About Radiation
Margaret
Hi I'm MARGARET
Eric
….and I'm ERIC. Have a seat.
Margaret
This is the London Regional Cancer Program's virtual experience for radiation therapy. If you're watching this, it's likely that you or someone you love has been diagnosed with cancer and radiation therapy has become a part of the treatment plan.
ERIC
We know you must have a lot of questions before starting treatment - I sure did. I wanted to know who'd be involved in my care, how radiation works and what I might hear and feel during treatment.
That's why we wanted to be a part of your journey through this module, to give you answers to these questions and to share what we've learned from our experiences at the LRCP.
Margaret
You may be feeling overwhelmed by your emotions as you prepare to begin your treatment. It's our hope that this experience can make you more familiar with the LRCP and more comfortable with the journey ahead.
I may look familiar. I'm a volunteer at the clinic, and not long ago, myself and a friend of mine Judy, helped by telling you what to expect on your first visit. If you missed it, I highly recommend going back through.
Eric
For now we're going to talk openly about radiation therapy, how to prepare for treatment, and possible side effects. We'll also introduce you and your family to some of the helpful resources you can use during, and after treatment.
If this is your first time through with us, it's important that you watch the whole thing. If you've already viewed this orientation, you can skip ahead to watch any section again.
Margaret
Here's Kathryn.
What Is Radiation Therapy?
Margaret
Hi, it's good to see you.
Kathryn
It's good to see you too.
Margaret
Kathryn is a a radiation therapist here at the LRCP.
Kathryn
Hi there, I'm Kathryn, it's nice to meet you.
Radiation therapy is a local treatment, meaning it is focused on one part of your body. Radiation is commonly used in low doses for things like x-rays. Radiation therapy, uses higher doses of radiation to damage cancer cells - and by targeting them repeatedly cancer cells don't have time to repair themselves in between treatments.
Sometimes we'll use radiation together with chemotherapy or surgery to achieve the best results possible. You can learn more about chemotherapy in the Chemotherapy section of this virtual tour.
How Does It Work?
Kathryn
There are a few different ways to receive radiation therapy - either from an external source, or internal source. The most common way to receive radiation treatment is through external beam radiation therapy. A machine called a 'Linac' which is short for a Linear Accelerator, delivers the radiation from a source outside of your body.
Eric
I have a video here that helped me out a lot.
Kathryn
Oh great.
The radiation therapists use this machine to send focused beams of radiation to the area around the tumor. It aims to destroy the cancer cells and shrink the tumor. It's difficult to destroy the cancer cells without damaging any of the healthy cells, which is why you may experience some side effects. We'll talk more about how the machine works and what some of the common side effects are a little bit later.
Internal beam radiation, or brachytherapy, is when the radiation source is placed inside your body. This treatment is delivered directly to the tumour site through a small seed or an implant that's placed in your body. If you're receiving internal beam radiation therapy, your health-care team will be happy to provide more information on this type of treatment.
Eric
Thanks Kathryn. That got us off to a really great start.
Kathryn
Oh you're so welcome.
Eric
Bye.
I've asked Dr. Connor to meet you hear to tell you more about your healthcare team.
Your Healthcare Team
Eric
Here comes Dr Connor now. Hi Dr. Connor
Dr. Connor
Eric. Hi nice to meet you, I'm Dr. Connor a radiation oncologist here at LRCP.
Up until now, you've worked closely with your family doctor to monitor your health. He or she will still play a role in your care if you have health concerns that are not related to cancer, such as a heart condition or diabetes.
To ensure you get the proper care during treatment your health-care team will grow to include specialists in cancer care. I'm a Radiation Oncologist, a doctor who specializes in treating cancer with radiation therapy. Oncology nurses specialize in caring for people with cancer and will teach you how to care for yourself and manage side effects. Radiation therapists help plan and administer your daily radiation treatments. A pharmacist will provide drugs prescribed by your oncologist and answer any questions or concerns about your medications. Booking clerks look after scheduling. They'll schedule your appointments and will be the first face you see when you check in at Radiation Reception. Students are the future of cancer care, and LRCP is proud to be a teaching hospital. You may have a student involved in your care, learning from LRCP medical professionals. Volunteers at the cancer centre will also help to make your stay more comfortable. If you have questions about the centre, they're a great person to ask.
