Introduction: Therapies such as acupuncture are being increasingly used as an integrative treatment for chemotherapy-induced peripheral neuropathy (CIPN). This study aimed to explore the experience of partici-pating in a clinical study of acupuncture for CIPN.Methods: This qualitative study was nested within a trial (n = 120) with participants randomised to 10 sessions of acupuncture or the control group wait list for acupuncture posttrial. Participants (n = 23) volunteered to be interviewed either by telephone (n = 20) or face-to-face (3). The audiotapes were transcribed verbatim and analysed using a thematic approach.Results: Analysis of qualitative data identified 4 key themes: 1. Information, motivation, and allocation - partici-pants expressed positive expectations and hoped that acupuncture would improve symptoms of CIPN. 2. Acupuncture experiences - participants reported beneficial effects of acupuncture on their CIPN symptoms and quality of life. 3. Trial experience and procedures - some participants disclosed some difficulty in completing the trial but also felt their CIPN was being taken seriously. 4. Suggestions for improving the study - recommendations were made for future studies about recruitment and the questionnaires.Conclusion: Participants in the treatment arm were largely delighted and many experienced benefits, including effects on other symptoms. There were some non-responders in those interviewed, but most valued the experi-ence of taking part. The findings from this nested study would be useful to refine procedures and protocols in any future large multisite trial. Trial No. NCT02275403 on Clinicaltrials.gov

BACKGROUND:Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting side-effect for patients undergoing a variety of chemotherapy regimens. These effects can have a detrimental impact on patients' quality of life and ability to perform everyday tasks.OBJECTIVE:This study aimed to explore the experience of living with CIPN prior to and while participating in a randomised study of acupuncture versus a control wait group.DESIGN:The study was nested within a randomised trial (n=120) with participants randomised to acupuncture or to control (wait list for acupuncture).METHOD:Participants (n=23) volunteered to be interviewed either by telephone (n=20) or face to face (n=3). The audiotapes produced were transcribed verbatim and analysed using a thematic approach.RESULTS:Four themes developed; these included daily life with CIPN, signs and symptoms, interacting with others and management of CIPN. Patients reported compromised dexterity and ability to safely carry out activities. They were often reliant on help and sought out information from others living with the condition. There were also concerns about the lack of effectiveness and the side-effects of medication prescribed.CONCLUSION:Participants were self-selecting volunteers across different cancer groups, but the information gathered could influence future study designs and increase understanding of the impact of CIPN on patients' lives.

PURPOSE:Chemotherapy-induced peripheral neuropathy (CIPN) is a dose limiting toxicity posing a major clinical challenge for managing patients receiving specific chemotherapy regimens (e.g., Taxanes). There is a growing body of literature suggesting acupuncture can improve CIPN symptoms. The purpose of the ACUFOCIN trial was to collect preliminary data on the safety, feasibility, acceptability and initial effectiveness of acupuncture as a treatment for CIPN, comparing use of acupuncture plus standard care (Acupuncture) against standard care alone (Control). METHOD:At a tertiary cancer centre, a pragmatic, randomised, parallel group design study was used to investigate the effectiveness of a 10-week course of acupuncture. Participants experiencing CIPN of ≥ Grade II, recording a 'Most Troublesome' CIPN symptom score of ≥3 using the "Measure Yourself Medical Outcome Profile" (MYMOP 2), were randomised to 'Acupuncture' or 'Control' arms. Clinicians were blinded to allocated groups, however as it was not possible to blind participants, it cannot be guaranteed they did not disclose study allocation within their clinic assessments. The primary outcome measure was the number of patients reporting a ≥ 2-point improvement (success) in their MYMOP2 score at week 10. 100 participants (120 to allow for attrition) were required for a hypothesised improvement in success proportions from 30% to 55% using a primary analysis model with logistic regression adjusted for stratification factors and baseline MYMOP2 scores. Feasibility and acceptability of study design was addressed through percentage return of primary outcome, retention rate and a nested qualitative study. RESULTS:Primary MYMOP2 outcome data at week 10 was available for 108/120 randomised participants; this is greater than the 100 participants required to adequately power the study. There were 36/53 (68%) successes in 'Acupuncture' compared to 18/55 (33%) in 'Control'. Beneficial effects were seen in the secondary outcome data, including clinicians' grading of neuropathy, EORTC, QLQ-CIPN20, QLQ-C30 summary scores and patient reported pain scores. There were no serious adverse events reported within the study and only 16 acupuncture associated events, none of which required intervention. CONCLUSION:A 10-week course of acupuncture resulted in measurable improvement in participants symptoms of CIPN. The results warrant further investigation.

