Department Radiotherapy General Information about radiotherapy Information for patients Introduction This information sheet is a general guide to radiotherapy. The treatment and side-effects you have from radiotherapy will vary depending on which part of your body you are having treated. If you have any questions, or would like more advice, please ask a member of your treatment team. The team consists of radiographers, doctors and nurses who will help and support you throughout your treatment. What is radiotherapy? Radiotherapy uses high energy x-rays (or similar rays) to treat cancer. It damages your body s cells within the treatment area, destroying the cancer cells but allows your normal cells to recover. Any side-effects are usually confined to the area you are having treated. Planning your treatment Before your planning appointment you will be asked to sign a consent form. This is to confirm that you agree to have the radiotherapy treatment. At your first appointment a radiographer will ask you to verbally confirm that you consent to have radiotherapy, this is a good time to ask any questions that you may have. The planning session will take place in radiotherapy at Charing Cross Hospital. This appointment may take between one to two hours. Your treatment will be planned using a CT (computerised tomography) scanner. What happens during a CT scan For the CT scan you will need to remove some of your clothing and we will give you a gown to wear. You will be asked to lie on the couch and the radiographers will move you into position. The couch will move slowly through the open scanner and back, you will not feel anything and nothing will touch you. During the procedure we ask that you remain as still as possible and breathe normally. At the end of the scan the radiographers will take some measurements and ask your permission to make some small permanent marks on your skin using ink and a needle. These marks show the radiographers exactly where the treatment needs to be given each time.
Mould preparation For some patients it is necessary to make a plastic mould to fit the treated area such as the head, neck or limb. The mould will be made at the time of your CT scan. The mould helps us to ensure that the treatment is delivered accurately each day. Treatment marks are put on the mould, so it is not normally necessary to put marks on your skin. Before you leave the department we will give you information about your treatment schedule, and you can ask any questions you may have about your treatment. Your treatment will start approximately one to three weeks after your planning session. Treatment Your doctor will prescribe the amount of radiation you need for your treatment. This amount is then divided up into smaller doses (called fractions). These are given over a period of days or weeks. Treatment is usually given Monday to Friday and occasionally on a Saturday. You will be given a list of treatment appointments at your CT scan. When you arrive for your first appointment please report to the reception desk. Treatment may be given at either Charing Cross Hospital or Hammersmith Hospital. On your first day a radiographer will explain your treatment and any possible side-effects. Please feel free to ask any questions. What will happen during your treatment Before treatment you will need to change into a gown like you did for your CT planning scan. Please be prepared to be in the treatment room for up to 30 minutes. The radiographers will help you get into the same position you were in for the planning session. They will then move the treatment machine into position. The machine will come close to you, but it will not touch you. The machine will then move around you to enable the treatment to take place at different angles. Each area takes from one to three minutes to treat and you will have the same areas treated each day. It is important that you keep still throughout your treatment and breathe normally. The radiographers will leave the room to switch the machine on. You will be alone in the room during treatment, but don t worry as the radiographers close by and will watch you closely on monitors. If you need help the radiographers will give you instructions of what to do, such as raising your arm to signal to them. Then the machine will be switched off and the radiographers will return to the room to assist you. 2
Treatment review Review radiographers are available everyday if you have a specific problem with your treatment or any side effects. You will be seen routinely at least once during the course of your treatment. Side effects The side-effects of radiotherapy are usually felt only in the area that you are having treated. You will not experience everything that is in this guide as it will depend on which part of the body you are having treated. The radiographers will give you specific information about the side-effects that you may experience during and after your treatment. Skin reaction Sometimes people have a skin reaction from radiotherapy. The reaction depends on your skin type, which part of the body you are having treated, and the amount of the radiotherapy that you have. Any reaction will not happen immediately, but can develop over several treatments. The skin in the treatment area may become dry, red and itchy. The reaction may be worse in skin folds, such as the groin, buttocks or under the breast. For further information please ask a member of staff for a copy of Skin care during radiotherapy. Hair loss You may lose your hair in the area where you are having radiotherapy. Macmillan and Maggie s Centre has information on coping with hair loss. Their