The aim of this retrospective study is to develop an evidence-based approach to managing radiation induced skin reactions. A Clinical Guideline Development Group was established to undertake a systematic review of literature and a survey of cancer centres with the objectives of highlighting and recommending best practice. Thirty-one papers were reviewed using the United States Health Care Policy and Research and Scottish Intercollegiate Guidelines Network criteria and 42 United Kingdom Cancer Centres responded with a mix of guidelines and information about skin care assessment and advice. The evidence base for the findings is mainly levels II, III and IV.

Although perceived as common, the incidence of skin reactions has not been quantified. There is little evidence of consistent assessment of acute reactions and the survey data shows that the use of a scoring tool such as the Radiation Oncology Group criteria (RTOG/EORTC 1985) is rare. It also demonstrates that advice to patients is variable and sometimes contradictory. Appropriate and timely information is essential to relieve anxiety and reduce problems.

There appears to be a place for the use of creams in the management of early (RTOG/EORTC 0,1, 2a) skin reactions and in delaying the onset of subsequent skin breakdown, however this evidence is not clear and several of the studies identified some allergic reactions to creams. The intervention used varies between departments and individual patients and is ad hoc rather than based on firm evidence.

For reactions graded RTOG/EORTC 2b and 3, evidence from wound care literature suggests the use of hydrocolloids or hydrogels which are founded on moist wound healing principles. No evidence could be found to support the management of RTOG 4.

The study recommends the development of a clinical guideline encompassing factors affecting the onset of reactions, assessment and management principles, and patient information and makes suggestions for much needed further research.

Introduction: Health professionals have a duty of care to radiotherapy patients in providing them with adequate information before treatment. There is a lack of research that describes the roles of radiation therapists and radiation oncology nurses in providing information to patients. This study aimed to: (1) explore how radiation therapists communicate with breast cancer patients during a radiotherapy planning appointment; (2) determine what information is provided during this appointment and (3) explore radiation therapists’ perspectives on their role in providing patient information and support.

Methods: The following methodologies were used: self-report questionnaires; simulated radiotherapy planning sessions and joint interpretive forums. Statistical analysis was used to analyse the questionnaires and the simulated planning sessions and forums were analysed qualitatively.

Results: A total of 110 radiation therapists participated in the survey. We simulated two radiotherapy planning appointments and held two forums. Four themes emerged: role definitions, reducing patient anxiety and distress, barriers and strategies for effective communication and confidence in patient communication.

Conclusion: Radiation therapists play an important role in communicating with patients and providing information, particularly if patients exhibit anxiety and distress. Further research is required to determine whether patients’ information needs can be met with additional information provided by radiation therapists.

Reflection, reflective learning, reflective writing and reflective practice are used increasingly in higher education and professional development–but we do not work to one definition and there are considerable differences in the views of educationists on issues of definition. Such discrepancies can exist between the staff working with the same student group. The situation can lead to difficulties in indicating to students how to reflect, and what reflective writing ‘should look like’. Once students do manage to represent their reflection broadly in the required manner (usually writing), there is frequently observed to be a further problem because their reflection is superficial and descriptive. A consequence is that their learning from the reflective process is restricted.

This paper addresses the issue of definition of reflection initially through clarifying the different words used around the notion of reflection (e.g., reflection, reflective learning, reflective writing) and providing some suggested definitions. It then addresses the matters both of how we should help students to start with reflection, and with the problem of the superficiality of much of their work. The ‘depth’ of reflection is a concept that has not been much discussed in the literature of reflection and yet it seems to be closely related to the quality of reflective work. The paper discusses the concept of depth and then introduces a style of exercise in which a scenario is reproduced at progressively deeper levels of reflection. The exercise is related to a generic framework for reflective writing. The rationale and justification for the exercise and the framework are discussed and suggestions are made for its manner of use. The exercise and the generic framework for reflective writing are in Appendices 1 and 2.