Objectives In lung cancer, three prominent symptoms, such as breathlessness, cough and fatigue, are closely related with each other forming a ‘respiratory distress symptom cluster’. The aim of this study was to determine the clinical and cost-effectiveness of the respiratory distress symptom intervention (RDSI) for the management of this symptom cluster in people with lung cancer. Methods A single blind, pragmatic, randomised controlled trial conducted in eight centres in England, UK. A total of 263 patients with lung cancer were randomised, including 132 who received RDSI and 131 who received standard care. To be eligible, participants self-reported adverse impact in daily life from at least two of the three symptoms, in any combination. Outcomes were change at 12 weeks for each symptom within the cluster, including Dyspnoea-12 (D-12), Manchester Cough in Lung Cancer (MCLC) and Functional Assessment of Chronic Illness-Fatigue. Results At baseline, nearly 60% of participants reported all three symptoms. At trial completion the total trial attrition was 109 (41.4%). Compared with the control group, the RDSI group demonstrated a statistically significant improvement in D-12 (p=0.007) and MCLC (p<0.001). The minimal clinically important difference MCID) was achieved for each outcome: D-12 –4.13 (MCID >3), MCLC −5.49 (MCID >3) and FACIT-F 4.91 (MCID >4). Conclusion RDSI is a clinically effective, low-risk intervention to support the management of the respiratory distress symptom cluster in lung cancer. However, the study did experience high attrition, which needs to be taken onto consideration when interpreting these results. Trial registration number NCT03223805.

12003 Background: CIPN is a dose limiting toxicity, and a major clinical challenge. This study aims to explore the use of acupuncture with standard care (Acu +SC) against SC alone, to reduce symptoms of CIPN. Methods: A phase II, randomised, parallel group design was used to investigate the effectiveness of a 10 week course of acupuncture to manage CIPN. Patients experiencing CIPN ≥ Grade II (CTCAE v4.03), recording a ‘Most Troublesome’ CIPN symptom score of ≥ 3 using the "Measure Yourself Medical Outcome Profile" (MYMOP 2), were randomised (1:1) to either Acu+SC or SC alone. The primary end-point was a ≥ 2 point improvement in MYMOP2 score at week 10 (logistic regression adjusted for stratification factors and baseline MYMOP2 score). The necessary sample size was 100 patients;120 were randomised to allow for attrition (90% power; 10% one-sided alpha), for a hypothesised improvement in success proportions from 30% to 55%. Results: 120 patients were randomised to ACUFOCIN; diagnosis: breast 61 (51%), multiple myeloma 9 (8%), GI 48 (40%), gynaecological 2 (2%). MYMOP2 score for most troubling CIPN symptom at baseline: 3-4 33 (28%), 5-6 87 (73%). CTCAE CIPN at baseline; grade II 103 (86%), grade III 17 (14%). Baseline characteristics were balanced between arms. Primary outcome data were available for 108 participants with 36/54 (67%) successes in the Acu+SC arm compared to 18/55 (33%) in the SC arm. Adjusted success odds ratio was 4.3 (95% CI 1.9-9.6; p < 0.001; Acu+SC vs SC). Additionally, 27/53 (51%) participants achieved a CIPN success (grade ≤ I) in the Acu+SC arm compared to 4/56 (7%) in the SC arm with adjusted odds ratio 13.1 (95% CI 4.1-41.7; p < 0.001; Acu+SC vs SC). Significant reduction in week 10 pain score; mean difference (SC+Acu – SC alone) -1.45 with 95% CI (-2.25, -0.65) after adjustment for week 1 pain, breast cancer diagnosis and treatment complete status. (note pain on a 0-10 scale). Significant increase in the EORTC QLQ-C30 summary score; mean difference (SC+Acu – SC alone) 9.51 with 95% CI (5.01, 14.02) after adjustment for the baseline score, breast cancer diagnosis and treatment complete status. (note summary score on a 0-100 scale). Significant effects seen at week 10 are also present at week 6. The week 6 effect estimates are consistently less than the week 10 effects (but not usually statistically significantly so). Conclusions: In this patient cohort, a 10 week course of acupuncture significantly improved symptoms of CIPN. These results support further investigation within a phase III trial. Clinical trial information: NCT02275403 .

