Your Radiation Therapy at the Princess Margaret Hospital

Transcription

1 Your Radiation Therapy at the Princess Margaret Hospital *This document was developed by a multidisciplinary team within the Radiation Medicine Program PMH Introduction Radiation therapy* is one treatment that can be used for people diagnosed with different types of cancer. Patient Education Improving Health Through Education This booklet may help you and your family or friends understand some general information about radiation therapy and will help you to get to know some of the services and programs offered at Princess Margaret Hospital. This booklet may not answer all of your questions. Please discuss any additional questions you may have with your doctor, nurse or radiation therapist. More information can be obtained from: The University Health Network web site follow link to PMH The Patient & Family Library located on the main floor of PMH (416) ext Radiation Therapy In general, Radiation Therapy aims to: get rid of the tumour and prevent the cancer from spreading. control tumour growth and reduce symptoms. It may be used alone, or together with surgery, chemotherapy, hormone therapy or other treatments. * Words in bold are explained in a glossary at the end of the booklet. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only University Health Network. All rights reserved. Author: Angela Cashell and Caroline Davey Created: 02/2004 Form: D-5040 (08/2011)

2 There are many types of cancer, which is why the type and amount of radiation given depends on the type of cancer. Like other cancer treatments, radiation therapy has side effects. These side effects depend on the area of the body being treated and the amount of radiation given. Pamphlets are available to help you understand and manage the side effects you may experience. These pamphlets have more detailed information about radiation treatment to different areas of the body. Please ask your doctor, nurse or radiation therapist if you have questions about your treatment and possible side effects. How Does Radiation Work? Radiation works by depositing energy in your cells in the treatment area. This energy can kill off cells or make them less able to divide and produce more cells. Cells that are very active, such as cancer cells, are usually more sensitive to radiation. Normal cells in the treatment area may also receive some radiation, which is why you may experience side effects. However, normal cells are able to recover slightly better than cancer cells. Radiation is usually given in small amounts over a few days or a number of weeks. Ask your doctor about the number of treatments you may be getting. Types of Radiation Generally, there are two main ways of delivering Radiation Therapy. External Beam Radiation Therapy The radiation is produced by a treatment unit called a Linear Accelerator which directs radiation beams to a specific area within the body. Linear Accelerator Page 2 of 16

3 There are also some very specialized treatment units such as the Gamma Knife which only treats the brain, and a treatment unit for some skin cancers. Smaller Treatment Unit The machine used for your treatment and the type of radiation you may get depends on many things which your doctor will talk to you about. Please ask your doctor any questions you may have. There are 18 different treatment units at PMH. The unit used for your treatment and the type of radiation you may get depends on many factors. Your doctor, nurse or radiation therapist will explain the type of treatment you will be receiving. Brachytherapy - internal radiation therapy Radioactive sources are placed inside the body and in or around the tumour. This only applies to certain cancers. Specific teaching will be provided if you are having brachytherapy. The Department of Radiation Therapy The staff consists of a team of health care experts, working together to provide you with the best possible care. The team monitors you during your treatment and helps you to manage any side effects that may happen. Please discuss any concerns or questions you may have with any member of this team. Here are the team members and what they do: Radiation Oncologists: are the doctors responsible for prescribing and planning your radiation treatment. will monitor your progress throughout your course of treatment, and will follow your progress after your treatments have finished. at the Princess Margaret Hospital lead a team of dedicated radiation therapists, clinical physicists and radiation oncology nurses to provide you with the best possible care using the latest technology and techniques within a patient centered environment. Radiation Therapists: work closely with the radiation oncologists and clinical physicists to develop your specific treatment plan. are also responsible for the safe and accurate delivery of your daily treatment. Page 3 of 16

