Patient Instructions During Treatment

Patients have asked many questions about the treatment course, several of which are addressed below. You may be given different instructions than those listed here due to your specific circumstances. Always give priority to what the physicians, nurses, and radiation therapists tell you.

Daily Treatment Schedule

You will be coming for daily treatment for a perscribed period, typically several weeks excepting the 5-day MammoSite therapy. An appointment time is routinely prearranged. Arrive a few minutes before your scheduled time, as there are normally patients treated before and after you. If you are going to be late or unable to come, please call us and we will try to accommodate you. A short wait before your treatment is not unusual. The typical total treatment and preparation time is less than 30 minutes.

You will most often see a radiation therapist, who administers the daily treatment. If you are having any problems or side effects, tell the therapist and he or she will communicate them to the physician. The physician will usually see you weekly to monitor your progress.

Clothing and Marks

Since the treatment often will require the removal of your clothes to uncover the area being treated, wear clothing that is easy to remove. The marks placed on your skin to help us target the tumor must be maintained throughout the treatment course. Do not use soap in the area or rub off the marks. You may shower and expose the treated area, but do not rub the area with a towel. Instead, “pat dry” the area gently. Also, wear older clothes, as marks may rub off onto your clothing.

Diet

Eat a normal, well-balanced diet with three regular meals. If you have trouble eating large portions, eat six smaller meals with snacks, if possible. This is one of the few times in your life when you will have the doctor’s permission to splurge and gain weight. Dieting to lose weight during your radiation therapy is not advisable. In general, you should aim to take in at least 2000 calories per day.

If you have trouble eating or swallowing, dietary supplements are necessary to maintain an adequate caloric intake. There are many products available including Ensure Plus, Isocal, Sustacal, and others. Some of these may be too sweet, and often a drop of bitters in each glass will make it more palatable. At least three or four cans of these supplements are necessary to provide an adequate number of calories. In some cases, a temporary tube can be placed in your stomach (PEG tube) to allow you to get nutrition directly to the bowels, if for some reason you are unable to swallow foods.

If you are eating a balanced diet, vitamins are generally not necessary. However, if you do not eat properly, any commercial multivitamin preparation taken daily may be helpful. If you are anemic, a multivitamin with iron may be more appropriate. Vitamin supplements, including A, B12, C and others, have NOT been shown to be effective against cancer. You should specifically avoid supplements like vitamins A and E, which are free radical scavengers, as in high doses they may impair the ability of the radiation to kill the cancer cells.

Activity

You may continue your normal activities if you feel up to it. However, you may notice some fatigue during the treatment course and may need to rest more and perhaps take an afternoon nap. Most people are able to work while receiving treatment, but may need to adjust their hours, depending upon their level of fatigue. Exercise within limits is still advisable. Walking, jogging, bicycling, and swimming are all good if your physical condition permits. We do ask that you try to keep any areas being irradiated out of the direct sunlight, to limit the tendency to sunburn.

Transportation

If you currently drive, you should be able to drive yourself to and from the treatment center daily. If you have a medical problem which limits your ability to drive, the physician may advise you not to drive. If you are unable to find anyone to drive you, the American Cancer Society often has volunteers who will drive you to the center at no charge. Consult your phone book for a local chapter in your community. If you continue to have difficulty, please call the center for transportation assistance.

Medications

Do not take any non-prescription drugs or supplements without informing our staff. Continue to take your regular medications prescribed by other physicians, but please let us know what you take so we can be sure the drugs will not adversely affect your therapy.

Special instructions for patients receiving radiation therapy to the Head & Neck area

For patients with cancer involving the head and neck area (but not patients with brain tumors) or other cancers where treatment to the head and neck is required (e.g., Hodgkin’s disease), special care and attention are necessary.

Radiation therapy given to your mouth area may reduce saliva, which is responsible for the natural cleansing of your teeth. Consequently, you may have a reduced ability to resist tooth decay. The responsibility and the means to prevent oral and dental difficulties lie with you: Good oral hygiene habits and regular dental visits are the best means to preventing dental problems down the road.

To minimize the effects on your teeth and help prevent tooth decay, follow these guidelines:

  • Visit your dentist prior to or soon after the beginning of radiation therapy, and regularly at least every six months. Be sure to tell your dentist that you are receiving radiation therapy so he or she can take appropriate action.

  • Brush your teeth regularly, three to four times a day. Use a soft toothbrush to avoid trauma to the gums, and use fluoride-containing toothpaste.

  • Use dental floss daily.

  • Because salivation is decreased, frequent rinsing or gargling will help to keep the mouth moist and clean. You may use plain water, one teaspoon of baking soda in warm water (preferred), or one part hydrogen peroxide to six parts warm water. Do not use a commercial mouthwash, as it has alcohol and other chemicals that can irritate your mouth.

  • Rinse daily with fluoride obtained from your dentist.

  • Avoid foods that stick in your mouth.

  • Use sugarless gum, mints, lemon drops, or the like as desired.

Once again, pay attention to nutrition and use liquid supplements such as Ensure Plus, Sustacal, Carnation Instant Breakfasts, etc., if you are unable to eat solid foods.

Treatment to your mouth area also may cause other side effects, such as a dry mouth, sore throat, loss of taste, and loss of appetite, all of which are discussed more extensively in the following section on side effects. There has been recent progress in trying to lessen the long-term mouth dryness using a special radioprotector called Amifostine prior to each radiation treatment. Ask your Radiation Oncologist if you are a candidate to receive such additional preventative therapy.