What to Expect From Your Treatment

What to Expect Before Treatment

Meeting With the Radiation Oncologist

If you are considering radiation therapy, you must first meet with a radiation oncologist to see if radiation therapy is right for you. During your first visit, your doctor will evaluate your need for radiation therapy and its likely results. This includes reviewing your current medical problems, past medical history, past surgical history, family history, medications, allergies and lifestyle. The doctor will also perform a physical exam to assess the extent of your disease and judge your general physical condition. You may also be seen by a medical student, a resident (radiation oncologist in training), a nurse practitioner, a physician’s assistant or a nurse.

After reviewing your medical tests, including CT scans, MRI scans and PET scans, and completing a thorough examination, your radiation oncologist will discuss with you the potential benefits and risks of radiation therapy and answer your questions. For a list of questions that you may want to ask, please see the section "What Questions Should I Ask My Doctor?"

Simulation

To be most effective, radiation therapy must be aimed precisely at the same target or targets each and every time treatment is given. The process of measuring your body and marking your skin to help your team direct the beams of radiation safely and exactly to their intended locations is called simulation.

During simulation, your radiation oncologist and radiation therapist place you on the simulation machine in the exact position you will be in during the actual treatment. Your radiation therapist, under your doctor’s supervision, then marks the area to be treated directly on your skin or on immobilization devices. Immobilization devices are molds, casts, head rests or other devices that help you remain in the same position during the entire treatment. The radiation therapist marks your skin and/or the immobilization devices either with a bright, temporary paint or a set of small, permanent tattoos.

Your radiation oncologist may request that special blocks or shields be made for you. These blocks or shields are put in the external beam therapy machine before each of your treatments and are used to shape the radiation to your tumor and keep the rays from hitting normal tissue. Multileaf collimators may also be used to shape the beam and achieve safe delivery of your radiation treatment.

Treatment Planning

Once you have finished with the simulation, your radiation oncologist and other members of the treatment team review the information they obtained during simulation along with your previous medical tests to develop a treatment plan. Often, a special treatment planning CT scan is done to help with the simulation and treatment planning. This CT scan is in addition to your diagnostic CT scan. Frequently, sophisticated treatment-planning computer software is used to help design the best possible treatment plan. After reviewing all of this information, your doctor will write a prescription that outlines exactly how much radiation you will receive and to what parts of your body.

Material on this site is informational only and should not be used in place of advice from a medical professional. If you have questions about a specific treatment, please ask your radiation oncologist

What to Expect During Treatment

External Beam Radiation Therapy Treatments

When you undergo external beam radiation therapy treatment, each session is painless, just like getting an X-ray. The radiation is directed at your tumor from a machine located away from your body, usually a linear accelerator. External beam radiation is noninvasive, unlike surgery which is an invasive process. One of the benefits of radiation therapy is that it is usually given as a series of outpatient treatments (meaning you don’t have to stay in the hospital). You may not need to miss work or experience the type of recuperation period that may follow other treatments. Treatments are usually scheduled five days a week, Monday through Friday, and continue for one to 10 weeks. The number of radiation treatments you will need depends on the size, location and type of cancer you have, the intent of the treatment, your general health and other medical treatments you may be receiving.

The radiation therapist will give you your external beam treatment following your radiation oncologist’s instructions. It will take five to 15 minutes for you to be positioned for treatment and for the equipment to be set up. If an immobilization device was made during simulation, it will be used during every treatment to make sure that you are in the exact same position every day. Once you are positioned correctly, the therapist will leave the room and go into the control room next door to closely monitor you on a television screen while giving the radiation. There is a microphone in the treatment room so you can always talk with the therapist if you have any concerns. The machine can be stopped at any time if you are feeling sick or uncomfortable. The radiation therapist may move the treatment machine and treatment table to target the radiation beam to the exact area of the tumor. The machine might make noises during treatment that sound like clicking, knocking or whirring, but the radiation therapist is in complete control of the machine at all times.

The radiation therapy team carefully aims the radiation in order to reduce the dose to the normal tissue surrounding the tumor. Still, radiation will affect some healthy cells. Time between daily treatments allows your healthy cells to repair much of the radiation effect, while cancer cells are not as likely to survive the changes. Sometimes a course of treatment is interrupted for a day or more. This may happen if you develop side effects that require a break in treatment. These missed treatments may be made up by adding treatments at the end. Try to arrive on time and not miss any of your appointments. Time spent in the treatment room may vary depending on the type of radiation, but it generally ranges from 10 to 40 minutes. Most patients are treated on an outpatient basis, and many can continue with normal daily activities.