Introduction: A feasibility study of acupuncture for quality of life in cancer patients is planned. The pragmatic randomised controlled trial will aim to assess the feasibility of training radiographers to administer acupuncture to their patients undergoing radiotherapy intended to cure their cancer. The preliminary phase covered in this paper aimed to develop the trial acupuncture intervention and ensure its model validity. Methods: A mixed methods approach will be adopted. Systematic review conducted examining the treatments administered in papers reporting acupuncture treatment for cancer patients. Subsequently, one-day workshop held with an acupuncture expert panel. Informed by the systematic review and their clinical expertise the expert panel devised and agreed the trial acupuncture intervention. Results: The acupuncture expert panel came to a consensus on the trial acupuncture intervention. Trial radiographers will treat patients for 30 min, with needles inserted for approximately 20 min of this time. The trial will employ a standard treatment protocol for constitutional symptoms (fatigue, hot flushes, mood problems, anxiety, depression, and sleep problems) consisting of non traditional ASAD (anxiety, sickness and dyspnoea) acupoints, LI4, LR3, SP6 and ST36. Additional acupoints can be utilised for nausea/vomiting and pain. Guidelines on safe practice were also agreed. Conclusions: Few clinical trials of acupuncture, and complementary medicine interventions generally, document details of the process by which they ensured the model validity of their trial intervention. It is recommended that researchers in acupuncture, and other forms of complementary medicine, adopt appropriate methodological approaches to ensure model validity.

There is evidence of a causal link between smoking and cancer, and its effects on cancer survivorship. Smoking is common among the lesbian, gay, bisexual, trans (LGBT) population, but data on cancer rates, and engagement with smoking cessation services, are poor. This article describes, and reports results of, a survey of smoking and electronic cigarette use (vaping) among attendees of the annual Manchester LGBT Pride festival. Results suggest that smoking triggers include social situations, partners/friends smoking, stress, drinking alcohol, needing to take a break/move away from difficult situations and relieving boredom. There was also reported use of vaping, combining smoking and vaping, and slipping back to smoking in social situations.‘Trans’ and ‘in another way’ are used in the article as inclusive terms to embrace transgender, gender non-conforming, gender variant, gender queer, non-binary and non-gender people.

Smoking tobacco continues to be the world's most preventable cause of death and disability with over six trillion cigarettes sold each year. Patients, visitors and health professionals who smoke on hospital sites present a challenge to the effectiveness of public health messages. Health professionals who ignore ‘No smoking’ hospital/clinic signage, and avoid smoking-cessation activity, help to sustain the perception that smoking is tolerated. Case studies, with a focus on lung cancer and chronic obstructive pulmonary disease (COPD), are used to illustrate how nurses can ‘seed’ the idea of hospitals becoming smoke-free, provide brief interventions and support patients, carers and colleagues to make that change.

British Journal of NursingVol. 25, No. Sup2 CommentConsidering the relationship between the needle, patient and cannulatorPeter Mackereth, Lynne TomlinsonPeter MackerethSearch for more papers by this author, Lynne TomlinsonSearch for more papers by this authorPeter Mackereth; Lynne TomlinsonPublished Online:29 Jan 2016https://doi.org/10.12968/bjon.2016.25.Sup2.S27AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Lang EV, Hatsiopoulou O, Koch T et al. (2005) Can words hurt? Patient-provider interactions during invasive procedures. Pain 114(1-2): 303–9. doi: https://doi.org/10.1016/j.pain.2004.12.028 Crossref, Medline, Google ScholarMcGowan D (2014) Peripheral intravenous cannulation: what is considered ‘best practice’? Br J Nurs 23(Suppl 14): S26–8. doi: https://doi.org/10.12968/bjon.2014.23.Sup14.S26 Link, Google ScholarMackereth P Tomlinson L (2014) Procedure-related anxiety and needle phobia: rapid techniques to calm. Nursing in Practice 80: 55–7 Google ScholarMackereth P, Hackman E, Tomlinson L, Manifold J, Orrett L (2012) ‘Needle with ease’: rapid stress management techniques. Br J Nurs 21(Suppl 14): S18–22. doi: https://doi.org/10.12968/bjon.2012.21.Sup14.S18 Link, Google Scholar FiguresReferencesRelatedDetails 27 January 2016Volume 25Issue Sup2ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 29 January 2016 Published in print 27 January 2016 Information© MA Healthcare LimitedPDF download

