The study, led by Sarah Boafowaa Owusu with colleagues Konlan Kennedy Dodam and Lydia Aziato, used an exploratory descriptive qualitative design. The participants were women diagnosed with breast cancer who had undergone radiotherapy at Komfo Anokye Teaching Hospital in Kumasi, one of Ghana’s major referral centres for cancer care. Each woman took part in an in-depth interview guided by a piloted interview guide, meaning the questions had been tested and refined before the main data collection began. The interviews were audio-recorded, transcribed word for word, and then analysed using thematic analysis with the assistance of NVivo 10, a software package designed to help researchers organise and code large volumes of qualitative text.

The analysis revealed two overarching themes: physical experiences and social experiences. Within the physical domain, the researchers identified four sub-themes: pain, breast and skin changes, physical exhaustion, and gastrointestinal symptoms. These are not minor inconveniences. The title of the paper itself, drawn from a participant’s words, captures the daily reality many of these women described: after radiation sessions, they sometimes felt weak and dizzy. Such systemic symptoms, layered on top of localised effects at the treatment site, shaped how the women judged the entire treatment experience and whether they would encourage others to follow the same path.

The physical findings carry particular weight in the Ghanaian context. Breast cancer remains one of the leading causes of illness and death among women worldwide, and radiotherapy, alongside surgery and chemotherapy, is a well-established treatment option. Yet the authors note that many women in low-resource settings refuse these allopathic treatments precisely because of adverse effects that remain poorly identified and poorly managed. In other words, the problem is not only that side effects occur, but that health systems often fail to detect, acknowledge, and treat them effectively. When a woman’s suffering goes unrecognised, her experience becomes a cautionary tale told to sisters, friends, and neighbours, and the cycle of treatment refusal deepens.

The biology of these side effects is well understood in radiation oncology. Ionising radiation damages cancer cells by breaking their DNA, but it also injures surrounding healthy tissue. Skin in the treated field can become red, dry, itchy, and in more severe cases blistered, a condition known as radiation dermatitis. Fatigue is among the most commonly reported effects of radiotherapy across all cancer types, and dizziness and weakness, as the study participants described, can compound the exhaustion. Gastrointestinal symptoms such as nausea can arise when radiation fields affect or lie near the upper abdomen, and radiation-induced nausea and vomiting are recognised clinical entities in the pharmacological literature. Pain at the treatment site and changes in the appearance and texture of the breast add a further layer of physical and emotional burden.

What makes the new study distinctive is not the catalogue of symptoms itself but the way those symptoms ripple outward into women’s decisions and their communities’ attitudes. The researchers found that several of the physical experiences reported after radiation therapy deter women diagnosed with breast cancer from consenting to radiotherapy, or from recommending it as a treatment option to others in Ghana. In a health system where late presentation of breast cancer is already a documented problem, and where studies from across Sub-Saharan Africa have shown that women are often diagnosed and treated late, any factor that discourages acceptance of effective treatment has serious consequences for survival.

Yet the study is not only a story of suffering. The second major theme, social experiences, contained three sub-themes: family and partner support, support from employers, churches, and friends, and sexual life challenges. The women’s social networks emerged as a genuine resource. Family members and partners who provided practical and emotional support helped women cope with the demands of daily treatment trips and the physical aftermath. Employers, churches, and friends also played roles in sustaining women through the treatment period, offering encouragement, material help, and a sense that they were not facing the disease alone. The authors argue that these networks could serve as useful motivators in promoting radiotherapy, turning social capital into a clinical asset.

At the same time, the study does not shy away from the difficulties embedded in social life after treatment. Sexual life challenges formed one of the identified sub-themes, reflecting a dimension of post-treatment experience that is frequently overlooked in busy oncology clinics but that shapes intimate relationships and self-image. Research elsewhere in Africa has documented how changes in body image following breast cancer treatment affect women’s sense of identity and their relationships, and the Ghanaian findings align with that broader picture. The authors also build on their own earlier work in Kumasi, which examined the psycho-spiritual wellbeing and coping strategies of women after radiation therapy, indicating a sustained research programme into how Ghanaian women live with and through this treatment.

The recommendations that flow from the study are directed at two levels of the health system. First, the authors call on nurses, midwives, and other health professionals to handle the negative physical symptoms experienced after radiation therapy with tact and professionalism through supportive care services, with the aim of improving acceptance of this treatment option. Supportive care, the branch of oncology concerned with symptom management and quality of life, is thus framed not as an optional extra but as a strategic necessity: if side effects are managed well, women will be more willing to start and complete radiotherapy, and more willing to speak positively about it to others. Second, the researchers recommend that the Ghana Health Service ensure nurses at breast cancer care units utilise the social networks of women undergoing radiation therapy as social capital to reduce the psychological stress associated with the treatment.

