Immune checkpoint inhibitors (ICIs) have revolutionised cancer treatment through targeted disruption of the physiological pathways that maintain tissue tolerance, but which are co-opted by cancers to evade immunosurveillance. Thus, the resultant T-cell activity often causes immune-related adverse events including immune checkpoint inhibitor-induced inflammatory arthritis (ICI-IA). ICI-IA results in functional impairment that frequently persists, even after ICI discontinuation, with substantial quality-of-life impacts for cancer survivors.

A high-quality body of evidence to guide ICI-IA management remains an unmet need. Pharmacological treatment may be prolonged, typically begins with non-specific immunosuppression, including systemic steroids, and is usually only rationalised to more targeted therapy in resistant cases. Moreover, retrospective data suggest the high dose glucocorticoids sometimes used in new-onset ICI-IA may be associated with worse cancer outcomes.

Tumour necrosis factor (TNF) inhibition strategies are well established with excellent efficacy and safety profiles in ‘spontaneous’ inflammatory arthritides including rheumatoid and psoriatic arthritis. Mechanistic evidence from ex vivo and murine studies also supports the utility of anti-TNF therapy for steroid-refractory cases of ICI-IA. Although good clinical responses have been reported in this setting, the REACT trial (REmission induction of Arthritis caused by Cancer ImmunoTherapy) aims to provide randomised and robust clinical evidence for deploying targeted therapy earlier in ICI-IA management. It will test whether up-front anti-TNF therapy can more effectively and quickly control symptoms, reduce glucocorticoid exposure, prevent early ICI discontinuation and increase the frequency of drug-free ICI-IA remission.

REACT is a prospective, multicentre, open-label, superiority, two-arm, randomised controlled clinical trial to guide initial therapy for patients with ICI-IA. The trial will compare the current standard of care (initial prednisolone; Arm A) with the anti-TNF drug, adalimumab without glucocorticoids (Arm B).

The primary outcome is glucocorticoid-free arthritis remission rate at 24 weeks where remission is defined as: (i) No use of systemic or intra-articular glucocorticoids (except when used for adrenal insufficiency) within 4 weeks prior to assessment at 24 weeks; and (ii) absence of synovitis on clinical examination.

The protocol was approved by East Midlands—Leicester South Research Ethics Committee on 31-Oct-2024 (Ref: 24/EM/0202). Participants are required to provide written informed consent. The results of this trial will be disseminated through national and international presentations and peer-reviewed publications.

ISRCTN18217497.

The incidence of anal carcinoma is increasing, with the current gold standard treatment being chemoradiotherapy. There is currently a wide range in the radiotherapy dose used internationally which may lead to overtreatment of early-stage disease and potential undertreatment of locally advanced disease.

PLATO is an integrated umbrella trial protocol which consists of three trials focused on assessing risk-adapted use of adjuvant low-dose chemoradiotherapy in anal margin tumours (ACT3), reduced-dose chemoradiotherapy in early anal carcinoma (ACT4) and dose-escalated chemoradiotherapy in locally advanced anal carcinoma (ACT5), given with standard concurrent chemotherapy.

The primary endpoints of PLATO are locoregional failure (LRF)-free rate for ACT3 and ACT4 and LRF-free survival for ACT5. Secondary objectives include acute and late toxicities, colostomy-free survival and patient-reported outcome measures. ACT3 will recruit 90 participants: participants with removed anal tumours with margins ≤1 mm will receive lower dose chemoradiotherapy, while participants with anal tumours with margins >1 mm will be observed. ACT4 will recruit 162 participants, randomised on a 1:2 basis to receive either standard-dose intensity modulated radiotherapy (IMRT) in combination with chemotherapy or reduced-dose IMRT in combination with chemotherapy. ACT5 will recruit 459 participants, randomised on a 1:1:1 basis to receive either standard-dose IMRT in combination with chemotherapy, or one of two increased-dose experimental arms of IMRT with synchronous integrated boost in combination with chemotherapy.

This study has been approved by Yorkshire & The Humber – Bradford Leeds Research Ethics Committee (ref: 16/YH/0157, IRAS: 204585), July 2016. Results will be disseminated via national and international conferences, peer-reviewed journal articles and social media. A plain English report will be shared with the study participants, patients’ organisations and media.

ISRCTN88455282.

To investigate physical activity (PA) promotion practices among primary care health professionals in England. To assess whether attitudes, confidence, role perceptions, knowledge of PA guidelines, and PA behaviour were related to PA promotion practices. To examine the barriers to and facilitators of PA promotion practices.

A cross-sectional online survey study with open (free text) questions.

National survey and online-administered survey conducted in England.