The use of reflection to enhance formal learning has become increasingly common in the past 7 years. From the principle beginnings of its use in the professional development of nurses and teachers, its use has spread through other professions. Now, in the form of personal development planning (PDP), there is an expectation that all students in higher education will be deliberately engaging in reflection in the next 2 years.1 In addition, there are examples of the use of reflective learning journals and other reflective techniques in most, if not all, disciplines.2

Reflection is not, however, a clearly defined and enacted concept. People hold different views of its nature, which only become revealed at stages such as assessment. For example, what is it that differentiates reflective writing from simple description? There are difficulties not only with the definition itself but also in conveying to learners what it is that we require them to do in reflection and in encouraging reflection that is deeper than description. In this paper, we consider some issues of definition and then focus on the means of encouraging learners to produce a reflective output of good-enough quality for the task at hand. The latter is presented as an exercise for staff and learners (Appendix 1) with a framework that underpins it (Appendix 2).

Introduction: Many patients in the United Kingdom having radiotherapy for breast cancer are recommended not to use a deodorant during treatment. The advice is not evidence based, it is solely thought as deodorants contained metals, which would react with radiation and cause an increased skin reaction. Hence this research was undertaken to establish whether patients having a course of radiotherapy for breast cancer could use a deodorant as part of their daily routine.

Method: The research took place between May 2004 and February 2005. A total of 192 breast cancer patients were recruited. This included breast or chest-wall patients with or without axilla involvement. The study was designed with two groups. Group 1 used no deodorant and Group 2 a specific deodorant. The researcher reviewed patients weekly, assessing skin reactions and recording the researcher and patient's observations.

Results: Most patients experienced no reaction or mild erythema and dry desquamation in the axilla. This was observed in both groups. Therefore, findings of this study indicate that future breast cancer patients should be given the choice of using this deodorant.

Further recommendations: Test the reliability of the skin assessment form, extend the research to include other patient groups who have their axilla treated, test different deodorants.

When preparing radiation treatment, the prescribed dose and irradiation geometry must be translated into physical machine parameters. An error in the calculations or machine settings can negatively affect the intended treatment outcome. Analysing incidents originating in the treatment preparation chain makes it possible to find weak links and prevent treatment errors. The aim of this work is to study the effectiveness of a multilayered error prevention system by analysing both near misses and actual treatment errors.

The system utilised in this centre has primary and secondary checking as two layers of independent calculation-checking. We studied near misses as well as the actual errors which were not picked up by these pre-treatment checking procedures over a year (5154 treatment plans). Furthermore, the primary checking was studied in more detail over three years (15,386 treatment plans) to increase the statistical accuracy.

For each reported actual treatment error originating in the treatment preparation chain, 13.8 near misses were found by primary and secondary checking and thereby prevented from becoming actual errors. The total frequency of near misses was 34.4 per 1000 treatment plans. The primary checkers reported 23 types of errors for manual treatment plans (without dose distribution) and 30 types of errors for computer plans. Computer plans also showed a near miss rate that was 42% higher than for manual plans. The high ratio of near misses per actual error demonstrates an effective error prevention system, independent of the quality of the initial treatment preparation. Complex treatment plans were shown to be particularly error-prone, thereby requiring extra vigilance when checking.

In recent years there has been a push to move away from traditional clinician led on treatment review of radiotherapy patients. Despite this impetus there has been little published work relating to how the new system can be implemented. This article describes how one department implemented a change in direction from the conventional and moved forward with radiographer-led review clinics. The Plan–Do–Check–Act cycle is used as a basis for evaluation with results of a small-scale patient audit and a comparison with other departments in the UK being presented. This method of implementation and evaluation proved successful and may serve as an early model for radiotherapy departments elsewhere.

Background: Radiotherapy skin reactions have been well documented in the past. Until recently, washing of the treated area and the use of perfumed products that contain metals has not been advocated during treatment. The aims of this study were to assess the skin reactions of patients using a non-metallic deodorant and to see whether there were any psychological benefits from being able to use the deodorant.

