Radiation Therapy H OSPITAL THE CANCER CENTER AT THE C ANCER C ENTER AT L EHIGH VALLEY

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1 Radiation Therapy AT THE C ANCER C ENTER AT L EHIGH VALLEY H OSPITAL THE CANCER CENTER

2 The Cancer Center at Lehigh Valley Hospital was created to make quality cancer care as comfortable and convenient as possible for our patients and their families.

3 R ADIATION THERAPY AT THE C ANCER C ENTER AT L EHIGH V ALLEY H OSPITAL The Right Place for Radiation Therapy When you receive radiation therapy at the Cancer Center at Lehigh Valley Hospital, you have the security of knowing that you are cared for by experienced physicians, nurses, therapists and other professionals who are specialists in their field and who have helped thousands of patients confront cancer. As your care progresses, you will learn more about the resources of our department and our Cancer Center, including our specialists and the availability of the finest state-of-the-art technology. This guide is designed to help you understand radiation therapy and explain what you can expect during and after your treatment. We will do all we can to treat the cancer and help you and your family achieve the best results possible. 1

4 About Radiation Therapy Radiation therapy uses X-rays, electrons and other types of radiation to treat cancerous and some non-cancerous areas of the body in a variety of ways. It usually involves focusing beams of radiation on cancerous cells. Radiation, by itself or in conjunction with other kinds of treatment, can often cure cancer. If a cure is not possible, it may help relieve the symptoms of cancer, such as pain, through palliative care. Radiation therapy may be the only treatment necessary or it may be used in combination with surgery or chemotherapy (drugs). For example, radiation therapy may help shrink a cancerous tumor before surgery or stop the growth of remaining cancer cells after surgery. When used with chemotherapy, it may help destroy cancer or prevent its reappearance. If you are receiving radiation therapy and chemotherapy, your doctors will work as a team to ensure that you receive the most appropriate care. About Your Radiation Therapy Team Radiation therapy involves many specialists from the Department of Radiation Oncology at Lehigh Valley Hospital, all of whom are certified by their respective boards. 2

5 Radiation Oncologists are board-certified doctors with specialized training in the use of radiation for the treatment of cancer and other diseases. You will see the same radiation oncologist (referred to as your doctor throughout the rest of this guide) as your treatment progresses. Radiation oncologists are skilled in assessing the long-term effects of the therapy and monitoring the cancer. Radiation Therapists are certified therapists trained to use radiation treatment machines. They assist your doctor with treatment planning and deliver your daily treatment. Radiation Oncology Nurses are registered nurses with certification in the care of oncology patients. Trained in radiation, they assist you in preparing for treatments and help you with any problems you may have during your care. Radiation Physicists are individuals trained in measuring and delivering radiation doses. They make sure the machines are delivering the right doses and performing properly. The physicists work closely with your doctor to plan your treatments. Medical Dosimetrists work closely with the radiation oncologists, physicists and radiation therapists to calculate your radiation doses and plan your treatment. Clerical Staff members arrange your first appointment and assist you with your daily arrival. Cancer Support Team members are available to support you and your family members. Social workers, a psychologist, a dietitian, a financial coordinator, a chaplain and others are here for you and ready to help. 3

6 Our Equipment and Resources A number of methods are used to treat the many types of cancer. We have the following equipment and resources available to help with your care. Our principal external beam treatment machines, called high-energy linear accelerators, offer the most powerful beams of radiation available on the East Coast and make an enormous difference in how well we can treat deep-seated tumors. We are able to target the treatment precisely with only minimal effect on adjacent healthy tissue. Our equipment is capable of delivering Intensity Modulated Radiation Therapy (IMRT), an advanced technique in radiation treatment delivery. IMRT uses high-energy linear accelerators, equipped with multi-leaf collimators, to deliver tiny beamlets of radiation to the tumor site with a high degree of precision. Radiation therapy is planned on simulators, conventional X-ray machines configured in the same design as the linear accelerators. We have two simulators that allow for precise mapping of the tumor for radiation delivery. In certain cases, planning is performed on a dedicated CT scanner. In conjunction with these planning tools, we have sophisticated three-dimensional computer treatment planning 4

