Radiotherapy Treatment For Breast Cancer

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1 Radiotherapy Treatment For Breast Cancer Introduction This pack has been put together to back up the information and advice already passed onto you. Take it home and dip into it when you feel you need to. Hopefully this will make you feel more in control. You may wish to share it with your family and friends, so that they can understand a little more about your treatment. More advice/information is available from the Breast team including your Nurse Specialist, the Radiographers and Review Radiographer during your radiotherapy treatment and the Chemotherapy team should you be having chemotherapy. Radiotherapy Your Doctor has recommended that you receive a course of radiotherapy. This pack will help to answer some of your questions. What is Radiotherapy? Radiotherapy treats cancer using high energy beams to destroy cancer cells, whilst causing the minimum amount of damage to normal cells. Your treatment will be given by a team of male and female Radiographers, who will help and support you if you have any problems. The Review Radiographer will also see you regularly to assess your side effects and offer advice. When is it given? You will receive the treatment over a number of weeks, usually as an outpatient, on a daily basis, Monday to Friday, with a rest at weekends. What will I feel? During your treatment you will not feel anything, or see anything. The actual treatment machine makes a high-pitched noise, and the treatment lasts for only a few minutes at each visit. Will I experience any side effects? You may get some side effects towards the end of your course of treatment; see separate section for skin care and side effects. You will be seen regularly by Review Radiographer during your File Name: RT treatment for Breast Cancer Page 1 of 6 IssueNo : 1 Issue Date: 30/10/17

2 treatment and by the radiographers who will give you advice and support on a daily basis. A followup appointment will be given at the end of your course of radiotherapy. Will I be radioactive? You will not be radioactive, and it is safe for you to be around other people and children. How do I get to the hospital? Friends and family often like to help. If there is a medical reason, then the hospital can arrange transport for you. Will I be told if the treatment is working? Treatment for cancer is individualized; your doctor will discuss with you the best way to monitor your response to the treatment. In some cases the treatment is given to reduce the chance of the cancer recurring and there may not be a specific scan or test that will be helpful directly after treatment as there is no cancer left to measure.. You can speak to your clinical nurse specialist or oncologist to discuss any concerns. CT Planning Following your initial consultation with the doctor you will receive an appointment by telephone to attend for a pre-treatment CT (planning) scan at the Lingen Davies Centre. When you attend for this appointment, a member of the pre-treatment team will explain the procedure, check that you understand the information given by your doctor and that you agree to proceed with the treatment. All female patients under the age of 55 will be asked to confirm their pregnancy status. It is important that you are not pregnant and do not become pregnant whilst undergoing radiotherapy planning and treatment. If you think that you may be pregnant at any point during planning or treatment, please inform a radiographer immediately. Prior to planning and treatment it is important to keep hydrated by increasing your fluid intake. You may need an injection of dye (intravenous contrast) into your hand or arm during the planning scan. If you need intravenous contrast we will require you to have a blood test a few days before your CT (planning) scan, so all the relevant checks can be carried out. The CT (planning) scan is used to plan your radiotherapy treatment and is not used for diagnostic purposes. The process takes approximately 30 minutes 1 hour. The equipment we use to set you up during your CT (planning) scan, and the position you are put in will be the same for your radiotherapy treatment. If you are uncomfortable or in pain maintaining the treatment position you must inform the CT radiographers as we are unable to alter your position once you have been scanned. At the end of your planning scan, you will be given up to three permanent ink (tattoo) dots under the skin in the most suitable area of your body. These marks will not come off but may fade slightly with time. The permanent marks are used to position you accurately for treatment each day. It may also be necessary to take photographs of your position on the couch to assist the radiographers at treatment. You will be given your treatment start date and time before you leave the department following your planning scan. If you have any appointments that may clash with your radiotherapy treatment please advise the radiographers when you attend for your CT (planning) scan as we may be able to alter your appointment. File Name: RT treatment for Breast Cancer Page 2 of 6 IssueNo : 1 Issue Date: 30/10/17

