Understanding Radiation Therapy
Common questions about radiation therapy
Radiation therapy uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread. The radiation is usually in the form of focused x-ray beams. It can also be in other forms such as electron beams, proton beams, or gamma rays from radioactive sources. Radiation therapy is a localised treatment, which means it generally affects only the area being treated. Treatment is carefully planned to do as little harm as possible to the normal body tissue near the cancer.
Answers to some common questions about radiation therapy are below.
Radiation therapy aims to kill or damage cancer cells in the area being treated. Cancer cells begin to die days or weeks after treatment starts, and continue to die for weeks or months after it finishes. Although the radiation can also damage healthy cells, most of these cells tend to receive a lower dose and can usually repair themselves. You should not feel any pain or heat during radiation therapy.
Many people will develop temporary side effects during or shortly after treatment that may cause pain or discomfort.
Research shows that about one in two people with cancer would benefit from radiation therapy. It can be used in three main ways:
As the main treatment to achieve remission or cure – Radiation therapy may be given as the main treatment with the aim of causing the cancer to disappear. This is called curative or definitive radiation therapy. Sometimes definitive radiation therapy is given with chemotherapy to increase its effectiveness. This is called chemoradiation or chemoradiotherapy.
To help other treatments achieve remission or cure – Radiation therapy is often used before (neoadjuvant) or after (adjuvant) other treatments to make the treatment more effective.
For symptom relief – Radiation therapy can help to relieve pain and other symptoms by making the cancer smaller or stopping it from spreading. This is known as palliative treatment.
There are two main ways of giving radiation therapy, outside the body or inside the body. You may have one or both types of radiation therapy, depending on the cancer type and other factors.
External beam radiation therapy (EBRT) – Radiation beams from a large machine called a linear accelerator are precisely aimed at the area of the body where the cancer is located. The process is similar to having an x-ray. You will lie on a treatment table underneath a machine that moves around your body. You won’t see or feel the radiation, although the machine can make noise as it moves.
Internal radiation therapy – A radiation source is placed inside the body or, more rarely, injected into a vein or swallowed. The most common form of internal radiation therapy is brachytherapy, where temporary or permanent radiation sources are placed inside the body next to or inside the cancer.
You may have treatment once a day, Monday to Friday, for several weeks, but shorter courses of one to five treatments are also common.
- Consultation session – You will meet with a radiation oncologist. They will check your test results and scans, and assess your fitness for radiation therapy. They will explain the treatment process and expected results, as well as possible side effects and risks, so that you can agree (consent) to have radiation therapy.
- Planning session – You will meet with the radiation therapy team in the radiation therapy department so they can work out the best position for your body during treatment (EBRT) or where to place the applicators (brachytherapy).
- Treatment plan – The radiation oncologist, radiation therapist and radiation physicist will use the information from the planning session to work out the treatment area and how to deliver the right dose of radiation, based on the treatment guidelines for the particular type of cancer. The treatment plan will also include ways to prevent or manage possible side effects.
- Treatment sessions – Radiation therapists will deliver the course of radiation therapy as set out in the treatment plan. How long each treatment session takes will depend on the type of radiation therapy.
- Follow-up – You will have regular check-ups with your treatment team to see whether the cancer has responded to treatment and to discuss how to manage any side effects.
If you receive radiation therapy as an outpatient in a public hospital, Medicare pays for your treatment. Medicare also covers some of the cost of radiation therapy in private clinics. How much Medicare pays depends on your treatment plan. Private health insurance does not usually cover outpatient treatments. Ask your provider for a written quote that shows what you will have to pay.
Many people can continue to work during their treatment and feel well enough to do all their usual activities. Others may need to reduce their hours or take time off. How much you will be able to work depends on the type of radiation therapy you have, how the treatment makes you feel and the type of work you do. Ask your treatment team if they offer very early or late appointments so that you can fit your treatment appointments around your work.
Talk to your employer about your working arrangements. Explain that it is hard to predict how radiation therapy will affect you, and discuss the options of flexible hours, modified duties or taking leave.
Your treatment team will encourage you to be as active as possible, and they can answer your questions about working during treatment. Ask your social worker about any practical or financial assistance available to you.
You probably won’t be able to have radiation therapy if you are pregnant, as radiation can harm a developing baby. It’s important that you don’t become pregnant during the course of treatment. If you suspect you may be pregnant at any stage, it is important to tell your doctor. If you are breastfeeding, talk with your doctor about whether it is safe to continue during your treatment course.
Men who have radiation therapy should avoid getting their partner pregnant during treatment and for about six months afterwards, as radiation can damage sperm. Your doctor will be able to give you more information about radiation therapy and pregnancy.
