Huei-Fang Yanga,b,c, Hsueh-Ya Tsaib, Ying‑Hsiang Choua,d, Yu‑Chen Hsieha, Shao‑Ti Lia, Hsiao‑Ju Huanga, Ya‑Fang Kea,b, Pei‑Fang Tsaia,b, Hsiu‑Man Chana,b, Yueh‑Chun Leea,e*
aDepartment of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan, bDepartment of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan, cInstitute of Medicine, Chung Shan Medical University, Taichung, Taiwan, dDepartment of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan, eSchool of Medicine, Chung Shan Medical University, Taichung, Taiwan
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Objectives: During radiation therapy, clear and stable body‑surface markers are essential for accurate patient positioning. Peer benchmarking across four Taiwanese tertiary centers (January 2023–Mar 2024) revealed marker detachment rates of 0.8%–10.7%, whereas our in‑house audit documented 15%, underscoring a significant quality gap (unpublished institutional quality assurance data). Marker detachment or fading commonly occurs due to daily activities, hygiene routines, and patient‑specific factors, adversely affecting treatment accuracy, prolonging treatment duration, and increasing patient anxiety and medical costs. This study aimed to reduce the rate of marker detachment in radiotherapy patients from the previous level of approximately 15% to below 5%, thereby decreasing repositioning time, treatment delays, patient anxiety, family inconvenience, and hospital resource expenditure. Materials and Methods: This was a single‑center pre–post comparative study conducted from January to June 2023. Two hundred cancer patients undergoing radiation therapy participated in this study. Patients were classified using an in‑house‑developed red–green light marking system based on body mass index (BMI >25 or ≤25), educational level (high school or below and above high school), and presence of a specific caregiver. Patients with higher risk (BMI >25, education level ≤ high school, and no specific caregiver) received weekly education sessions emphasizing marker maintenance, whereas lower‑risk patients received sessions at the beginning, middle, and near the end of treatment. Interventions included personalized educational pamphlets, hypoallergenic adhesive patches, standardized marker pen replacements, and systematic tracking using the MOSAIQ® Radiation Oncology Management System (Elekta AB, Sweden). Data on marker detachment rates, repositioning times, and patient anxiety (Beck Anxiety Inventory) were collected before and after implementation. Statistical analyses, including paired t‑tests, were conducted to assess the significance of observed changes. Results: After the implementation of interventions, marker repositioning incidents significantly decreased from 82 instances (average 102.5 min/month) to 7 instances (average 23.4 min/month) (P < 0.001). The marker detachment rate was effectively reduced from approximately 15% to 3.5%, achieving the targeted goal. In addition, patient anxiety scores significantly decreased from an average of 5 points to 3 points (P < 0.001), reflecting clinically meaningful improvement. Conclusion: The implementation of a structured nursing intervention program, featuring a red–green light marking system, personalized education, and systematic management, effectively decreased marker detachment rates, repositioning times, and patient anxiety. These improvements highlight the feasibility and effectiveness of integrating such interventions into routine radiation oncology practice, ultimately enhancing treatment accuracy, patient comfort, and resource efficiency.
Keywords: Anxiety, Marker detachment, Patient education, Quality improvement, Radiotherapy
