S2653
RTT - Patient experience and quality of life
ESTRO 2026
1 Department of Allied Health Professions, Careggi University Hospital, Florence, Italy. 2 Radiation Oncology Unit, Careggi University Hospital, Florence, Italy. 3 Regional Center for Critical Relationships, Careggi University Hospital, Florence, Italy. 4 Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy. 5 Medical Physics Unit, Careggi University Hospital, Florence, Italy. 6 NEUROFARBA (Neuroscience, Psychology, Drug Research and Child Health) Department, University of Florence, Florence, Italy Purpose/Objective: Traditionally, the reproducibility of patient positioning in radiotherapy has relied on permanent tattoos. However, these may have negative cosmetic effects, induce psychological stress, particularly in breast cancer patients, and lead to body image concerns. In recent years, alternative methods, based on SGRT, for patient positioning have been implemented in clinical practice. The aim of this study is to assess the psychological impact of tattoo-less radiotherapy for breast cancer. Material/Methods: A prospective, single-centre, observational, not-for- profit trial, entitled BRIGHT (Breast Cancer Radiation Therapy Innovation through Surface Guidance for High Precision Tattoo-less Treatment), is currently being conducted with the aim of introducing tattoo-less breast cancer treatment into clinical practice. To evaluate patients' perceptions and the psychological impact of tattoos, an anonymous questionnaire developed in collaboration with psychologists was administered before CT simulation. This was measured using 10 items on a 5-point Likert scale. At the end of the tattoo-less radiotherapy, patients were also asked to rate their level of satisfaction, using a 5- point response scale.The factorial validity and internal consistency of the questionnaire were examined by exploratory factor analysis (EFA) and Cronbach’s alpha. Descriptive statistics and independent-samples t-tests were also used. Results: Seventy patients completed the questionnaire (mean age=60.15 years, SD=11.39).The EFA supported a one- factor solution with satisfactory loadings (range .53- .80) and showing good internal consistency (Cronbach’s α =.89).Descriptive statistics of all items are reported in Table 1.
The highest mean score was observed for item “tattoo avoidance relief”; whereas the lowest was for ”social perception”. Independent-samples t-tests were conducted for each item to compare responses between patients without personal tattoos (74%) and those with personal tattoos unrelated to radiotherapy. Although no statistically significant differences emerged for most items, the analysis of effect sizes (Cohen’s d) indicated small-to-moderate effects for several items (range=0.21–0.57), and a medium-to- large effect for item "Tattoo significance" (d=0.73), suggesting that patients with personal tattoos tended to show greater acceptance of radiotherapy-related tattoos and lower discomfort toward body markings. Mean scores for both groups across all items are illustrated in Figure 1.
Regarding satisfaction with the tattoo-less treatment, assessed at the end of radiotherapy, the mean score was 4.85 (SD=0.36), indicating a very high level of satisfaction among participants. Conclusion: The preliminary findings indicate that patients reported considerable discomfort toward radiotherapy tattoos, while expressing high satisfaction with their tattoo-less treatment experience. Overall, these results support psychological benefits of implementing tattoo-less breast radiotherapy in clinical practice. References: Lastrucci, A., Marrazzo, L., Meattini, I., Simontacchi, G., Wandael, Y., Talamonti, C., Pallotta, S., Ricci, R., & Livi, L. (2024). Advancing patient setup: A comprehensive scoping review of tattoo-less techniques in radiation therapy. Critical reviews in oncology/hematology, 204,
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