7 systems that allow us to deliver concentrated doses of radiation to cancerous tissue with minimal effect to surrounding healthy tissue. Stereotactic radiosurgery is a major advance in the treatment of certain brain tumors and certain non-cancerous conditions of the brain. We are one of a few cancer centers in the country to offer this treatment. The treatment sends concentrated doses of radiation to cancerous cells from a series of different angles, so there is minimal effect to the surrounding healthy tissue. Gamma Knife radiosurgery is available in the Cancer Center at Lehigh Valley Hospital Muhlenberg, the area s only hospital-based program. Patients with brain lesions and other very complex problems benefit from this advanced technology that aims highly focused gamma rays at the target with only minimal risk to surrounding normal tissue and involves no incisions. This non-invasive treatment is primarily for malignant and benign brain tumors, vascular malformations and trigeminal neuralgia (facial pain). The Gamma Knife reduces surgical risk and patient discomfort, resulting in a shorter hospital stay and lower risk of complications. Brachytherapy services enable us to place radioactive material in the body surgically. The radioactive source in the implant may transmit rays outside your body, so hospitalization in a private room may be required. For some patients, however, HDR (High Dose Rate) brachytherapy allows us to provide these services on an outpatient basis. Prostate seed implants are performed at the Cancer Center. For this procedure, tiny radioactive seeds are permanently implanted into the prostate gland. The implant is typically an outpatient procedure allowing you to be discharged on the same day. Since our goal is to achieve the best possible results for you, we take a number of safety precautions to ensure your well-being. We use custom-made lead alloy shields and multi-leaf collimators to protect other parts of your body from exposure to radiation. Lead alloy shields are mounted on plates imprinted with a unique digital code for each patient to ensure that the correct shield is used every time. 5

8 About Your Treatment: Step by Step Radiation therapy treatments usually extend over several weeks, requiring daily visits Monday through Friday. The weekend time away from therapy gives you and your body a chance to rest. Because you will receive individual medical evaluation and treatment planning, your specific experience might differ slightly from the general process explained here. Scheduling Your First Appointment You or your referring doctor may schedule your first appointment. Many people find it helpful to have a relative or friend accompany them for their first visit and we invite you to ask anyone you wish to join you for your initial consultation. Your First Appointment: A Consultation Your first appointment will be a consultation with one of our radiation oncologists. During this visit, the doctor will discuss your medical history and talk with you about your condition. You will have a physical examination and your medical records and X-rays will be reviewed. You also will meet with a radiation oncology nurse. This visit will last one to two hours. 6

9 Our experienced staff of doctors, nurses and radiation therapists will do everything possible to make sure you have the best possible results. The radiation oncologist will discuss your treatment options with you and explain the possible side effects and the anticipated benefits of your therapy. If you decide to proceed with treatment you will be asked to sign an informed consent form prior to treatment and an appointment will be made to begin treatment planning and simulation. Treatment Planning and Simulation Before your radiation therapy begins we must plan a program to deal specifically with your type of cancer. We do this with the help of an X-ray machine called a simulator that looks like, or simulates, the treatment machine. In conjunction with simulation, a CT scan may be done to assist in treatment planning. 7

10 At the time of simulation, we will take your photograph for identification purposes. During simulation, X-rays are taken to determine the precise location of the cancer area. Since radiation affects all cells, both normal and abnormal, it is important to ensure that as little as possible of the normal tissue is treated. The skin over that area will be outlined with a special marking pen to identify exactly where the radiation will be directed. These marks will wash off easily, but since they may rub off, you might want to wear older undergarments and clothing for this visit. You will not need to keep these marks on for the treatment. We will also place tiny tattoos over the area to be treated. This helps us reproduce precisely the treatment we have designed for you each time you receive your therapy. Once these marks are placed, pictures are taken of the area that will receive treatment to further assure accuracy and safety. An appointment will be made for your next visit, usually within one week after this simulation. This time allows our staff and your doctor to make accurate computer calculations for the radiation treatment. It also gives us time to design shields to protect other areas of your body from receiving unnecessary radiation. Because each patient is different, treatment plans will vary. The number or frequency of your appointments does not imply anything about the expected results of your care. Your schedule is planned specifically for you, to help you achieve the best results, so we ask that you help by maintaining that schedule. During the progress of your therapy, we may find it appropriate to use more than one type of radiation treatment machine because each one performs different functions in the course of therapy. Also, you may have a simulation more than once to make adjustments in your treatment plan as your cancer shrinks. 8

11 9 Simulators allow for precise location of the treatment area.