The broader significance of the study lies in its method and its setting. Qualitative research of this kind cannot measure how common each symptom is across the population, and the authors are careful to present the findings as the experiences of seventeen women at a single teaching hospital. But what such research can do, and does here, is reveal the texture of lived experience that surveys miss: the weakness and dizziness after a session, the fear of a changing breast, the strain on intimate life, and the quiet power of a supportive church community or an understanding employer. In resource-constrained settings, where oncology services are concentrated in a handful of teaching hospitals and follow-up care can be fragmented, understanding these experiences is a prerequisite for designing services that women will actually use. The study suggests a practical path forward: manage the physical side effects with skill and compassion, and mobilise the families, faith communities, and friendships that already surround these women. If those two strands are woven together, the authors argue, radiotherapy in Ghana could move from being a feared ordeal to an accepted and better tolerated part of breast cancer care.

Subject of Research: Physical and social experiences of Ghanaian women with breast cancer after radiotherapy

Article Title: “After radiation sessions, I sometimes feel weak and dizzy’’: Experiences of Ghanaian women with breast cancer post radiotherapy

Article References: Owusu, S. B., Dodam, K. K., & Aziato, L. (2026). “After radiation sessions, I sometimes feel weak and dizzy’’: Experiences of Ghanaian women with breast cancer post radiotherapy. Supportive Care in Cancer, 34(10), Article 1064. https://doi.org/10.1007/s00520-026-11304-7

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11304-7

Keywords: breast cancer, radiotherapy, Ghana, qualitative research, supportive care, side effects, nursing, social support, Sub-Saharan Africa, cancer treatment, radiation side effects, women's health

The stakes are high because AGASACA behaves in a paradoxical way. Although the primary tumor at the anal sac can be small at diagnosis, metastatic lymph nodes in the sublumbar region can grow large enough to partially obstruct the rectum, creating life-threatening consequences from disease that started in a gland the size of a pea. The disease also tends to progress relatively slowly compared with many other malignancies, which means that long-term locoregional control, rather than a rapid strike against distant spread, is the single most important goal for a successful outcome. Late in the disease course, metastases can also appear in distant organs such as the lungs, but it is the pelvic battlefield where most treatment decisions are won or lost.

Surgery has long been considered the first line of defense. Yet the review makes clear that the surgical landscape is more complicated than many clients realize. Local recurrence of the primary tumor after resection has been reported in anywhere from 4 to 44 percent of cases, with a median time to recurrence ranging from 140 to 374 days. When surgeons attempt to remove metastatic iliosacral lymph nodes, recurrence within the lymphocentrum has been documented in between roughly 12 and 59 percent of cases, sometimes within just six months of the operation. Perioperative complications occur in 12 to 39 percent of patients, and the most feared complication, hemorrhage during lymph node extirpation, affects up to 18 percent of dogs, with mortality reaching 2.2 percent. Critically, the risk of complications climbs sharply when lymph nodes exceed 4.5 centimeters in size, a threshold that should prompt especially careful conversations between veterinarians and owners.

Patterns of treatment failure tell a coherent story across studies. In one investigation of 34 dogs with early-stage disease treated with surgery alone, 21 percent developed local recurrence of the primary tumor at a median of 354 days, and 26 percent developed locoregional metastases at a median of 589 days. A larger study of 161 dogs stratified patients by surgical margins, using the familiar R0, R1, and R2 classification system, and found that only the presence of lymphovascular invasion and an R1 resection, in which tumor cells extend to the cut edge of the specimen, were statistically associated with recurrence. In dogs with massive primary tumors greater than 5 centimeters, none of the stage 2 patients developed lymph node metastasis, while more than half of those presenting with stage 3 disease progressed further. The unifying message is that disease stage at initial treatment mediates the risk of relapse, which implies that adjuvant therapies should be deployed on a risk-based basis rather than universally.

This is where radiation therapy enters the picture, and where the review offers its most nuanced analysis. Conventionally fractionated definitive radiotherapy, or CFDRT, aims to deliver the highest possible dose to residual tumor cells while respecting the tolerance of surrounding normal tissues, typically in 16 to 20 fractions of 2.5 to 3 Gy for total doses of 48 to 50 Gy. The problem is that its clinical role in microscopic AGASACA after surgery remains poorly defined. In a study of 113 variably treated dogs, adjuvant radiation did not produce a significant improvement in survival time, though the small number of irradiated patients and the slow natural history of the tumor may have masked a real effect. Meanwhile, dogs undergoing CFDRT develop moderate to severe acute side effects in organs at risk including the rectum, colon, urinary bladder, skin, and spinal cord, with recovery from acute toxicity taking 23 to 36 days after onset. The therapeutic index, the ratio of benefit to harm, may simply not be favorable enough for this approach in every patient.

