Pelvic radiotherapy can damage surrounding tissue and organs, causing chronic conditions including bowel symptoms. We systematically identified quantitative, population-based studies of patient-reported bowel symptoms following pelvic radiotherapy to synthesize evidence of symptom type, prevalence, and severity. Medline, CINAHL, EMBASE, and PsychINFO were searched from inception to September 2022. Following independent screening of titles, abstracts, and full-texts, population and study characteristics and symptom findings were extracted, and narrative synthesis was conducted. In total, 45 papers (prostate, n = 39; gynecological, n = 6) reporting 19 datasets were included. Studies were methodologically heterogeneous. Most frequently assessed was bowel function (‘score’, 26 papers, ‘bother’, 19 papers). Also assessed was urgency, diarrhea, bleeding, incontinence, abdominal pain, painful hemorrhoids, rectal wetness, constipation, mucous discharge, frequency, and gas. Prevalence ranged from 1% (bleeding) to 59% (anal bleeding for >12 months at any time since start of treatment). In total, 10 papers compared radiotherapy with non-cancer comparators and 24 with non-radiotherapy cancer patient groups. Symptom prevalence/severity was greater/worse in radiotherapy groups and symptoms more common/worse post-radiotherapy than pre-diagnosis/treatment. Symptom prevalence varied between studies and symptoms. This review confirms that many people experience chronic bowel symptoms following pelvic radiotherapy. Greater methodological consistency, and investigation of less-well-studied survivor populations, could better inform the provision of services and support.

Background: Faecal immunochemical testing (FIT) is now core to the management of patients presenting in primary care with symptoms of possible colorectal cancer. Patients with a positive FIT (≥10 μg haemoglobin [Hb]/g faeces) qualify for an urgent suspected cancer referral. FIT-negative patients are typically managed in primary care or referred through routine pathways. Aim: To examine practitioners’ experiences of delivering symptomatic FIT, identifying perceived benefits, disbenefits, and implementation issues, to inform potential future service improvements. Design and setting: A qualitative interview study with primary and secondary care health professionals involved in delivering symptomatic FIT pathways from across the UK. Method: Thirty semi-structured interviews were conducted with professionals from a range of specialties. An iterative topic guide informed interviews while allowing freedom to explore novel lines of enquiry. Pseudo-anonymised transcripts were coded, and themes were identified and developed. Results: Symptomatic FIT was seen to be beneficial for increasing confidence in clinical decision making and enriching the pool of patients being definitively investigated for colorectal neoplasia. There were varying views on the impact of symptomatic FIT on workload with the burden of additional workload generally seen to impact primary care. Concerns about current practice included overuse of FIT, burden of investigations in patients with false-positive results, and diagnostic delays for both cancer and benign disease. Uncertainties existed around management of patients with rectal bleeding, appropriate strategies for safety netting, and the value of repeat FIT. Conclusion: Symptomatic FIT is largely seen as beneficial; however, health professionals would welcome further evidence and guidance around optimal application.

Face washing for trachoma, like most public health improvements, necessitates behaviour change, yet traditional educational interventions frequently fail to achieve this goal. Behavioural science frameworks offer guidance to develop alternative types of interventions, helping to translate formative research and insights about the target population and behavioural determinants into more effective strategies. This paper outlines the outputs and decision-making underlying the five-stage process we followed to translate formative research findings into intervention activities and materials: (1) synthesising formative research findings into a creative brief to guide intervention development; (2) selecting behaviour change techniques (BCTs) to address key behavioural targets; (3) selecting an overarching intervention concept; (4) developing intervention content; and (5) finalising the intervention’s Theory of Change. This paper presents our experiences and reflections on the intervention design process, using a practical example of a face washing intervention for trachoma control. The intervention was designed for delivery in the Stronger SAFE trial in rural Oromia, Ethiopia (ISCRTN 40760473).

