Qualitative exploration of patients’ experiences with Intrabeam targeted intraoperative radiotherapy (TARGIT-IORT) and External-Beam Radiotherapy Treatment (EBRT)

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Abstract For patients with early breast cancer undergoing breast conserving surgery, radiotherapy is given either as a post-operative course of External-Beam RadioTherapy (EBRT), given daily for over a number of days and often weeks, or with TARGeted Intrabeam Intraoperative radioTherapy (TARGIT-IORT), which is delivered, during surgery under the same anaesthetic. Several studies have reported the quantitative Quality-of-Life (QoL) benefits of TARGIT-IORT over EBRT. This qualitative study was designed to gather a deep understanding of the benefits and impacts of receiving EBRT or TARGIT-IORT as perceived by patients. It also captured how differently the treatments affected the lived experience of the patient and their care partner through their treatment journey. A patient-led Working Group was established to guide study design, delivery and to help validate findings. Patients with experience of receiving EBRT or TARGIT-IORT were first purposively sampled by Hampshire Hospitals NHS Foundation Trust after which a randomiser was applied to ensure the final selection process was free from bias. In February and March 2023, 29 semi-structured interviews (15 EBRT, 14 TARGIT-IORT) were conducted virtually via Zoom. Thematic analysis of verbatim interview transcripts was then carried out by two coders generating 11 themes related to either EBRT or TARGIT-IORT. A number of procedural grievances were noted among EBRT patients. EBRT was perceived as being disruptive to a range of normal routines (work, home-life, and the burden of travel), and dissatisfying due to discomfort of side effects. TARGIT-IORT was perceived by patients and care partners as being efficient (given while they are asleep during surgery and without additional hospital visits) with minimal if any disruptions to QoL and that it was the safer option. The need for adequate, accessible information provision at the right time to reduce anxieties was noted in both cohorts. These new insights are valuable for healthcare staff and policy makers and could help incorporate the two treatments into routine practice. Further research is now needed to explore TARGIT-IORT in more diverse populations and in the 35 other countries where it is already a well- established treatment option.

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