contact details can be found at the end of this leaflet. If you do not have a wig and would like one, please ask to be referred to the patient appliance department who will help you to choose and fit your wig. If you do experience hair loss, your hair may re-grow but it may not be the same colour and texture. The time it takes to grow back will vary for each person. Fatigue As treatment progresses you may feel tired and develop fatigue. This is a tiredness which is not entirely relieved by resting and can make physical activity difficult. Some of the things that can contribute to fatigue are: travelling to the hospital for treatment change to your daily routine change to your eating habits dehydration reduced physical activity interrupted sleep emotions - like feeling low in mood and isolated Even so, it is beneficial for your health to take gentle exercise as well as ensuring you rest. 3
Macmillan produces a free booklet that you may find helpful called Coping with fatigue. To get this booklet, please contact Macmillan using the contact details given at the end of this information sheet. Constipation or diarrhoea The combination of radiotherapy and some medicines can change your bowel habits. If you have any changes, tell the radiographers or nurses who will be able to advise you. Other side-effects Please tell the radiographers if you are concerned about any other effects of your radiotherapy treatment. They will be able to help and advise you. After radiotherapy The side-effects from the radiotherapy reach a peak about 10 to 14 days after you have finished treatment. Any side-effects you have experienced may continue to get worse during this period. You may develop side-effects if you have not had any. The radiographers will explain this more fully and advise you. Sometimes people feel anxious at the end of their treatment. You will need time to recover physically and emotionally. Follow-up appointments You will have a follow-up appointment between two and twelve weeks after your course of radiotherapy ends. This will be with a doctor at the cancer centre or with the doctor who referred you to us. You will be given details of how to make this appointment. After treatment skin care Depending on your course of treatment, your skin may be red and sore, and you will need to continue to follow the skincare advice. If your skin is broken, you will need to see the review radiographers for advice, and possibly a dressing. You may need to return to the department or visit your local GP practice nurse. Carry on with the same skin care until your skin does not look red or feel sore, and then slowly introduce your usual washing routine. If your skin starts to feel sore again, return to using warm water and try again after a week. When you can return to your normal products (such as soap) will depend on your skin reaction. This can vary for each person. After treatment diet If you changed your diet to cope with the side-effects, continue with this for a couple of weeks. Slowly introduce foods that you stopped. If your throat is sore, continue with the same mouth care that you used during your treatment. Eat soft food that is not too hot or too spicy. Your taste buds may take three months or more to recover, and you may find that you have less saliva. It is important that you drink plenty of fluids each day. 4
Your radiotherapy team Clinical oncologist - is a doctor trained in the use of radiotherapy and chemotherapy. Radiographer a therapy radiographer gives you your radiotherapy and will be able to help and advise you during your treatment. Students Imperial College Healthcare NHS Trust is a training hospital for postgraduate and undergraduate trainees so you may meet male and female students in all areas of the hospital. We train doctors, nurses, radiographers and other therapists in the treatment and care of cancer patients. Placements at Imperial College Healthcare NHS Trust are an important part of student training, so by allowing them to assist in your care; you will be making a valuable contribution to student education. Students are always supervised by fully qualified staff. However, you have the right to decide if students can take part in your care. If you prefer them not to, please tell the doctor, nurse, radiographer or other therapist in charge as soon as possible. You have a right to do this and your treatment will not be affected in any way. We also try to respect the concerns of patients in relation to the gender of their doctor and other health professionals. Radiotherapy /open evenings The open evenings have been designed to answer any questions you may have about radiotherapy. It has been running for the last 20 years and has helped many patients, carers and their relatives understand more about their radiotherapy treatments. The open evenings are held in the radiotherapy department at Charing Cross Hospital from 18.00 to 19.00 and usually take place on the 2 nd and 4 th Thursday of the month. To book yourself in and for more information, contact the radiotherapy department Call 020 3311 1737. Contact us If you have any questions or concerns about your radiotherapy treatment, please call on the numbers listed below: Radiotherapy reception: 0203 311 1737 Review radiographers: 0203 311 0706 Appointment enquiries: 0203 311 1612 Appointment enquiries email radiotherapybookings@imperial.nhs.uk 5
