Tel: 01206 745 055
A guide for patients having radiotherapy to the spine or limbs
What is radiotherapy?
Radiotherapy is a treatment for cancer which uses high energy X-rays. It is carried out using a machine called a Linear Accelerator or ‘Linac’
Having radiotherapy is similar to having a scan. It is painless and you need to lie still while you are on the treatment couch.
Radiotherapy is usually (but not always) given as a series of treatment sessions Monday to Friday. The number of treatments will depend on each patient’s specific treatment needs.
The treatment is carefully planned, however, some healthy cells in the treatment area can be affected which can cause some side effects.
The treatment will not make you radioactive and it is safe for you to be with other people, including babies, children and pregnant women, throughout your treatment.
Support for radiotherapy patients
Macmillan Radiotherapy Advanced Practitioners
These are therapy radiographers with extensive experience in all aspects of radiotherapy treatment and care. They will provide:
- a direct contact to give support and specialist radiotherapy advice for you and your relatives and carers before, during and after a course of radiotherapy
- time for you and your family to talk through the information you have been given and discuss any concerns you may have
- a link with all doctors, nurses and other health care professionals involved in your care, both in the hospital and in the community. We can also refer you on to other health professionals or services, if necessary.
Please ask a member of staff if you would like to speak to a Macmillan Radiotherapy Advanced Practitioner or contact them by phone on 01206 745 025. They will try to answer your call straight away, but if you leave a message they aim to respond within one working day.
Prescription medical exemption
All people undergoing treatment for cancer can apply for an Exemption Certificate by collecting a form FP92A from your GP surgery, oncology clinic or treatment department.
General information and arrival
The main entrance to the Radiotherapy Department is behind Gainsborough Wing (diagonally opposite the Constable Wing entrance). Alternatively you may use the main front entrance to the hospital and follow signs to the Radiotherapy Department.
Travel and car parking
Patients undergoing radiotherapy treatment do not have to pay to park at the hospital. There is a car park designated for radiotherapy patients beside the radiotherapy main entrance behind Gainsborough Wing. You will be given information about entry to this car park when you are informed about your first radiotherapy appointment.
Hospital transport can only be booked if you are not well enough to make your own way, or you have no alternative means of private or public transport available.
Important – If you use hospital transport, you should be prepared to be away from home for at least four hours. If you take regular medication or are diabetic, please make sure you have what you need with you when you come.
Please be aware that the hospital does not have a childminding service. Children who cannot be left unattended cannot be looked after by staff.
Important Information relating to pregnancy
We are legally obliged to ask all persons of child bearing potential whether there is any chance of being pregnant. We also have to ask you to sign a form to confirm that you are not pregnant. If there is a possibility that you may be pregnant, you must inform a member of staff.
Treatment planning process – clothing and gowns
We may ask you to change into a gown and remove your shoes for your planning appointment and for all your radiotherapy treatments. For this reason it may be helpful for you to wear clothes that are easily removed, including slip-on shoes if you have them or you may prefer to bring some slippers. We will ask you to wear shoes or your slippers to go between the changing room and the treatment rooms, to prevent any slips or falls.
Please note: you may be asked to remove your gown while you are on the couch for your planning and treatment.
Planning your treatment
Your first appointment in the Radiotherapy Department is usually a treatment planning appointment. You will be taken into a room where your treatment will be discussed and any questions answered. We will then ask you to sign a consent form to say that you agree to have radiotherapy.
For the next stage of your planning process you will have a computerised tomography (CT) scan.
After the scan we will ask your permission to make some tiny permanent ink marks with a pin prick on your skin. They are no bigger than a full stop (.) and will be used as reference points for all the measurements for your treatment. These will ensure treatment is accurate each day. You may hear us refer to these as ‘tattoos’. If you have any concerns about having these markings please let us know when you attend your treatment planning appointment.
The information and measurements we obtain from the CT planning session will be passed on to our physics department, who will use it to produce a computerised treatment plan specifically for you.
This is a complicated process and usually takes 1 to 3 weeks to complete. We usually give a provisional list of the dates and times of all your treatment appointments before you leave but please be aware that occasionally these may change.