Chronic bowel symptoms are common late-effects of pelvic radiotherapy associated with significantly decreased quality-of-life. For some, perhaps many, people these symptoms may be mitigated or treated, if appropriately investigated and diagnosed. We explored experiences of health service access and provision of support for people with chronic bowel symptoms after pelvic radiotherapy, from the perspectives of cancer survivors and health professionals. Our aim was to highlight processes and contextual factors that may hinder access to effective support and treatment. We carried out semi-structured interviews with 28 cancer survivors (14 female) with experience of post-radiotherapy, chronic bowel symptoms, and 19 health professionals involved in the care of such patients. Recruitment was through three NHS hospitals, cancer charities and professional networks. Data were analysed thematically, deductively (guided by the Model of Pathways to Treatment (MPT)) and inductively. We organised data around three overarching themes positioning experiences within MPT's event sequence or describing health system factor. Gratitude for treatment of cancer, embarrassment and acceptance of symptoms led survivors not to seek further care. Health professionals not recognising symptoms or focusing only on discounting cancer recurrence were barriers to effective care for those who sought it. System barriers included professional specialities working in isolation and geographical disparity in availability of late-effects services. Our findings suggest a need for raising awareness of late-effects of pelvic-radiotherapy among patients and health professionals encompassing recognition of symptoms and awareness of treatments and support and for accelerating access to specialist late-effects services nationally.

Objectives Faecal immunochemical testing (FIT) is now commonplace in the UK to prioritise symptomatic patients for urgent gastrointestinal investigation. The test requires a stool sample to be collected at home by the patient and returned for analysis. In this qualitative study, we sought to understand the feasibility and acceptability of FIT-based triage for patients. Design A cross-sectional, qualitative, experiential interview study. Setting Recruitment was through three participating UK NHS sites (Yorkshire, Midlands, North-East). Health professionals were also identified through membership of the BSG/ACPGBI Symptomatic FIT Guideline Development Group and snowball sampling. Participants We interviewed 21 patients who had completed FIT and been referred for colonoscopy and 30 primary and secondary care health professionals involved in symptomatic FIT delivery. Results Completion of FIT was unproblematic from the perspective of patients who returned the test. However, health professionals expressed concern over non-return. Among patients, understanding of the purpose of FIT and the meaning of results varied. Health professionals acknowledged that ensuring patient understanding of these can be challenging. Patients believed colonoscopy was less likely to miss cancer than FIT. Patients with a family or personal history of cancer were particularly anxious and wanted the reassurance of colonoscopy, even with a negative FIT result. Conclusions We found no major barriers to the use of FIT in prioritising symptomatic patients for urgent investigation. Improving communication might increase compliance and, possibly, acceptability of non-referral for colonoscopy in the case of a negative test result.

Purpose: For people living with and beyond cancer, access to clear, accurate, relevant information is crucial for meaningful participation in shared decision-making and is associated with better quality-of-life. Many cancer patients who undergo pelvic radiation experience chronic bowel symptoms, decreasing quality-of-life. We aimed to explore information access among survivors with experience of chronic bowel symptoms and develop a framework to guide future information provision. Methods: We conducted cross-sectional, semi-structured interviews with 28 cancer survivors (14 prostate, 10 gynecological, 4 anal/rectal) with experience of chronic bowel symptoms after pelvic radiotherapy, and 19 health professionals who provide treatment and care for survivors with these symptoms. Participants were recruited through UK cancer charities and National Health Service hospitals. Data were analyzed thematically. Findings informed a framework to guide improvements to information provision, developed with a patient panel. Results: Data were organized to reflect survivor experiences with information access and provision at different points along their cancer journey: Pre-treatment; Recognizing Symptoms; Managing S ymptoms; and two cross-cutting categories of Information Sources and Challenges in Information Provision. The framework encompasses information purpose and channels, survivors’ information needs at different time points and challenges and considerations for implementation. Conclusion: Access to timely, relevant, accurate information was an issue across the cancer pathway for this survivor group. Participants reported disparate information needs which could not have been fully known at treatment outset, and which changed over time. Our framework offers a potential starting point for efforts to improve information access and provision.