This paper reports finding from a nested qualitative study designed to elicit the views and perceptions of those who participated in a randomised controlled feasibility trial testing a non-pharmacological intervention, Respiratory Distress Symptom Intervention (RDSI), for the management of the breathlessness-cough-fatigue symptom cluster in lung cancer. Semi-structured interviews were conducted with 11 lung cancer patients, three caregivers and seven researchers involved in recruitment, consent, RDSI training and delivery and participant follow-up. Thematic analysis identified key considerations including: the importance of informed consent emphasising commitment to completion of paperwork and raising awareness of potential sensitivities relating to content of questionnaires; ensuring screening for the presence of symptoms reflects the language used by patients; appreciation of the commitment required from participants to learn intervention techniques and embed them as part of everyday life; conduct of interviews with patients who decline to participate; and conduct of serial interviews with those receiving RDSI to further inform its routine implementation into clinical practice. This study will inform the development of a fully powered follow-on trial testing the hypothesis that RDSI plus usual care is superior to usual care alone in the effective management of this symptom cluster in lung cancer.

This paper describes the production and analysis of an informal prostate cancer awareness survey (n = 217), which was conducted in Manchester, UK, in August 2014 by the LGBT (Lesbian, Gay, Bisexual, Transgender) Cancer Support Alliance. Data collected from the survey along with anecdotal evidence collected by the researchers was used to produce a series of four Prostate Cancer Awareness postcards targeted at gay and bisexual men and trans women, and which could be displayed in public spaces likely to be accessed by these groups. The aim was to raise awareness of key issues picked up by the survey amongst the local population and highlight particular issues which may encourage men or transsexual women to think about the risk of developing prostate cancer, and what their relationship with sexual partners, carers and health care professionals might be following diagnosis and treatment.The postcards were titled: (1) We are struggling to have sex after treatment (2) Are gay men more likely to develop prostate cancer than straight men? (3) Tips for the guys...looking after your G-spot (4) My doctor always asks me about my wife.