Margaret
Other important members of your health-care team include social workers, dietitians, and spiritual care specialists. We'll talk more about their involvement later on in this tour.
Members of your health-care team are experts in cancer care, but you know yourself better than anyone - so be sure to let them know how you're feeling and ask questions along the way. Be open and honest with your team - it's one of the best ways you can contribute to your care. Thanks Dr. Connor.
Dr. Connor
All the best. I'll see you again soon.
Clinical Trials
Margaret
Oh yes. I'd like to tell you about clinical trials too.
Clinical research plays a vital role in the fight against cancer.
LRCP is an academic setting and is actively involved in clinical trials.
Clinical trials are research studies that involve people. They help answer questions about the best way to treat cancer, how to catch and diagnose cancer early on, and how to manage side effects. Clinical trials are the last step in a very long research process.
All common treatments that are used to fight cancer are the result of past successful clinical trials.
Eric
If you're a good fit for a clinical trial that is happening at LRCP, you may be approached by a clinical research associate. I was. They'll tell you more about what the clinical trial is about, including the risks and benefits. Sometimes, the benefit of participating in a clinical trial is receiving a treatment that otherwise would not be available. A possible risk of joining a trial includes unexpected side effects. Again, these are things that will be discussed with you, your family, research associate and your doctor. So don't be afraid to ask questions. The final decision about whether you want to take part in a clinical trial is always up to you.
Margaret
I want to grab a coffee and head over to the library.
Eric
Ok, see you there.
Preparing For Treatment
Eric
Everyone will need to do different things to prepare for treatment, but there are a few tips I can share to help you get started.
You may feel scared, worried, or angry; this is normal. When I was about to start treatment, I couldn't believe this was happening to me, my mind was overflowing with questions. You are not alone and your health-care team will be there to support you.
There will be many changes to your day-to-day life which you may have noticed already. Some of these changes can affect your family's routines as well.
Listen to your body, and rest when you need to. When it was time for me to rest, I turned off my phones and let my family know not to disturb me.
Don't be afraid to ask for help or accept the help that's offered. I kept a list so when people called and asked what they could use help with so when people called and asked what they could do - I was ready with an answer. I included things such as grocery shopping, preparing meals, driving me to an appointment, or help with chores around the house.
Margaret
Some people will want to know everything about their treatment - but others can become overwhelmed with too much information. Let your health-care team know how much detail to give you.
Your "My Care Binder" is a good place to start. Use it to keep yourself organized, write notes, track appointments and to hold all of the information you collect along the way.
Eric
If you don't have a ride to and from treatment, consider contacting the Canadian Cancer Society to arrange for a volunteer driver. With three business days notice, the CCS can provide free transportation.
Margaret
If you're a caregiver and watching this guide, don't forget take care of yourself too. Long days spent driving to and from appointments, talking to the health-care team, keeping track of medications and caring for your loved one can be difficult, so be mindful of your own health along the way.
Oh. One second... That's Kathlin.
Eric
The last tip I can share with you as you prepare to start treatment is to notice the improvements, even if they are small and to focus on things that make you feel good. That made such a difference for me.
How Long Will It Take?
Margaret
This is Kathlin, she's also a radiation therapist here. She's going to explain a little bit more about how long you can expect your treatment to take.
Kathlin
Hi. Nice to meet you.
Typically, you're treatment will be once a day, everyday, Monday through Friday. Your treatment times will not be the same each day but if you can't make an appointment, call the radiation therapy reception desk and be sure to give as much notice as possible. It's a good idea to arrive 10-15 minutes before your appointment so you can check in, walk to your treatment area and get dressed. The treatment usually only lasts a few minutes but be prepared to be at the LRCP for longer. Getting set up for treatment is what takes most of the time. Your radiation team does everything they can to run on schedule, but there's always a chance of an unforeseen delay.
You may be given special instructions to follow before your CT planning appointment or your radiation therapy sessions. It's important that you follow these instructions as best as you can because they help make your treatment more accurate. Your treatment may be delayed if the instructions are not followed.
Eric
Thanks, Kathlin we really appreciate it.
Kathlyn
You're welcome.
What To Bring
Margaret
I see you have a bag, let's make sure you have everything you need.
