Care of Clients Receiving Radiotherapy

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Introductions

– Non surgical intervention ( radiotherapy & chemotherapy) and surgery may be used alone or in combination, depending on the stage of cancer.

– About 60% of all cancer patients, are treated with some form of (radiotherapy).

– This treatment delivers X-rays or gamma-rays directly to the cancer place. Radiotherapy effects are local because only the area being treated experiences direct effects.

Radiation doses are based on:

– type

– stage

– location of the tumor

– patient’s size

– condition and overall treatment goals.

Radiation Dose

Radiation doses are given in increments, usually three to five times a week, until the total dose is reached

Goal of radiation therapy

– cure(in which the cancer is completely destroyed and not expected to recur).

– control(in which the cancer doesn’t progress or regress but is expected to progress at some later time

– palliation( in which radiation is given to relieve symptoms caused by the cancer (such as bone pain, bleeding, and headache).

Types of radiation therapy

1- External Radiation Therapy:

it method of delivering radiation to destroys cancerous cells at skin surface or deeper in the body.

Specific instructions for the woman undergoing external radiation for endometrial cancer:

–  monitoring of sign of skin breakdown , especially in the perineal area.

–  Do not remove the markings outline the treatment site .

–  No sunbathing.

–  Inform the client that cystitis, diarrhea, and anorexia are common during the weeks of therapy .

2- Internal Radiation Therapy(IRT):

A special prepared applicators are inserted into the endometrial cavity and vagina. After verification the of the applicators position to tumor site the radiologist will load the device with amount of radioactive material. Patient remains isolated in private room for 1 to 3 days until application is completed.

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Internal Radiation in the rectum of male patient.

Implantation of radiation therapy

1.Explain the treatment to the patient and his family:

– Review the treatment goals.

– Discuss the range of potential adverse effects as well as interventions to minimize them.

– Discuss possible long-term complications and treatment issues.

– Educate the patient and his family about local cancer services.

– Obtain sign consent from patient.

2. Make sure the radiation oncology department has obtained informed consent.

3. Review the patient’s clinical record for recent laboratory and imaging results.

4. Transport the patient to the radiation department.

5. The patient begins by undergoing simulation (treatment planning), in which the target area is mapped out on his body using a machine similar to the radiation therapy machine. Then the target area is tattooed or marked in ink on his body to ensure accurate treatments.

6. The physician and radiation oncologist determine the duration and frequency of treatments, depending on:

– the patient’s body size

– size of portal

– extent and location of cancer,

– treatment goals.

7. The patient is positioned on the treatment table beneath the machine. Treatments last from a few seconds to a few minutes. Reassure the patient that he won’t feel anything and won’t be radioactive. After treatment is complete, the patient may return home or to his room.

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Nursing Care of Patients receiving Radiotherapy

1. Explain to the patient that the full benefit of radiation treatments may not occur until several weeks or months after treatments begin. Instruct him to report long-term adverse effects.

2. Emphasize the importance of keeping follow-up appointments with the physician.

3. Refer the patient to a support group, such as a local Zahra group for Breast cancer or Eman society .

Nursing Care of clients with sealed implants of radioactive source:

1. Assign client to private room.

2. Place a Caution radioactive material sign on the door of the client`s room.

3. Wear a dosimeter film badge at all times while caring for clients with radioactive implants.

4. Stay as far away from the radiation source as possible.

5. Do not allow pregnant women or children younger than 16 years of age.

6. Limit each visitor to one half hour per day.

Home care after Radiotherapy done
– Instruct the patient and his family about proper skin care and management of possible adverse effects.

Complications of Radiotherapy

– Adverse effects arise gradually and diminish gradually after treatments. They may be:

– acute.

– sub acute (accumulating as treatment progresses),

– chronic (following treatment), or long-term (arising months to years after treatment). Adverse effects are localized to the area of treatment, and their severity depends on the total radiation dose, underlying organ sensitivity, and the patient’s overall condition.

Common acute and sub acute adverse effects can include altered skin integrity, altered GI and genitourinary function, altered fertility and sexual function, altered bone marrow production, fatigue, and alopecia.
Chronic and long-term complications or adverse effects may include radiation pneumonitis, neuropathy, skin and muscle atrophy, telangiectasia, fistulas, altered endocrine function, and secondary cancers.
Other complications of treatment include headache, alopecia, xerostomia, dysphasia, steatites, altered skin integrity (wet or dry desquamation), nausea, vomiting, heartburn, diarrhea, cystitis, and fatigue.

Desquamation also called skin peeling, is the shedding of the outermost membrane or layer of a tissue

Telangiectasias are small dilated blood vessels  near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter. They can develop anywhere on the body but are commonly seen on the face around the nose, cheeks, and chin. They can also develop on the legs, specifically on the upper thigh, below the knee joint, and around the ankles. (Source: WikiPedia)

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– Xerostomia is the medical term for the subjective complaint ofdry mouth due to a lack of saliva.

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– Alopecia means loss of hair from the head or body .

Male-pattern hair loss, the hair loss begins at the temples and either thins out or falls out. Female-pattern hair loss occurs when hair thinning occurs at the frontal and parietal.

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Documentation of Radiotherapy Procedure

– Record radiation precautions taken during treatment.

– Interventions used and their effectiveness.

– Grading of adverse effects.

– Teaching given to the patient and his family and their responses to it.

– The patient’s tolerance of isolation procedures and the family’s compliance with procedures.

– Discharge plans and teaching; and referrals to local cancer services, if any.

 

References:

– Nurse-ocha.com

– ÒMedical & Surgical Nursing by Brunner & Saudraths 2007 edition

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