METHODS: This study employed a two-arm, single-blind cluster randomized controlled trial in a community setting within Union Council Kuri Dolal, Tehsil Gujjar Khan, District Rawalpindi-Pakistan. It compared an Active Treatment group, receiving five sessions of the IA-PM+ intervention, against a Delayed Treatment Control group. A total of 148 participants were randomized. Randomization occurred at the village level, with clusters assigned to either the intervention or control group. The intervention's effectiveness and participant satisfaction were assessed using a variety of measures, including the GHQ-12, WHODAS 2.0, DASS-21, and the Client Satisfaction Questionnaire, at baseline, the 8th week, and during a 3-month follow-up. Qualitative feedback was gathered at the end of the study to assess the intervention's acceptability among the participants.
RESULTS: The study achieved a 100% retention rate. Baseline demographics showed a majority male participation with a variety of disabilities predominantly lower limb. Significant improvements were noted in the intervention group across WHODAS scores (Cohen's d= 0.66), PTSD symptoms (d= 0.75), and DASS scores for depression (d= 0.46), anxiety (d=0.65), and stress (d= 0.47). Similar trends were noted during the follow-up phases. However, life satisfaction scores initially higher in the control group evened out by follow-up, and perceived social support was consistently lower in the intervention group. High levels of client satisfaction were reported in the intervention group, with most participants finding the sessions beneficial and expressing willingness to recommend the service to others. The qualitative interviews revealed that the integration of religious practices, such as associating stress management techniques with Adhan, significantly enhanced the acceptability of the culturally adapted PM+ intervention. Participants reported that this cultural alignment made the coping strategies more relatable and easier to adopt, contributing to improvements in both their mental health and somatic symptoms.
CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT04981522, identifier NCT04981522.
MATERIALS AND METHODS: A 21-point electronic survey (Federation of Asian Radiation Oncology Research Network [FERN]-S-005) was designed by the FERN and was circulated through the FARO research secretariat to the FARO council member countries and the responses were collected between August and November 2023.
RESULTS: Twelve of 14 member countries (85.7%) responded to the survey. Twenty-seven responses were received and 78% of the respondents belonged to government/teaching academic institute. 4/27 (14.8%) reported never using HYPO-RT for any of the clinical subsite of HNCs, while the majority (85.2%) used it for glottic cancers and 22% also used it for postoperative setting. Majority (77.7%) used a fractionation schedule with dose per fraction ranging between 2.2 and 2.5 Gy. 6/27 (22.2%) used AFRT for definitive setting and five of these also used concurrent chemoradiotherapy. 4/27 (14.8%) centers reported using HFRT. The most common reason (62.9%) for the limited usage of AFRT/HFRT was reported to be logistical, such as unavailability of machine slots, patient load, and so on.
CONCLUSION: The result of the survey suggests that among the ALFT strategies for HNCs, HYPO-RT schedules have common interest and feasibility among the FARO member countries and also highlights the challenges in the delivery of AFRT/HFRT in the Asian region.