Grant Number:	1R21CA300943-01 Interpret this number
Primary Investigator:	Salwei, Megan
Organization:	Vanderbilt University Medical Center
Project Title:	BREATHS: Breast Cancer Radiation Training for Improved Heart Safety
Fiscal Year:	2025

Our proposal addresses an urgent need to mitigate the long-term morbidities of cancer treatment. Breast cancer is the most common cancer in the US, with approximately 310,000 new cases diagnosed annually. Over half of all breast cancer patients undergo radiation therapy, which improves both local control and overall survival. However, radiation therapy, especially to the left breast, increases the incidence of ischemic heart disease. Patients receiving radiation therapy to the left breast have a 50% increased rate of major coronary events over the next 20 years. Cardiac toxicity from radiation therapy remains a major patient safety concern. Deep inspiration breath hold (DIBH) is a method used to extend the chest wall away from the heart during radiation therapy; this is achieved by coaching patients to hold a deep breath as radiation is delivered. DIBH can significantly reduce the mean radiation dose to the heart. Yet, it is challenging for patients and radiation therapy teams to execute consistently over a 3-to-5 week treatment course. DIBH variability leads to excessive cardiac toxicity as well as decreased patient and care team satisfaction. Currently, patients receive minimal training on DIBH. We propose to develop a personalized, patient-centered anatomy informed system, BReaTHS, to support optimal and consistent execution of DIBH. Patients will use BReaTHS to practice DIBH at-home and continue using the system during treatment to ensure reproducible DIBH. The system will include video display glasses to provide visual feedback and a respiratory sensor belt to measure real-time patient breath volume. The Specific Aims are: Aim 1: Refine and evaluate the personalized system using rigorous human-centered design methods. To optimize our existing prototype, we will conduct interviews, design sessions, and formative and summative usability testing. Throughout this process, we will engage breast cancer survivors who used DIBH during radiation therapy treatment to ensure the system is patient-centered. Aim 2: Pilot test the system’s effectiveness and acceptance with breast cancer patients and with radiation therapy teams. We will conduct a pilot randomized controlled trial with 24 left-sided breast cancer patients. Our primary outcome will be DIBH consistency and treatment duration. Secondary outcomes will be maximum and mean cardiac dose, duration of breath holds, patient anxiety, fatigue, and engagement throughout treatment, and patient and clinical team acceptance. We propose the development of a patient-centered, anatomy-informed training system can improve deep inspiration breath holds and reduce the long-term cardiac toxicities of radiation therapy. This work is aligned with NCI’s priorities outlined in the National Cancer Plan, including optimizing the delivery of care that is patient-centered and reduces the morbidity of cancer. Future work will include a multi-site randomized controlled trial to further evaluate the system’s effectiveness on patient care and outcomes.





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