The most striking finding in the review concerns hypofractionated radiotherapy for advanced disease. In a study comparing hypofractionated radiation against surgical extirpation of iliosacral lymph nodes in dogs with stage 3b AGASACA, radiation produced significantly longer outcomes: a median progression-free interval of 347 days versus 159 days for surgery, and a median survival time of 447 days versus 182 days. The authors offer a compelling technical explanation rooted in the geometry of radiation planning. When radiation oncologists contour a CT scan, they delineate all visible gross disease as the gross tumor volume, then add margins for subclinical microscopic extension to create the clinical target volume, and finally add further margin for setup uncertainty to create the planning target volume. This means radiation can treat the entire iliosacral lymphocentrum, including microscopic disease threading through the lymphatic network, in a way that no surgeon’s hands can match. Surgery removes individual enlarged nodes; radiation can sterilize the whole nodal basin.

Even the terminology of palliative care may need revision for this disease. Protocols delivering 20 Gy in five daily 4 Gy fractions, often labeled palliative because of their low total dose, have produced median progression-free survival of 289 to 347 days and median survival times of 329 to 447 days in AGASACA patients. For comparison, across a broad range of other tumor types treated with the same 4 Gy by 5 protocol, median progression-free survival was only 4.4 months. AGASACA appears roughly twice as responsive as expected, suggesting the tumor may harbor a low alpha-beta ratio, the radiobiological parameter that determines sensitivity to large fraction sizes, consistent with its slowly proliferating nature. The authors argue that defining treatment intent purely by fraction size and number may be inappropriate when a so-called palliative regimen delivers a year of disease control with mostly mild, grade 1 to 2 gastrointestinal side effects.

Not every advanced technique earns endorsement. Stereotactic body radiotherapy, which delivers ablative doses of 6 to 10 Gy per fraction over 3 to 5 fractions, showed promising survival numbers in small studies, with one report of a 991-day median survival in five dogs. But the largest SBRT study to date, involving 25 dogs treated for metastatic sublumbar lymph nodes, revealed a sobering safety signal: 48 percent of dogs developed late-onset changes in gait and hind limb lameness, including ataxia, paraparesis, weakness, and pain. The authors recommend reserving SBRT for macroscopic disease rather than microscopic tumor beds, and focusing treatment on the nodal region while addressing the primary site surgically. Chemoradiotherapy fares even worse in the evidence hierarchy. The largest dataset, 15 dogs treated with concurrent mitoxantrone, produced a 93 percent rate of severe moist desquamation and a 53 percent rate of clinically relevant late effects, including two dogs euthanized for chronic colorectal toxicity. The review concludes there is insufficient evidence to recommend routine chemoradiotherapy in this disease.

One further clinical pearl concerns hypercalcemia of malignancy, a paraneoplastic syndrome affecting 27 to 34 percent of AGASACA patients that can become an emergency when total calcium exceeds 16 mg/dL. Hypofractionated radiation resolved hypercalcemia in about 31 percent of cases alone, rising to 77 percent when combined with steroids or bisphosphonates, offering a non-surgical route to controlling this dangerous metabolic derangement. Looking forward, the authors call for prospective trials comparing fractionation schemes, systematic imaging-based assessment of response rates, and rigorous studies of patterns of failure. Modern technology, including intensity-modulated radiation therapy and cone beam CT image guidance, should theoretically reduce both acute and late toxicities compared with the older two-dimensional planning used in much of the published literature, though no study has yet confirmed this. For now, the review’s practical bottom line is clear: surgery remains the cornerstone for the primary tumor, radiation deserves serious consideration, and may even be preferred, for advanced nodal disease, and the humble five-fraction protocol may deserve a better name than palliative.

Subject of Research: The role of radiotherapy in treating canine apocrine gland anal sac adenocarcinoma

Article Title: Role of radiotherapy in canine apocrine gland anal sac adenocarcinoma: a review

Article References: Murakami, K., & Rancilio, N. (2025). Role of radiotherapy in canine apocrine gland anal sac adenocarcinoma: a review. Veterinary Oncology, 2(1), Article 12. https://doi.org/10.1186/s44356-025-00028-1

Image Credits: AI Generated

DOI: 10.1186/s44356-025-00028-1

Keywords: canine cancer, AGASACA, radiotherapy, veterinary oncology, hypofractionated radiation, SBRT, iliosacral lymph nodes, hypercalcemia, chemoradiotherapy, surgical oncology, dogs, radiation side effects