12 Beginning Treatment This visit will take longer than later ones because your therapist and doctor must verify your treatment set-up. For your convenience, there is a section at the back of this booklet to write down your treatment information and any questions you may have for us. When you arrive in the reception area, please check in with our receptionist. Your radiation therapist will call you to the treatment room. To verify accuracy of the planned treatment, the therapist will take X-rays. These X-rays are taken to ensure that your treatment matches what was designed during simulation. This visit may take 30 to 45 minutes. You may or may not receive a treatment on this day. Special cushions may be used to help you stay in position. It is important that you remain still so the radiation reaches only the area where it is needed and so the same area is treated each time. You may breathe normally during the treatment. The therapist will then control the treatment unit from outside the room and observe you on closed-circuit television. You may talk to each other via an intercom. You may feel alone for the next few minutes, but remember that you are constantly monitored and you can talk with your therapist at any time. A radiation therapy machine looks like other X-ray equipment. You will not see or hear the radiation, and you probably won t feel anything. Some patients say they notice warmth or tingling in the area being treated, but you should not experience any discomfort. You will not become radioactive from your therapy. If, for any reason, you feel ill or very uncomfortable during your treatment, please tell your therapist. Please do not hesitate to ask any questions you may have during your visit. 10

13 Your Daily Treatments Within a short time you will become familiar with your treatment routine and the medical team that is helping you fight your disease. You will find your treatments will become routine after the first one. For all regular visits, please sign in with our receptionist. Your radiation therapist will call you to the treatment room. For each radiation therapy visit you will be in the treatment room with the therapist about 15 minutes. You may need to change into a gown. Administering the radiation takes only a few minutes during which time you will be alone in the room. Once a week you may have a blood test to check your red and white blood cell counts and platelets, and additional X-rays to assure the accuracy of the treatment. These X-rays do not usually show response to treatment; they are used to ensure that the treatment is being given as designed. You also will be examined regularly by your doctor and nurse to monitor your progress and to answer your questions. We care about your general health and well-being, so please let us know how you are feeling. 11

14 Care Following Radiation Therapy If you have any questions or problems before returning for your follow-up visit, please call us at (610) at the John and Dorothy Morgan Cancer Center or (484) at Lehigh Valley Hospital- Muhlenberg. Professional health care related to your cancer does not end when your radiation treatment is completed. You will need regular follow-up exams, laboratory tests and perhaps X-rays. Also, you may be seeing other cancer care specialists after your radiation therapy. We will send reports about your care to your referring doctor. We will schedule a follow-up appointment for you after your final treatment session. Managing Side Effects We will tell you about possible side effects and recommend how to deal with them. Most are not serious and they usually disappear a few weeks after your treatment ends. We will suggest ways you can reduce the discomfort of any side effects and possibly prevent their recurrence. Many patients are able to work and enjoy normal activities during their radiation therapy. Others find that they need more rest than usual and cannot do as much. You will be the best judge of how much activity you are able to handle. There is no need to avoid being with other people during your radiation therapy. Your body will not contain any radioactive substance, so you are not a hazard to others, even in intimate contact. The only exception to this is for some patients 12

15 Your radiation team works together to ensure you have the best possible chance for recovery. receiving internal radiation therapy, or brachytherapy. If you are receiving this therapy, you may need to be isolated while the radioactive material is within your body. As soon as this material is removed, however, there is no radiation hazard to anybody around you. Patients receiving prostate seed brachytherapy are discharged with permanent seeds in place and are given specific care instructions. About Your Health Care Each patient responds to radiation therapy differently. We will give you specific instructions for at-home care to fit your needs. It is important that you take good care of yourself during the course of your treatment to protect your overall health and assure that you receive the greatest benefit from your radiation therapy. 13

16 Overall Health Guidelines Get plenty of rest. Your body will use extra energy during the course of your treatment. Sleep as much as you need. If you have extreme fatigue, please discuss the problem with your doctor. Eat wisely. Good nutrition is essential and we will discuss your special dietary needs. For patients receiving radiation therapy to certain parts of the body, dietary restrictions may be given. Your doctor or nurse will discuss these restrictions with you when the therapy starts. You should maintain a balanced diet and try to maintain your weight. If you have problems eating or need extra help with nutrition planning, please let us know. Be kind to your skin. You need to treat the skin in your treatment area with extra care since in some cases it can become sun burned from your treatment. Since we do not use marks during the treatment but rather rely on the tattoos, you are allowed to gently wash the area being treated. This is somewhat different than what you may read in some of the other booklets you will be receiving. We will give you specific instructions about proper skin care. Do not apply creams or lotions to the treatment area unless approved by your doctor. 14

17 We rely heavily on technology and Tell us about any medication you are taking before treatment begins. In addition, do not take any medication during treatment, even aspirin, without first discussing it with your doctor or nurse. Ask questions. Please don t hesitate to ask questions at any time. We are here to help you and want to hear your concerns and answer your questions. Taking good care of yourself and learning all you can about your body and its response to your disease and treatment can be helpful during radiation therapy. Maintaining good health care routines after your treatment program is essential. professional skill, while recognizing that personal support is a key component in cancer care. 15