When you arrive for your treatment, please report to reception.
Before your treatment you will be asked to change into a hospital gown and you will then be taken into a treatment room.
The radiographers will ask you to lie on the treatment couch. They will spend a few minutes positioning you correctly and precisely for your treatment. It is important at this stage that you remain as still as you can. The radiographers switch on the machine from outside the room so, when all the adjustments have been made, they will leave while you have your treatment. The machine makes a noise when it is operating so you will know when it is on. This is the only time you will be left alone. However, the radiographers are able to see you on CCTV and they can also hear you over the intercom. This routine will be the same every time you come for treatment until your course is completed.
How long will it take?
After only a few minutes your treatment will be over. Exactly how many minutes it will take varies but you are likely to be in the treatment room for 10 to 20 minutes.
How long will you be in the department?
We hope that you will be in the department no longer than 45 to 60 minutes each visit but this may vary. If you travel by hospital transport, however, you will be here quite a lot longer than that. The transport is unable to take you back until all the patients who came with you have also been treated. Patients are also reviewed by other members of the team during their course of radiotherapy and on these days you may expect to be in the department longer. Sometimes these reviews may be done by telephone.
Side effects of radiotherapy
How will you feel?
Your normal routine need not be greatly affected but you may feel tired. Although radiotherapy is completely painless, it is a very powerful treatment and does have some side effects. These vary depending not only on how much treatment you receive but also which part of the body is being treated.
Some people are more sensitive to radiation than others and are more likely to experience side effects. Unfortunately, there is no way of identifying these people before they are treated. Please note that if you have a short course of treatment (fewer than 10 treatments) you are less likely to have significant side effects. If side effects do occur, they will usually develop during the second half of your treatment and could last for some time after your treatment has finished. Recovery rates vary from person to person, so it is difficult to give an exact time for how long they will last.
Why do side effects occur?
Radiotherapy is a localised treatment, so it affects only the part of the body being treated. When your treatment is being planned, your oncologist will select a dose of radiation that has the best chance of destroying any cancer cells while having the smallest possible effect on healthy tissue.
Radiation can cause some damage to the normal, healthy tissues in and around the treated area, however, and it is this damage that causes side effects. These tissues usually recover and return to normal after the treatment has been completed. Any possible long-term effects of having radiotherapy will be discussed with you.
Possible side effects
You may feel tired during your radiotherapy treatment, because the body has to repair damage caused by the radiotherapy to healthy cells. It can often be made worse by having to travel to hospital each day, or by other treatments such as surgery or chemotherapy.
What can be done?
- There’s good evidence that physical activity can actually help to reduce the symptoms of fatigue. Get plenty of rest but balance this with some gentle exercise, such as short walks if you are able. This will give you more energy and help to keep your muscles working.
- Save some energy for doing the things you enjoy and ask others for help doing chores if these are tiring you out.
- Eating well can help to boost your energy levels.
- Drink plenty of fluids.
If you are having your spine treated, you may feel sick. However, this will depend on which part of your spine is being treated and how many treatments you have. Please ask if this is likely to affect you.
What can be done?
Please let us know if you feel sick or have been sick. We can then advise you what to do. You may need medication to control it.
If you are having treatment on bones in your pelvis, your bowel may be in the treatment area. In this case you may have some diarrhoea. Please ask if this is likely to affect you.
What can be done?
Please let us know if you have diarrhoea. We can then advise you what to do. You may need medication to control it.
You may experience some ‘pain flare’ in the area of treatment. It can cause a temporary increase in pain and tenderness. Radiotherapy may not help relieve your pain until 1 to 2 weeks after treatment, so your painkillers may need to be adjusted during this time.
Sore, red skin (erythema)
You may develop a skin reaction in the area being treated during your radiotherapy and for a while afterwards. You may notice:
- your skin gradually becoming pinker or darker, depending on your skin colour
- the skin may feel dry or tight, and sore
- a rash may also appear and feel itchy.
A skin reaction may appear at any time but usually begins about 10 days after starting treatment. If you are having less than 10 radiotherapy treatments you are unlikely to experience a significant skin reaction.
What can affect my skin reaction?
