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Development of an intervention to reduce distress during and after brachytherapy for locally advanced cervical cancer

Chief Investigator

Institution

Dates

Funding Stream

Grant Ref

Amount

Pauline Humphrey

University Hospitals Bristol NHS Foundation Trust and University of the West of England, Bristol

01/05/2018-31/08/2022

(48 months) + 4 months extension

NIHR HEE/ NIHR ICA Programme Clinical Doctoral Research Fellowship

ICA-CDRF-2017-03-079

£322,731

Summary

Brachytherapy, a type of internal radiation therapy, is a treatment offered to women with cervix cancer. It is given after a course of external radiotherapy and chemotherapy to women with locally advanced cervical cancer, usually when surgery is not possible. It involves placing a number of applicators like hollow tubes inside the womb and then putting a radioactive source into the applicators to deliver a dose of radiation to kill cancer cells.

Some centres give brachytherapy in 3 or 4 day case procedures. Others give treatments with 1 or 2 overnight stays, with applicators remaining in place for up to 48 hours. Women have to stay in bed and not move while the applicators are inside them, but may have less visits and less anaesthetics overall. These different regimes are thought to be equally as effective in controlling the cancer, but we do not know how much this affects women's experiences.

The researcher has looked at all the published studies that tell us about women's experiences and written a report called a systematic literature review. This has found a number of reports that have shown a significant proportion of women who experienced a lot of physical and psychological distress during and after brachytherapy. The causes of distress appears to be quite complicated, with many different factors such as anxiety, pain, memories of pain from their last treatment, lying in a room on their own for a long time, having to lie still for a long time while applicators are inside them and the amount of time feeling embarrassed and humiliated. One study showed that over 4 in 10 women had symptoms of post-traumatic stress disorder 3 months after finishing brachytherapy. A number of other studies found that pain was generally mild to moderate, but that a small number of women suffered with severe pain. Some studies have looked at different ways of giving anaesthetics and pain killers to try and lower pain levels. Some used general anaesthetics where a patient is unconscious, some gave numbing injections into the spine and some sprayed local anaesthetic onto the cervix itself. They have measured pain and other side effects to try and find out what works best. Overall it was found that there is no standard way of giving anaesthetics and pain killers and is likely to be dependent on availability and cost of resources. Also, the amount of time for the procedure varies a lot, and some methods will be better suited to shorter or longer treatment times.

To be able to find a way to reduce distress from brachytherapy, we need to understand better what parts of the treatment causes most upset to women. Also we want to find out what women found helped them cope, and what they think would have made it better for them. To find this out the study will have 3 stages:

1.        Exploratory stage

  • A survey of all UK radiotherapy departments to find out how they give brachytherapy, what type of anaesthetics, what painkillers, how long it takes and how many treatments, and if any extra support like counselling is offered to help women cope.
  • Interviews with 25 women, from 5 different hospitals who do the treatment in different ways.
  • A survey of over 200 women across to find out what they had experienced.

2. Development of an intervention (to reduce distress)

From the information collected, the researcher will work out what needs to be done to help women cope better with brachytherapy. This may include better pain control, relaxation therapies like music videos or counselling.

3. Testing the intervention

A small number of women will try out the intervention to see if it can be used to help them cope.

With advances in computer technology, this leads to ways of planning the treatment so that higher radiation doses can be given to the cervix cancer, and reducing doses to the normal tissues close by, such as bowel, and bladder. This means that cure rates can go up and side effects go down, but overall time for highly skilled staff time is likely to increase and therefore time to give the treatments will be longer. So trying to help women cope with this longer time will be increasingly important in the future.

Overall the aim of this study is to develop an intervention to help women cope better with this highly effective but potentially distressing treatment.

Pump Priming

Preliminary data to support the application for this grant was generated by a UHBW Research Capability Funding (RCF) pump priming grant.  Please visit  /research-innovation/our-research/grants-and-infrastructure-awards/above-and-beyond-research-capability-funding/completed-grants/development-of-an-intervention-to-reduce-distress-during-and-after-brachytherapy-for-locally-advanced-cervical-cancer/ for further details of this grant.