Your radiation oncologist monitors your daily treatment and may alter your radiation dose based on these observations. Also, your doctor may order blood tests, X-rays and other tests to see how your body is responding to treatment. If the tumor shrinks significantly, another simulation may be required. This allows your radiation oncologist to change the treatment to destroy the rest of the tumor and spare even more normal tissue.

Weekly Status Checks

During radiation therapy, your radiation oncologist and nurse will see you regularly to follow your progress, evaluate whether you are having any side effects, recommend treatments for those side effects (such as medication) and address any concerns you may have. As treatment progresses, your doctor may make changes in the schedule or treatment plan depending on your response or reaction to the therapy. Your radiation therapy team may gather on a regular basis with other healthcare professionals to review your case to ensure your treatment is proceeding as planned. During these sessions, all the members of the team discuss your progress as well as any concerns.

Position Verification

During your course of treatment, correct positions of the treatment beams will be regularly verified with images made using the treatment beam itself, external X-rays or cone beam CT. These images (called port films (portal verification), CBCT Image or KV Image) represent an important quality assurance check, but do not evaluate the tumor itself.

Brachytherapy

Brachytherapy is the placement of radioactive sources in or just next to a tumor. The word brachytherapy comes from the Greek “brachy” meaning short distance. During brachytherapy, the radioactive sources may be left in place permanently or only temporarily, depending upon your cancer. To position the sources accurately, special catheters or applicators are used. There are two main types of brachytherapy — intracavitary treatment and interstitial treatment. With intracavitary treatment, the radioactive sources are put into a space near where the tumor is located, such as the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as the prostate.

Sometimes these procedures require anesthesia and a brief stay in the hospital. Patients with permanent implants may have a few restrictions at first and then can quickly return to their normal activities. Temporary implants are left inside of your body for several hours or days. While the sources are in place, you will stay in a private room. Doctors, nurses and other medical staff will continue to take care of you, but they will take special precautions to limit their exposure to radiation. Devices called high-dose-rate remote afterloading machines allow radiation oncologists to complete brachytherapy quickly, in about 10 to 20 minutes. Powerful radioactive sources travel through small tubes called catheters to the tumor for the amount of time prescribed by your radiation oncologist. You may be able to go home shortly after the procedure. Depending on the area treated, you may receive several treatments over a number of days or weeks.

Most patients feel little discomfort during brachytherapy. If the radioactive source is held in place with an applicator, you may feel discomfort from the applicator. There are medications that can relieve this discomfort. If you feel weak or queasy from the anesthesia, your radiation oncologist can give you medication to make you feel better. Depending on the type of brachytherapy you received, you may need to take some precautions after you leave your treatment, particularly if you plan to be around young children or pregnant women. Ask your radiation oncologist or radiation oncology nurse about anything special you should know.

Material on this site is informational only and should not be used in place of advice from a medical professional. If you have questions about a specific treatment, please ask your radiation oncologist

What to Expect After Treatment

Follow-Up

After treatment is completed, follow-up appointments will be scheduled so that your radiation oncologist can make sure your recovery is proceeding normally and can continue to monitor your health status. Your radiation oncologist may also order additional diagnostic tests. Reports on your treatment may also be sent to the other doctors helping treat your cancer. As time goes by, the number of times you need to visit your radiation oncologist will decrease. However, you should know that your radiation oncology team will always be available should you need to speak to someone about your treatment.

Material on this site is informational only and should not be used in place of advice from a medical professional. If you have questions about a specific treatment, please ask your radiation oncologist.

Personal Care During Radiation Therapy

Get plenty of rest

Many patients experience fatigue during radiation therapy, so it is important to make sure you are well rested. If possible, ask friends and family to help out during treatment by running errands and preparing meals. This will help you get the rest you need to focus on fighting your cancer.

Follow doctor’s orders

In many cases, your doctor will ask you to call if you develop a fever of 101° or higher. Be sure to read your instructions as far as caring for yourself during treatment. Eat a balanced, nutritious diet.

A nutritionist, nurse or doctor may work with you to make sure you are eating the right foods to get the vitamins and minerals you need. With certain types of radiation, you may need to change your diet to minimize side effects. You should not attempt to lose weight during radiation therapy since you need more calories due to your cancer and treatment.

