Objective-To assess the needs of patients with cancer for information about their condition.Design-Cross sectional survey of patients' views by means of semistructured interview with questionnaire.Setting-A regional cancer centre and two university hospitals in west Scotland.Subjects-250 (93%) of 269 cancer patients invited to participate in study who were selected by age, sex, socioeconomic status, and tumour site to be representative of cancer patients in west Scotland.Main outcome measures-Patients' need to know whether they had cancer, the medical name of their illness, progress through treatment, how treatment works, side effects, chances of cure, and treatment options.Results-79% (95% confidence interval 73% to 84%) of patients wanted as much information as possible, and 96% (93% to 98%) had a need or an absolute need to know ifthey had cancer. Most patients also wanted to know the chance ofcure (91% (87% to 94%)) and about side effects of treatment (94% (90% to 97%)). When the replies were cross tabulated with patients' age, sex, deprivation score, and type of treatment there was a linear trend for patients from more affluent areas to want more information and those from deprived areas to want less. There was a strong preference for diagnosis of cancer to be given by a hospital doctor (60% (53% to 66%).

The aim of this retrospective study is to develop an evidence-based approach to managing radiation induced skin reactions. A Clinical Guideline Development Group was established to undertake a systematic review of literature and a survey of cancer centres with the objectives of highlighting and recommending best practice. Thirty-one papers were reviewed using the United States Health Care Policy and Research and Scottish Intercollegiate Guidelines Network criteria and 42 United Kingdom Cancer Centres responded with a mix of guidelines and information about skin care assessment and advice. The evidence base for the findings is mainly levels II, III and IV.Although perceived as common, the incidence of skin reactions has not been quantified. There is little evidence of consistent assessment of acute reactions and the survey data shows that the use of a scoring tool such as the Radiation Oncology Group criteria (RTOG/EORTC 1985) is rare. It also demonstrates that advice to patients is variable and sometimes contradictory. Appropriate and timely information is essential to relieve anxiety and reduce problems.There appears to be a place for the use of creams in the management of early (RTOG/EORTC 0,1, 2a) skin reactions and in delaying the onset of subsequent skin breakdown, however this evidence is not clear and several of the studies identified some allergic reactions to creams. The intervention used varies between departments and individual patients and is ad hoc rather than based on firm evidence.For reactions graded RTOG/EORTC 2b and 3, evidence from wound care literature suggests the use of hydrocolloids or hydrogels which are founded on moist wound healing principles. No evidence could be found to support the management of RTOG 4.The study recommends the development of a clinical guideline encompassing factors affecting the onset of reactions, assessment and management principles, and patient information and makes suggestions for much needed further research.

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Two recent studies carried out by the Medical Research Council Lung Cancer Working Party have suggested that large fraction radiotherapy to the chest in either 10-Gy single fraction or 17-Gy two-fraction doses, 1 week apart, is safe and effective for patients who require palliation for bronchogenic cancer. The Beatson Oncology Centre, Glasgow, participated in the original MRC trial and anecdotal reports of acute chest pains, fevers, sweats and rigors in some patients during the first 24-hour period after radiotherapy treatment were noted. These acute side-effects were not monitored during the Medical Research Council trials. It was felt that this area warranted further evaluation in order to identify the incidence of such acute side-effects and to what extent they caused a reduction in the patients' remaining quality of life. A pilot study of 10 patients confirmed the manifestation of the side-effects reported anecdotally in the MRC trial. It was on this basis that the study was extended, with a further 51 patients being invited to participate over a 4-month period. The findings indicate a significant incidence of adverse side-effects in patients receiving large fraction radiotherapy to the chest in either 10-Gy single fraction or 17-Gy two-fraction doses, but that these are transient and do not cause unacceptable disruption to the patients over an extended period.

Background: Non-Hodgkin's Lymphomas (NHL) are considered to be a highly radiosensitive group of diseases with radiotherapy playing a major role in their treatment. It is recognised that the different grades and stages of NHL require different treatment approaches with current recommendations including combined chemotherapy and radiotherapy, chemotherapy alone or radiotherapy alone. Despite these recommendations there still remains a variation in the radiotherapy dose and fractionation regimens prescribed for NHL and this could be attributed to a lack of written treatment protocols for these patients. This paper gives an overview of the literature and reports on a small local study.Method: A retrospective study recorded the treatment details of 35 patients treated with radiotherapy for NHL between April and September 1996 in a major radiotherapy centre. An analysis of the various radiotherapy dose and fractionation regimens identified was carried out and an attempt to identify the rationale behind the variations was made by correlating them to the grade of disease, the age of the patients, the prescribing consultants and whether chemotherapy was part of the treatment regimen.Results: Thirteen consultants were identified as prescribing treatment for NHL. Forty-nine percent of patients presented as low, 11% intermediate and 31% high grade NHL. Of the 60% of patients who underwent chemotherapy the majority (62%) were prescribed Cyclophosphamide, Hydroxydaunorubicin, Oncovin (Vincristine) and Prednisolone (the CHOP regimen). Nineteen different radiotherapy dose and fractionation regimens were identified, 20 Gy in 5 fractions being the most common. No correlation was found between the age of the patients and the radiotherapy dose delivered. A strong positive relationship (r = 0.95) was identified between the radiotherapy dose and the number of fractions. There was no effect on the radiotherapy dose delivered between the different grades of disease or whether chemotherapy was administered.Conclusions: It is considered that the implementation of a NHL treatment protocol is important and in an attempt to initiate this, specific NHL teams should be formed.