For all of your appointments you'll need your health card, reading glasses any mobility aids that you may need. You'll also want to bring all of the medications that you're taking in their bottles or containers so your health-care team knows exactly what you're taking. If you're taking any vitamins, minerals or herbal supplements, bring those to share with your healthcare team as well.
The first thing you'll want to pack is your 'My Care Binder'. In the 'About Me' section you'll notice there's a place where you can list all the medications you're taking, any questions that you have for your team, plus pertinent contact information. There's also a place for you to list your allergies - you'll probably want to fill this out before hand, because your team will be asking you about any allergies.
Bring cash, a debit or credit card for expenses such as parking and food and if you have private insurance, don't forget your drug plan information such as a group or policy number.
Great, it looks like you have everything you need.
Who To Bring
Eric
Now that we know what to bring, lets talk about who to bring.
Margaret
I'm going to head up to radiation reception so I'll meet you up there in a bit.
Eric
Ok.
This is JESS. A volunteer at the clinic. Can you tell us who we should bring?
Jess
Of course.
Hi there. It's really nice to meet you.
If you haven't already arranged for a volunteer driver to bring you to and from your treatment, you can ask a family member or friend to drive you. Friends and family members are also welcome to come with you to your weekly treatment review appointments.
Let me know if there's anything else I can help you with?
Eric
Now lets go meet Margaret at reception.
Planning Appointment
Margaret
Welcome to radiation reception.
Eric
I'll go find us a seat.
Margaret
Your CT planning appointment, or sometimes called "simulation", is the first step in designing your radiation treatment plan. This appointment helps your radiation therapy team gather more information about the cancer to best plan your treatment.
Come with me to the reception desk...
Receptionish
Hello, your health card please.
Thank you.
I see you've booked for your CT planning appointment. Here's your pager.
Margaret
Your pager will light up and vibrate when they're ready to see you. Why don't we go wait with Eric.
Eric
Oh, that's you.
I have to go for now. I'll meet up with you guys a little later.
Margaret
Your radiation therapist is ready for you. I'll wait for you out here.
Andrea
Hi, my name is Andrea.
May I have your name and date of birth please? We'll ask this each time you come in for treatment. We want to make one hundred percent sure that we are bringing in the right person for their treatment.
Follow me. Right down here. And just in here.
Today's visit helps us plan your treatment using a machine called a CT scanner. The CT scanner takes a picture of the area around the cancer. This picture tells us about the shape, size, and location of the tumor. This is where all the behind the scenes work takes place. A team of radiation planners will plan your radiation therapy using this computer technology so that the radiation is aimed at the exact same area every time you come in for treatment.
During this visit, we'll also decide the best way to position you during your treatment. The way we position you today will be the same way you're positioned every time. We'll do our best to help make you comfortable. Everyone is positioned differently depending on where the tumor is. Let me demonstrate what you will be doing during your visit. Right in here.
Kathlyn
Hello
Kathryn
Hello there.
Kathlyn
So when you come for your CT appointment the first thing we are going to do is lie you down on our bed. I'm just going to raise the table so you can see better. So we get you nice and straight on our table using lasers that come from our ceiling and side walls.
We have a few different ways that we get you comfortable and in the same position for treatment each day. This one here is called a vac lock. It's a treatment pillow basically that holds your arms up above your head. We also have a board that helps keep your arms above your head and if you are having treatment in the head and neck region we make a mask of your face that is very breathable and full of holes.
The next thing we'll do is put some marks on your skin in the area that the doctor has asked us to and slide you into our CT scanner. It's open the whole way through so you're never enclosed.
Once we get you into position we're going to leave the room and do the scan. Once the scan is finished we'll come back in and take you down and put some permanent marks on your body called tattoos. We'll use them to position you each day and they will be permanent. Kathryn's going to demonstrate the tattoos to you now.
Kathryn
Hello there.
What we do when we make a tattoo is we just clean the area with some cool alcohol and then I'm going to drop just a very small amount of ink right on the area we want to tattoo and then I'm going to make a small scratch into your skin with a very small needle and wipe that off and then we're going to have a tattoo, and that's all there is to it.
Andrea
Kathlyn is there anything else you'd like to add?
Kathlyn
yes you should be receiving and appointment for your first treatment today, if not, you can expect a call within the next two weeks.