Treat the skin that is exposed to radiation with extra care The skin in the area receiving treatment may become red and sensitive, similar to getting a sunburn. Your radiation oncology nurse will review specific instructions for caring for your skin with you. Some guidelines include:

• Clean the skin daily with warm water and a mild soap recommended by your nurse.
• Avoid using any lotions, perfumes, deodorants or powders in the treatment area unless approved by your doctor or nurse. Try not to use products containing alcohol and perfumes.
• Avoid putting anything hot or cold on the treated skin. This includes heating pads and ice packs.
• Stay out of the sun. If you must spend time outdoors, wear a hat or clothing to protect your skin. After treatment, use sunscreen with an SPF of at least 15

Seek out support

There are many emotional demands that you must cope with during your cancer diagnosis and treatment. It is common to feel anxious, depressed, afraid or hopeless. It may help to talk about your feelings with a close friend, family member, nurse, social worker or psychologist. To find a support group in your area, ask your radiation oncology nurse. There are many support groups that meet in person, over the phone or on the Internet.

Material on this site is informational only and should not be used in place of advice from a medical professional. If you have questions about a specific treatment, please ask your radiation oncologist.

Questions To Ask Your Doctor

Coping with a diagnosis of cancer and researching the various treatment options can be a stressful experience. To assist you in this process, below is a list of questions you may want to ask your radiation oncologist if you are considering radiation therapy.

Questions to ask before treatment

• What type and stage of cancer do I have?
• What is the purpose of radiation treatment for my type of cancer?
• How will the radiation therapy be given?
• Will it be external beam or brachytherapy?
• What do the treatments feel like?
• For how many weeks will I receive radiation?
• How many treatments will I receive per week?
• What are the chances that radiation therapy will work?
• Can I participate in a clinical trial? If so, what is the trial testing? What are my benefits and risks?
• What is the chance that the cancer will spread or come back if I do not have radiation therapy?
• Will I need chemotherapy, surgery or other treatments? If so, in what order will I receive these treatments?
• How soon after radiation therapy can I start them?
• How should I prepare for this financially?
• What are some of the support groups I can turn to during treatment?
• If I have questions after I leave here, who can I call?
• Will radiation therapy affect my ability to have children?
• Do you take my insurance?

Questions to ask during treatment

• How can I expect to feel during treatment and in the weeks following radiation therapy?
• Can I drive myself to and from the treatment facility?
• Will I be able to continue my normal activities?
• What side effects may occur from the radiation and how are they managed?
• Do I need a special diet during or after my treatment?
• Can I exercise?
• Can I have sex?
• Can I smoke or drink alcohol?
• Will side effects change my appearance? If so, will the changes be permanent or temporary? If temporary, how long will they last?
• Is it safe to take vitamins during treatment?

Questions to ask after treatment ends

How and when will you know if I am cured of cancer?

What are the chances that the cancer will come back?

How soon can I go back to my regular activities? Work? Sexual activity? Aerobic exercise?

How often do I need to return for checkups?

Material on this site is informational only and should not be used in place of advice from a medical professional. If you have questions about a specific treatment, please ask your radiation oncologist.

Understanding Clinical Trials

What Are Clinical Trials?

Clinical trials are research studies involving people.

• They test ways to treat and prevent cancer.
• All of today’s standard cancer treatments are a result of clinical trials completed many years ago.

Facts About Clinical Trials

• More than 25,000 cancer patients enroll each year in clinical trials through the National Cancer Institute. Many more patients are enrolled in clinical trials sponsored by other groups.
• About 60 percent of the adults enrolled in clinical trials are women.
• Lung, breast, prostate and colon cancers have the highest number of clinical trials dedicated to them — more than 40 percent of the total number of trials.
• Only a small percentage of all cancer patients enroll in clinical trials. Their participation may benefit them as well as future cancer patients.

Who Organizes a Clinical Trial?

Organizations or individuals looking for better treatments for cancer or new ways to prevent or detect cancer may sponsor clinical trials. Individual doctors at cancer centers or other medical institutions can also conduct trials.

• The National Cancer Institute sponsors numerous clinical trials covering a variety of cancers.
• Other sponsors include drug makers, technology companies and groups like the American Cancer Society.
• Each trial has a person in charge, usually a doctor, who is called the protocol chair or principal investigator (also called the PI).
• Before enrolling in a trial, ask whether the trial has been approved by an Institutional Review Board or IRB. IRBs exist at most hospitals to help safeguard patient rights.

How Are Clinical Trials Conducted?

Clinical trials testing new treatments are carried out in phases.

• Phase I — Is the Treatment Safe? As the first step in testing the research, doctors gather information about the side effects of the treatment and decide on the safe dose. Only a few patients in a few places take part in a Phase I trial.
• Phase II — Does the Treatment Work? In this step, doctors test the treatment to see how well it works. Most of the time, fewer than 100 patients are involved in Phase II trials. Phase III — Is the Treatment Better?
• Phase III trials compare the new treatment against the current standard therapy and randomly assign patients into one of the two groups. Many people from all over the country take part in these trials.
• Phase IV — Are There Better Ways to Use the Treatment? In this final step, treatments are tested to make sure they are safe and work well over a long period of time. This phase most often occurs once the new treatment has been approved for standard use. Anywhere from several hundred to several thousand people are enrolled in a Phase IV trial.

