Perceived patient burden and acceptability of whole body MRI for staging lung and colorectal cancer; comparison with standard staging investigations.

Ruth Ec Evans,Alison Morton,Steve Halligan,Andrea Rockall,Alf Oliver,Sandra Beare,Stuart A Taylor,Anne Miles

doi:10.1259/bjr.20170731

Abstract

Objective:To evaluate perceived patient burden and acceptability of whole body MRI (WB-MRI) compared to standard staging investigations, and identify predictors of reduced tolerance.Methods:Patients recruited to multicentre trials comparing WB-MRI with standard staging scans for lung and colorectal cancer were invited to complete two questionnaires: a baseline questionnaire at recruitment, measuring demographics, comorbidities, and distress; and a follow-up questionnaire after staging, measuring recovery time, comparative acceptability/satisfaction between WB-MRI and CT (colorectal cancer) and PET-CT (lung cancer), and perceived scan burden (scored 1, low; 7, high). Results:115 patients (median age 66.3 years; 67 males) completed follow up and 103 baseline questionnaires. 69 (63.9%) reported “immediate” recovery from WB-MRI and 73 (65.2%) judged it “very acceptable”. Perceived WB-MRI burden was greater than for CT (p < 0.001) and PET-CT (p < 0.001). High distress and comorbidities were associated with greater WB-MRI burden in adjusted analyses, with deprivation only approaching significance (adjusted regression β = 0.223, p = 0.025; β = 0.191, p = 0.048; β = −0.186, p = 0.059 respectively). Age (p = 0.535), gender (p = 0.389), ethnicity (p = 0.081) and cancer type (p = 0.201) were not predictive of WB-MRI burden.Conclusion: WB-MRI is marginally less acceptable and more burdensome than standard scans, particularly for patients with pre-existing distress and comorbidities. Advances in knowledge:This research shows that WB-MRI scan burden, although low, is higher than for current staging modalities among patients with suspected colorectal or lung cancer. Psychological and physical comorbidities adversely impact on patient experience of WB-MRI. Patients with high distress or comorbid illness may need additional support to undergo a WB-MRI.

Highlights

Patients diagnosed with cancer must be staged accurately prior to treatment decisions
Patients recruited to multi-centre trials comparing whole body MRI (WB-MRI) with standard staging scans for lung and colorectal cancer were invited to complete two questionnaires: a baseline questionnaire at recruitment, measuring demographics, comorbidities, and distress; and a follow-up questionnaire after staging, measuring recovery time, comparative acceptability/ satisfaction between WB-MRI and CT and PET-CT, and perceived scan burden
Advances in knowledge: This research shows that WB-MRI scan burden, low, is higher than for current staging modalities among patients with suspected colorectal or lung cancer

Summary

Introduction

Patients diagnosed with cancer must be staged accurately prior to treatment decisions. In particular it is imperative to detect metastatic disease, as this impacts considerably on therapeutic approach. Standard staging pathways are often complex, time consuming and involve several different imaging modalities, potentially adding to physical and psychological burden of patients with known or suspected cancer.. Recent data suggests whole body MRI (WB-MRI) has potential as an “all-in-one” staging investigation that at least matches and possibly betters the accuracy of conventional investigations for detecting metastatic disease.2;3 One critical but often neglected aspect influencing adoption of any new technology is patient experience. Low patient acceptability reduces adherence, which diminishes diagnostic impact, even when superior to existing tests. Uptake of bowel cancer screening colonoscopy is an example where perceived test burden impacts directly to reduce participation.

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