Single-Fraction Stereotactic vs Conventional Multifraction Radiotherapy for Pain Relief in Patients With Predominantly Nonspine Bone Metastases

Nguyen Q, Chun SG, Chow E, et al.| 2019|  Single-Fraction Stereotactic vs Conventional Multifraction Radiotherapy for Pain Relief in Patients With Predominantly Nonspine Bone MetastasesA Randomized Phase 2 Trial| JAMA Oncology  doi:10.1001/jamaoncol.2019.0192

Research published in the JAMA Oncology concludes that delivering high-dose, single-fraction (SBRT) seems to be an effective treatment option for patients with painful bone metastases.

Question  Does single-fraction stereotactic body radiotherapy (SBRT) for bone metastases lead to better pain response rates than standard multifraction radiotherapy (MFRT)?

Findings  In this prospective randomized phase 2 noninferiority trial, 160 patients with mostly nonspine bone lesions were randomly assigned to receive single-fraction SBRT (12 Gy for less than or equal to 4-cm lesions or 16 Gy for more than 4-cm lesions) or MFRT to 30 Gy in 10 fractions. Single-fraction radiation led to more patients experiencing complete or partial pain response at 2 weeks, 3 months, and 9 months compared with standard MFRT.

Meaning  Pain response rates were higher for high-dose, single-fraction SBRT, which should be considered for patients with bone metastases and long estimated survival times.

The full text of the article is available from the Library

In the news:

OnMedica  OTP Oncology – May 2019


Mindfulness dispositions and defense style as positive responses to psychological distress in oncology professionals

Di Giuseppe, M., Ciacchini, R., Piarulli, A., Nepa, G., & Conversano, C. |2019|Mindfulness dispositions and defense style as positive responses to psychological distress in oncology professionals| European Journal of Oncology Nursing |Vol.40|2019| P.104-110

A new study published in the European Journal of Oncology Nursing looks at mindfulness dispositions and defense mechanisms as responses to psychological distress in oncology professionals. 


Oncology professionals are exposed to work-related stress responses that can be handled with defense style and mindfulness dispositions.

Depression symptoms are reduced by both mindfulness and defense mechanisms, whereas immature defense style increase anxiety symptoms.

The early detection of pitfalls in defensive functioning and mindfulness dispositions might help in providing psychological interventions.



Working in oncology departments is a stressful and emotionally consuming experience and oncology professionals are particularly at risk for developing stress-related syndromes. Defense mechanisms (high-adaptive) and mindfulness dispositions are known as facilitators of well-being and adaptation. In this study we analysed the role of these unconscious and conscious strategies in protecting the oncology clinicians from stress-related symptoms.


A convenience sample of 63 oncology professionals was assessed on defense style, mindfulness disposition, depression and anxiety symptoms using self-reported questionnaires. Demographic and professional information was included in data collection.


Results did not show significance differences in demographic and professional characteristics among all studied variables. Mature defense style and mindfulness were highly and negatively correlated with depression and anxiety, while a positive association was found between immature defense style and both depression and anxiety symptoms. Hierarchical multiple regression analyses found defense styles and mindfulness as predictors of depression, whereas only immature defense style predicted anxiety.


The present study provides the first empirical evidence of the influence of unconscious defense mechanisms and conscious mindfulness dispositions in protecting oncology professionals from depression and anxiety symptoms. Defense mechanisms and mindfulness share several common-points and should be seen as complementary in enhancing physical and psychological well-being. Further studies are required for a deeper understanding of the impact of mindfulness and defenses in improving adaptation.

The Library & Knowledge Service can provide access to this article for Rotherham NHS Staff, request a copy here 

Clinical oncology UK workforce census 2018 report

Royal College of Radiologists | March 2019 | Clinical oncology UK workforce census 2018 report

The Royal College of Radiologists have published their workforce census for clinical oncology.  Clinical oncology UK workforce census is conducted on annual basis, it has three foci:

  1. Provide comprehensive, accurate and timely information on the number, distribution and working patterns of consultant-grade clinical oncologists employed in UK NHS cancer centres.
  2. Forecast future workforce numbers and working patterns
  3. Estimate the extent to which future workforce supply and demand for cancer treatments are aligned

According to this report: “cancer services will only improve with concrete action to boost staff numbers and equipment across diagnostics and treatment”.

clin onco
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The key recommendations are structured around the report’s findings:

  1. Workforce shortages have increased and are forecast to increase further
  2. Clinical oncology trainee numbers need to double to close the growing gap between supply and demand
  3. Consultant clinical oncologists are showing signs of stress and burnout, with early retirement resulting in the loss of valuable expertise.
  4. Consultants have less time supporting professional activities (SPAs),  which are vital for quality improvement
  5. Workforce gaps are variable across geographies and roles, with some areas, such as Wales, being particularly adversely affected.

The full report is available from The Royal College of Radiologists 

See also:

Clinical oncology UK workforce census 2018 report

Infographic of key findings

In the news:

BBC News Cancer doctor shortage ‘puts care at risk’

Daily Mail Severe shortage of NHS cancer specialists is threatening patient care, warns report

The Independent Cancer patients may suffer because of NHS consultant shortage, report warns