Fatigue during radiotherapy for early-stage breast cancer and its relationship to irradiated volumes, IL-6sR and anxiety and depression: Towards a prognostic model

Introduction Fatigue is the most troublesome untreated symptom during radical breast radiotherapy. This situation persists due to an uncertain aetiology and an inability to identify patients at high risk of experiencing significant fatigue during subsequent radiotherapy. Aetiological investigations of the current study concentrated on discriminating the radiotherapy-specific effects on fatigue, in a context encompassing multiple psychological and physiological covariates. Prognostic aspects sought to characterise a 'high-risk' patient. Methods The study cohort comprised 100 women, diagnosed with Stage 0 to IIA breast cancer, and prescribed standard whole breast irradiation to 40Gy in 15 fractions over three weeks. The use of systemic therapies was an exclusion criterion. A cytokine-induced sickness behaviour model framed the study investigations, and provided a theoretical link between localised radiotherapy and systemic fatigue. The outcome fatigue was assessed before, during and four weeks after radiotherapy, using the Functional Assessment of Chronic Illness Therapy Fatigue Subscale. Volumes of tissue irradiated were derived from dose-volume histogram analysis concentrations of the cytokine interleukin-6 soluble receptor were established via enzyme-linked immunosorbent assay. Multivariate analysis determined the factors that contributed to fatigue and generated a prognostic model that classified participants to fatigued or non-fatigued groups. Results 38% of participants experienced significant fatigue during radiotherapy, with the remainder little affected. The fatigued group recorded relatively elevated pre-radiotherapy levels of depression, and particularly anxiety, as measured by the Hospital Anxiety and Depression Scale. Depression uniquely accounted for 34% of the variance in pre-treatment fatigue. During radiotherapy, depression level and interleukin-6 soluble receptor concentration were significantly elevated in the fatigued group compared to the non-fatigued group (p < 0.0001, p = 0.01, respectively). The volume of tissue irradiated significantly affected peripheral interleukin-6 soluble receptor concentration (p = 0.003), but was not significantly associated with fatigue. A model comprising pre-treatment fatigue, anxiety and activity level (as measured by the International Physical Activity Questionnaire) reliably classified 82% of the study participants to the correct fatigue outcome (sensitivity 71.1% specificity 88.7%). Conclusion Psychological mood is the strongest predictor of fatigue before and during radiotherapy. Inter-related data is consistent with the concept that a lower psychological mood prior to radiotherapy relates to a distinct immunological and behavioural response during radiotherapy. These aetiological insights may inform fatigue treatment pathways, and ensure the targeting of future interventions at early breast cancer patients at a high risk of experiencing fatigue

Perceptions of faculty in health care and social sciences on teaching international students

Background Increased cultural diversity of higher education (HE) students has created both learning opportunities and teaching challenges for vocational health care programs. An internationalized curriculum reflects sociocultural issues in professional practice and enhances intercultural competency amongst students. However, the literature is limited in seeking the key perspective of those delivering the curriculum. This study explores the awareness of health care teaching staff on issues related to internationalization, perceived responsibility in supporting international students, and teaching practices toward an inclusive curriculum. Methods An anonymous questionnaire was developed, consisting of different types of questions (Y/N, Likert scale, and multiple choice) with opportunities for free text on each main theme. The questionnaire was sent to all 205 staff members with a teaching remit at Cardiff University Schools of Postgraduate Medicine, Healthcare Sciences, Pharmacy, and Social Sciences. Key findings In all, 102 responses were received. Despite 70% of respondents feeling that the responsibility for an improved learning experience for international students lies beyond them—with the University, their School, or students themselves—inclusive teaching practices that consider cultural diversity are widely reported. Some individuals feel unprepared to teach international students, citing a lack of cultural knowledge and training. The proportion of international students is perceived as the most important aspect of internationalization. Other key components of national and institutional HE strategies, such as “internationalization abroad”, appear to be relatively unimportant. Findings from this study provide a basis for all higher education institutions educating health and social care professionals to reflect critically on the realities of engaging with the internationalization of vocational programs

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

Opportunities for radiographer reporting in Ghana and the potential for improved patient care

Objective To explore factors that influence the introduction of role extension in radiography and to discuss its potential for improved healthcare in Ghana. Key findings Key findings of this review are the lack of literature on role extension in radiography in Ghana. The factors that have influenced the introduction of role extension in radiography globally include a shortage of radiologists, increased demand for radiology services, government policy and radiographer's desire for professional development. Conclusions Evidence indicates that radiographers can report radiographs as accurately as radiologists and appropriate education improves their performance. Radiographer-led reporting is the professional practise most likely to deliver local patient benefit. Developments in professional perceptions, training, education and regulation of reporting are required to establish confidence in radiography-led reporting. Implications for practice Radiographer reporting has the potential to improve patient outcomes, reduce waiting times, increase job satisfaction for radiographers and result in financial savings