Understanding Patient Perspectives on Radiation Tattoos

Abstract Purpose The standard of care for patients undergoing radiation therapy (RT) is to receive permanent, skin-based tattoos to assist with treatment alignment. Prior studies suggest that tattoos can generate emotional distress for patients with cancer, adding to the burden of cancer treatment and recovery. We surveyed patients who received tattoos for radiation therapy to understand their perspectives and attitudes toward tattoos. Materials/Methods We conducted a cross-sectional survey of patients who previously received radiation therapy at either XXXX or XXXX and returned for routine clinical follow-up between May and November of 2021. They were asked to complete a 16-item survey that queried patients' understanding of the purpose of tattoos and the level of distress experienced from receiving tattoos. Results Three hundred patients with radiation tattoos completed the survey. Median age was 68 years, 48% were female, 81% white, with 39% and 46% diagnosed with breast and genitourinary cancers, respectively. Overall, 20% of patients experienced distress from tattoos. Younger age (49% age <50 years vs 25% age 50-64 vs 11% age ≥65) and not understanding the purpose of tattoos were independently associated with experiencing distress (p<0.001, p=0.043). Furthermore, younger age, a primary language other than English, being unaware that they would receive tattoos, and a lack of understanding of the purpose of tattoos were also associated with continued or increased distress. Notably, one-quarter of patients indicated that they were unaware they would be receiving tattoos prior to radiation planning. Conclusions Receiving radiation tattoos is a source of distress for a sizable minority of patients receiving radiotherapy for cancer. Young patients and those lacking understanding of the purpose of tattoos were most likely to experience distress. Future interventions should address both patient education and the elimination of permanent tattoos for radiotherapy, as appropriate.