Knowledge, Attitudes, and Practice of In-Patient Physiotherapists in Ontario Regarding Patients Who Are Super-Morbidly Obese

Current Alberta radiation therapy care practices for patients with obesity and recommendations for improvement

INTRODUCTION

Obesity has been associated with increased incidence of cancer thereby impacting the number of patients with obesity who may require radiation therapy (RT) treatment. Previous studies have detailed the impacts of obesity on RT treatment delivery including considerations when positioning, imaging, and communicating with patients. However, there is limited literature regarding best clinical practices used by Canadian RT departments when treating patients with obesity. This study aimed to answer the following question: How can the current standards of care (SOC) used by Alberta RT departments be improved to ensure safe and quality care of patients with obesity?

METHODS

Semi-structured interviews were conducted with 19 practitioners including three RT managers, two medical physicists, two clinical educators, two radiation oncologists, a senior practice lead, and nine radiation therapists from five cancer centers across Alberta. Interviews were transcribed and analyzed independently by two researchers and used to inform recommendations for improvement to existing care practices.

RESULTS

Four themes emerged as unique considerations for patients with obesity undergoing RT, which included technical factors, interpersonal interactions, patient care factors, and education and training. Recommendations to improve the current SOC in Alberta RT departments included the need for longer appointment times, sufficient staff, accessible mobility equipment, and additional education and training for HCPs tailored towards patients with obesity.

CONCLUSION

SOC in Alberta could be improved for patients with obesity with modified appointment time, increased staff and resources, and more in depth and tailored education. Implementation of these considerations and recommendations for improvement to the current SOC used by Alberta RT departments has the potential to ensure safe and quality care of patients with obesity.

Rising prevalence of BMI ≥40 kg/m2 : A high-demand epidemic needing better documentation

Whilst previously rare, some surveys indicate substantial increases in the population with body mass index (BMI) ≥40 kg/m2 since the 1980s. Clinicians report emerging care challenges for this population, often with high resource demands. Accurate prevalence data, gathered using reliable methods, are needed to inform health care practice, planning, and research. We searched digitally for English language sources with measured prevalence data on adult BMI ≥40 collected since 2010. The search strategy included sources identified from recent work by NCD-RisC (2017), grey sources, a literature search to find current sources, and digital snowball searching. Eighteen countries, across five continents, reported BMI ≥40 prevalence data in surveys since 2010: 12% of eligible national surveys examined. Prevalence of BMI ≥40 ranged from 1.3% (Spain) to 7.7% (USA) for all adults, 0.7% (Serbia) to 5.6% (USA) for men, and 1.8% (Poland) to 9.7% (USA) for women. Limited trend data covering recent decades support significant growth of BMI ≥40 population. Methodological limitations include small samples and data collection methods likely to exclude people with very high BMIs. BMI ≥40 data are not routinely reported in international surveys. Lack of data impairs surveillance of population trends, understanding of causation, and societal provision for individuals living with higher weights.