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Course: Oncology Nursing�Topic: Radiotherapy in Cancer Treatment Part 2

The Nurses International Community

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Module Goals

Learners will be able to:

Identify the impact of radiotherapy on various aspects of the patient's overall health.
Describe the prevention, detection, and management of common health alterations experienced by people undergoing radiotherapy for cancer.
Identify upcoming radiotherapy alternatives for cancer management.

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Impact of Radiotherapy on Patient

EdCaN module/Treatment completion and

management of responses to radiotherapy.

Depends on individuals’ characteristic:

Body site Treatment intent

Dose Treatment volume

Machine energy Neoadjuvant

chemotherapy

Emotional response impacted by:

Severity of symptoms, specific side effects
Need for hospital stay OR everyday long distance travel
Difficulty coping in an unfamiliar environment, separated from supports
Limited knowledge, resources to manage these problems

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Impact of Radiotherapy on Patient

Treatment effects can be divided into:

Acute reactions: occur within days to weeks after commencing treatment
Late reactions: occur from few weeks to years after completing treatment

Healthy tissue responds to radiotherapy with an inflammatory response
There is lack of standardized assessment in monitoring of radiation side-effects and treatment of toxicity
Symptoms develop in several stage further compromising effective assessment/monitoring of associated toxicities

EdCaN module/Treatment completion and

management of responses to radiotherapy.

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Common Side-effects of Radiotherapy

Fatigue
Radiation enteritis
Radiation skin reactions
Sexual Dysfunction
Mucositis

EdCaN module/Acute Effects.

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Fatigue

Incidence and severity known to fluctuate over the treatment trajectory
Factors influencing the occurrence of fatigue include:

adjuvant therapy - hormone, chemotherapy, recent surgery
age
frailty and functional status
site of radiotherapy
dosage of treatment
fractionation regimen
advanced disease

Important to prepare cancer affected people for possibility of fatigue
Fatigue needs to be differentiated from:

depression
Anemia related to disease, radiotherapy or adjuvant therapies

EdCaN module/Fatigue.

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Fatigue

EdCaN module/Fatigue.

Aetiology and mechanism of radiation induced fatigue unknown.
Interventions are mainly based on behavioral or psychosocial strategies.
Subjective assessment using 0 to 10 scale is recommended.
Management of fatigue needs to be individually tailored.
Physical exercise and psychosocial interventions associated with positive effects during and after treatment of cancer.

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Radiation Enteritis

Common side effect of radiotherapy involve pelvis or abdomen
Diarrhea, commonly an acute side effect¹

May be treatment-limiting
Requires careful monitoring and swift treatment
Pain, discomfort, frequent trips to the toilet can interfere with sleep and rest patterns

Late effects of radiation occur from 6-18 months: Proctitis, colitis, enteritis, fistula formation, obstruction²
Nursing management¹:

Patient education on a low residue diet, prescribed antidiarrheals

EdCaN module/Radiation enteritis.
EdCan module/Late effects.

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What Would The Nurse Do?

A nurse observes that Alan, 60 year old man undergoing radiotherapy, has reduced level of activity and looks uninterested in what is happening around him. When asked to join physical activities he says he feels ‘tired all the time’.

What should the nurse do?

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Radiation Skin Reactions

Depends on the location of the radiation field
Nurse’s interventions are targeted at:

Assessment of skin reaction
Patient education of skin care include

Avoiding mechanical, thermal, and chemical irritation
Application of moisturising cream to affected area twice a day

Managing skin breakdown if it occurs

Goals of skin care management are:

Enhance comfort
Promote healing
Minimise trauma
Prevent skin infection

EdCaN module/Radiation skin reaction.

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Radiation Skin Reactions

EdCaN module/Radiation skin reaction.

Dressing for skin breakdown

Needs to be moist and non-adherent

To ensure new epithelial cells are not separated from vascular bed

Need to protect skin against friction of clothes and other irritants
Needs to be kept clean to prevent infection
Hydrogel and hydrocolloid wound dressings provide protection and moist healing environment
Pain from skin breakdown needs to be managed appropriately with pain medications

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Radiation Skin Reactions

Late or delayed effects of radiation:

Fibrosis
Atrophy
Altered pigmentation
Slow healing trauma
Telangiectasia (dilated vascular channels after within 1-2 years after treatment

With high doses of radiation there may be:

Loss of sebaceous and sweat gland activity
Hyperpigmentation
Fibrosis of subcutaneous tissue
Impairment of lymphatic drainage

EdCaN module/Late effects.

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Mucositis

Inflammatory response to destruction of mucosal or glandular cells within head/neck
Treatments factors that affect degree of mucositis and vulnerability:

Radiation regimen
Dose
Fractionation
Area and volume
Anatomic location

Individual factors that increase risk of mucositis:

Age
Poor oral/dental hygiene
Smoking alcohol
Fungal infections
Traumatising agents, i.e dentures
Large amalgam fillings
Chemotherapy

EdCaN module/Mucositis.