The outcome variables were attitudes, confidence, role perceptions, PA behaviour, knowledge of the PA guidelines and PA promotion practices. Structural equation modelling evaluated associations between these variables.

A total of 181 primary care healthcare professionals completed an online survey. The majority were general practitioners (GPs) (66.7%), followed by first contact physiotherapists (13.8%), practice nurses (12.2%) and link workers (7.7%).

Most (59%) healthcare professionals did not meet recommended levels of PA and could not accurately identify the PA guidelines (53%). Most provided PA advice to patients but fewer than 40% assessed PA, supported behaviour change or made referrals to PA support programmes. More first contact physiotherapists and link workers reported more frequent engagement in collaborative aspects of PA promotion, including assessing PA motivation, supporting behaviour change and providing follow-up. Confidence in promoting PA (β=0.30, p

Most primary care professionals routinely provide PA advice and feel confident doing so. However, with fewer than half able to accurately recall current PA guidelines and routine assessment and behaviour change support rarely reported, the quality and specificity of this advice remain unclear. While time constraints remain a major barrier to PA promotion, particularly among GPs, the addition of first contact physiotherapists and link workers is likely to enhance capacity for promoting PA in busy primary care settings.

Cancer and its treatment can negatively impact physical function, general well-being and quality of life. An evidence-based strategy to manage this is to prescribe exercise. One approach is to prescribe exercise prehabilitation to improve pretreatment health and function. However, current exercise prehabilitation programmes are under-researched, and the quality of their reporting has not been systematically assessed.

This review aimed to identify the following: the characteristics of prehabilitation exercise programmes; how intensity, physical function, patient-reported outcomes and treatment-related outcomes were measured; the quality of reporting and programme implementation.

Studies were eligible for inclusion if they reported a cancer prehabilitation exercise intervention, reported outcomes relating to physical function and patient-reported outcomes, and full-text copies were available in English.

PubMed, Mednar and Scopus were screened for studies from inception until 4 of April 2024.

Exercise characteristics were extracted and manually charted in Microsoft Excel using the Template for Intervention Description and Replication. The tool for the assessment of study quality and reporting in exercise (TESTEX) framework was used to assess study quality and intervention reporting.

1495 results were retrieved, 28 of which were included. Exercise sessions lasted a mean of 42.5±21.9 min and were completed 3.7±1.3 times per week. 22 studies implemented concurrent exercise, five prescribed aerobic, and one prescribed resistance. High-intensity exercise was prescribed in four studies, moderate-high in 12, seven prescribed moderate, three prescribed low-moderate, and one was low intensity. 10 studies prescribed exercise intensity using the Borg Rating of Perceived Exertion Scale, five prescribed heart rate (HR) zones, six used a set workload, and seven did not monitor intensity. A mean TESTEX score of 9.3±2.3 out of 15 was achieved. The lowest scoring criterion (n=3) related to the reporting of the exercise dose.

There was heterogeneity among studies regarding exercise intervention characteristics and measures of effectiveness. The overall quality of reporting was satisfactory, yet inconsistencies were apparent regarding quantifying and monitoring exercise dose, which limits the ability of researchers and clinicians to replicate, evaluate or scale cancer prehabilitation exercise interventions, impeding evidence-based practice. As such, to be able to optimise cancer prehabilitation exercise programmes, research must first focus on improving the quality of reporting and standardising outcome measures and methods of monitoring and prescribing exercise.

Social media sites are increasingly used to assess and treat different mental health problems in adolescents and young adults. However, it is still unclear which social network sites are the most used for this purpose and what interventions for tackling unhealthy body image have been validated. This systematic review will assess evidence on the effectiveness of social media interventions in improving unhealthy body image among adolescents and young adults.

Five databases, including Embase, Scopus, MEDLINE, Web of Science (Core Collection) and PsycINFO, will be consulted, with a publication window starting in 2011 and ending on 31 October 2024. Rayyan software will detect and eliminate duplicates. We will include only studies based on social media-based interventions for adolescents and young adults with body image problems. Two independent reviewers will screen titles, abstracts and full-text articles, resolving conflicts through discussion with a third reviewer as needed. The two reviewers will complete the risk of bias assessments for each included study, using the Joanna Briggs Institute critical appraisal checklists for randomised controlled trials and quasi-experimental studies. We will report on the characteristics of studies, participants and interventions in descriptive narrative form, along with the results from the assessment of social media interventions.

Universidad Cesar Vallejo’s ethics committee approved this systematic review protocol as part of a wider project (code 100-CEI-EPM-UCV-2022). Results will be shared via social media to engage stakeholders and promote awareness of body image issues.