- Having treatment to areas where there are skin folds can make your skin reaction worse. This includes the groin or between the buttocks because they can be warm, moist and rub together causing friction.
- Smoking can make your skin reaction worse – if you need help to stop please ask for advice.
- A skin reaction is more likely if you are overweight, due to more skin folds.
A member of the radiotherapy team will talk to you about your usual daily skin care routine. He or she will let you know if any changes are advised. Please share any worries you have.
What can be done?
Skin reactions can be kept minimal by following the advice below.
Skincare for patients having radiotherapy treatment
It may not be possible to stop a skin reaction but by following this advice you may feel more comfortable.
Important – this only applies to the skin in the area being treated. Please ask the treatment staff if you are unsure of the exact area of skin which will be affected by your treatment.
- Wash the skin gently with soap and warm (not hot) water; gently pat dry.
- Avoid tight clothing in the treatment area.
- Wear loose-fitting, natural fibre clothing next to the skin.
- Avoid rubbing the area.
- Avoid extremes of temperature such as heating and cooling pads, hot water bottles and microwaveable wheat bags.
- Avoid sticky tape on the area (such as ElastoplastTM or MicroporeTM).
- It may also help to reduce irritation to the treated area if you use a moisturiser sparingly – gently smooth it on and apply in the direction of hair growth. Please stop using if it irritates your skin and talk to your treatment team. Aquamax cream (available from pharmacy counters) and E45 cream are examples of suitable moisturisers. If you’re choosing a new moisturiser, one that is free from sodium lauryl sulphate would be best. Ask the team if you are unsure about the cream you wish to use.
- Do not wipe moisturiser off before treatment. If your skin breaks or blisters you should stop using moisturiser. Your treatment team will advise you further.
- Avoid using products containing alcohol on the skin.
- You may use deodorant, unless it irritates your skin. Please stop if the skin breaks.
- You may swim if your skin isn’t broken. Shower after swimming to wash off the chlorine and apply your moisturiser. Please stop swimming if it irritates your skin.
- Avoid sun exposure and protect the area from direct sunlight. Be careful in the sun for at least a year after you have finished. Use a sunscreen with a minimum UVB sun protection factor (SPF) of 50 and UVA protection, because your skin will be more sensitive. Your treatment team will let you know if this advice changes during treatment.
Important – Please stop using any particular product which you think may be irritating your skin in the treatment area and ask your treatment team for advice. It may help to keep up a good fluid intake and eat a nutritionally well-balanced diet.
As your treatment progresses
Your oncologist will oversee your planning and treatment and you will be monitored daily by the radiotherapy team. Please always make sure that you let the radiographers know if you get any side effects. If you have a concern about side effects or problems that you wish to discuss and your appointment is after 3pm, please call ahead well before your appointment time. The radiographers may advise you to come earlier to be seen by the appropriate member of the team.
What happens if I miss any treatments?
Ideally, you should not miss any of these appointments. If you are ill and unable to come, however, or something unforeseen happens which stops you having your treatment, your missed appointment(s) will be reorganised.
They will usually be added on to the end of your list. If you miss an appointment, please check with the radiographers to find out exactly what will happen in your case.
After your treatment finishes
Most patients have follow-up appointment for 4 to 12 weeks after radiotherapy. Please call if you do not receive it.
Side effects of radiotherapy often reach their peak 7 to 14 days after treatment has finished. They will then gradually settle and improve. It is very hard to put an exact timescale on it because everyone’s recovery rate is different.
Important – Continue following our skincare advice for two weeks after your treatment has finished, and then start to return to your normal routine.
Please share this information with your family and friends. It is important that they feel well-informed and understand what is happening. If you or your family need any further information, please do not hesitate to call.
Useful Contact information
Macmillan advanced radiotherapy practitioners
01206 745 025
Monday to Friday, 8.30am–4.30pm
01206 745 055
01206 745 033
01206 745 037
Wellbeing Centre and Macmillan Cancer Information Centre, Colchester Hospital
01206 745 347
Macmillan Cancer Information Centre, Broomfield Hospital
01245 515 981
Macmillan Cancer Support
Freephone 0808 808 0000
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