Multidimensional expectations of radiotherapy among patients with cancer - A cross-sectional study (ExpectRT)

Patients' expectations correlate with outcomes. Yet little is known about multidimensional expectations and associated factors among patients with cancer awaiting radiotherapy.

We conducted a cross-sectional survey to explore expectations and associated factors based on the Likert-type Treatment Expectation Questionnaire (TEX-Q) among patients with cancer awaiting radiotherapy. The TEX-Q mean (higher score = more positive overall expectations) was the primary outcome. Secondary outcomes included the TEX-Q Treatment benefit (higher score = more beneficial expectations) and Adverse events (higher score = worse adverse events expectations) subscales. TEX-Q scores range from 0 to 10. We performed univariate and multivariate analyses (MVA).

Among 368 eligible patients, 140 participated and 133 were analysable. The median age was 67.5 years (interquartile range: 18.8) and the female-male ratio was 1:1. The TEX-Q mean value was 7.0 (SD:1.8), the Treatment benefit mean was 8.6 (SD:1.7), and the Adverse events mean was 4.3 (SD:2.3). Treatment benefit and Adverse events expectations did not correlate. On MVA, overall expectations were worse among patients living alone (p = 0.01), with higher education (p < 0.001), and receiving concomitant chemotherapy (p = 0.048). Treatment benefit expectations were worse among patients with higher education (p = 0.03) and with palliative/unknown intent (p = 0.003). Adverse event expectations were more pronounced among patients living alone (p = 0.01), inpatients (p = 0.04) and more distressed patients (p = 0.01).

Patients' expectations were favourable overall. Patients living alone, treated with palliative intent and at more distress expected worse outcomes which may require adapted communication strategies or supportive measures. Future longitudinal studies should investigate expectation-outcome pairings and interventions to realistically improve patients' expectations regarding radiotherapy.