Method: 41 women attending for radiotherapy to either the breast or breast and axilla were recruited into the trial. They were randomised into one of two groups. Complete data was obtained for 36 patients. 20 patients used the deodorant and 16 did not. Any skin reactions noted were recorded on a weekly basis. Patients were also asked to complete a questionnaire relating to feelings and activities and to comment on the deodorant if they had used it.

Results: Skin reactions did seem to be slightly worse in the patients using deodorant, and it was only in this group of patients that axillary reactions were noted. However, neither of these results were statistically significant. The use of the deodorant did not have any impact on the psychological well being of the patients, but patients using it had found it pleasant to use and the majority said that they would use it again.

Conclusion: Further study is indicated to look at skin reactions using the deodorant with a larger sample of patients.

Purpose: The purpose of this study is to identify the incidence of anxiety and distress among patients requiring immobilization during radiation therapy to the head and neck region; then to compare this with radiation therapists’ ability to identify anxiety in the same group of patients.

Materials and methods: Data from a sample of 70 patients requiring an immobilization mask participated in this study. Patient self-report assessments and radiation therapists’ ratings were recorded at two time points, CT-Simulation and fraction 1 of treatment. Self-reported patient anxiety was assessed with the Brief Symptom Inventory-18. To determine radiation therapists’ ratings of patient anxiety, two rating scales were developed.

Results: Patient self-report identified anxiety in 16% and 14% of patients at CT Simulation and fraction 1 of treatment, respectively. Radiation therapists identified anxiety in 24% patients at time point one and in 44% of patients at time point two.

Conclusion: There was slight agreement between patient self-reported levels of anxiety and radiation therapists’ ratings of patient anxiety. This study suggests that there is scope for further investigation into the identification and management of anxiety and distress in head and neck cancer patients requiring immobilization.

As radiation therapy practice evolves with advancing treatment and planning technologies, merging of imaging modalities, changing working models and the advancement to higher education, radiation therapists are frequently finding themselves on the frontline of translating new knowledge into practice. To a large degree, this growing involvement in self-directed original research, with associated dissemination of completed results, has led to an increasing number of therapists being encouraged to pursue an academic path in addition to a clinical career. In Canada, radiation therapists are being appointed as faculty to university departments for the first time. It is heartening that such opportunities are increasing; therapists are able to play a profound role in developing an evidence-based professional body of knowledge while at the same time being recognised for scholarly endeavours. However, despite these many positive steps, barriers and challenges to the development of a scholarly culture for radiation therapists still exist. Part one of this two-part series explores the history of the profession and the subsequent development of a scholarly culture.

roles for radiation therapists are currently in a period of rapid global change. technological advancement, increased entry-level education and the growing specialisation and professionalisation of many non-physician clinician groups are all significant drivers for change. there has been considerable interest in the province of ontario in “advanced practice” roles for therapists. this literature review identifies some of the background issues involved from a local and global perspective.

Oral mucositis is an unavoidable side effect of radiation therapy to the head and neck, which can compromise patient health and quality of life. This study investigates the effect of manuka honey on the extent of oral mucositis in head and neck patients in New Zealand. A total of 28 patients were recruited; 10 patients received standard care and 18 patients were given additional manuka honey. Honey was used three times a day; assessment included: extent of oral mucositis using a multi-site mucositis scoring system, weight and quality of life. The first six patients, randomised to the honey arm, used undiluted honey and pulled out in the first week because of extreme nausea, vomiting and stinging sensations in the mouth. The next 12 honey patients used a honey mouthwash (diluted 1:3). Six of these patients completed the trial and four more completed the first 4 weeks of the trial. Eight control patients completed the trial. In contrast to previous honey trials in Malaysia, Egypt, Iran and India, diluted manuka honey did not decrease the extent and onset of radiation-induced oral mucositis but did appear to ameliorate radiation-induced weight loss and increase quality of life in the absence of cisplatin chemotherapy.