4 will also monitor your progress and provide support and advice on the management of radiation side effects and other services. You will meet the radiation therapists at the CT simulation appointment and your treatment appointments. Clinical Physicists: are responsible for the safety and accuracy of the equipment and computer systems used in treatment planning and treatment delivery. work behind the scenes with the doctors and radiation therapists to make sure your treatment is designed specifically for your needs. Specialized Oncology Nurses: are the registered nurses (RN) who work closely with your oncologist. are responsible for the management of your symptoms, emotional support, education and coordination of all aspects of your treatment. are available to you at the clinics, and can be reached by voic and by pager while on treatment. As well, there are other professionals such as Dietitians, Advanced Practice Nurses, Social Workers and Spiritual Care Professionals available to help you during treatment if needed. Please ask if you wish to speak with any of them. The Princess Margaret Hospital is a large teaching hospital. During your course of treatment you may meet a variety of students and trainees, who will be working under the supervision of the staff members. Residents and Clinical Fellows are medical doctors who are receiving training or post-certification experience in radiation oncology. They will assist your oncologist with your medical care. The Radiation Therapy department is located below the main floor of the Princess Margaret Hospital and is on 2 levels: Level 1B is where the preparation work for radiation treatment takes place Level 2B is where the treatment takes place Page 4 of 16

5 Planning Your Radiation Treatments (Level 1B - 1 Below Main Floor) Once you have given consent to have radiation therapy, an appointment will be made for planning your radiation treatments. Depending on the area of treatment and the treatment technique, you may be asked to prepare for the planning appointment. These special instructions will be given to you before you come. It is important to follow these instructions carefully so the planning can be done properly. Please expect to be here for 1 to 2 hours for the planning appointment. For this appointment, please check in at the reception desk on level 1B. A photograph will be taken to help us identify you during the course of your treatment. This photograph remains in your hospital chart. You will be asked to fill out a form about your travel arrangements and the time you would prefer to come for your treatments. While we cannot always accommodate your requests, we will do our best. Before you come to the planning appointment, please discuss the practical impact of daily treatments with your family and friends. To avoid conflicts with your other medical appointments, please bring along any scheduled medical appointments that you may have already. At the request of your Radiation Oncologist, a Radiation Therapist will use a CT simulator to determine the area of treatment. A CT simulator is a CT scanner with sophisticated computer software that provides detailed images of the body. Some patients may also have a Magnetic Resonance (MR) scan. These images will also be used to plan the treatment. CT Simulator used for planning treatment Sometimes a positioning device or mould is made to help keep you still during your treatments. The radiation therapist will explain the details to you at the planning appointment. When the CT simulation is completed, marks will be placed on your skin with a marker pen. As these marks can wash off, it may be necessary to give you very tiny permanent tattoo marks using a fine needle. The Radiation Therapist will explain this procedure to you. Page 5 of 16

6 Your position, use of accessories and any other planning details will be recorded in your electronic chart. After your planning appointment is finished, the doctors, physicists and therapists will use the information obtained from the CT scan to develop a plan that is specific to you. This step may take a few days for most patients. When possible, we will give you your first treatment appointment before you leave the CT simulator. If this is not possible, our booking staff will call you at home within the next 5 to 7 business days with the date, time and treatment unit you will be going to. Your Radiation Treatment Level 2B 2 Below Main Floor Radiation Treatment Unit The first appointment is usually longer than the rest of the treatments. It can take 30 to 45 minutes because the Radiation Therapists will be checking all details of the treatment plan. Using instructions recorded from the planning appointment, the therapists will place you in the same position for treatment as you were for the planning. Also any positioning devices or moulds used during the planning appointment will be used for the treatments. At the first treatment appointment, X-ray pictures or images are taken. To check your position, these images are matched exactly with the images taken during planning. Once the radiation therapist has checked all the details and you are in exactly the correct position the treatment will start. For some patients, this imaging procedure may be repeated during the course of treatment. The radiation treatment units are large. They can move in many directions to allow the radiation beam to be focused on the area of interest from different angles. The number of beams and the angles used are decided during the planning process and are designed for you. If you wish, please ask the radiation therapists to explain your treatment plan. Receiving a radiation treatment is like having an X-ray taken. There is no pain or any sensation involved, and you do not become radioactive. It is important that you stay relaxed, breathe normally and remain very still. Page 6 of 16

