# Increasing patient comfort in palliative radiotherapy with a newly developed mattress: a nonrandomized clinical trial

## TL;DR

A new mattress called RTComfort was developed to increase comfort during radiotherapy without affecting treatment quality, and most patients preferred it over standard mats.

## Contribution

The RTComfort mattress improves patient comfort in radiotherapy without compromising positioning or dosimetry.

## Key findings

- 98% of patients preferred the RTComfort mattress over the standard thin foam mat.
- Median pain scores were significantly reduced when using the RTComfort mattress.
- No relevant dosimetric effects were observed with the RTComfort mattress.

## Abstract

•Flat and hard treatment tables can cause discomfort and pain during radiotherapy.•The new RTComfort mattress adds comfort without affecting positioning and dosimetry.•This clinical study showed that a great majority preferred the RTComfort mattress.•Median pain scores were significantly reduced, both statistically and clinically.•Findings support further deployment, also for curative (online adaptive) treatments.

Flat and hard treatment tables can cause discomfort and pain during radiotherapy.

The new RTComfort mattress adds comfort without affecting positioning and dosimetry.

This clinical study showed that a great majority preferred the RTComfort mattress.

Median pain scores were significantly reduced, both statistically and clinically.

Findings support further deployment, also for curative (online adaptive) treatments.

In palliative radiotherapy, many patients experience discomfort and pain during treatment, particularly while lying on flat, hard treatment couches that are considered essential for accurate treatment delivery. Thin foam matts, often used for palliative treatments, can somewhat reduce discomfort, but they are frequently insufficient.

In this study a mattress was developed and investigated, with the aim to reduce pain during radiotherapy treatments without affecting treatment quality.

A nonrandomized clinical trial compared the newly designed RTComfort mattress with a standard thin foam matt. The primary endpoint was mattress preference, while secondary endpoints included experienced pain, positioning stability, and dosimetric effects. Included patients tested both the mat and mattress for one minute each in the treatment position before planning-CT acquisition, scoring their preference and pain on a Numerical Rating Scale (NRS, 0–10). Subsequently, patients were scanned and treated on their preferred option. Positioning stability during treatment was evaluated using optical surface scanning and dosimetric effects were evaluated through dose calculations with the treatment planning system.

Out of 45 patients, 44 (98 %) preferred the RTComfort mattress, with 35 patients showing a strong preference (p < 0.0001). The median pain score on the RTComfort mattress decreased from 4.8 (IQR: 2.0–6.1) to 2.0 (IQR: 0.4 to 4.0 NRS) (p < 0.0001). Both options showed negligible patient sagging, with marginally less on the RTComfort mattress (p < 0.0001). No relevant dosimetric effects were observed.

This prospective clinical trial highlights the need for more comfortable radiotherapy treatments. Compared to the standard thin foam matt, 98% of patients preferred the RTComfort mattress. The RTComfort mattress provided clinically significant reduction in pain associated with lying on flat, hard treatment couches. The mattress is safe for clinical use and shows potential beyond palliative radiotherapy settings.