British Journal of NursingVol. 24, No. 5 RegularsFree AccessPlain packs and more: towards a smoke-free futurePeter MackerethPeter MackerethPeter MackerethPublished Online:10 Mar 2015https://doi.org/10.12968/bjon.2015.24.5.256AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail Across the Greater Manchester area approximately 37% of the population smoke; this is higher than the national average of 20% (Health and Social Care Information Centre (HSCIC), 2014a). At The Christie our audits indicate that 40% of patients are smoking at the point of cancer diagnosis, sometimes increasing usage and arguing that for them it is the wrong time to stop. Many of our patients are unaware that toxic chemicals found in the smoke interfere with the efficacy of chemotherapy and radiotherapy. Specifically, carbon monoxide, a colourless gas found in smoke, increases anxiety, nausea and breathlessness and impairs circulation. Additionally, the tar and other chemicals interact with and reduce the effectiveness of drug treatments and increase side-effects (Cataldo et al, 2010). Smoking cessation is an essential component of evidence-based cancer treatment, extending survival times and lowering the risk of new primaries and metastatic disease across a range of cancers (Mudie et al, 2006; Parsons et al, 2010).'Compassionate care requires nurses to see beyond appeasing addiction'At The Christie nurses and senior management have embraced our smoking-cessation (SC) services, with funding in place for skilled heath advisors. Our SC package includes smoking assessment, provision of nicotine replacement therapy (NRT), motivational interviewing, stress management techniques and clinical hypnotherapy. As lead for tobacco control, my role includes maintaining a smoke-free site, engaging nursing and medical staff to become champions for early referral and linking the gains from going smoke-free to cancer treatment. In addition our SC team works with carers and staff to assist them in becoming smoke free.Over the last few years I have been invited to engage in debates on plain packaging, smoke-free sites, and smoke-free cars for children and have engaged in discussion on television, radio and in the press. Some commentators have used social media to label my arguments as those of a 'nanny state', but others have said 'it's time we see smoking for what it is—a harmful and damaging addiction that compromises the health of adults and children'.Arguments against plain packaging by the tobacco industry focus on the potential for driving up the illicit tobacco trade and reducing users' ability to distinguish brands, so damaging the industry's trade. Counterfeit cigarettes are already here and those who smoke them will also buy the big brands to maintain their addiction. Legal action has been threatened as a means of deterring government from replicating Australia's courageous stance of adopting plain packaging. The tobacco industry needs new recruits, as 50% of all smokers will die as a result of their habit (Jha and Peto, 2014) so engaging with children of adult smokers via 'glamourous' packs is now the main stage. Our streets are often littered with empty packs; they are typically pulled out of pockets and handbags 20 or more times a day, sit on tables and are propped up on dashboards. Films, videos and television often include smokers pulling cigarettes out of glamorous packets; yet I doubt if we will see the drab brown packets with diseased lungs in close-up displayed in contemporary dramas.Health care and wellbeing is unavoidably a political and social activity. Compassionate care requires nurses to see beyond appeasing addiction. Would we allow alcohol and recreational drug use on site at a hospital? I would argue plain packaging is a necessary step towards de-normalising smoking. There was a time that many UK hospitals were funded by the tobacco industry, now we have around 1300 admissions a day and 79 000 deaths a year due to smoking (HSCIC, 2014a). Over 200 000 children aged 11-15 years old will start smoking in the next 12 months with the majority of lifetime smokers starting as teenagers (HSCIC, 2014b). Plain packaging is the next brave step for the UK towards tobacco-free futures for both current patients and future generations.The British Heart Foundation's No Smoking Day takes place on 11 March 2015. For more information visit: https://nosmokingday.org.uk References Cataldo J, Dubey S, Prochaska J (2010) Smoking cessation: an integral part of lung cancer treatment. Oncology 78(5-6): 289–301. doi: https://doi.org/10.1159/000319937 Crossref, Medline, Google ScholarHealth and Social Care Information Centre (2014a) Statistics on Smoking: England—2014. http://tinyurl.com/nwdbfpv (accessed 24 February 2015) Google ScholarHealth and Social Care Information Centre (2014b) Smoking drinking and drug use among young people in England in 2013. http://tinyurl.com/pgzwky6 (accessed 24 February 2015) Google ScholarJha P, Peto R (2014) Global effects of smoking, of quitting, and of taxing tobacco. N Engl J Med 370(1): 60-8. doi: https://doi.org/10.1056/NEJMra1308383 Crossref, Medline, Google ScholarMudie NY, Swerdlow AJ, Higgins CD et al. (2006) Risk of second malignancy after non-Hodgkin's lymphoma: a British Cohort Study. J Clin Oncol 24(10): 1568–74 Crossref, Medline, Google ScholarParsons A, Daley A, Begh R, Aveyard P (2010) Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. BMJ 340: b5569. doi: https://doi.org/10.1136/bmj.b5569 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetailsCited bySmokeless tobacco control in India: policy review and lessons for high-burden countries14 July 2020 | BMJ Global Health, Vol. 5, No. 7 11 March 2015Volume 24Issue 5ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 10 March 2015 Published in print 11 March 2015 Information© MA Healthcare LimitedPDF download

Objective: To explore the experiences of therapists providing acupuncture in a trial context, to women with fatigue, following breast cancer treatment.Methods: The focus groups were nested within a multi-site randomised control trial. Therapists (n = 15) involved in the trial were invited to participate in one of the focus groups, which took place in the north and south of England. The treatment protocol imposed constraints on dialogue to essential procedural conversation and stipulated needling times of 20 min.Results: All 15 therapists (100%) participated. Whilst they reported learning more about fatigue and cancer, adhering to the trial protocol limited the holistic nature of their practice. Seeing improvements, despite the protocol, made some therapists question their practice, in terms of needling times and limiting dialogue.Conclusions: The study provided information about the therapists' perspective of working within a trial. This could have implications for providing acupuncture treatments more cost effectively and timely within clinical practice. (C) 2015 Elsevier Ltd. All rights reserved.