3 Radiotherapy Treatment On your first day of radiotherapy a member of staff will come and collect you from reception and show you the way round to the treatment area. At this point you will be informed of the process you are to undertake and this is your opportunity to ask any questions. You will be asked to change into your dressing gown or something similar and wait in the patients waiting room by the Linac (treatment machines). On your subsequent visits after checking in at reception please take a seat and wait for your name to be called over the tannoy. Once you are called on the tannoy make yourself around to the treatment area and change ready for your treatment. A radiographer will come and collect you from the patients waiting area when it is time for your treatment. Once in the treatment room you will be asked for your ID and then asked to remove your dressing gown and to get on to the treatment couch. You may like to wear a strappy vest and lower the straps once you are on the treatment bed. The couch will rise up quite high and move under the Linac. There will be a minimum of two radiographers in the treatment room; one either side of you. It is really important for you to just lie heavy and to relax as the radiographers move you to line up your skin tattoos with the lasers that are in a fixed position in the room. Once you have been aligned correctly you may feel the treatment couch move, this is normal and it is the radiographers carrying out the moves from the treatment plan that your consultant has planned for you. The Linac will then move into the treatment position. The Linac will not touch you as it moves around. You may hear a buzzing noise as the radiographers leave the room; this will last for about 15 seconds and is nothing to worry about. It is important to keep still until a radiographer informs you that the treatment is completed. X-ray images are taken regularly during your treatment to ensure you are in the correct position. You may hear a buzzing noise whilst these are taken and then there will be a short delay whilst these images are checked by the radiographers. If the x-ray image confirms you are in the correct position, the radiographers will then deliver the treatment. You will not see or feel anything, but you will hear a buzzing noise and this is completely normal. If the x-ray images show that an adjustment to your position is needed you will feel the bed move slightly, again this is normal and it is the radiographers doing this from the control room. The Linac will then move to the next treatment angle and then deliver the next field of treatment, this sequence will continue until all the fields of treatment have been delivered. The radiographers are watching you on the CCTV to ensure you haven t moved during the course of the treatment. It is really important to keep as still as possible, so the radiographers can deliver the treatment as accurately as possible. Once all the treatment has been given the radiographer will enter the room and tell you the treatment has finished and that you are free to leave the treatment room. If you want to discuss any aspect of your treatment you are more than welcome to, but this may need to take place in another room to avoid a delay in treating the next patient. You will be seen regularly by the review radiographer who will assess your side effects and provide you with any information you may need. You will be given the appointment times for the following week on the Thursday or Friday of the previous week. Due to the lack of space and for the comfort of all patients we respectfully ask that it is only the patient that comes round to the patient waiting room. Radiotherapy Side-effects Radiotherapy is an effective treatment for reducing the risk of cancer returning in your breast. To be effective, the radiotherapy dose needs to be high enough to kill any cancer cells. It will also have an effect on the normal healthy cells in the area but to a much lesser degree. This means that you may notice some side effects which should settle within a few weeks of treatment completion. Possible side effects: File Name: RT treatment for Breast Cancer Page 3 of 6 IssueNo : 1 Issue Date: 30/10/17

