ABSTRACT
Introduction: Lung cancer patients often have a number of comorbidities which impacts patient mortality and morbidity rates. Lifestyle changes for this group of patients have the potential to positively impact both quality of life and longevity. The Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS) was designed to determine if it is feasible to embed interventions promoting a healthier lifestyle into the radical lung radiotherapy pathway. Method(s): The PREHABS study was led by therapeutic radiographers trained in smoking cessation provision, motivational interviewing, informed consent and good clinical practice and a dietitian. Radiographers screened and consented study participants, delivered the exercise intervention and up to 12-weeks of smoking cessation support, whilst dietary advice was provided by the dietitian. Patients diagnosed with chronic obstructive pulmonary disease (COPD), were referred to a community based pulmonary rehabilitation service rather than the PREHABS exercise intervention. Ethical and regulatory approvals were secured in September 2021. Result(s): 61 patients were recruited between September 2021 and October 2022. The majority were female (n=42), mean age 73.1 years (SD 9.36 years). Discussion(s): In addition to the training requirements detailed above and the challenges of COVID-19, the radiographers had to become adept in a number of study-specific aspects including writing the study standard operating procedures (SOPs), creating a study organisational workflow and patient recruitment. The PREHABS study has broadened the radiographer's perspective beyond the radiotherapy department, by further understanding the complex comorbidities that lung cancer patients present with, how to motivate patients to positively change their lifestyle, and how the side effects caused by cancer treatment can affect a patient's ability to change their lifestyle. Conclusion(s): Therapeutic radiographers, after appropriate training, are capable of delivering lifestyle intervention support within a radical lung cancer radiotherapy pathway. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.
ABSTRACT
Patients treated with curative-intent lung radiotherapy are in the group at highest risk of severe complications and death from COVID-19. There is therefore an urgent need to reduce the risks associated with multiple hospital visits and their anti-cancer treatment. One recommendation is to consider alternative dose-fractionation schedules or radiotherapy techniques. This would also increase radiotherapy service capacity for operable patients with stage I-III lung cancer, who might be unable to have surgery during the pandemic. Here we identify reduced-fractionation for curative-intent radiotherapy regimes in lung cancer, from a literature search carried out between 20/03/2020 and 30/03/2020 as well as published and unpublished audits of hypofractionated regimes from UK centres. Evidence, practical considerations and limitations are discussed for early-stage NSCLC, stage III NSCLC, early-stage and locally advanced SCLC. We recommend discussion of this guidance document with other specialist lung MDT members to disseminate the potential changes to radiotherapy practices that could be made to reduce pressure on other departments such as thoracic surgery. It is also a crucial part of the consent process to ensure that the risks and benefits of undergoing cancer treatment during the COVID-19 pandemic and the uncertainties surrounding toxicity from reduced fractionation have been adequately discussed with patients. Furthermore, centres should document all deviations from standard protocols, and we urge all colleagues, where possible, to join national/international data collection initiatives (such as COVID-RT Lung) aimed at recording the impact of the COVID-19 pandemic on lung cancer treatment and outcomes.