Download Head and Neck Cancer - Adelaide Radiotherapy Centre

Head and Neck Radiotherapy
Patient Information Booklet
www.adradcentre.com.au
Personal Notes Page
Contents
Introduction 5
First Visit 5
CT Simulator Appointment 5
Treatment Principles 5
Treatment 5
Appointment Times 6
How Does Radiotherapy Work 6
How is it Used to Treat Cancer 6
Side Effects of Radiotherapy 6
Specific Side Effects 6
Dental Management 6
Toothbrush 7
Brushing 7
Toothpaste 7
Mouth Wash 7
Flossing 7
Denture Care 7
Sore Throat & Mouth (Mucositis/Stomatitis) 8
Dry Lips 8
Dry Mouth (Xerostomia) 8
Difficult or Painful Swallowing 8
Systemic Pain Control for Swallowing 9
Topical Pain Control for Swallowing 9
Taste Changes (Mouth Blindness)
10
Thrush10
Cough10
Voice Change (Laryngitis)
10
Neck Swelling
10
Dry Nose
10
Lack of Appetite
10
Commercial Supplements
12
Tube Feeding
12
Nausea12
Constipation12
Chemotherapy12
Smoking13
Skin Reaction 13
Treatment - Post Radiotherapy
14
Weekends or After Hours
14
3
Introduction
Radiotherapy has been recommended for the
treatment of your cancer.
First Visit
Your first visit to the Adelaide Radiotherapy Centre
will involve a consultation with your radiation
oncologist (your doctor). At this time the radiation
oncologist will review your records, talk about your
general health and diagnosis, examine you, discuss
radiotherapy including its effects and answer your
questions. At the completion of your consultation,
arrangements will be made for a CT Simulator
appointment. Please bring any relevant X-rays, MRI’s,
or scans with you to this.
CT Simulator Appointment
The CT Simulator appointment involves the
radiation therapists gathering the information
required by the radiation oncologist to be able to
prescribe treatment. This can take up to an hour and
will include having a CT (computer tomography)
scan, on one of our dedicated, purpose built CT
units.
As part of the simulation procedure, marks may
be drawn directly onto your skin to outline the
treatment area. These marks are made with a non
toxic water based marker and will come off easily.
Most of you will have a few permanent tattoo dots
placed on your skin that will enable the radiation
therapists to replicate your daily treatments. These
are very small and unlikely to be observed by causal
observation.
At your simulation appointment for your head
and neck cancer, a face cast is often required. The
cast holds you in the correct position ensuring
you receive radiotherapy in exactly the same
configuration each day. The cast is made of mesh
like plastic which allows you to breath normally and
you will be able to see and hear through it.
Following simulation, your doctor and radiation
therapists will begin planning your treatment. This is
also called dosimetry. You will not be present for this
work as it requires a number of complex steps and
computer calculations using the information gained
from your simulation procedure, this work takes
many hours. It is at this time that your radiation
oncologist determines exactly what needs to be
treated the dose number of treatments required.
Following this, the radiation therapists will develop a
programme to deliver the required treatment in the
most effective manner.
Treatment Principles
Radiotherapy treatment involves lying on the
treatment couch in the same position as your
CT simulation appointment. The treatment
machine (the linear accelerator) delivers your
radiation treatment from several different angles.
The radiation therapists use your ‘tattoo’ dot, skin
markings, immobilisation cast and individual
dosimetry plan to set you up daily and deliver the
treatment your radiation oncologist has prescribed.
The radiation therapists also need to take regular
position cross-check/images during your course of
treatment to ensure the accuracy of your treatment.
Treatment
Treatment is given in specialised rooms called
bunkers. After you have been carefully positioned,
the radiation therapists will leave you alone in
the room for treatment, but at all times you can
communicate with the radiation therapists and
you are observed with the aid of a closed circuit
television.
The treatment machines make a buzzing noise,
but you will feel nothing. Treatment usually only
takes a few minutes each day, the first treatment
appointment being the longest. Some treatments
require the radiation therapists to re-enter the
room to change the position of the machine. It is
important you remain still on the treatment couch
and that you do not attempt to get off the couch
without a radiation therapist being with you. You
can be assured that no radiation remains in your
body after each treatment.
