ESTRO 2023 - Abstract Book

S2056

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ESTRO 2023

was reviewed in an MDT setting by senior RTs, nursing and admin. Aria Carepaths were updated to ensure this was routinely integrated with ease for both the department and patient. Results A comprehensive claustrophobia management program has been developed which consists of several key interventions. Firstly, a video link is emailed to the patient 1 week prior to their CT which demonstrates the mask making process and includes patient testimonials to familiarise the patient with the process. The email encouraged patients to contact the department if they anticipate any distress relating to the mask. A personalised care-plan and referral pathways can then be established prior to CT such as medication intervention to reduce anxiety hence shortening appointment length. In addition, a claustrophobia brochure has been developed to be given out before CT. This again emphasises the purpose of the mask and interventions available such practicing mindfulness, manipulating the mask, relaxation music and controlled breathing. Providing a video resource and written resource means patients and their support people can process the information in their own time away from the clinical setting. A patient alert is also added on day 2 of treatment which prompts the radiation therapist to have a conversation with the patient about how they are managing with the mask, making any adaptations to their care plan as necessary. Conclusion A radiotherapy mask can cause significant anxiety in patients. To improve a patient’s experience and deliver patient centred care our department has created a comprehensive intervention program. The effectiveness of this program will be evaluated in future work for on-going development.

PO-2286 Nutritional interventions in acute radiation-induced diarrhoea in pelvic cancer: a systematic review

M.O. Holm 1 , U. Falkmer 1 , M.K. Yilmaz 2 , J. Søndergaard 2 , R. Tobberup 3 , H.H. Rasmussen 4 , C. Lauridsen 5 , A. Bye 6 , L.Ø. Poulsen 1 1 Clinical Institute, Faculty of Medicine, Aalborg University, Department of Oncology, Aalborg, Denmark; 2 Aalborg University Hospital, Department of Oncology, Aalborg, Denmark; 3 Center for Nutrition and Bowel Failure, Department of Gastroenterology, Aalborg, Denmark; 4 Clinical Institute, Faculty of Medicine, Aalborg University, Center for Nutrition and Bowel Failure, Aalborg, Denmark; 5 Aarhus University, Department of Animal and Veterinary Sciences, Foulum, Denmark; 6 Oslo University Hospital, Department of Oncology, Oslo, Norway Purpose or Objective A well-known side effect of EBRT to the pelvis is acute radiation-induced diarrhoea (RID). RID is reported as the problem with the greatest impact on HRQOL. In about 80% of patients receiving pelvic RT loose stool has been reported, usually occurring two weeks after the start of EBRT and peaks at 4-5 weeks post irradiation. Recently, a systematic review showed low evidence that protein supplements, dietary counselling and probiotics may reduce acute RID. The aim of the current review is to investigate if there is any evidence for nutritional interventions improving acute RID in patients with pelvic cancer during curative RT. Materials and Methods The Cochrane technology platform Covidence was used. PROSPERO registration (ID: CRD42020209499). Databases searched were PubMed, Embase, Cinahl and Cochrane Library from January 1st 2005 to October 10th 2022. Included were RCT’s or prospective observational studies, including ≥ 20 patients, published in English. Search terms were primary pelvic cancer, curative EBRT, acute RID, nutritional interventions, antidiarrheal agents, and gastrointestinal toxicity. Risk of bias (RoB) was assessed with the Cochrane RoB tool. Improved or unchanged effect on acute RID appears as up or horizontal arrows, respectively. The quality of evidence (QE) was graded using the GRADE system, categorized as high, moderate, or low (Table 1). Results The literature retrieved, see Fig. 1. The 21 studies included a total of 2,225 patients with pelvic cancer, sample from 26- 490, 20 RCTs and one observational trial. In almost all studies, patients with different cancer types were treated with different RT techniques. Nutritional interventions were probiotics (n=6), prebiotics (n=6), glutamine (n=4), and others (n=5). Most RoB was noticed because “incomplete outcome data” and other bias due to several cancer diagnoses, RID not defined as primary endpoint, few patients, unclear nutritional interventions, different RT’s, and adapted Bristol Stool Scales (Table 1). Six probiotic trials showed improvement of acute RID in 5 studies. The common probiotic interventions were given in solid form containing Lactobacillus acidophilus and different Bifidobacterium species. Conclusion In all 15 of the 21 included studies have high RoB. Low patient numbers; clinical heterogeneity including multiple cancer diagnoses and radiotherapy regimes; and non-systematic assessment of acute RID seem to be the main reasons for low quality of evidence. However, five probiotics studies were identified, two of them with high quality of evidence, with improvement of acute RID, all of them using a combination of different probiotics. Future well-designed clinical studies investigating the effect of probiotics on acute RID should be done.