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“Current”, “heated rods”, and “hot vapour”: why patients refuse radiotherapy as a treatment modality for cancer in northern Sri Lanka

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Abstract

Purpose

Significant proportions of patients either refuse or discontinue radiotherapy, even in the curative setting, leading to poor clinical outcomes. This study explores patient perceptions that underlie decisions to refuse/discontinue radiotherapy at a cancer care facility in northern Sri Lanka.

Methods

An exploratory descriptive qualitative study was carried out among 14 purposively selected patients with cancer who refused/discontinued radiotherapy. In-depth semi-structured interviews were transcribed in Tamil, translated into English, coded, and thematically analyzed.

Results

All participants referred to radiotherapy as “current” with several understanding the procedure to involve electricity, heat, or hot vapour. Many pointed to gaps in information provided by healthcare providers, who were perceived to focus on side effects without explaining the procedure. In the absence of these crucial details, patients relied on family members and acquaintances for information, often based on second or third-hand accounts of experiences with radiotherapy. Many felt pressured by family to refuse radiation, feared radiation, or felt ashamed to ask questions, while for others COVID-19 was an impediment. All but three participants regretted their decision, claiming they would recommend radiation to patients with cancer, especially when it is offered with curative intent.

Conclusion

Patients with cancer who refused/discontinued radiation therapy have significant information needs. While human resource deficits need to be addressed in low-resource settings like northern Sri Lanka, providing better supportive cancer care could improve clinical outcomes and save healthcare resources that would otherwise be wasted on patient preparation for radiotherapy.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

Data collection was supported by the Department Fund of the Tellipalai Trail Cancer Hospital, Sri Lanka.

Author information

Authors and Affiliations

  1. Base Hospital Tellippalai, Tellippalai, Sri Lanka

    Jeyasuthan Mahadevan

  2. Department of Clinical Oncology, Hospital Road, Teaching Hospital Jaffna, Jaffna, 40 000, Sri Lanka

    Ramalingam Appudurai & Chrishanthi Rajasooriyar

  3. Tellipalai Trail Cancer Hospital, Tellipalai, Sri Lanka

    Ramalingam Appudurai & Chrishanthi Rajasooriyar

  4. Tianjin Medical University, Tianjin, China

    Shobikgha Sothipragasam

  5. Department of Community and Family Medicine, University of Jaffna, Jaffna, Sri Lanka

    Ramya Kumar

Authors
  1. Jeyasuthan Mahadevan
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  2. Ramalingam Appudurai
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  3. Shobikgha Sothipragasam
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  4. Ramya Kumar
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  5. Chrishanthi Rajasooriyar
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Contributions

Mahadevan Jeyasuthan

1. Made substantial contributions to the conception or design of the work, acquisition of data,

2. Drafted the work and revised it critically for important intellectual content;

3. Approved the version to be published.

4. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Appudurai Ramalingam

1. Made substantial contributions to the conception or design of the work, acquisition of data,

2. Drafted the work or revised it critically for important intellectual content;

3. Approved the version to be published.

4. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Shobikgha Sothipragasam

1. Made substantial contributions to the analysis and interpretation of data;

2. Revised it critically for important intellectual content;

3. Approved the version to be published; and.

4. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Ramya Kumar

1. Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data.

2. Contributed significantly to drafted the work and revised it critically for important intellectual content;

3. Approved the version to be published; and.

4. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

5. Offered great help in amending the manuscript as per the reviewer's comments and responding to the reviewer.

Chrishanthi Rajasooriyar

1. Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data.

2. Contributed significantly to drafted the work and revised it critically for important intellectual content;

3. Approved the version to be published; and

4. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

5. Involved in amending the manuscript as per the reviewer's comments and responding to the reviewer.

Corresponding author

Correspondence to Chrishanthi Rajasooriyar.

Ethics declarations

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Review Committee of the Faculty of Medicine, University of Jaffna (Ref J/ERC/18/100/NDR/0201).

Consent to participate

Informed consent was obtained from all participants.

Consent for publication

Consent for publication was obtained from all participants.

Competing interests

The authors declare no competing interests.

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Mahadevan, J., Appudurai, R., Sothipragasam, S. et al. “Current”, “heated rods”, and “hot vapour”: why patients refuse radiotherapy as a treatment modality for cancer in northern Sri Lanka. Support Care Cancer 32, 361 (2024). https://doi.org/10.1007/s00520-024-08561-9

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