact and a copy of the questionnaire. Written consent was obtained after the last fraction in person or returned by mail.

A brachytherapy radiation therapist contacted the patients every three months by telephone and completed a toxicity questionnaire. The questions were based on the LENT/SOMA Patient Questionnaire and Toxicity grading of late effects, EORTC QLQ-C30 and CTAE grading. All data was recorded in Microsoft Excel® and questionnaire answers in the patient’s electronic medical record (VARIAN ARIA®).

Results

In the first 12 months of the study, 50 patients consented. Thirty-one patients were able to be contacted by telephone and 19 patients were uncontactable. Not all 31 patients could be contacted at each of the 3 month time points; however 62% had responded at the 6 month time point.

Patients reported little chronic toxicity at 6 months. Minor bladder symptoms included frequency (22.6%), leakage (35.5%) and dysuria (9.7%). Vaginal complaints included minor discharge (16.1%) and minor bleeding (6.5%). Gastrointestinal complaints included urgency (19.4%), diarrhoea (ranging from little, 22.6% to quite a bit, 3.2%). Dilator compliance was reasonable, 48.4% of patients used dilators 1 to 2 times per week and 6.2% using them more than 2 times per week.

Conclusion

The telephone follow-up method has proven to be useful for patients who have received brachytherapy. Regular contact with a brachytherapy radiation therapist provided an opportunity to have questions and concerns addressed, especially for those from regional centres follow-up of these patients will continue for 5 years with annual evaluation of the results.


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