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ObjectivesTo investigate the usefulness of using automated appointment check-in screens to collect brief research data from patients, prior to their general practice consultation.DesignA descriptive, cross-sectional study.SettingNine general practices in the West Midlands, UK. Recruitment commenced in Autumn 2018 and was concluded by 31 March 2019.ParticipantsAll patients aged 18 years and above, self-completing an automated check-in screen prior to their general practice consultation, were invited to participate during a 3-week recruitment period.Primary and secondary outcome measuresThe response rate to the use of the automated check-in screen as a research data collection tool was the primary outcome measure. Secondary outcomes included responses to the two research questions and an assessment of impact of check-in completion on general practice operationalisationResultsOver 85% (n=9274) of patients self-completing an automated check-in screen participated in the Automated Check-in Data Collection Study (61.0% (n=5653) women, mean age 55.1 years (range 18–98 years, SD=18.5)). 96.2% (n=8922) of participants answered a ‘clinical’ research question, reporting the degree of bodily pain experienced during the past 4 weeks: 32.9% (n=2937) experienced no pain, 28.1% (n=2507) very mild or mild pain and 39.0% (n=3478) moderate, severe or very severe pain. 89.3% (n=8285) of participants answered a ‘non-clinical’ research question on contact regarding future research studies: 46.9% (n=3889) of participants responded ‘Yes, I’d be happy for you to contact me about research of relevance to me’.ConclusionsUsing automated check-in facilities to integrate research into routine general practice is a potentially useful way to collect brief research data from patients. With the COVID-19 pandemic initiating an extensive digital transformation in society, now is an ideal time to build on these opportunities and investigate alternative, innovative ways to collect research data.Trial registration numberISRCTN82531292.

ObjectivesTo evaluate the effectiveness of an intervention, with and without a height adjustable desk, on daily sitting time, and to investigate the relative effectiveness of the two interventions, and the effectiveness of both interventions on physical behaviours and physical, biochemical, psychological, and work related health and performance outcomes.DesignCluster three arm randomised controlled trial with follow-up at three and 12 months.SettingLocal government councils in Leicester, Liverpool, and Greater Manchester, UK.Participants78 clusters including 756 desk based employees in defined offices, departments, or teams from two councils in Leicester, three in Greater Manchester, and one in Liverpool.InterventionsClusters were randomised to one of three conditions: the SMART Work and Life (SWAL) intervention, the SWAL intervention with a height adjustable desk (SWAL plus desk), or control (usual practice).Main outcomes measuresThe primary outcome measure was daily sitting time, assessed by accelerometry, at 12 month follow-up. Secondary outcomes were accelerometer assessed sitting, prolonged sitting, standing and stepping time, and physical activity calculated over any valid day, work hours, workdays, and non-workdays, self-reported lifestyle behaviours, musculoskeletal problems, cardiometabolic health markers, work related health and performance, fatigue, and psychological measures.ResultsMean age of participants was 44.7 years, 72.4% (n=547) were women, and 74.9% (n=566) were white. Daily sitting time at 12 months was significantly lower in the intervention groups (SWAL −22.2 min/day, 95% confidence interval −38.8 to −5.7 min/day, P=0.003; SWAL plus desk −63.7 min/day, −80.1 to −47.4 min/day, PConclusionsBoth SWAL and SWAL plus desk were associated with a reduction in sitting time, although the addition of a height adjustable desk was found to be threefold more effective.Trial registrationISRCTN RegistryISRCTN11618007.

Immune checkpoint inhibitors (CPIs) have radically changed outcomes for patients diagnosed with metastatic melanoma globally in the last 10 years, based on evidence of overall survival (OS) benefits generated from international randomised controlled trials (RCTs). Since RCTs do not always reflect real‐world prescribing, we interrogated established national databases to track prescribing of CPIs approved for first line treatment of metastatic melanoma patients in England since 2014 and determined patient outcomes associated with OS, as well as treatment‐related toxicity. Between April 2014 and March 2018, 5465 melanoma patients were diagnosed and treated with systemic anticancer therapy (SACT), 2322 of which received first‐line CPIs. There was good 3‐year OS concordance with RCT outcomes for ipilimumab (32%), ipinivo (56%) and nivolumab (51%), but OS was lower than expected for pembrolizumab (40%). Comparing patients prescribed ipinivo with those prescribed pembrolizumab, ipinivo‐treated patients were younger (88% vs 49% patients, What's new? Immune checkpoint inhibitors (CPIs) greatly impact overall survival in metastatic melanoma. In England, CPIs have been used as first‐line therapy for this malignancy since 2014. This retrospective study assessed survival and toxicity among English metastatic melanoma patients prescribed CPIs between 2014 and 2018. For the CPIs ipilimumab, nivolumab, and ipinivo, survival outcomes were remarkably similar to registration trials. Poorer outcomes were associated with pembrolizumab, possibly because patients who received this drug were older and relatively less fit. Ipinivo generated the highest rates of emergency hospital visits and admissions, although 30‐day mortality was unchanged, potentially reflecting effective management of complications.