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Mucositis

Affects eating and nutrition¹
Causes pain and sensations of coughing and choking¹
Changes in saliva, taste and pain impact on patient’s quality of life¹
Late effects of radiation to oral cavity may result in²

Tooth decay and changes in the structure of the gums
Trismus- reduced capacity to open mouth due to scar formation
Osteoradionecrosis, i.e bone death due to radiation

EdCaN module/Mucositis.
EdCaN module/Late effects.

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Mucositis

Nursing management strategies:

Assessment of oral cavity.
Arrange for timely referral to dentist for removal of diseased teeth prior radiation.
Provide patient education on good oral and dental hygiene.
Support to provide symptomatic relief and prevent secondary infection.

Reduces distress from symptoms of mucositis.

Daily fluoride treatment of healthy teeth to prevent dental caries as per dentist advise.

EdCaN module/Mucositis.

Contact info: info@nursesinternational.org

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Sexual Dysfunction

Sexual desire, function and fertility are significantly affected
Cause is likely to be multifactorial with

Disease
Social cultural factors
Radiotherapy or adjuvant therapies
Other symptoms affecting individual

Treatment of gynaecological cancers may experience changes to vaginal canal and ovaries leading to

Decrease in vaginal lubrication and sensation
narrowing and lack of elasticity in vaginal canal
cessation of ovulation
Pain during intercourse
post-coital bleeding

EdCaN module/Sexual dysfunction.

Contact info: info@nursesinternational.org

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Sexual Dysfunction

Management of sexual dysfunction in women patient:

Sexual rehabilitation with vaginal dilator and douches to prevent vaginal stenosis and adhesion
Lubrication for dry vagina to reduce irritation and pain
Different positioning may reduce discomfort

Men receiving treatment for genitourinary cancers may experience:

Impotence
reduction in libido
erectile dysfunction
cessation of sperm production
pain on ejaculation
permanent decrease in semen volume

Assessment of risk and appropriate referral for sexual counselling is an essential nursing role

EdCaN module/Sexual dysfunction.

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Future Radiotherapy Alternatives

Advancement in early detection of cancer.
With early detection of tumors, ablative stereotactic radiotherapy and brachytherapy might be developed for a wider spectrum of tumor sites.

will compete with minimal invasive surgery or endoscopy approaches.
evidence needs to show these techniques has better outcomes or lower cost.

Radiation oncologist should intensify research programs on early stage of tumors.

Baunman et al, ( 2020).

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Future Radiotherapy Alternatives

Ongoing clinical trials important for the development of optimal treatment guidelines that support clinical decision making
Radiotherapy will become more closely integrated with:

different fields of diagnostic imaging
data scientists from different fields, like medical informatics, bioinformatics, image analytics, biostatistics, and artificial intelligence

Baunman et al, ( 2020).

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What Would The Nurse Do?

During a follow up visit Laila is distraught and inconsolable. She mentions to the nurse that she is experiencing severe pain and bleeding after intercourse. Because of the pain and bleeding, her partner refuses to continue to have an intimate relationship thus, Laila states she wants to stop treatment.

What would the nurse do?

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Reference:

Baumann, M, Ebert, N.g, Kurth, I., Bacchus, C., & Overgaard, J. (2020). What will radiation oncology look like in 2050? A look at a changing professional landscape in Europe and beyond. Molecular Oncology, 14 (7):1577-1585. Accessed From: https://febs.onlinelibrary.wiley.com/doi/full/10.1002/1878-0261.12731

Cancer Australia (2018). EdCaN module: Fundamentals of radiotherapy for cancer/Mucositis. 2.2. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/radiotherapy/acute-effects/mucositis

Cancer Australia (2018). EdCaN module: Fundamentals of radiotherapy for cancer/Late effects. 2.2. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/radiotherapy/late-effects

Contact info: info@nursesinternational.org

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Reference:

Cancer Australia (2018). EdCaN module: Fundamentals of radiotherapy for cancer/Treatment completion and management of responses to radiotherapy 2.2. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/radiotherapy/treatment-effects

Cancer Australia (2018). EdCaN module: Fundamentals of radiotherapy for cancer/Acute effects. 2.2. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/radiotherapy/acute-effects

Cancer Australia (2018). EdCaN module: Fundamentals of radiotherapy for cancer/Fatigue. 2.2. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/radiotherapy/acute-effects/fatigue

Contact info: info@nursesinternational.org

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Reference:

Cancer Australia (2018). EdCaN module: Fundamentals of radiotherapy for cancer/Radiation enteritis. 2.2. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/radiotherapy/acute-effects/radiation-enteritis

Cancer Australia (2018). EdCaN module: Fundamentals of radiotherapy for cancer/Radiations skin reactions. 2.2. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/radiotherapy/acute-effects/radiation-skin-reactions

Cancer Australia (2018). EdCaN module: Fundamentals of radiotherapy for cancer/Sexual dysfunction. 2.2. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/radiotherapy/acute-effects/sexual-dysfunction

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