Ruth’s story – how deep inspiration breath hold helped during treatment

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With a background in medical management, Ruth is a consultant for start-up medical practices and has a comprehensive healthcare knowledge working with private practices and hospitals. However, despite her familiarity with the medical sector, nothing could have prepared her for her diagnosis of breast cancer. In February 2021, Ruth spotted a change in her left breast. A small area around her left nipple appeared to be slightly raised and bumpy. She immediately booked a phone consultation with her GP who, unable to examine her during the pandemic, referred her to the GenesisCare One Stop Breast Clinic (OSBC) in Maidstone.

Ruth had an appointment at GenesisCare soon after. She saw a consultant who arranged a mammogram and ultrasound. Despite the changes she’d noticed, her left breast was perfectly healthy. However, during the thorough investigation, GenesisCare also checked her right breast. This diligence proved worthwhile as it identified a small tumour. Ruth felt extremely fortunate that it had been found so early. A sample was taken and histology confirmed she had Invasive ductal carcinoma, where abnormal cancer cells form in the milk ducts and spread into other parts of the breast tissue. This is the most common form of breast cancer and accounts for around 70% of all invasive breast cancers1.

Despite the bad news, Ruth felt relieved to have had such thorough examinations carried out all on one day. The swift diagnosis meant she could access treatment very quickly and within two weeks of diagnosis she had surgery. This involved a lumpectomy and nodes removed from under her arm. She was then referred to GenesisCare oncologist, Dr Russell Burcombe, to discuss further treatment options.

Ruth was told her treatment would comprise five doses of radiotherapy over one week. Radiation is very effective at destroying cancer cells, but great care needs to be taken to make sure it doesn’t reach nearby organs such as the heart and lungs, where it could also cause damage.

At GenesisCare our radiotherapists are extremely skilled at using a technique called DIBH (Deep Inspiration Breath Hold) to protect the heart on the left side, during radiotherapy. It’s a technique that we’ve now started using on the right side too, because studies have shown the benefits to patients of protecting the right lung and liver as much as possible.

It may seem a simple idea, but the success lies in the clever technology used at GenesisCare called surface-guided radiotherapy (SGRT).  This uses sophisticated CT scan images to line up the radiation with the patient’s position with absolute precision before and during every treatment.  Our highly skilled dosimetrists use these images to carefully plan how much radiation is going to reach the edges of the treatment area. So, when you hold your breath, as well as moving your lung and liver further away, we know that the exact amount of radiation is directed precisely at the treatment area. The equipment also monitors very tiny movements during treatment, so if you move even slightly, the radiation beam automatically switches off.

Not only does this approach protect nearby organs, it also ensures the cancer is targeted precisely. DIBH allows us to offer many of the modern radiotherapy techniques for breast cancer.  The extra accuracy means we can target the cancer cells even better, and confidently give the radiotherapy in just five treatments

Ruth said “The technique involves breathing in deeply and holding your breath for about 20 seconds regularly throughout your treatment. Each time you do this, you raise your chest wall which creates distance between the area receiving radiotherapy and surrounding healthy organs, such as the heart, lungs and liver. As a patient, it gives you extra peace of mind that your treatment is being delivered where you need it and that we’re keeping everything around it as protected as possible. I was told I would need to hold my breath during treatment for a period of about 20 seconds, so I went home and practised around the house. Every time I put the kettle on, I would see how long I could hold my breath for. I am sure that being a swimmer and singing in an amateur choir really helped me with this. I found I was easily able to hold my breath for this length of time and, during the next week, I managed to extend my breath for a total of 40 seconds! Although this length of time wasn’t necessary it does show that by practising you can extend your original breath hold greatly.”

Ruth went for a planning scan before treatment started and demonstrated that she could hold her breath for 20 seconds. She was anxious about panicking during treatment, but her mind was quickly put at ease when the team let her know that they would go at a pace that suited her and could pause at any time during treatment until she felt relaxed enough to continue.

There was a countdown clock on the machine that showed the amount of time left of treatment which Ruth found useful as it gave her something to focus on. She found that breathing in this way was relaxing and felt like a calming exercise, keeping her focussed on her breath and helping her to alleviate any anxiety.

The whole experience, from diagnosis to treatment, was mentally exhausting. Being told you have cancer is stressful, but Ruth felt safe in the knowledge that she was being looked after very well by experts.

Ruth said “The care package I received was very comprehensive. My treatment was complimented with reflexology as GenesisCare really understand that integrated cancer care is very important. They offer exercise medicine and advice on health and nutrition to ensure every patient receives all round personalised care. The care I received has been superb.”

Dr Burcombe said “GenesisCare use the most modern radiotherapy technology available to ensure accurate treatment delivery. As an oncologist, DIBH radiotherapy means I can be sure we are targeting the cancer, minimising the dose to surrounding organs and maximising outcomes for our patients”

Find out more about deep inspiration breath hold for breast cancer.