Access, acceptance and adherence to cancer prehabilitation: a mixed-methods systematic review.

PURPOSE: The purpose of this systematic review is to better understand access to, acceptance of and adherence to cancer prehabilitation. METHODS: MEDLINE, CINAHL, PsychINFO, Embase, Physiotherapy Evidence Database, ProQuest Medical Library, Cochrane Library, Web of Science and grey literature were systematically searched for quantitative, qualitative and mixed-methods studies published in English between January 2017 and June 2023. Screening, data extraction and critical appraisal were conducted by two reviewers independently using Covidence™ systematic review software. Data were analysed and synthesised thematically to address the question 'What do we know about access, acceptance and adherence to cancer prehabilitation, particularly among socially deprived and minority ethnic groups?' The protocol is published on PROSPERO CRD42023403776 RESULTS: Searches identified 11,715 records, and 56 studies of variable methodological quality were included: 32 quantitative, 15 qualitative and nine mixed-methods. Analysis identified facilitators and barriers at individual and structural levels, and with interpersonal connections important for prehabilitation access, acceptance and adherence. No study reported analysis of facilitators and barriers to prehabilitation specific to people from ethnic minority communities. One study described health literacy as a barrier to access for people from socioeconomically deprived communities. CONCLUSIONS: There is limited empirical research of barriers and facilitators to inform improvement in equity of access to cancer prehabilitation. IMPLICATIONS FOR CANCER SURVIVORS: To enhance the inclusivity of cancer prehabilitation, adjustments may be needed to accommodate individual characteristics and attention given to structural factors, such as staff training. Interpersonal connections are proposed as a fundamental ingredient for successful prehabilitation.

Developing a policy framework to support role extension in diagnostic radiography in Ghana.

INTRODUCTION: A global shortage of radiologists is affecting the timely provision of imaging reports and thus healthcare delivery. This situation has been the main driving factor behind successful role extension by radiographers into areas that traditionally were within the scope of radiologists, including image interpretation and reporting. The shortage of radiologists is even worse in developing countries like Ghana. There is a need for policy to guide the introduction and implementation of role extension in Ghana. METHODS: A qualitative, single case study with multiple sites across the country was used. A sample of 16 participants, including 8 radiographers, 3 radiologists, 3 medical officers, a senior official each from the Ministry of Health and the Allied Health Professions Council, were interviewed about role extension. RESULTS: The findings indicate the need for a guiding policy of role extension to be spear headed by the Ministry of Health to gain the needed credibility. The findings suggest the policy should be made to meet the local needs of the country. It also established the policy should regulate education and training and the scope of practice. CONCLUSION: The study established the need for policy to guide the introduction and practice of role extension in diagnostic radiography in Ghana. The study also established the need for a broad consultation of all key stakeholders based on an internationally accepted consensus building model.

Potential for identification of memory problems in the cancer clinic to enable improved treatment experience and outcomes: Mixed methods case study research.

PURPOSE: To inform improvement in cancer treatment experience and outcomes for people with dementia or milder cognitive impairment. People with dementia, compared to those without, experience more side effects from cancer treatment and have poorer outcomes including poorer survival. METHODS: The research was a mixed methods exploratory case study. Each case was a cancer treatment in a person with memory loss, a common symptom of dementia. Observations were conducted in 30 clinic sessions at one cancer centre between September 2014 and February 2015. Thirty-three encounters between people with a memory problem and a staff member were observed and ten consultations recorded. Interviews were conducted with five staff members and six people receiving cancer treatment, five accompanied by their carer. Analysis, informed by hermeneutic phenomenology, enabled the treatment pathway to be mapped and modelled to reveal sites for intervention. FINDINGS: Five potential sites of intervention were identified in the treatment pathway. Five actions at the sites of intervention that may improve patient experience and outcomes include, raising awareness of common problems for people with cognitive impairment receiving cancer treatment, encouraging disclosure of memory problems, staff training to identify memory problems and to know what to do, offering tools and techniques to aid self-management of memory problems, and addressing carer support needs. CONCLUSION: Embedding biomedical treatment of cancer within a dementia-friendly psychosocial system may enable safe cancer treatment for a greater number of people with dementia or milder cognitive impairment.

Evaluating Canadian Radiation Therapists and UK Therapeutic Radiographers' Experiences and Opinions of a Safety Strap to Secure Patients during Radiotherapy.