Aim: To assess the efficacy of a probiotic preparation on the prevention of radiation-induced diarrhoea in cancer patients.

Methods: Group of 42 radio-oncology patients who had undergone adjuvant post-operative radiation therapy (RT) after abdominal and pelvic cancer were randomised to receive either the probiotic preparation “5” Strain Dophilus (twice per day; L-Group), or the preparation Hylak Tropfen Forte (40 drops, three times per day; H-Group). Supplementation started on the first day and lasted until the end of RT. Efficacy endpoints were the incidence and the severity of the radiation-induced diarrhoea. All patients received a paper form in which they recorded monitored parameters on a daily basis during RT.

Results: The mean daily number of bowel movements during the whole period was 4.16 in the L-Group and 2.52 in the H-Group; 62.5% of patients in L-Group and 81% in H-Group had a mean daily number of bowel movements of ≤4/day. Abdominal pain was recorded in 25% of the patients in L-Group and 22% of the patients in H-Group. Blood in the bowel movement was found in one patient from H-Group (9 days). Of patients in L-Group, 27% required diphenoxylate treatment during pelvic radiotherapy, compared with 55% in H-Group. Of patients from L-Group, 9% required antibiotics administration, compared with 25% in H-Group.

Conclusion: We concluded that the prophylactic probiotic therapy produced a highly favourable benefit/risk ratio. Supplementation with the probiotic preparation is an easy and safe approach to protect cancer patients from the risk of radiation-induced diarrhoea and carry out improvement in their quality of life.

High therapist vacancy rates and an unsatisfied workforce reduce the opportunity to meet waiting time targets or maintain high standards of care. Current vacancy rates may conceal true staff shortages because of financial pressures. Levels of job satisfaction among the therapy radiographer workforce are presently unknown. A multi-phase study to investigate job satisfaction of therapy radiographers in the United Kingdom is under way. Phase I was an interpretive grounded theory study and, as interviews progressed, a review of the literature on job satisfaction was warranted (in line with the principles of grounded theory). The purpose of this article is to evaluate the literature on job satisfaction as a way to inform the development of retention strategies within the radiotherapy profession. The discussion is focused under the following three themes identified from our phase I study: job design, leadership and organisational governance, stress and burnout. A number of models within the wider literature can inform retention strategies for radiotherapy managers. In particular, the job characteristics model and the model for job-specific well-being adequately identify factors that are relevant to the work of a therapy radiographer. Ensuring mental challenge through job design and continuing professional development opportunities is vital to retaining staff. Support from immediate managers is also a crucial aspect of workers development of intentions to leave. Manager support can moderate experiences of job stress, limiting job dissatisfaction and reducing leaving intentions. Stress and burnout have been cited as significant in reducing job satisfaction in health workers. In the United States, high levels of emotional exhaustion among radiation therapists highlight the potential for the development of burnout within the UK therapy workforce. The discussion looks at the importance of these characteristics within a general retention strategy and recommends future areas of study.

A patient arriving for their first Radiotherapy appointment can exhibit an array of behaviours, such as anxiety or aggression, which are generated by intense emotions. Each patient will have their own individual concerns and their needs should be addressed, to make their first experience in the Radiotherapy Department as smooth and stress free as possible.

The radiographer's role at this point is undoubtedly to provide patients with information, whilst demonstrating a compassionate and genuine nature. This can make all the difference to the way a patient reacts and copes with the entire course of radiotherapy.

The skills that will allow a radiographer to handle these situations are, in the first instance; good communication skills, but in addition to this the development of some basic counselling skills could further enhance patient care.

The aim of this article is to discuss the benefits of utilising basic counselling skills to create the best environment possible for the patient, and possibly answer some questions about their legitimate nature.