7 Although you will not see or feel anything during treatment, you may hear clicking or whirring noises while the treatment machine is on. The Radiation Therapists will not stay in the room with you during the treatment, but they can see you at all times on a television screen. There is also an intercom in the room for you to speak to the Radiation Therapist. Please ask the radiation therapists to talk to you if you wish. Please feel free to bring in your own music on CD, which can be played while you are having your treatment. Control area where the radiation therapists operate the machines. The rest of the treatment appointments are about 20 to 30 minutes. This time will depend on the amount of radiation being given and the treatment unit used. Once all your appointments are booked, you will be given your appointment times for the following week, so you can make plans for the days ahead. Your appointment times may vary each day. Here are a few reasons for this: the department has many different units there are approximately 400 patients treated in our department every day doctors clinics are scheduled to be at specific times patients come for treatment in a variety of ways, transportation times are limited for patients coming with the Canadian Cancer Society Any changes to these appointments will be restricted to emergency and medical situations. Please bring your other medical appointments, and we will do our best to coordinate them with your radiation therapy schedule. Things to bring with you each day: Hospital Card (blue plastic card) Health card (red and white card, or photo card) Appointment cards: Green for radiation treatment appointments White for all other appointments List of all of your medications Page 7 of 16

8 ANY medicines that you may need to take while you are here, or in case you are delayed getting home Public Holidays and Equipment Maintenance The Department of Radiation Therapy opens from Monday to Friday. The department is closed on the weekends and statutory holidays. To make sure the treatment units run accurately and safely, tests and maintenance checks are done regularly. There may not be any treatment for you on that day. If you do miss a treatment because of a public holiday or machine maintenance, the appointment will be added to the end so you still get the same number of treatments the doctor has prescribed for you. Sometimes the doctor may request that you are treated twice in one day to make up for this break in your treatment. If this is the case, there must be a minimum of 6 hours between the 2 treatments. Usually the appointments will be made so the 1st treatment is in the morning and the 2nd one will be in the afternoon. During the time in between, you may wish to go home if you can. Alternatively we can make arrangements for you to rest at the ambulance holding area or another patient care area at PMH. Side Effects: Information pamphlets are available to help you understand and manage any side effects you may experience from your radiation treatment. These pamphlets are specific for different parts of the body that are being treated. Please speak to your Radiation Therapist or nurse if you have not received one of these pamphlets. Seeing your doctor during treatment (Review Clinic) During your course of treatment, the Radiation Oncologist will see you weekly as a routine check up to see how things are going. These review appointments will coincide with your treatment time and are booked for you. This is an opportunity for you to discuss concerns and have prescriptions written, if necessary. It is often helpful to write your questions in a notebook and bring them with you to the review appointment. Family members or friends are encouraged to attend this review appointment with you! Page 8 of 16

9 Some things you might want to talk about during your review appointment: Any questions to do with your treatment Are you having any symptoms or side effects of treatment? Do you need a prescription renewed? Do you have enough medicine until your next visit with the doctor? How are you coping with treatment? What may be causing difficulty for you? Are you getting enough support from friends and family? Do you have any financial problems or difficulties paying for medicines or supplies needed for your care? Radiation Nursing Clinic (RNC) Hours of operation: Monday to Friday 9:00 a.m. to 5:00 p.m. The RNC is closed on weekends and statutory holidays. Located on level 2B Check in at the reception desk and the RNC staff will call you from the waiting area Who can be seen in RNC? Due to the large number of patients seen in the clinic, the RNC can only see patients undergoing radiation treatment or being planned for treatment. If you have problems or concerns related to treatment and your treatment is completed please call your Radiation Oncologist. For any problems or concerns NOT related to treatment, contact your family doctor. Common reasons for going to RNC Assessment of new, changing or worrisome symptoms or side effects from your radiation treatment. Skin care (e.g., saline soaks, dressing changes, etc.) Problem solving and support with new skills (e.g., feeding tubes, medication use). Page 9 of 16