Out of hours care If you have a problem in the evening or weekend, please contact: Acute oncology assessment unit Monday Friday 09.00 to 18.00 Call 0203 311 1966 UK Oncology Nursing Society (UK-ONS) 24 hour helpline Call 0203 311 5160 Charing Cross Hospital main switchboard Call 0203 311 1234 and ask for the operator or dial 0 Ask the operator for the clinical oncology registrar on call Hospital transport Many patients are able to bring themselves or can ask a friend or relative to help them out. If you think you may need hospital transport please discuss this with your oncologist or radiographer. Hospital transport can be arranged subject to an eligibility criteria based on medical need. If you want to bring an escort on hospital transport there must be a medical need to do so. There can be delays for some time either side of your appointment because of the high demand for transport. Please take this into account when you are deciding whether to use ambulance transport. Call 0203 311 5272 to be assessed for hospital transport If you meet the criteria for hospital transport you must inform the appointments team so you appointment times can be altered. Information and support Where to get further help Many people find it hard to cope with what is happening to them and feel anxious or depressed. It can be helpful to know that most people find these feelings ease with time. Try to discuss your concerns with the staff that are involved in your treatment, as well as your family and friends. Talking to other people can help you to find the answers to your questions. Macmillan information and support services at Charing Cross and Hammersmith hospitals There are drop-in services provided to give you emotional and practical support. The drop ins are set in friendly, non-clinical environments in which people affected by cancer can discuss in private their needs with dedicated and expert information professionals. The information centre is located on the ground floor of Charing Cross Hospital 09.00 to 17.00, Monday to Friday 6
09.00-16.00, Tuesday, Wednesday and Thursday Call 020 3313 0171 The infopod on the ground floor of the Garry Weston Centre at Hammersmith Hospital is open 09.00-17.00, excluding bank holidays Monday and Tuesday 09.00-16.00, Wednesday, Thursday, and Friday Call 020 3313 4248 Macmillan s call centre is a free service and offers support and information for people affected by cancer. 09.00-20.00, Monday to Friday (interpretation service available) Call 0808 80 80000 Visit www.macmillan.org.uk Imperial companions, is a Macmillan volunteer led service - the Imperial Companion service provides fully trained and supported volunteers who can meet patients at the hospital or nearby. They will listen to, and give patients the space to talk, and to provide help in getting any extra support needed. Patients receiving active cancer treatment can request a companion by talking to a clinical nurse specialist (CNS) or contacting the companion team. Call 07455 773 416. Maggie s Cancer Caring Centre - Maggie s centre is in the grounds of Charing Cross Hospital and provides emotional, practical and social support to people with cancer, their families and friends. All services are drop-in and free. There are also various support groups, courses and activities running that may be of interest. Call 020 7386 1750 Visit www.maggiescentres.org to check the current timetable As part of the Macmillan Cancer Support and Imperial College Healthcare NHS Trust partnership, we have introduced the Macmillan cancer navigators service. Macmillan navigators offer phone contact for all cancer patients. They can help with booking appointments, accessing local support services and finding answers to any questions. Please call the Macmillan navigators team with any questions you have about your cancer care. 08.00 to 20.00 Monday to Friday 09.00 to 17.00 Saturday and Sunday Call 020 3313 0303 Prescriptions From 1 April 2009 NHS patients treated for cancer became entitled to free prescriptions. Prescriptions from The Christie Pharmacy are free for NHS patients. You will need an exemption certificate to get free prescriptions from a community pharmacy. Exemption certificates are available from the radiotherapy department and from your GP. Pharmacy medicines helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. Call 020 3311 1703 from 9.15am to 17.00, Monday to Friday 7
24 hours a day, seven days a week medical help and advice is available from fully trained advisers supported by experienced nurses and paramedics. Call 111 NHS Choices Online information and guidance on all aspects of health and healthcare Visit www.nhs.uk How do I make a comment about my visit? We aim to provide the best possible service and staff will be happy to answer any of the questions you may have. If you have any suggestions or comments about your visit, please either speak to a member of staff or contact the patient advice and liaison service (PALS) on 020 3313 0088 (Charing Cross, Hammersmith and Queen Charlotte s & Chelsea hospitals), or 020 3312 7777 (St Mary s and Western Eye hospitals). You can also email PALS at pals@imperial.nhs.uk. The PALS team will listen to your concerns, suggestions or queries and is often able to help solve problems on your behalf. Alternatively, you may wish to express your concerns in writing to: Complaints department fourth floor Salton House St Mary s Hospital Praed Street London W2 1NY Alternative formats This leaflet can be provided on request in large print, as a sound recording, in Braille, or in alternative languages. Please contact the communications team on 020 3312 5592. We have a free and premium wi-fi service at each of our five hospitals. For further information please visit our website: www.imperial.nhs.uk Department of Radiotherapy Published: August 2016 Review date: August 2019 Reference no: 2668 Imperial College Healthcare NHS Trust 8