Aims The aim of the PULsE-AI trial was to assess the effectiveness of a machine learning risk-prediction algorithm in conjunction with diagnostic testing for identifying undiagnosed atrial fibrillation (AF) in primary care in England. Methods and results Eligible participants (aged ≥30 years without AF diagnosis; n = 23 745) from six general practices in England were randomized into intervention and control arms. Intervention arm participants, identified by the algorithm as high risk of undiagnosed AF (n = 944), were invited for diagnostic testing (n = 256 consented); those who did not accept the invitation, and all control arm participants, were managed routinely. The primary endpoint was the proportion of AF, atrial flutter, and fast atrial tachycardia diagnoses during the trial (June 2019–February 2021) in high-risk participants. Atrial fibrillation and related arrhythmias were diagnosed in 5.63% and 4.93% of high-risk participants in intervention and control arms, respectively {odds ratio (OR) [95% confidence interval (CI)]: 1.15 (0.77–1.73), P = 0.486}. Among intervention arm participants who underwent diagnostic testing (28.1%), 9.41% received AF and related arrhythmia diagnoses [vs. 4.93% (control); OR (95% CI): 2.24 (1.31–3.73), P = 0.003]. Conclusion The AF risk-prediction algorithm accurately identified high-risk participants in both arms. While the proportions of AF and related arrhythmia diagnoses were not significantly different between high-risk arms, intervention arm participants who underwent diagnostic testing were twice as likely to receive arrhythmia diagnoses compared with routine care. The algorithm could be a valuable tool to select primary care groups at high risk of undiagnosed AF who may benefit from diagnostic testing.

BACKGROUND: The indirect impact of the COVID-19 pandemic on cancer outcomes is of increasing concern. However, the extent to which key treatment modalities have been affected is unclear. We aimed to assess the impact of the pandemic on radiotherapy activity in England. METHODS: In this population-based study, data relating to all radiotherapy delivered for cancer in the English NHS, between Feb 4, 2019, and June 28, 2020, were extracted from the National Radiotherapy Dataset. Changes in mean weekly radiotherapy courses, attendances (reflecting fractions), and fractionation patterns following the start of the UK lockdown were compared with corresponding months in 2019 overall, for specific diagnoses, and across age groups. The significance of changes in radiotherapy activity during lockdown was examined using interrupted time-series (ITS) analysis. FINDINGS: In 2020, mean weekly radiotherapy courses fell by 19·9% in April, 6·2% in May, and 11·6% in June compared with corresponding months in 2019. A relatively greater fall was observed for attendances (29·1% in April, 31·4% in May, and 31·5% in June). These changes were significant on ITS analysis (p

