Consent for radical radiotherapy to the brain Information for patients Weston Park Hospital
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General information Radiotherapy uses high energy X-rays to kill tumour cells. Treatment is given once a day, Monday to Friday, usually as an outpatient and is directed to the tumour in the brain. A course of treatment lasts up to 6 weeks. Before consenting to treatment you should feel that you have had an explanation of the procedure and its possible side effects. This leaflet is designed to supplement verbal information already given. This information does not replace the process of obtaining informed consent through discussion with your doctor. Please ask if you have any concerns which have not been answered. Signing a consent form does not mean you cannot withdraw from treatment, although it is advisable to complete the course once it has started. Treatment procedure At the beginning of your treatment you will be given a written information leaflet about how to care for yourself during radiotherapy and this will be supplemented by a chat with one of the radiographers. Please ask about anything concerning or worrying you at any stage throughout the treatment. Side effects These may vary from person to person. The type and site of your tumour may also determine the side effects you experience. Any side effects you experience will be monitored regularly by the doctor / radiographer / specialist nurse and will normally gradually start to occur after 2 weeks of treatment. Some side effects, such as headaches, may occur much sooner. page 3 of 8
Side effects during treatment These side effects may occur during your course of radiotherapy treatment or in the first few weeks after completion. Hair loss Unfortunately you are likely to lose your hair in the area being treated. This usually occurs 3 weeks after starting your radiotherapy. Your scalp in this area may feel a little sensitive prior to the hair coming out. After the hair has come out this usually improves. You may notice some hairs come out when you brush your hair or on your pillow after sleeping. This usually occurs gradually. A wig can be organised for you if you would prefer one. Please speak to the doctor / radiographer / specialist nurse for more information about the wig service that is provided. Your hair may or may not re-grow following radiotherapy. You may notice that it is finer and similar to baby hair. Skin The skin in the treatment area may become very red, dry and itchy. To minimise this reaction oilatum, diprobase or e45 cream may be applied to this area. The skin may also become sensitive; it is best to avoid over-exposure to the sun and cold winds. It is recommended that you wear a hat or scarf (made of natural fibres) when going outside. The skin behind your ears may be particularly sore if this area is included in the treatment. The skin reactions will settle soon after the course of radiotherapy is completed. page 4 of 8
Tiredness This varies from person to person. In general, it gradually increases from the start to about a month after completing the radiotherapy. Occasionally patients may experience severe tiredness (somnolence) 4 to 6 weeks after completing the radiotherapy. This normally settles without the need for treatment and lasts for about 6 weeks. Headaches and nausea Radiotherapy is likely to cause some swelling of the tissue in the area being treated, particularly during the first week of treatment. This may cause headaches, nausea and occasionally vomiting. If you have any of these side effects speak to a radiographer giving you your treatment. It is usually easily managed by the doctor / specialist nurse altering your steroid dose or prescribing anti-sickness medication. Seizures Radiotherapy may temporarily increase the likelihood of fits, especially in patients who already have them, due to an increase in swelling. For patients who take medication to control fits, it may be necessary to increase the medication. Steroids are used to help control fits whilst having radiotherapy. The fits will usually improve once the course of radiotherapy is complete. Ears Radiotherapy can make your ears feel blocked and temporarily reduce your hearing. This does not need to be treated (e.g. by syringing) and will improve in the weeks and months after completion of the radiotherapy. page 5 of 8
Late side effects Radiotherapy treatment for a brain tumour can have long term effects. These will not happen to everyone. For the vast majority of people, the benefits of the radiotherapy treatment far outweigh the risk. Some people may have late side effects that can come on months or years after treatment. Unfortunately, it is not always possible for doctors to tell beforehand who will have long term effects and who won't. Long term side effects are the rarest and will only affect a few people treated with radiotherapy to the brain. Late side effects may arise anything from a few months to several years following radiotherapy treatment. These side effects are caused by radiation damage to small blood vessels within the brain. The vessels become scarred and blocked which may result in some mild changes. People may notice some mild changes with their memory and behaviour. This may also increase the risk of a stroke in the future. Symptoms can be mild, moderate or severe, depending on how much radiation damage there is. Unfortunately, these late side effects are usually permanent. They may also slowly get worse over a long period of time; some people may notice that their hearing is affected or they may develop early cataracts. It is possible to control some of the late effects with medication. Your doctor will discuss these options with you should they be necessary. Exposure to radiation may cause a second cancer, however this is very rare and occurs many years after treatment. The benefits of the treatment far outweigh any potential risk in the future. page 6 of 8
Other late effects If your radiotherapy treatment is near your pituitary gland, it is possible that you might develop hormone imbalances in the future. This is because the pituitary gland controls your: Thyroid gland / Adrenal gland Sugar balance in the body Fertility Replacement hormones can be given to correct any imbalances if this occurs. On completion of radiotherapy The radiographers will give you advice and contact numbers at the end of your treatment. You will be seen in the outpatients clinic 1 month after completion of radiotherapy by which time the short term side effects of treatment should be settling. For more information on living with brain tumours You / your family may find the following web site helpful: www.cancerhelp.org.uk Additional information Macmillan www.macmillan.org.uk 0808 800 1234 page 7 of 8
Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more www.sheffieldhospitalscharity.org.uk Registered Charity No 1059043 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2016 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD5182-PIL1553 v5 Issue Date: June 2016. Review Date: June 2018