How do you take a treatment that has been clinically highly successful for decades and improve it? By looking at the elements that the patients worry most about, that cause the greatest anxiety, and making more patient friendly developments without compromising treatment delivery. It’s not surprising that going through brain tumour treatment often proves to be a fearful and stress inducing experience for most patients. And although Gamma Knife radiosurgery treatment is non-invasive, patients still understandably experience a huge amount of anxiety during their time being treated. Not only is it scary enough dealing with cancer or life-threatening tumours and lesions, but when these present in the brain, even more daunting risks arise.
Understandably, patients can arrive at radiosurgery treatment centres already anxious with general whitecoat hypertension and stress about their underlying condition, which unfortunately can often be increased by the immobilisation frame involved in Gamma Knife treatments. Gamma Knife radiosurgery uses up to 192 precisely focussed beams of radiation to target selected brain tumours and lesions, without harming the surrounding healthy brain tissue. For Gamma Knife to be as highly precise as it is, the procedure involves an immobilisation frame to be fixed to the patient’s head with the traditional frame composed of around 60 metal parts. This involves the frame being screwed to the head and while these screws do not break the skin and a local anaesthetic is administered, it involves putting pressure on the skull and has been described as a crushing sensation by some patients.
However, Amethyst UK have now introduced the new Vantage frame by Elekta, which takes on a more patient friendly design. Designed to significantly increase patient comfort, as well as enhance target visualisation for treatment accuracy, the new frame allows open face visibility and is made up of only 10 components and uses glass fibre reinforced epoxy instead of metal. The non-metallic materials that minimise imaging and radiofrequency heating issues; but more excitingly, it significantly improves patient comfort during radiosurgery. In the case of Gamma Knife, until recently patient immobilisation options were limited to the traditional ‘head-frame’. This rather imposing piece of equipment causes patients anxiety and stress, even before it is fitted and is often the lasting memory from the treatment for many patients.
A recent study by Advances in Radiation Oncology explores the trajectory of anxiety related to radiation therapy mask immobilisation in head and neck cancer patients. And while this study is not specific to Gamma Knife treatments and the frame used here, it speaks to patient experiences of immobilisation masks and clinician’s abilities to detect anxiety in patients. The study found that nearly half (43%) of participants reported clinically significant anxiety before having their mask fitted, and between 30% and 43% across trajectories reported significant anxiety immediately before treatments. The study also found that the radiosurgery therapists were unable to reliably capture patients’ situational anxiety, suggesting a need for patients to be regularly screened throughout treatment. This is made more difficult however, with the immobilisation mask covering the patients’ face, hindering observation possibilities.
As no healthcare professional takes comfort seeing their patients in pain or stress, this new frame is welcomed by clinicians and consultants as it allows the possibility of improving patient comfort and observation. Considered efforts are already made to alleviate anxiety around treatment, ensuring patients have the most relaxing and calming experience possible. And although the comfortable waiting rooms, teas and pastries offered and attentive clinicians vastly improves the experience, the Vantage frame keeps patient airways unobstructed and patient facial expressions clearly observable. This further allows the clinicians to better observe the emotional and mental state of their patients to offer more reassurance where needed.
The first patient treated with the new Vantage frame in the UK was Lynette Pratchett from London. Lynette was diagnosed with Lung Cancer in 2021, after undergoing surgery and numerous other treatments, she had a routine CT head scan which revealed two brain lesions. This meant the cancer had spread to her brain and treatment was urgently needed. The lesions were relatively small, which meant that the rest of the brain tissue was still healthy. In cases such as this, it is important to preserve this healthy brain tissue whilst areas of concern are treated effectively. With this in mind, Lynette’s case was discussed in a multidisciplinary team meeting where it was decided by several Neurosurgeons, Oncologists and Radiologists that Gamma Knife Radiosurgery would be the most effective treatment option and Lynette consented to be the first patient in the UK to have this frame fitted.
On the day of treatment, the new Vantage frame had been trialled and tested, ready for clinical use. When asked about her experience with the Vantage Frame, Lynette said: “I’ve never had anything like this done before, I expected it to hurt, but to my surprise, it didn’t, it was a piece of cake!”. Lynette goes on to explain how it felt to have the frame on for the rest of the treatment day, “it wasn’t heavy, I could eat and drink with it, I just couldn’t put my glasses on, but that’s neither here nor there, I’m just glad to have had the treatment with no pain”.
Lynnette is also currently having Chemotherapy and experiencing side effects which have had led to being hospitalised. When asked about side effects of the Vantage Frame and Gamma Knife treatment in comparison: “I’ve had no side effects, after my treatment ended and the frame was removed, I actually went back to Watford to have a Thai Curry, I’m on steroids so I was quite hungry. Since that day, I’ve not had any issues, Gamma Knife was the easiest and best experience of all the cancer treatments I’ve ever had, it was like lying in a scanning tunnel for a bit longer than usual, I wish they were all this easy, ZAP! and hopefully it’s gone”.
While there is still a clinical need for some patients to have the existing frame fitted, now there are options. For patients attending Gamma Knife consultations now, a clinical assessment is made as to suitability to be treated wearing the new Vantage frame. Without clinical compromise, this new frame addresses historical patient feedback on the looks, restrictive set-up, and weight of the original version. The Vantage frame is both lighter and more pleasing on the eye, which for both patients and clinicians makes the “fitting” process easier to undertake and less stressful. Initial patient feedback has all been positive, with patients feeling more mobile while wearing it, less stressed during fitting and it being easier to tolerate, and less obstructive, over the duration of treatment day.
By Sharmin Rahman, Clinical Services Manager and Daniel Lumley, Director of Clinical Operations at Amethyst Radiotherapy UK