upgrade:promising

The bladder and rectum change size from day to day and move the prostate with them. A randomised trial found that drinking about half a litre of water before each treatment kept the bladder more consistent than drinking a litre, and small trials of anti-wind medicines before prostate radiotherapy found no effect.

More cancer treatment now comes as tablets taken at home, where nobody sees missed doses or side effects building up. A nursing guideline recommends a structured programme: a check at the start of who may struggle, teaching, follow-up calls from the team, and coaching. The trials behind it are small and mixed, so this is promising rather than settled.

A spacer injected between the prostate and the rectum pushes the bowel out of the high-dose area for a few months and then dissolves. Randomised trials found fewer bowel side effects, but the procedure carries its own rare serious complications, and England's guidance allows it only with special arrangements for consent and audit.

About a quarter of people having radiotherapy for head and neck cancer say the mask makes them anxious, and radiographers do not reliably notice who. A randomised trial of 208 people in India found that music and a guided relaxation exercise during the first five sessions lowered mask anxiety scores.

Breath-hold is usually taught on the day of the planning scan. Two hospital series found that teaching it at least five days earlier, with practice at home, went with lower heart doses and shorter set-up times, and a survey of American radiation oncologists found interpreters were present at fewer than one in three first treatments for people who do not speak English.

Getting fitter and better nourished before an operation reduces complications and speeds recovery. It is cheap, but only a few hospitals do it.

Cooling the hands and feet, or squeezing them in tight surgical gloves, during paclitaxel infusions narrows blood vessels while the drug level peaks. In one randomised trial, moderate or worse nerve damage in the treated hand fell from 50 to 29 per cent with cooling; a larger trial of frozen gloves and socks missed its main target but found less numbness.

During breath-hold radiotherapy a camera or sensor measures how deep the breath is, but often only the radiographers see the trace. Showing it to the patient, on a screen or in video glasses with a target band to stay inside, made holds steadier and more repeatable in the clinical comparisons OnCo found, though none has yet measured whether it changes side effects.

Radiotherapy to the head usually means a moulded plastic mask clipped to the table over the whole face. In a randomised comparison in 29 people with brain tumours, a mask with the face cut out caused much less discomfort and anxiety with the same accuracy, and 27 of them preferred it.

A substantial share of patients with advanced non-small-cell lung cancer start first-line treatment before their biomarker results arrive, or without full testing, and so miss targeted therapy. Letting the pathologist order the full genomic panel the moment a cancer of a defined type and stage is confirmed shortens time to result and makes testing complete.

Before a results or treatment-planning appointment, patients receive a list of good questions to ask, tailored to their situation, and can tick the ones they want covered.

Most people having breast radiotherapy are given small permanent ink dots to line them up on the couch. In a United Kingdom survey of 204 people afterwards, half rated the impact of those tattoos as negative, and surface cameras or ultraviolet ink line people up as accurately without leaving a visible mark.

Every cancer consultation is recorded with consent and the patient receives the audio plus a checked written summary of what was said and decided.

Cancer often ruins families financially, and money worries make people skip treatment. Ask about finances at the first visit, as routinely as asking about allergies, and route people to assistance.

A randomised trial of 196 women about to have breast radiotherapy found that explaining the treatment with a virtual-reality walkthrough lowered anxiety and improved understanding compared with the usual explanation. A review of 15 education studies found that leaflets and brief talks made little difference, and more intensive, staff-led preparation did.