Sowing the seeds of knowledge in brachytherapy
Claire Deering: why it is our duty to ensure we do all that we can to understand brachytherapy for better patient care.
Oncology clinical nurse specialists (CNSs) are at the heart of multidisciplinary teams (MDTs). They make an invaluable contribution to supporting patients across the whole care pathway.
It is essential that nurses are able to communicate in-depth knowledge about a person's disease and all the treatment options available to them.
In the case of prostate CNSs, this leads to an interesting conundrum: a high number of prostate CNSs do not yet have access to the full range of services, available which presents limitations in their understanding of them, however it is our clinical duty to be able to give patients informed and impartial answers. One treatment where access and knowledge can be limited is brachytherapy – a form of internal radiotherapy that directly targets the affected area and is sometimes called implant therapy or seed implantation.
The clinical duty
CNSs empower patients to make the right choices about their care – and research continually shows that their support is pivotal to the patient experience.
In brachytherapy, patient experience is one of its strongest suits. The treatment is proven to present a reduced risk of side effects compared to other treatment options such as radical prostatectomy (RP) and external beam radiotherapy (EBRT). The risk of incontinence after brachytherapy is far lower than is the case in surgery, radiation and active surveillance. It is also associated with shorter recovery times and reduced overall treatment times, making it less disruptive to patients’ lives.
The impact on overall survival following brachytherapy is also important. Comparative effectiveness studies show that low dose rate (LDR) monotherapy brachytherapy reports recurrence-free survival rates similar to those for EBRT and RP in low and intermediate risk patients (Potters et al 2005, Sylvester et al 2011). And it is proving effective in high-risk patients too. Level one randomised controlled studies now show that in high-risk prostate cancer patients, an LDR brachytherapy boost in combination with EBRT, survival rates are higher than in radiotherapy alone (Morris et al 2017).
Of course, brachytherapy is not appropriate or recommended for everyone, with clear National Institute for Health and Care Excellence (NICE) guidance determining its use in the UK (NICE 2005). As a brachytherapy nurse specialist, it’s comforting for me to have the evidence to reassure patients that the only decision we’re asking them to make is to choose the treatment with the side-effect profile that’s likely to suit them best.
The biggest barrier to the wider uptake for this important treatment option in the UK is its availability. There remains great geographic variability in this regard. But we cannot afford to neglect it. As patient interest in brachytherapy grows, it’s our duty to ensure we do all that we can to understand it and to share that understanding among ourselves and, crucially, with our patients.
- Kishan A, Shaikh T, Wang P (2017) Clinical outcomes for patients with Gleason score 9-10 prostate adenocarcinoma treated with radiotherapy or radical prostatectomy: a multi-institutional comparative analysis. 71, 5, 766-773.
- Morris W J, Tyldesley S, Rodda S et al (2017) Androgen suppression combined with elective nodal and dose escalated radiation therapy (the ASCENDE-RT Trial): an analysis of survival endpoints for a randomized trial comparing a low-dose-rate brachytherapy boost to a dose-escalated external beam boost for high- and intermediate-risk prostate cancer. International Journal of Radiation Oncology, Biology, Physics. 98, 2, 275-285.
- National Institute for Health and Care Excellence (2005) IPG 132: Low dose rate brachytherapy for localised prostate cancer.
- Potters L, Morgenstern C, Calugaru E et al (2005) 12-year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. The Journal Urology. 173, 5, 1562-1566.
- Sylvester JE, Grimm PD, Wong J et al (2011) Fifteen-year biochemical relapse-free survival, cause-specific survival, and overall survival following I(125) prostate brachytherapy in clinically localized prostate cancer: Seattle experience. International Journey of Radiation Oncology Biology Physics. 81, 2, 376-81.
About the author
Claire Deering is a brachytherapy clinical nurse specialist at Royal Surrey County Hospital NHS Foundation Trust.