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Breast cancer patients referred for external beam radiotherapy and who have large and/or pendulous breasts can present positioning and immobilisation challenges. Deep infra-mammary and/or lateral wrap skin folds can occur that can lead to unwanted radiation-induced skin toxicity. The purpose of the study was to evaluate the immobilisation techniques adopted for this subgroup of patients in order to inform best practice.
A survey aimed to identify the current clinical practice in radiotherapy centres throughout the United Kingdom and Ireland was undertaken. The email survey was distributed with support of the Radiotherapy Services Managers group.
Twenty-six of the 74 radiotherapy centres responded to the survey. Responses demonstrated that supine positioning with or without additional immobilisation was preferable. Of the eight different immobilisation techniques identified, patients positioned supine on a breast board wearing a bra was the most common. Only two of the centres reported using a prone technique.
Immobilisation and reproducibility are key for successful external beam radiotherapy particularly when advanced treatment techniques are being employed. No single technique gained widespread acceptance as the optimum for the effective immobilisation of patients with large and/or pendulous breasts. Further evaluative research in the form of a multi-centre trial is warranted in order to clearly establish the most effective immobilisation methods/devices for this ever expanding, subgroup of cancer patients.
To evaluate the use of exercise in managing fatigue in breast cancer patients undergoing adjuvant radiotherapy. To explore the effectiveness of different exercise practices and explore how optimum management of fatigue might be achieved.
A CINAHL (Cumulative Index to Nursing and Allied Health Literature) database search of literature was undertaken and publications screened for retrieval with 24 qualifying for inclusion in the review.
There is evidence to support various forms of exercise including aerobic, resistance, alternative and combination exercise in the management of fatigue in early stage breast cancer patients undergoing adjuvant radiotherapy. The benefits of exercise for patients with later stage and metastatic disease is less clear and there is a lack of published research related to this category of patient.
Exercise is considered a safe, non-pharmacological intervention for early stage breast cancer patients receiving adjuvant radiotherapy. Further investigation is required into optimum exercise interventions and the effectiveness and viability of supervised and unsupervised models. Patient centred tailored advice and guidance needs to be developed and effectively promoted by therapeutic radiographers in order for patients to fully realise the benefit.