Where Are Clinical Trials Conducted?

Clinical trials are available through oncologists everywhere — not just in major cities or in large hospitals.

• Clinical trials take place in teaching hospitals, outpatient clinics, community hospitals and doctors’ offices.

What Are the Types of Clinical Trials?

Prevention

These trials test new approaches that doctors believe may reduce your chance of developing cancer. Most involve healthy people who have not had cancer. Some studies are conducted with people who have had cancer in the past to try to find ways to prevent second cancers.

Screening

Since cancer is often easier to cure when it is found early, screening trials test methods to better detect cancer, especially in the early stages. These studies also help find out whether finding cancer before it causes symptoms will lessen a patient's chances of dying from the disease.

Diagnostic

Diagnostic trials help answer whether or not there are new approaches that could be used to find certain types of cancer and at an earlier stage.

Treatment

The purpose of these trials is to find out if a new treatment or technique is better than the standard treatment. This can include new approaches to radiation therapy, new drugs, vaccines and different combinations of treatment.

Supportive Care/Quality of Life

These studies explore ways to improve the comfort and quality of life of people with cancer or survivors. These trials also study ways to better combat the side effects of some treatments.

Genetics Studies

These are generally done with another clinical trial and focus on how genetic makeup can affect detection, diagnosis or response to cancer treatment.

Who Can Participate in a Clinical Trial?

Each clinical trial calls for certain criteria that a patient must meet to be included in that trial.

• Your age, gender, medical history, current health, what type and stage of cancer all factor into eligibility.

It’s important to remember that clinical trials are completely voluntary. Patients can leave a trial at any time.

What Is Informed Consent?

Informed consent is the process by which you agree to take part in a clinical trial after receiving information about the purpose of the study, the treatment that will be given, the tests that will be taken, and the risks and benefits of treatment. You must sign a written consent form before being enrolled into a clinical trial. This form says that you understand the study and agree to take part.

What Are the Benefits?

Although there are risks with any treatment, there are also many benefits of taking part in a clinical trial. For example:

• Access to promising new treatments that are not available outside of the clinical trial setting.
• The treatment being studied may be better than the standard approach.
• You are followed very closely by a research team that is made up of doctors and other health professionals.
• You may be the first to benefit from the new method. Results from the study may help others in the future.

What Are the Risks?

Before taking part in a clinical trial, talk to your doctor about some of the risks involved with your treatment. For example:

• New drugs or treatments may not be any better than the standard care they are being compared to.
• New treatments may have side effects that are not expected.
• If you are in a randomized trial, you will not be able to choose if you are getting the new treatment or the standard approach.
• Health insurance may not cover all your costs.
• You may be required to make more frequent visits to the doctor.

Questions to Ask Your Doctor

Before joining a clinical trial, you may want to ask your doctor questions about the study and your treatment.

• What are you trying to learn from the study?
• What do doctors know already about the treatments being studied?
• What treatments and tests will I get during this trial?
• Who will be in charge of my care during the study?
• What are the differences between what I would get on this treatment and the standard treatment you would recommend?
• What are the benefits and risks?
• How will this affect my daily life?
• How long will the study last?
• What will I be asked to pay?
• How will I know if the study was successful?

How Can I Join a Clinical Trial?

If you are interested in joining a clinical trial, talk to your doctor. He or she can help you find out if a trial is right for you.

• The National Cancer Institute can give you information on current trials. Call 1-800-4-CANCER or visit www.cancer.gov to learn more.

Who Pays for a Clinical Trial?

Before taking part in a clinical trial, it's important to ask what your costs will be.

• In some cases, the sponsor of the study (such as the government, drug makers or technology companies) will provide the new treatment at no cost and pay for any special testing or extra doctor visits. Some sponsors may pay more than this, such as covering travel time and mileage expenses. However, other trials may pay very little of your treatment costs.
• If you have private insurance, check with your provider before you begin treatment. It may be willing to pay for some or all of the costs of your treatment, depending on the type of trial.
• Medicare will pay for the routine costs for some government sponsored clinical trials. Ask your doctor or call your local Medicare provider to find out what Medicare will pay for your treatment.

Material on this site is informational only and should not be used in place of advice from a medical professional. If you have questions about a specific treatment, please ask your radiation oncologist.