Background Physician associates (PA) form part of the policy-driven response to increased primary care demand and a general practitioner (GP) recruitment and retention crisis. However, they are novel to the primary care workforce and have limitations, for example, they cannot prescribe. The novel 1 year Staffordshire PA Internship (SPAI) scheme, introduced in 2017, was established to support the integration of PAs into primary care. PA interns concurrently worked in primary and secondary care posts, with protected weekly primary care focussed education sessions. This evaluation established the acceptability of PA interns within primary care. Methods All ten PAs from the first two SPAI cohorts, the nine host practices (supervising GPs and practice managers) and host practice patients were invited to participate in the evaluation. A conceptual framework for implementing interventions in primary care informed data collection and analysis. Data were gathered at three time points over the internship from practices, through discussions with the supervising GP and/or practice manager, and from the PAs via discussion groups. To enrich discussion data, PA and practices were sent brief surveys requesting information on PA/practice characteristics and PA primary care roles. Patient acceptability data were collected by the host practices. Participation at every stage was optional. Results By evaluation end, eight PAs had completed the internship. Seven PAs and six practices provided data at every time point. Five practices provided patient acceptability data. Overall PA interns were acceptable to practices and patients, however ambiguity about the PA role and how best to communicate and operationalise PA roles was revealed. An expectation-preparedness gap resulted in PAs needing high levels of supervision early within the internship. SPAI facilitated closure of the expectation-preparedness gap and its funding arrangements made the high supervision requirements more acceptable to practices. Conclusions The test-of-concept SPAI successfully integrated new PAs into primary care. However, the identified challenges risk undermining PAs roles in primary care before they have attained their full potential. Nationally, workforce leaders should develop approaches to support new PAs into primary care, including commitments to longer-term, sustainable, cohesive and appropriately funded schemes, including structured and standardised education and supervision.

Background: Physician associates (PA) are dependent healthcare professionals with two-years post-graduate generalist medical education. PAs can work in primary care immediately after graduation. However, PAs are novel to, and still relatively uncommon within, UK primary care. Recognising the challenges presented by UK primary care, including the undifferentiated, complex sociomedical and non-protocolised presentations, a novel one-year internship scheme was established to support PAs to work in primary care and to support PA retention in primary care and within the geographical region. This evaluation sought to gain feedback to guide further roll-out and development of the internship and to establish its success in supporting PAs into primary care.Methods: The Staffordshire PA Internship (SPAI) scheme was introduced in Staffordshire in 2017. PAs worked concurrently in primary and secondary care posts for one year, with protected weekly primary care focussed education sessions. Posts were subsidised and PAs were centrally employed. Evaluation data pertaining to the first two cohorts were sought from the PA interns, supervising GPs and practice managers.Results: By evaluation end, eight of the ten PAs had completed the internship. Practices valued the subsidised, central employment model of the internship as it provided a risk-limited opportunity to explore the PA role, which iteratively developed to establish weekly timetables that best suited PAs and practices. While the one-year PA programme had seen PA interns develop significantly from the start, many practices and PAs felt that a two year programme may have been preferable. There were mixed views about whether a split post or sequential posts may be preferable, however, PAs did not have experience of the latter.Conclusions: This test-of-concept SPAI was successful in retaining PAs in primary care in the geographical area of the internship. However, it highlighted the need for PA interns to have intensive supervision, particularly in the early weeks, and a dedicated educational programme, which was only possible due to the internship arrangements. The optimal internship design remains unknown, however, sole primary care internship posts may accelerate upskilling of PA interns for the challenges of primary care and may better support their integration within practices.

Negative psychosocial consequences have been reported for children with auditory processing disorder (APD). The current literature surrounding APD does not sufficiently address the emotional and psychological consequences of living with the disorder. It is recommended that data be collected from multiple sources, including the child living with APD. Subjective reports of the perceptions of children with APD and their families have real-life validity and can inform clinical decisions and guide future research.The aims of this study were to explore the psychosocial consequences of APD as perceived by children with the disorder and their parents.Qualitative cross-sectional study.Thirteen participants were interviewed: six children with APD, aged 10–12 yr, and one parent for each child (in one case, two parents participated in the interview).Semistructured interviews were used to examine the social, emotional, and educational well-being of children with APD. Inductive thematic analysis was conducted to develop themes that illustrated the experiences of living with APD.Three themes were identified forming a causal network conceptual framework that is reciprocal in nature: (1) external factors, (2) internal problems, and (3) coping. The themes revealed how APD impacted negatively on children’s psychosocial well-being (internal problems: covert thoughts, overt behaviors) and described the basis for these outcomes (external factors: environmentally based problems, dissatisfaction with support) and the ability of children and their parent(s) to manage the impact of APD (coping: positive, negative).The three themes identified in this research provide a novel understanding of the experience of APD. The themes reflect the psychosocial consequences of external factors that are created internally through “thought” and expressed externally through “behavior.” Pathways to support positive coping strategies while discouraging negative coping strategies will enable children to overcome problems and improve their psychosocial well-being.

