A new era in breast cancer radiotherapy : perceptions of radiotherapy staff regarding the FAST-forward trial

Abstract

Purpose: There is evidence that the FAST-Forward (FF) protocol is non-inferior to the previous standard protocol for breast cancer radiotherapy (START protocol). However, the evidence may be incomplete for certain indications (e.g., lymph node irradiation), endpoints (e.g. late side effects) and impact on workflow. Therefore, this study aims to better understand the perspectives of RT professionals regarding the introduction and implementation of the FF protocol as well as its benefits and disadvantages. Methodology: This study made use of a cross-sectional, quantitative approach. A self-designed questionnaire was distributed to oncologists, radiographers, medical physicists, and nurses in a local radiotherapy department. The questionnaire collected data regarding i) the professional demographics of the participants, ii) Likert scale questions to evaluate the level of agreement with statements related to FF protocol (1 = “strongly disagree”; 5 = “strongly agree”) and iii) open questions to further explore staff’s opinions. The data was analysed using descriptive and inferential statistics and thematic analysis. Results: A total of 19 RT professionals participated in the study. Oncologists and nurses did not respond to the questionnaire. RT staff agreed that the FF protocol should be the standard of care for breast cancer patients (Q8, Q23, mean score: 4.00, 3.94). They also acknowledged its importance during and after the COVID-19 pandemic (Q5, Q22, mean: 4.18, 4,18). RT professionals also agreed or strongly agreed that the FF protocol benefits their personal and the department’s workflow while also providing financial, emotional, physical, and psychological benefits for the patients (Q9, Q10, Q14, Q15, mean: 4.70, 4.65, 3.94, 4.35). Disagreement was observed with the standard of care for node-positive patients becoming the FF protocol (Q19, mean: 2.29). RT staff expressed neutrality to the FF being used only for patients >50 years and for the protocol to be used only with respiratory gating (Q20, Q21, mean – 3.00, 3,18). Staff who consider themselves familiar with the evidence about the FF trials and related research showed more confidence in using the FF protocol than those unfamiliar with it (p<0.005). Conclusion: The FF protocol should be the standard of care for node-negative breast cancer patients requiring radiotherapy. Additional evidence is needed to increase staff’s confidence in using the FF protocol for women younger than 50, when respiratory motion control is not used and for radiotherapy for the lymph node regions.