10 To give yourself a feeding through your g-tube. Note: you will need to bring your own feeding supplies. To rest between your morning and afternoon radiation treatments if you are on twice daily treatments. Patient Safety Your safety is very important to us. When you are here in the hospital please ask us any questions you may have, and let us know if there are any changes in your health status that we should know about. To help us reduce the risk of infection to you, other patients and healthcare workers, please tell us if you have any diarrhea or vomiting, a new cough, fever and/or chills. Please remember to wash your hands often. The Patient Education program also has a number of brochures on patient safety. These can be obtained from the Patient and Family library on the main floor or on the UHN web site at the following link Transportation Most patients travel daily from home for their treatments. Depending on how you feel you should be able to come by yourself or be driven to the hospital by a relative or friend. Some patients prefer to come by public transportation to avoid parking problems. Transportation by Canadian Cancer Society volunteer drivers may be available and should be arranged through the Canadian Cancer Society by calling 1 (888) For information on parking or directions to the hospital, please go to the University Health Network website at A booklet called Parking Lot Rates is also available. Please ask for a copy at the Patient & Family Library located on the main floor. Page 10 of 16

11 Lodge Accommodation The PMH Lodge offers accommodation for patients living outside the Greater Toronto Area. The Lodge is located at 545 Jarvis Street. A regularly scheduled shuttle bus is available, free of charge, to get you to and from your treatments. A cafeteria is located on the premises where meals are provided. The Lodge is staffed by Registered Nurses who help to manage treatment side effects but you must be able to look after yourself and climb at least one flight of stairs. If there is room, a family member may stay with you. For further information and weekly rates please call (416) or visit their web site at Clinical Trials Clinical trials are studies that have been designed to find improved ways to treat patients with cancer. They will often compare one treatment to another, or study the effectiveness or side effects of a new drug. You may be asked to take part in one or more of these studies. If so, your doctor will discuss this with you in detail before your treatment. Whether you decide to take part or not, it will not affect the quality of care you receive. If you do decide to participate in a clinical trial, a clinical trials nurse or therapist will be available to assist you while you are on the study. For more information on clinical trials, please pick up a copy of the Canadian Cancer Society s booklet entitled Clinical Trials: A guide for people with cancer. This booklet is available from the Patient & Family Library on the main floor. Information sessions about clinical trials are also held in the Patient & Family Library. Please call (416) ext for information. Information about Antioxidants during Radiation Therapy Antioxidants are nutrients found in food, vitamin or mineral supplements. Taking large amounts of antioxidants supplements (such as pills) can reduce the effects of your radiation treatment on cancer cells Taking small amounts of antioxidants, like those found in food and some one a day multi-vitamins is allowed Page 11 of 16

12 Do not take large amounts of antioxidants during your radiation treatment and 1 week after your last treatment If you normally take large amounts of antioxidant supplements and if time allows, you should stop 1 week before your first treatment For more background information, please ask for a pamphlet entitled, What you need to know about Antioxidants and Your Radiation Therapy. If you have questions, please speak to a member of your health care team. Smoking and Quitting Information The Canadian Cancer Society has information on tobacco use and provides a free support service and advice. This is available for anyone who: wants to quit smoking wants to help someone else quit is thinking of quitting has quit in the last 6 months and needs help to stay smoke-free does not want to quit. More information can be found at the website: Toll-free at 1 (877) Packages are also available on levels 1B and 2B. Follow-up Visits When your course of treatment is finished, your Radiation Oncologist or referring doctor may wish to see you at regular intervals. These check-up appointments are important so that your doctor can monitor the effectiveness of the treatment and your progress. You should continue to see your general practitioner (GP) or family doctor for ongoing medical care about other medical concerns such as diabetes or high blood pressure. Page 12 of 16

