Common questions about radiation therapy

Radiation therapy is an important part of treating cancer. It’s estimated that radiation therapy would be a suitable treatment for 50% of people with cancer. It can be used in three main ways:

To achieve remission or cure – Radiation therapy may be given as the main treatment to cause the cancer to reduce (remission) or disappear (curative or definitive radiation therapy). Sometimes definitive radiation therapy is given together with chemotherapy to make it work better. This is called chemoradiation or chemoradiotherapy.

To help other treatments – Radiation therapy is often used before other treatments (neoadjuvant) to shrink the tumour or after other treatments (adjuvant) to kill any remaining cancer cells.

To relieve symptoms – 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.

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. Treatment is carefully planned to do as little harm as possible to healthy cells near the cancer. Most of these cells tend to receive a lower dose and can usually repair themselves.

Many people will develop temporary side effects during or shortly after treatment that may cause pain or discomfort.

There are two main ways of giving radiation therapy – from 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.

Chemoradiation means having radiation therapy at the same time as chemotherapy. The chemotherapy drugs make the cancer cells more sensitive to radiation therapy. Having radiation therapy and chemotherapy together increases the success of the treatment compared with having either treatment on its own.

Chemoradiation is only used to treat some cancers such as anal, brain, bowel, head and neck, lung, cervical, uterine, oesophageal, pancreatic and vaginal cancer.

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 plan.

The side effects of chemoradiation depend on the type of chemotherapy you have. They also depend on the radiation therapy treatment area.

Your radiation therapy team can provide support and information about how to manage any side effects you develop.

During and after treatment, you will see a range of health professionals who specialise in different aspects of your cancer 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. You may also see some allied health professionals to help you manage any treatment side effects.

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)

surgeon – surgically removes tumours and performs some biopsies

dietitian – helps with nutrition concerns and recommends changes to diet during 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

occupational therapist – assists in adapting your living and working environment to help you resume usual activities after treatment

physiotherapist, exercise physiologist – help restore movement and mobility, and improve fitness and wellbeing

lymphoedema practitioner – educates people about lymphoedema prevention and management, and provides treatment if lymphoedema occurs

Radiation therapy is usually given in the radiation oncology department of a hospital or in a treatment centre. This may be in the public or private health system.

Most people have radiation therapy as an outpatient. This means you do not stay in hospital, but travel to the hospital or treatment centre for each session. It’s a good idea to think about how you will get to the radiation therapy sessions. For some types of internal radiation therapy, you may need to stay in hospital overnight or for a few days.

If you are having radiation therapy with the aim of making the cancer go away, you may have treatment for 5–7 weeks. Usually treatment is once a day, Monday to Friday, but sometimes it’s given twice a day. Your doctor will tell you how many treatments you will have. If you live a long way from the treatment centre and you’re having a short course, your treatment may be given two or three times per week.

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, but you may have to pay the difference between the cost of treatment and the Medicare rebate (gap payment). Private health insurance does not usually cover radiation therapy, as it’s considered an outpatient treatment. Before treatment starts, ask your provider for a written quote that shows what you will have to pay.

1. Consultation session – You will meet with a radiation oncologist. They will check your test results, assess your fitness for treatment, and explain the process and expected results, and discuss possible side effects and risks. You will be asked to agree (consent) to have treatment.
2. Planning session – You will meet with a radiation therapist. They will work out how to best position your body during EBRT or where to place the applicators for brachytherapy.
3. Treatment plan – Based on the planning session and the treatment guidelines for the cancer type, the radiation oncologist, radiation therapist and medical physicist will work out the radiation dose, what area needs to be treated and how to deliver the right dose of radiation.
4. 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.
5. Review and follow-up – You will have regular reviews during treatment to monitor and discuss how to manage any side effects. After radiation therapy ends, you will see the radiation oncologist to find out whether the cancer has responded to treatment.

The side 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 about the likely effects for you. It can be hard to know how to prepare, but several issues are worth thinking about in advance.

Ask about fertility – Some types of radiation therapy affect 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.

Download our booklet ‘Fertility and Cancer’

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 breathing exercises or meditation, or ask the radiation therapists if you can listen to music.

Organise help at home – Support with housework and cooking can ease the load. If you have young children, arrange for someone to look after them during radiation therapy sessions. Older children may need someone to drive them to and from school and activities. Ask a friend or family member to
coordinate offers of help, or use an online tool such as candoapp.com.au or gathermycrew.org.au.

Consider quitting – If you smoke, it is important to stop smoking before starting treatment. Smoking may mean the treatment doesn’t work as well and it can make side effects worse. If you need support to quit smoking, talk to your doctor or call the Quitline on 13 7848.

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 having radiation therapy, talk to the treatment team, your GP, a family member or friend, or call Cancer Council 13 11 20.

Arrange transport and accommodation – Plan how you will get to radiation therapy sessions. If travelling by car, ask about parking. You are likely to feel more tired as the treatment goes on, so arrange for someone to drive you. 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. Call Cancer Council 13 11 20 to find out more about our accommodation lodges and how to access patient travel assistance.

Check your teeth – If you are having radiation therapy for a cancer in the head and neck region, visit your dentist for a check-up before radiation therapy begins. The dentist can check for any teeth that may cause an infection and advise if they need to be removed before you start treatment.

Mention medical implants – Let your treatment team know if you have any medical devices in your body. This may be a pacemaker, cochlear implant  or metal implant, such as a hip or knee replacement. Radiation therapy can affect these devices or be affected by them.

You may feel well enough to continue working and doing your usual activities when you first start radiation therapy. As you have more sessions, you may feel more tired or lack energy. Whether 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.

Let your employer know about how much time you are likely to need off work. 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 as this can help you feel better. Research shows that exercise can help manage ongoing effects of radiation therapy, including fatigue.

Download our booklet ‘Cancer, Work & You’

Download our booklet ‘Exercise for People Living with Cancer’

You probably won’t be able to have radiation therapy if you are pregnant, as radiation can harm a developing baby. It’s also important that you don’t become pregnant during the course of treatment. If at any time you suspect you may be pregnant, it is important to tell your doctor. If you are breastfeeding, ask your doctor whether it is safe to keep breastfeeding while you’re having radiation therapy.

It is recommended that people who have radiation therapy to the pelvic area avoid getting their partner pregnant during treatment and for about six months afterwards, as radiation therapy can damage sperm. Your doctor will be able to give you more information about radiation therapy and pregnancy.

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. After treatment finishes, you will have regular check-ups. Your radiation oncologist will do a physical examination and arrange tests or scans to check how 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, for example pain medicine.