“We always assume as practitioners that chemotherapy is the hardest bit and radiotherapy is a breeze – the light is at the end of the tunnel,” says Prof Heidi Probst. “But actually what patients were saying to us was the opposite: that it’s really difficult. They’ve been through so much by the time they get there.”
Probst, a researcher and lecturer at Sheffield Hallam University who specialises in improving delivery of radiotherapy for breast cancer and the patient experience, is talking about the crucial insights she gained from co-design workshops with past patients as she led a project to increase accuracy and dignity in radiotherapy.
They’re insights that inform her teaching of the next generation of radiographers, as well as driving innovation. “I try to make sure we feed all of that understanding back to our students,” says Probst, who was recently awarded an MBE for services to radiography. “It seems simple to us – we’re working with it every day – but patients still find it incredibly scary.”
The SuPPORT 4 All (S4A) project was inspired by Probst’s concern, after 14 years of clinical experience in therapeutic radiography, that when treating women with larger breasts in particular, it can be more difficult and time consuming to make sure the patient is positioned in the same way each day. On top of that, she worried about the impact on patients of having to lie naked from the waist up – at the end of a gruelling treatment journey and at a time when they’re coming to terms with an altered body image following surgery – while staff manually adjust their position.
“I thought: ‘Surely we can come up with something a bit better,’” says Probst. “Something that can allow us to reduce the dose of radiation that is received by the lung and the heart, give patients some dignity and modesty, and also secure the breast in a position that’s reproducible every day.”
Knowing she needed expertise from various disciplines, she took the idea to research colleagues working in different areas of the university, where she linked up with an industrial designer and a sports engineer to develop the concept. Later they were joined by an NHS physicist and clinical oncologist.
The result, helped by initial funding from the university, and created together with patients and a commercial lingerie company, was a painstakingly designed special bra that lifts women’s breasts away from the ribcage and holds them in the same position for each treatment session.
Front and back fastenings make it easy to put on, so women can come to their appointments already wearing it, and a clinical feasibility trial [pdf] has shown that it reduces radiation doses to the lung. The next stage of development, for which the team has recently applied for funding, is to refine the fitting process. With backing from Sheffield Hallam’s research and innovation staff, they hope to eventually produce a consumer version of the bra.
“Past patients told us a lot about how they felt really disempowered during the radiotherapy process,” says Probst. “We thought maybe giving them the bra would be one way of them getting a little bit of control.”
Then, when the trial had just started, Probst herself was diagnosed with stage 2B breast cancer. Her treatment was “the works” – surgery, chemotherapy, radiotherapy and hormone therapy – and despite her professional experience, it was a tough journey. “I found it really difficult, even though I knew what was going to come,” she says.
“Some things didn’t go according to plan. I found the chemotherapy really hard. I lost all my hair, and that affected me way more than I thought it would. I was almost clinically depressed by the time I got to the radiotherapy.”
Two of her former students carried out her treatment and she was blown away by the standard of their care. “They were absolutely amazing,” she says. “They made me feel so comfortable. It showed me the importance of good training: it can make a massive difference to somebody’s experience and their ability to cope.”
One of those former students was Anna Southworth, who had joined Probst on the S4A project and other research. Now a treatment delivery team leader with a research specialism at the Royal Preston hospital’s Rosemere Cancer Centre, she says the opportunity to work alongside Probst as a student was inspirational, helping shape her career. “She’s just so supportive and encouraging,” says Southworth. “She’s got so much time for you; you really feel like she values your opinion. Her enthusiasm passes on to you – and then you get the bug for it as well: you want to improve things for the patient.”
Probst says her personal cancer journey has had a profound impact both on her teaching and research at Sheffield Hallam, underlining the importance of clinicians recognising that all patients need to be treated differently, and of the psychological value of high quality care. “I try to explain to undergraduates the importance of understanding the individual, and what matters to them, the things they want to get back to,” she says. “It’s that big, holistic approach.”
And it is just this kind of approach that is typical of Sheffield Hallam. The University was awarded gold in the 2023 Teaching Excellence Framework, which is a national assessment of how universities rate when it comes to teaching, learning and students achieving positive outcomes from their studies.
Probst describes her own positive experience of radiotherapy as an eye-opener. “I worked all the way through it, and that was purely because of the way they managed my care and holistically looked after me,” she says. “Their care, and their knowledge and capability made such a difference to the experience I had. It was really inspiring to be on the other end of it. They helped me feel empowered. And feeling empowered to get on with your life is a gift, isn’t it?”
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