13 Special Concerns Communication: When a person has an illness such as cancer, family members and friends will be concerned. They may tell you what they have heard or read about the effects of radiation. Some of these stories may be true, but most often they are exaggerated or depressing. It is important to remember that each person is an individual, that each illness is different and that your treatment plan is special to you and your illness. Always discuss with the doctor, Radiation Therapist or nurse any concerns you may have about your treatment. Only in this way will they become aware of your problems or concerns and be able to explain the facts and correct any false information you may have received. Emotions: Your reactions to your diagnosis and treatment can produce physical and emotional changes that may make you feel alone. Learning to discuss your feelings or problems may be helpful to you. Family and friends often provide this needed support. Health professionals both in the hospital and in the community are available to help you in overcoming difficult times. Please ask your doctor, Radiation Therapist or nurse to refer you to the Psychosocial Oncology department at PMH. The Patient & Family Library on the main floor and the Patient Resource Centres on levels 1B and 2B have information on support services both in the hospital and the community. Language: If you speak very little or no English, we can arrange for interpretation as needed. Please let us know as soon as possible that you need help with interpretation. Summary We hope that this booklet has helped you to understand radiation therapy and that the information given about the treatment, and the equipment will be useful. However, no booklet can take the place of an exchange of questions and concerns between you and the professional team of doctors, Radiation Therapists, Nurses and other health professionals involved in your care. Page 13 of 16

14 These Resources may Provide Further Help for You: PMH Patient & Family Library (416) ext. 5383, Main Floor address: Canadian Cancer Society (416) or toll-free at 1 (800) Community Care Access Centre: Information about home care, long-term care destinations and other services in your community. (416) 310-CCAC ( ) Caring Voices: Online community for cancer survivors with help and support. Healing Journey (416) Wellspring (416) or Toll Free Gilda s Club (416) Useful PMH telephone numbers: PMH main hospital switchboard (416) Radiation Therapy Reception Desk (416) or (416) Psychosocial Oncology department (416) Page 14 of 16

15 Glossary of Terms Advanced Practice Nurses: A nurse who specialises in the management of symptoms and side effects of radiation treatments. They work with the entire oncology team to ensure your needs are met during treatment. Antioxidants: Antioxidant vitamins include vitamin C, vitamin E and betacarotene. Antioxidant minerals include selenium. These nutrients can be found in foods, vitamins or mineral supplements. Brachytherapy: A type of internal radiation therapy in which a radioactive source is placed inside a body cavity, or an organ such as the uterus, lung or prostate. Cancer: A general term for more than 100 diseases where there is an abnormal and uncontrolled growth of cells. The resulting mass, or tumour, can spread to the surrounding normal tissues or spread to other parts of the body. Chemotherapy: Treatment with anticancer drugs. Clinical Trials: A scientific study designed to determine the best treatment of a disease. Clinical Physicist (Radiation Physicist): A scientist who specialises in calculating/ computing precise radiation doses. CT Scan: A computerised scanner that uses x-rays to show the internal organs of the body. CT simulator: A CT simulator is a CT scanner that is used to obtain images of the organs and the body. Dietitian: A specialist in food and nutrition who provides advice regarding your nutritional health, eating problems and weight change. They work with the oncology team. External Beam Radiation: Radiation therapy using a machine that has a highly focused beam of radiation directed at the part of the body receiving treatment. Linear Accelerator: A machine that produces high energy x-rays for treatment purposes. MR: Magnetic Resonance imaging (MRI). This is a large machine consisting of a magnet, which is used to show the location of internal organs of the body. Often referred to as an MRI scan. Radiation Oncologist: A doctor who specialises in the treatment of cancer with radiation. Radiation Therapy: The use of ionising radiation to treat disease. Page 15 of 16

16 Radiation Therapist: A healthcare professional who is qualified to plan and deliver radiation treatment as prescribed by a radiation oncologist. Side Effects: Changes to your normal physical and/or mental well being, that are caused by the treatment of a particular illness. They are usually temporary. Social Worker: Coordinates the help of social agencies to encourage the patient s well being. Provides counseling and support to the patients. Specialized Oncology Nurse: A registered nurse who works closely with your radiation oncologist. Symptom: Any sign of change from the normal condition. X-rays: A form of electromagnetic radiation that may be used to treat cancer. Page 16 of 16