Abstract
To determine the current U.S. practice patterns of analgesia (AG) and anesthesia (AS) for gynecologic brachytherapy (BT) procedures.
A 27-item survey created with expertise from five brachytherapists was distributed electronically to 90 U.S. Radiation Oncology academic programs and publicized on social media and at two national meetings during June-October 2023.
Forty-one responses were received (46%). Fifty-four percent identified as female, 66% Caucasian and 85% non-Hispanic/Latino ethnicity. Forty nine percent utilize a BT suite +/- CT simulator alone, 39% the operating room +/- BT suite or CT simulator or other location, 10% CT simulation room alone, and 2% clinic exam room. Thirty four percent utilize general anesthesia alone (GA) for intracavitary BT (n=41), 20% conscious sedation (CS) alone, 10% oral analgesia (OA) alone, and 9% spinal or epidural AS alone, and 27% combination. Among those performing hybrid BT (n=25), 40% use GA alone, 16% use CS alone, 12% epidural or spinal AS alone, and 4% OA alone, and 28% combination. For template interstitial BT (n=25), 44% use GA alone, 48% epidural alone or in combination with other AS, and 8% CS alone. Twenty-two percent of respondents provide AG or AS during applicator placement only, while 32% provide it during placement, planning, treatment, and removal. The most common reasons for not using CS or GA were lack of anesthesia resources and clinician preference. Seventy-three percent reported the belief that patients suffer from post-traumatic stress disorder (PTSD) symptoms after BT. However, 68% reported not using techniques to alleviate BT related emotional distress.
Many U.S. brachytherapists report using GA, CS or epidural AS, yet 10% are using only OA and 22% offer AG/AS only during applicator placement. Furthermore, a majority of respondents believe PTSD symptoms can occur after BT, but few offer any intervention. AS resources and clinician preference should be targeted for expansion of higher quality care.