The purpose of our survey was to identify the awareness of the smoking cessation policy and smoking habits of staff within the hospital. Hospital employees were asked to complete a short questionnaire on their awareness of the smoking cessation policy and their smoking habits. A total of 325 members of staff completed the questionnaires. 99% of respondents were aware of the hospital site being smoke free. There was less awareness around smoking cessation services for staff, patients and caregivers. There were 23 current smokers, of which 12 expressed interest in stopping smoking. The sample was 13% of the total workplace and our plans are to promote and repeat the survey in 2015.

This study aimed to explore the experience of women living with fatigue following chemotherapy for breast cancer. Six focus groups were conducted (n=40); all participants had taken part in a multi-site acupuncture trial. There were three to seven people per focus group. Additionally, two people attended one-to-one interviews and four people provided written responses to the trigger questions. The audiotapes from these sessions were transcribed and analysed using a thematic approach. Participants raised concerns about fatigue possibly being a symptom of the cancer coming back or a sign of senility. Respondents described the effects of fatigue on relationships, sexuality, social life, home life and returning to work. The Coping with Fatigue booklet ( Macmillan Cancer Support, 2011 ) was discussed in terms of legitimising the experience of cancer-related fatigue and explaining symptoms to family and work colleagues. More research work is required to evaluate non-pharmaceutical interventions and advice to support women living with fatigue after chemotherapy for breast cancer.

An acute complementary therapy service has been successful in helping oncology patients to overcome procedure-related distress

OBJECTIVE:To explore the experience of training and performing self-needling from both the practitioners' and patients' perspective.METHODS:A qualitative study was conducted using focus groups and interviews, nested within our multi-site randomised controlled trial, Acupuncture for Cancer-Related Fatigue in Patients with Breast Cancer. Patients allocated to self-needling across two UK study sites and all therapists who were involved in the trial were invited to participate. The interviews/focus groups were then transcribed verbatim and analysed thematically by the process of content analysis.RESULTS:Of the 67 eligible patients, 8 (12%) contributed to the focus groups and 15 practitioners (100%), contributed to the study by either attending a focus group or being interviewed. Themes identified for patients included: the allocation to self-needling, teaching techniques and practical considerations and whether they would self-needle again. Themes identified for practitioners included: views on self-needling, teaching self-needling and future implications of self-needling.CONCLUSIONS:Self-needling was found to be acceptable to, and manageable by, patients, and enthusiastically adopted by most practitioners. Methods of teaching self-needling need to be developed and evaluated with guidelines recommended for best practice.

Aim: To develop a regime of care for patients with head and neck cancers undergoing intensity-modulated radiotherapy (IMRT), with the support of a health advisor ( HA) and temporary access to the mouth care product Caphosol(TM).Materials and methods: A HA was temporarily employed to assess, monitor and refer patients as appropriate and ensure patients received and utilised supplies of Caphosol(TM). A retrospective audit was undertaken to provide a gap analysis of current service. The data were used to develop a pro forma for documenting assessments and monitoring lifestyle factors for IMRT patients. Assessments referrals and compliance, plus hospital admissions owing to treatment-related issues, were documented during the baseline audit and the temporary HA service and provision of Caphosol(TM).Results: The presence of a HA facilitated 100% compliance with appropriate assessments, referrals and adherence to treatment. The data suggests that the additional provision of Caphosol(TM) may have reduced levels of mucositis and associated pain.Conclusion: It is recommended that a HA role be established within radiotherapy departments to facilitate lifestyle assessments, referrals and compliance with positive behaviour changes (e.g., stopping smoking). The use of Caphosol(TM) as a routine part of mouth care regime for IMRT patients also warrants further investigation.