A nurse-led clinic for bowel problems after pelvic radiotherapy in every cancer centre

The trial. ORBIT randomised 218 people in London with new bowel symptoms persisting 6 months after pelvic radiotherapy to a detailed self-help booklet, algorithm-based care led by a gastroenterologist, or the same algorithm led by a nurse. At 6 months, bowel symptom scores (IBDQ-B) improved more with the nurse than the booklet (mean difference 4.12, 95 per cent confidence interval 0.04 to 8.19) and with the gastroenterologist than the booklet (5.47, 1.14 to 9.81), and the nurse group was not inferior to the gastroenterologist group. The authors concluded that for most patients the care can be given by a trained nurse. The algorithm is published as guidance (Andreyev 2015).

In practice. The EAGLE study set up two nurse-led and one doctor-led service in three UK cancer centres for men after prostate radiotherapy: of 339 men recruited, 91 screened positive and 58 accepted referral; diagnoses included radiation proctopathy, bile acid malabsorption, food intolerances or bacterial overgrowth, and vitamin B12 or D deficiency. Staff costs were estimated at 117 to 185 pounds per patient depending on the model, and staff worried about funding beyond the study.

The gap. No survey OnCo found counts how many centres run such a clinic. A 2025 qualitative study of 28 survivors and 19 professionals in England described geographical disparity in late-effects services and survivors feeling "cast adrift".