That's all we wanted to tell you about your CT Scanning appointment.
Andrea
Let me show you back to the waiting room.
Checking In
Eric
It's your first day of treatment. Use the level one entrance located on the lower level. Just like the CT planning appointment, check in at the Radiation Reception desk where you'll receive a pager. The pager protects your privacy while letting you walk freely around the centre.
For every other appointment, you'll check in at the Radiation Reception desk and go straight to your treatment area. When your pager goes off the radiation therapist will come out and meet you.
Treatment Waiting Area And Changerooms
Andrea
Hello, name and date of birth? See I told you I'd ask every time. Follow me.
You may need to change into a gown or hospital pants depending on where you're receiving radiation. Use one of these change rooms and put your things in the locker. There is a key available, so don't worry about bringing a lock with you.
When you're all set, have a seat and we'll come back for you when it's time to go into the treatment room.
The Treatment Room
Andrea
We're ready for you now, come with me.
During your treatment, we'll have to leave the treatment area, but we'll be right here, watching through this monitor. We'll also be able to talk to you through a speaker in the treatment area and we can stop the treatment from here at any time. Are you ready? Let's go.
And this is the Linac. First we'll help you lie down in the same position that they had you for your CT Planning Appointment. Let me demonstrate.
Kathlyn
We'll lay you in the same position as your CT planning appointment and then raise the bed up closer to the machine. We're going to use the tattoos that you were given to line up with the lasers in the room.
Kathryn
We're going to get you to lie nice and still and breath normally you won't feel anything.
Kathlyn
Once we have you in the position, depending on the area that is being treated, and additional part of the machine may come out.
All of the parts of the machine will move around you.
Now that you've seen how the machine works, it's your turn to try.
Kathryn
And we're going to help you sit back up.
Andrea
You're next.
Now I'm just going to have you lay down. Alright, and I'll be just outside.
Common Side Effects
Andrea
Now let's discuss some possible side effects.
It's possible that normal cells in the treatment area may also receive some radiation which is why you may experience side effects. The side effects you experience depend on many things, including which part of your body is receiving the treatment, how much radiation is part of your treatment, and your overall health.
Side effects can happen at any time during your treatment, but usually get stronger as the treatment continues. Some side effects go away soon after the treatment ends, but others may take longer or will become permanent.
Some common side effects from radiation therapy include changes to your skin, fatigue, and appetite. Your health-care team will explain which side effects you're likely to experience and suggest ways to manage them.
Now Radiation can leave the skin at the treatment area feeling sunburned, blistered, swollen, red, or itchy. Just use mild soap and lukewarm water to wash, and try not to scrub or scratch the treatment area. Avoid using creams, oils, or lotions on the area unless your health care team recommends them. Also, if you are shaving that area, use an electric razor instead of a blade. Wearing loose clothing can also help protect the treated area from any rubbing or irritation.
Fatigue, or feeling more tired than usual, is a common side effect and is usually present throughout treatment. It can leave you feeling like you don't have enough energy to do the things you want, such as socializing with your friends or going to work. Track your energy levels, and plan your day around when you have the most energy. Try not to overload your day, and prioritize what needs to be done.
When you are tired, the last thing you want to do is exercise, but the odd thing about fatigue is that the more you rest, the more tired you will feel. Incorporating some light exercise into your day can increase your energy level and help you sleep better at night.
Now my last tip for managing fatigue is to ask for help when you need it.
It is important to remember that radiation therapy will affect everyone differently.
You'll meet with a radiation therapist, nurse or oncologist once a week at the patient review clinic, and this will give you an opportunity to talk about any concerns, including side effects. We want to know how you're coping with your treatment and make sure that you and your family are getting the support you need.
Now let me lead you out.
James
Hi, I'm James.
Before each treatment review appointment, you'll be asked to use this touch screen kiosk. This kiosk will ask you some questions about how you're feeling that day. Your health-care team will review your answers each time. They may make suggestions on how to cope with a certain side effect, make changes to your medications, recommend other supports, or introduce other health-care professionals to your team.
If you're unsure how to use the kiosk, a volunteer like myself will be here to help.
Margaret
Thanks James.
James
You're welcome
Margaret
There's another service here at the clinic that I think you might find very helpful. Supportive Care. Follow me. Let's head over there...