Background The Systemic Anti-Cancer Therapy (SACT) dataset is a unique source of national, real-world data reporting chemotherapy activity delivered by NHS treatment providers in England. SACT data are collected with the intent of improving disease-free or progression-free survival. Main Aim The SACT dataset aims to provide a detailed resource on systemic treatments delivered in secondary and tertiary settings in England for patients with cancer. Approach The SACT dataset is collected and curated by the National Cancer Registration and Analysis Service (NCRAS) at Public Health England. The dataset was launched in a phased implementation from April 2012. From April 2014 submission of SACT data became mandatory for all NHS treatment providers. Data are collected on the patient, tumour, regimen, treatment cycle, drug details, and treatment outcomes. The SACT dataset can be linked to other data held by NCRAS, for example the cancer registry1, Hospital Episodes Statistics2, and the national Radiotherapy Dataset to provide a complete picture of the cancer patient pathway. Results The SACT dataset is being used: for the appraisal of drugs funded through the Cancer Drugs Fund; to review the quality of cancer care as part of the National Cancer Audits; and for observational research purposes, including investigating 30-day mortality following chemotherapy3, and sociodemographic variation in the use of chemotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer4. The data are also released to external researchers via the Office for Data Release. Conclusion The SACT dataset is a unique resource in terms of the breadth and depth of information on chemotherapy prescribed to cancer patients. The key strengths are: the national coverage; real-world data; detailed clinical information beyond cancer registration data; and the ability to link to other cancer datasets. References Henson KE, Elliss-Brookes L, Coupland VH, Payne E, Vernon S, Rous B et al. Data Resource Profile: National Cancer Registration Dataset in England. Int J Epidemiol 2019; doi 10.1093/ije/dyz076. Herbert A, Wijlaars L, Zylbersztejn A, Cromwell D, Hardelid P. Data Resource Profile: Hospital Episode Statistics Admitted Patient Care (HES APC). Int J Epidemiol 2017; 46(4): 1093-1093i; e-pub ahead of print 2017/03/25; doi 10.1093/ije/dyx015. Wallington M, Saxon EB, Bomb M, Smittenaar R, Wickenden M, McPhail S et al. 30-day mortality after systemic anticancer treatment for breast and lung cancer in England: a population-based, observational study. The Lancet Oncology 2016; 17(9): 1203-1216; doi 10.1016/s1470-2045(16)30383-7. Henson KE, Fry A, Lyratzopoulos G, Peake M, Roberts KJ, McPhail S. Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013-2014. Br J Cancer 2018; doi 10.1038/s41416-018-0028-7.

Inequality in education is neither a new nor novel issue. Scholars have repeatedly found that students with disadvantaged backgrounds across Europe display consistently lower levels of educational attainment, despite policymakers’ attempts to create more equitable outcomes. Germany is no exception, with one scholar claiming that it is “undeniable” that the children of immigrants fare worse in the country’s education system than their native-born peers (Alba, Handl, and Muller, 2017: 620). While scholars are divided on the source of this inequality, with some claiming that it can be solely explained by individual factors while others examine the structure of the country’s education system, most of these studies treat Germany as a country with a unitary education system. However, due to its federal structure, Germany actually has 16 different education systems. To address this gap in the literature, this paper asks whether and how differences in education system structures across the German federal states (Bundeslander) impact the educational attainment of students with a migration background. Ultimately, it aims to find if certain institutional arrangements can help to mitigate the effects of disadvantaged backgrounds. Using data from the National Educational Panel Survey (NEPS) collected by the Leibniz Institute for Educational Trajectories (LIfBi), the paper examines how different state-level educational structures impact outcomes for native-born students and those with a migration background. The results show that even when controlling for socioeconomic background certain structural arrangements significantly impact educational outcomes. Specifically, a high prevalence of Gesamtschulen (comprehensive schools where children are taught together regard of academic ability, instead of the traditional tracking structure in German education) is shown to drastically improve Abitur (leaving certificate required to enter university) attainment for students with a migration background.

