Understanding Patient Perspectives on Radiation Tattoos

The standard of care for patients undergoing radiation therapy (RT) is to receive permanent, skin-based tattoos to assist with treatment alignment. Prior studies suggest that tattoos can generate emotional distress in patients with cancer, adding to the burden of cancer treatment and recovery. We surveyed patients who received tattoos for RT to understand their perspectives and attitudes toward tattoos.

We conducted a cross-sectional survey of patients who previously received RT at either Massachusetts General Hospital or Boston Medical Center and returned for routine clinical follow-up between May and November 2021. They were asked to complete a 16-item survey that queried patients' understanding of the purpose of tattoos and the level of distress experienced from receiving tattoos.

Three hundred patients with radiation tattoos completed the survey. The median age was 68 years, 48% were women, and 81% were White; 39% and 46% were diagnosed with breast and genitourinary cancers, respectively. Overall, 20% of patients experienced distress from tattoos. Younger age (49% age <50 years vs 25% age 50-64 years vs 11% age ≥65 years) and not understanding the purpose of tattoos were independently associated with experiencing distress (p < .001 and p = .043, respectively). Furthermore, younger age, a primary language other than English, being unaware they would receive tattoos, and a lack of understanding of the purpose of tattoos were also associated with continued or increased distress. Notably, one-quarter of patients indicated that they were unaware they would be receiving tattoos prior to radiation planning.

Receiving radiation tattoos is a source of distress for a sizable minority of patients receiving RT for cancer. Young patients and those lacking understanding of the purpose of tattoos were most likely to experience distress. Future interventions should address both patient education and the elimination of permanent tattoos for RT, as appropriate.