When radiation therapy is combined with chemotherapy, it is known as chemoradiation. The chemotherapy drugs make the cancer cells more sensitive to radiation therapy. Chemoradiation is used for some cancers, such as head and neck, cervical and oesophageal cancers.
If you have chemoradiation, you will usually receive chemotherapy a few hours before some radiation therapy appointments. Your doctor will talk to you about your treatment course.
Having radiation therapy on the same day as chemotherapy may cause more severe side effects than if you have them separately.
Your radiation therapy team can provide support and information about how to manage any side effects you experience.
The effects of radiation therapy depend on the part of the body being treated, the radiation dose and the number of treatments you need. Your treatment team will tell you the likely effects for you. It can be hard to know how to prepare, but several general issues are worth thinking about in advance.
Explore ways to relax – Read a book or listen to music while you wait, ask a friend or family member to keep you company, or try chatting to other people waiting for treatment. To help you relax during the session, try meditation or breathing exercises, or ask the radiation therapists if you can listen to music.
Organise help at home – Some support with housework, meals and errands can ease the load. If you have young children, you may need to arrange for someone to look after them during radiation therapy sessions and possibly afterwards. Older children may need lifts to and from school and
activities. Consider asking one friend or family member to coordinate offers of help.
Discuss your concerns – Keep a list of questions and add to it whenever you think of a new question. If you are feeling anxious about radiation
therapy, talk to a member of the radiation therapy team, your GP, or a family member or friend.
Find out about quitting – If you smoke, it is important to stop smoking before starting treatment. Smoking may make the treatment less effective and side effects worse. For information and support, talk to your doctor or call the Quitline on 13 7848.
Arrange transport – Plan how you will get to radiation therapy sessions. If travelling by car, ask about parking as there will often be spots set aside for radiation therapy patients. At first, you may feel well enough to get yourself to radiation therapy sessions. You are likely to feel more tired as the treatment goes on, so it’s best to arrange for someone to drive you. Call Cancer Council 13 11 20 to find out if there is a transport to treatment service in your area.
Ask about patient travel assistance – If you have to travel a long way for radiation therapy, you may be eligible for financial assistance to help cover the cost of travel or accommodation. Cancer Council SA provides accommodation services to guests who need to travel to Adelaide for treatment. For details, speak to the hospital social worker or clinic receptionist, or call Cancer Council 13 11 20.
Mention medical implants – Let your treatment team know if you have any medical devices in your body, such as a pacemaker, cochlear implant or another metal implant, such as a hip or knee replacement. Radiation therapy can affect these devices or be affected by them.
Consider fertility – Some types of radiation therapy can affect your fertility. If you think you may want to have children in the future, talk to your treatment team about your options before radiation therapy begins.
During and after treatment, you will see a range of health professionals who specialise in different aspects of your care. The main specialist doctor for radiation therapy is a radiation oncologist. You may be referred to a radiation oncologist by your general practitioner (GP) or by another specialist such as a surgeon or medical oncologist. Treatment options will often be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting.
radiation oncologist – treats cancer by prescribing and overseeing a course of radiation therapy
radiation therapist – plans and delivers radiation therapy
radiation oncology nurse – provides care, information and support for managing side effects and other issues throughout radiation therapy
medical physicist – ensures treatment machines are working accurately and safely; oversees safe delivery of radionuclide therapy; monitors radiation levels
medical oncologist – treats cancer with drug therapies such as chemotherapy, targeted therapy and immunotherapy (systemic treatment)
dietitian – recommends an eating plan to follow while you are in treatment and recovery
speech pathologist – helps with communication and swallowing difficulties during treatment and recovery
social worker – links you to support services and helps you with emotional, practical and financial issues
psychologist/counsellor – help you manage your emotional response to diagnosis and treatment
physiotherapist, occupational therapist – assist with physical and practical problems, including restoring movement and mobility after treatment, and recommending equipment
lymphoedema practitioner – educates people about lymphoedema prevention and management, and provides treatment if lymphoedema occurs
Because cancer cells continue to die for weeks or months after treatment ends, your radiation oncologist most likely won’t be able to tell you straightaway how the cancer is responding. However, they can help you manage any side effects.
After treatment finishes, you will have regular check-ups. Your radiation oncologist will do a physical examination and arrange tests or scans to check whether the cancer has responded to treatment. You may not know the full benefit of having radiation therapy for some months.
If radiation therapy is given as palliative treatment, the relief of symptoms is a good sign that the treatment has worked. This may take a few days or weeks. Until then, you may need other treatments for your symptoms, e.g. pain medicine.