4 The most common side effects occur during or soon after treatment. They are usually most noticeable about ten days after finishing the course of treatment and may last for a few weeks. The severity of any side effects varies enormously from person to person. During radiotherapy you will be seen weekly by the review radiographer who will assess your side effects. You may feel more tired than usual. This can be helped by eating a balanced diet, drinking plenty of water and taking adequate rest. It is also important to carry-on doing any exercise that you would do normally, as this has been shown to reduce treatment related fatigue. You should not feel too tired to drive or carry on normal daily activities. In the treatment area the skin may become itchy, dry or develop spots. As treatment progresses your skin colour may turn pinkish-red and feel sore. Sometimes, especially where two layers of skin rub together, the skin may break. Gently wash, bathe or shower using tepid water. Pat gently dry. Apply a moisturiser to the treatment area three times daily from the start of treatment Do not irritate the skin by scratching, rubbing, or vigorously massaging. Minimise friction by wearing loose fitting clothes of soft natural fibres (e.g. cotton). Expose the area to air whenever possible but avoid strong sunlight or extremes of temperature (such as ice packs, hot water bottles, cold winds). Your breast may become swollen and you may feel unusual sensations in this area, such as tightness, tenderness or very occasionally short sharp pains. The skin in the treatment area will be more sensitive to sunlight and care should be taken to avoid exposure to the sun during treatment and for a few months after. If under arm is being treated, hair growth in this area will be reduced. This may last for some months. These side effects usually settle within a few weeks to a few months of treatment completion. If any symptoms persist or cause you concern please contact your GP in the first instance. After Treatment Care Some side effects may occur months or even years after treatment: Dryness of the skin in the area treated may persist and can be helped by regular use of a moisturising cream. The skin may appear slightly darker in colour than usual. Increased sensitivity to the sun with an increased risk of sunburn in the treated area may last up to two years or more. If you are outside in the sun you should use a high factor sunblock on your skin where it has been treated (sunblock aimed at children are good as they are high factor and recommended for sensitive skin). The shape of the treated breast may change. It may become slightly swollen or reduce in size, especially in women with large breasts. There may be some tenderness. The Breast Care Nurse can give help and advice if you experience difference in size of the two breasts or if you have had a mastectomy. The shape of the treated breast may change. It may become slightly swollen or reduce in size, especially in women with large breasts. There may be some tenderness. The Breast Care Nurse can give help and advice if you experience difference in size of the two breasts or if you have had a mastectomy. The treatment is directed to avoid the lungs; however a small amount of lung will be included in the treatment area. This does not normally cause any problems but sometimes you may develop a dry cough or breathlessness three to nine months after treatment. This usually only lasts a short time and settles on its own. Swelling of the arm on the treated side is uncommon using modern treatment methods. It usually only develops if your armpit or the lower part of your neck is treated. It is caused by the combined effects of surgery and radiotherapy. You can reduce the risk of your arm swelling by taking care to avoid injury or infection of the hand or arm, for example by wearing thick gloves for gardening. If you notice any swelling of your arm or hand you should contact your Breast Care Nurse so that this can be checked and, if necessary, physiotherapy arranged. Very rarely, your arm on the treated side can become painful and weak. This usually only happens if your breast and lower neck are treated separately. The symptoms of this rare side effect include numbness in the hand, weakening of the hand or constant pain around the shoulder. There can be many other reasons for such symptoms which are not usually from your radiotherapy treatment. If you are worried, please contact your Breast Care Nurse who will arrange for you to be seen. File Name: RT treatment for Breast Cancer Page 4 of 6 IssueNo : 1 Issue Date: 30/10/17

5 Extremely rare with modern machines is the possibility of pain or fracture in the ribs on the side that has been treated. Care should be taken with contact sports Pregnancy and Radiotherapy All female patients of childbearing age (12-55 years old) will be asked prior to CT scanning and maybe before the first treatment of radiotherapy to confirm that they are not pregnant. If you are unsure or think that you may be pregnant then the procedure will not take place until pregnancy has been excluded by a negative pregnancy result. It may seem insensitive to ask, but law requires staff to exclude this possibility before proceeding with any procedure that uses radiation for treatment. These regulations are designed to protect the unborn child as radiation may seriously affect their growth and development. You will be asked to sign a form to show that this question has been discussed. It is very important that you are not and do not become pregnant whilst undergoing radiotherapy planning and treatment. If you think you may be pregnant at any time during your course of treatment please tell your clinical oncologist or radiographer immediately. File Name: RT treatment for Breast Cancer Page 5 of 6 IssueNo : 1 Issue Date: 30/10/17

6 Further Information The Oncologist will ask for your consent for any treatment that you require. For more information on informed consent, see sandstatistics/publications/publicationspolicyandguidance/dh_ This is a time when you may be experiencing all kinds of emotions. The Hamar Help and Support Centre offer support for you and your family or carers. The staff at the Centre provides information, help and specific counselling to suit your individual needs. Please feel free to discuss any concerns with your Surgeon, Oncologist, Breast Care Team or Treatment Radiographers or Review Radiographer. They can also provide you with further information about local and national support groups. Further information is available from; Patient Advice and Liaison Service (PALS) PALS will act on your behalf when handling patient and family concerns; they can also help you get support from other local or national agencies. PALS, is a confidential service. Royal Shrewsbury Hospital Tel: or Princess Royal Hospital HELPFUL TELEPHONE NUMBERS Ward 23, Royal Shrewsbury Hospital Radiotherapy Treatment Hamar Help and Support Centre Breast Care Nurse - contact via Royal Shrewsbury Hospital Switchboard Princess Royal Hospital Macmillan Information & Support Service ext 1957 You can also find information about Radiotherapy on the SATH internet page. ROYAL SHREWSBURY HOSPITAL Mytton Oak Road Shrewsbury Shropshire SY3 8XQ Telephone: Fax: File Name: RT treatment for Breast Cancer Page 6 of 6 IssueNo : 1 Issue Date: 30/10/17