INTRODUCTION: A serious patient safety incident at a cancer centre in Ontario, Canada, saw a patient fall from an elevated treatment couch. A regional investigation recommended the use of a securing safety strap. The authors evaluate the value of the strap through the experiences of the radiation therapists' who use it. A secondary aim is to explore the potential for using a securing safety strap with UK therapeutic radiographers. METHODS: A two-stage design was guided by an evidence-based practice framework. Stage one used a questionnaire to capture treating radiation therapists' experiences and opinions of the strap at a single cancer centre. Quantitative data were analysed descriptively and free-text data via a content analysis. Stage two used semistructured interviews with thematic analysis to explore views of three UK therapeutic radiographers. RESULTS: Twenty-five of approximately 130 eligible staff responded to the Canadian questionnaire. Of the respondents, 24% (n = 6) 'strongly disagreed', 28% (n = 7) 'agreed' and 48% (n = 12) 'neither agreed nor disagreed' that they would recommend the strap to other departments. Most of the respondents think strap use should be at the staffs' discretion, with patients with dementia/cognitive impairment ranked as the group benefiting most. Ninety-two percent (n = 23) of respondents confirmed that patients sometimes refuse the strap. Themes arising from stage two interviews are as follows: patient benefit (use for select patients only); patient safety versus control (restraint); and practical implementation issues. CONCLUSION: The policy of universal use of the strap should be reviewed. Those who use it are equivocal about its value and feel it should be reserved for select patients at the treating professional's discretion. Full evaluation of the effectiveness and acceptability of the device for different patients may promote both staff enthusiasm towards the device and evidence-based practice. Adequate resources are required to evaluate implementation of such safety initiatives.

Soluble interleukin-6 receptor mediated fatigue highlights immunological heterogeneity of patients with early breast cancer who undergo radiation therapy.

PURPOSE: This study aimed to explore the associations between dose-volume parameters of localized breast irradiation, longitudinal interleukin-6 soluble receptor (sIL-6R), and leukocyte counts as markers of an immune-mediated response and fatigue as a centrally-driven behavior. METHODS AND MATERIALS: This prospective cohort study recruited 100 women who were diagnosed with stage 0-IIIa breast cancer, prescribed 40 Gy in 15 fractions over 3 weeks adjuvant radiation therapy, and had no prior or concurrent chemotherapy. Dose-volume parameters were derived from treatment plans and related to serum sIL-6R concentrations, leukocyte counts, and a validated measure of self-reported fatigue at baseline, after 10 and 15 fractions, and 4 weeks after radiation therapy. RESULTS: sIL-6R concertation was significantly higher in patients with a total volume of tissue irradiated within the 50% isodose >2040 cm3 (P = .003). When controlling for body mass index, this result only remained significant after treatment. The volume of liver irradiated within the 10% isodose correlated with the sIL-6R concentration during and after radiation therapy (ρ = .3-.4; P = .03-.007). The 38% of the cohort that was classified as fatigued had a higher mean sIL-6sR concentration at all observation points, but the differences were only statistically significant during radiation therapy: Mean (standard deviation [SD]) after 15 fractions for fatigued patients was 47.6 ng/dL (11.2 SD) versus 41.6 ng/dL (11.4 SD) for nonfatigued patients (P = .01). Cohort leukocyte counts and leukocyte subsets decreased consistently from baseline and the values for the fatigued group were 4% lower at baseline and between 7% and 9% lower during and after treatment compared with those of the nonfatigued group but the differences were not statistically significant. CONCLUSIONS: This is the first study to show that localized irradiation induces increased systemic sIL-6R during treatment in participants who reported elevated levels of fatigue before, during, and after treatment. This behavioral response appears to reflect a variation in innate host immunity, which then mediates the cellular and/or psychological stress of radiation therapy.

Psychological and immunological characteristics of fatigued women undergoing radiotherapy for early-stage breast cancer.

PURPOSE: The amelioration of fatigue in radiotherapy patients is limited by an equivocal aetiology and uncertainty regarding who is likely to experience significant fatigue. The research objective was to characterise fatigue in women undergoing radiotherapy for breast cancer, in order to evaluate associations with elevations in anxiety, depression and a marker of systemic inflammation. METHODS: Participants comprised 100 women, diagnosed with stages 0-IIA breast cancer and prescribed with 40 Gy in 15 fractions over 3 weeks. Fatigue was assessed at baseline between 10 and 22 days before radiotherapy, after 10 and 15 fractions of radiotherapy and 4 weeks after the completion of radiotherapy, using the Functional Assessment of Chronic Illness Therapy Fatigue Subscale. Psychological status was self-reported using the Hospital Anxiety and Depression Scale. Sera concentrations of interleukin-6-soluble receptor were established via enzyme-linked immunosorbent assay. The contributions of pretreatment factors to fatigue were analysed using multivariable regression. RESULTS: Thirty-eight percent of participants experienced significant fatigue during radiotherapy, with the remainder little are affected. After controlling for baseline fatigue, anxiety before treatment was the strongest unique predictor of subsequent fatigue. During radiotherapy, interleukin-6-soluble receptor was significantly elevated in the fatigued group compared to the non-fatigued group (p = 0.01). This association was not mediated by depression. CONCLUSIONS: The data are consistent with the concept that psychological distress prior to radiotherapy relates to a distinct immunological and behavioural response during radiotherapy. Patients reporting elevated anxiety should benefit from interventions that appropriately address the underlying psychological distress and have the potential to ameliorate disabling treatment-related fatigue.