Introduction: The aim of this EURECCA international comparison is to compare oncologic treatment strategies and relative survival of patients with stage I-III rectal cancer between European countries.Material and methods: Population-based national cohort data from the Netherlands (NL), Belgium (BE), Denmark (DK), Sweden (SE), England (ENG), Ireland (IE), Spain (ES), and single-centre data from Lithuania (LT) were obtained. All operated patients with (y)pTNM stage I-III rectal cancer diagnosed between 2004 and 2009 were included. Oncologic treatment strategies and relative survival were calculated and compared between neighbouring countries.Results: We included 57,120 patients. Treatment strategies differed between NL and BE (p Conclusion: Large differences in oncologic treatment strategies for patients with (y)pTNM I-III rectal cancer were observed across European countries. No clear relation between oncologic treatment strategies and relative survival was observed. Further research into selection criteria for specific treatments could eventually lead to individualised and optimal treatment for patients with non-metastasised rectal cancer. (C) 2018 Published by Elsevier Ltd.

The rural requirement for sustainable economic growth and an ever-increasing supply of energy is perhaps most pronounced in Africa. However, International Renewable Energy Agency (IRENA) and European Commission Joint Research Centre (JRC) experts believe the continent's renewable energy resources have the potential to support future national economic growth and local development.

BACKGROUND: The aim of the present EURECCA international comparison is to compare adjuvant chemotherapy and relative survival of patients with stage II colon cancer between European countries.METHODS: Population-based national cohort data (2004-2009) from the Netherlands (NL), Denmark (DK), Sweden (SE), England (ENG), Ireland (IE), and Belgium (BE) were obtained, as well as single-centre data from Lithuania. All surgically treated patients with stage II colon cancer were included. The proportion of patients receiving adjuvant chemotherapy was calculated and compared between countries. Besides, relative survival was calculated and compared between countries.RESULTS: Overall, 59,154 patients were included. The proportion of patients receiving adjuvant chemotherapy ranged from 7.1% to 29.0% (p < 0.001). Compared with NL, a better adjusted relative survival was observed in SE (stage II: relative excess risks (RER) 0.53, 95% confidence interval (CI) 0.44-0.64; p < 0.001), and BE (stage II: RER 0.84, 95% CI 0.76-0.92; p < 0.001), and in IE for patients with stage IIA disease (RER 0.80, 95% CI 0.65-0.98; p = 0.03).CONCLUSION: The proportion of patients with stage II colon cancer receiving adjuvant chemotherapy varied largely between seven European countries. No clear linear pattern between adjuvant chemotherapy and adjusted relative survival was observed. Compared with NL, SE and BE showed an improved adjusted relative survival for stage II disease, and IE for patients with stage IIA disease only. Further research into selection criteria for adjuvant chemotherapy could eventually lead to individually tailored, optimal treatment of patients with stage II colon cancer.

Between 1987 and 1994, three randomised phase III trials showed that chemoradiotherapy with mitomycin C and 5-fluorouracil was superior to radiotherapy alone (ACT1, European Organization for Research and Treatment of Cancer) or radiotherapy with 5-fluorouracil (Radiation Therapy Oncology Group 87-04, Eastern Cooperative Oncology Group 1289) for squamous cell carcinoma of the anus. We explored the population-based changes in England before, during and after the UK-based ACT1 trial. Information was extracted from the National Cancer Data Repository on patients diagnosed with squamous cell anal cancer in England between 1981 and 2010 (n = 11 743). Robust treatment information was available for the Yorkshire region (n = 1065). Changes in treatment patterns and 3 year survival were investigated in 7 year cohorts before, during and after the ACT1 trial. In Yorkshire, the proportion of patients receiving surgery alone fell from 61.6% before, 29.8% during and 12.5% after ACT1; the proportion of patients receiving primary chemoradiotherapy rose from 6.5% before, 17.7% during and 58.8% after ACT1 and continued to rise to 70.3% in the subsequent period. Three year survival improved during the study period from 59.5% (95% confidence interval 56.6-62.2) before ACT1 to 73.6% (95% confidence interval 71.9-75.2) after the trial. Survival in Yorkshire was comparable with that in England. The treatment for squamous cell carcinoma of the anus changed dramatically during the study period. The predominant use of surgery before ACT1, a transition phase during the trial and a dramatic increase in the use of chemoradiotherapy after ACT1 provide strong evidence of the effect of the trial on population-based practice. Survival continued to increase during this period.