18 General Information Appointments. We try to schedule convenient appointments for you so you can work, go to school, take care of your family and go about your usual activities. Please check with your therapist if you find it necessary to change your schedule. Please be prompt for your appointments so we may give all patients the best care and minimize inconvenience for everyone. If you will be late please call us at at the John and Dorothy Morgan Cancer Center or at Lehigh Valley Hospital-Muhlenberg. We try our best not to keep patients waiting, but occasionally delays are unavoidable due to the complexity of the equipment we use. Family and Friends. We encourage you to bring loved ones and we welcome them, especially during your first appointment. If you wish, family members or friends may accompany you during your daily visits here. To protect the privacy of all patients, we ask that they remain in the reception area. If you want other visits between your family and doctor, please ask and they will be arranged promptly. Parking. Please refer to the maps on pages 20 and 21 of this guide for the location of free parking. Smoking. Smoking is not permitted. Support Programs. We are dedicated to helping you maintain the best possible quality of life during and after your radiation therapy treatment. We understand the personal challenges you and your family face and offer special support services to help you deal with them. Please consult a nurse for more information about our programs. 16

19 Time Expectations. It takes time for us to carefully analyze your particular treatment needs, design your individualized radiation therapy program and provide accurate and effective treatments each time you come for care. The table below lists the average time required for each of your visits. Your individualized care may require additional time. Visit Average Time Initial consultation 1 2 hours Treatment planning/simulation hours Verification/first visit 45 minutes Regular treatments 30 minutes Follow-up visits minutes 17

20 Transportation. If you need help with transportation during the course of your treatment, please let us know and we will have one of our nurses meet with you to make arrangements. Billing. You will receive two separate bills for your care. One will cover your doctor s services and the other, from Lehigh Valley Hospital, will cover the technical component of your care. Although we do not generate the bills in our office, we can provide you with the information and phone numbers you may need to make inquiries about your bill. We will make every effort to minimize the concern associated with this aspect of your care. About Cancer Services Patients who come to Lehigh Valley Hospital soon discover that they are not alone when facing a diagnosis of cancer. We rely heavily on technology and professional skill, while recognizing that personal support is a key component in cancer care. We will do all we can not only to treat the cancer, but also to care for and heal the whole person. The Cancer Center at Lehigh Valley Hospital was created to make quality cancer care as comfortable and convenient as possible for our patients and their families. We offer a full range of outpatient diagnostic and treatment services, doctors offices and education, rehabilitation and support services. 18

21 We are a founding member of the Penn State Cancer Institute, enabling us to consult with their cancer care specialists and take part in the research activities and educational programming. A central part of the care available at the Cancer Center is providing support for cancer patients and their families. Our Cancer Support Team offers help to our patients and their entire family. A variety of support groups and special programs help patients and their families relate to others who have been there. The Cancer Center also offers education and prevention programs including our second opinion service, the cancer consultative service, a resource room and outreach and screening programs for the community. 19

22 Main Entranc Lehigh Valley Hospital Cedar Crest Blvd. & I-78 Jaindl Pavilion Pool Pavilion Anderson Pavilion 1230 MRI Parking 1220 MRI 1210 Free Valet Parking Lot B Parking Office Visit Parking 1240 Morgan Cancer Center entrance Office Visit & Cancer Center Parking Free Valet Parking Lot A Parking Medical Office Buildings Exit Exit 20

23 Lehigh Valley Hospital Muhlenberg Kolb Wing W E S T G AT E D R I V E South Campus Drive Behavorial Health Science Center P P MRI P P Physical Therapy South Entrance P Muhlenberg Behavorial Health B A T H G AT E R O A D Banko Community Center P Macada Road S C H O E N E R S V I L L E R O A D Emergency HealthWorks & Rehabilitation Services Lehigh Valley Eye Physicians Main P P Coordinated Health Campus Drive E.D. Drop Off Good Shepherd Rehabilitation Center E Free Valet Parking Cancer Center Entrance P Hospital Entrance Route (blue) Emergency Entrance Route (red) P LVH Muhlenberg Drop Off P Pediatric Specialties PASU P PA R O U T E To Rt. 22 P P Patient Parking Staff/Employee Parking 21

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28 John and Dorothy Morgan Cancer Center 1240 S. Cedar Crest Boulevard Allentown, PA Radiation Therapy: Lehigh Valley Hospital Muhlenberg Cancer Center Route 22 & Schoenersville Road Bethlehem, PA Radiation Therapy: THE CANCER CENTER CARE 888-LVH-CARE xxxx 4/06