Purpose This population-level study was conducted to define the health-related quality of life (HRQL) of individuals living with and beyond colorectal cancer (CRC) and to identify factors associated with poor health outcomes. Patients and Methods All individuals diagnosed with CRC in England in 2010 and 2011 who were alive 12 to 36 months after diagnosis were sent a questionnaire. This included questions related to treatment, disease status, other long-term conditions (LTCs), generic HRQL (EuroQol-5D), and cancer-specific outcomes (Functional Assessment of Cancer Therapy and Social Difficulties Inventory items). Results The response rate was 63.3% (21,802 of 34,467 patients). One or more generic health problems were reported by 65% of respondents, with 10% of patients reporting problems in all five domains. The reporting of problems was higher than in the general population and was most marked in those age less than 55 years. Certain subgroups reported a higher number of problems, notably those with one or more other LTCs, those with active or recurrent disease, those with a stoma, and those at the extremes of the age range (< 55 and > 85 years). Of respondents without a stoma, 16.3% reported no bowel control. Reversal of a stoma resulted in fewer severe bowel problems but more moderate problems than those who had never had a stoma. A quarter of rectal cancer respondents (25.1%) reported difficulties with sexual matters (compared with 11.2% of colon cancer respondents). Conclusion This study demonstrates the success of a national patient-reported outcomes survey. The results have the potential to support system-wide improvement in health outcomes through the identification of particular challenges faced by individuals after treatment for CRC.

The idea of incorporating radar systems into vehicles to improve road traffic safety dates back to the 1970s. Such systems are now reaching the market as recent advances in technology have allowed the signal processing requirements and the high angular resolution requirements from physically small antennas to be realised. Automotive radar systems have the potential for a number of different applications including adaptive cruise control (ACC) and anti-collision devices. This paper summarises recent developments in test methods that have been made to satisfy the compliance requirements for emissions and immunity.

A Jungian play psychotherapy approach to the treatment of a profoundly sexually abused mother-son incest victim is described. Emphasis is placed on (a) the therapeutic alliance, (b) a teleological approach; that is, following the child's play as it unfolds and, (c) the differences between acting- out and acting-in. The play evolved through the following stages: Symbolic and verbal disclosure in the first session; terror and rage; sexual, urination, cleansing, and nurturant themes followed by ego and superego development and latency aged play. The sexual abuse of infants and children has been occurring since time immemorial. When the first author started his psychotherapeutic practice some 28 years ago, there were always a few children on his caseload who had been sexually abused. Now one-half of his practice consists of sexually abused children. Though in the past 10 years our knowledge and research base about these children has vastly improved, much remains to be done in the realm of successful treatment. This paper reviews some of the literature on the sexual abuse of children, describes aspects of a Jungian play psychotherapy treatment paradigm and then gives examples from the successful treatment of a profoundly abused child. This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Introduction Radiotherapy is an important treatment modality in the multidisciplinary management of rectal cancer. It is delivered both in the neo-adjuvant setting and postoperatively but, whilst it reduces local recurrence, it does not influence overall survival and increases the risk of long-term complications. This has led to a variety of international practice patterns. This variation can have significant impact on commissioning but also future clinical research. This study explores its use within the large English National Health Service (NHS). Method Information on all individuals diagnosed with a surgically treated rectal cancer between the April 2009 and December 2010 were extracted from the Radiotherapy Dataset (RTDS) linked to the National Cancer Data Repository (NCDR). Individuals were grouped into those receiving no radiotherapy (NRT), short-course radiotherapy with immediate surgery (SCRT-I), short-course radiotherapy with delayed surgery (SCRT-D), long-course chemoradiotherapy (LCCRT), other radiotherapy (ORT) and post-operative radiotherapy (PORT). Patterns of use were then investigated. Results The study consisted of 9,201 individuals; 4,538 (49.3%) received some form of radiotherapy. SCRT-I was used in 12.3%, SCRT-D in 3.7%, LCCRT in 26.5%, ORT in 5.0% and PORT in 2.2%. Radiotherapy was used more commonly in men and in those receiving abdominoperineal excision and less commonly in the elderly and those with co-morbidity. Significant and substantial variations were also seen in its use across all the multidisciplinary teams managing this disease with the proportion of any radiotherapy use ranging from 5.1% to 77.8% of surgically treated rectal cancer patients treated in each of the MDTs managing the disease across England. Conclusion Wide variation exists in both the use of and type of radiotherapy delivered in the management of rectal cancer across the English NHS. Prospective population-based collection of local recurrence and patient-reported late toxicity information are required to further improve patient selection for preoperative radiotherapy. Disclosure of interest None Declared.