5
Appointment Times
Our helpful booking clerks or radiation therapists
will ask if you have any special circumstances that
require consideration when allocating treatment
times, they will do their best to try to accomodate
your request.
Your radiation oncologist will see you once a
week during the course of treatment or more
often if necessary. These consultations are called
treatment reviews. We do our best to coincide
all your treatment reviews with your treatment
appointment. If any problems arise between
treatment reviews, you are encouraged to speak
to the radiation therapists who will usually be able
to offer helpful advice and if necessary they can
have you further reviewed by a doctor or a nurse.
How Does Radiotherapy Work
Radiotherapy is a local treatment and in sufficient
doses, kills cancer cells in the area of the body
being treated because cancer cells are more
sensitive to radiation than normal cells.
The normal cells in the treated areas will be
affected to some extent but they are able to repair
the damage caused by radiation.
Treatments are planned to minimise damage to
healthy cells whilst ensuring the cancer or tumour
bed sreceives an adequate dose.
How is it Used to Treat Cancer
Radiotherapy is an extremely versatile form of
treatment. For some kinds of cancer, radiation
alone is enough to destroy the cancer. In other
cases, it is used in combination with surgery and/
or chemotherapy.
It may be used before surgery to “shrink” a cancer,
or after surgery to keep any possible remaining
cancer cells from growing again.
Radiotherapy treatment also has a very important
role in relieving cancer symptoms by reducing
pain, pressure or bleeding.
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Side Effects of Radiotherapy
Side effects of radiotherapy are predictable.
Radiotherapy causes side effects on the body as
a whole, as well as local effects, which depend
on the area being treated. Tiredness is a very
common side effect of radiotherapy, no matter
what part of the body is being treated. Fever and/
or chills are not related to radiotherapy, report
these symptoms immediately.
Some of the side effects associated with cancer
treatments can cause discomfort or distress but
can be prevented, reduced in severity or treated
quickly when the coordinated team of radiation
oncologists, radiation therapists and nurses
participate in your care. Remember that everyone
reacts differently and all reactions listed may not
apply to all patients.
Specific Side Effects
Radiotherapy to the head and neck has local side
effects which may occur to the mouth, throat,
salivary glands and to skin in the treatment area.
The side effects depend on the exact area being
treated.
Important Points
These are only guidelines and aim to give
you some general information about your
treatment and its likely side effects
Dental Management
If you have not already seen a dentist, your
radiation oncologist will refer you to a
specific dentist who will monitor your dental
management in stages.
The stages are: 1Pre-radiotherapy
2 During radiotherapy
3Post-radiotherapy
Toothbrush
Use a soft small-head toothbrush. For as long as
possible maintain regular brushing of your teeth
during radiotherapy you may need to change to
mouthwashes once you cannot brush your teeth.
Brushing
Brush your teeth at least four times a day using
small circular strokes. Avoid vigorous and
horizontal brushing at the gum line of your teeth
as this may damage the gum and cause root
surfaces to be exposed which can decay.
Toothpaste
Most toothpastes contain the foaming agent
sodium lauryl sulphate, or SLS, which has been
found to cause irritation in sensitive mouths.
Toothpastes containing SLS should be avoided
especially if you have a sore mouth, oral ulcers
or a dry mouth. Biotene ‘dry mouth toothpaste’ is
SLS free, contains fluoride and important salivary
enzymes. Our nurses or your dentist will be able
to advise on stockists for this product.
Mouthwash
As you progress with treatment you may be
advised to stop using a toothbrush and replace
it with a mouthwash to prevent injuring your
sensitive mouth and gums.
Difflam-C solution (chlorhexidine mouthwash) or
Biotene mouthwash will be recommended at the
beginning of your treatment.
• Difflam-C solution is chlorhexidine based,
alcohol free and an antibacterial mouthwash
• Biotene mouthwashes are alcohol free,
antibacterial and contain salivary enzymes
Sodium bicarbonate (baking soda) mouthwashes
are useful. It is readily and cheaply available
at supermarkets. Sodium bicarbonate has an
effervescent action and helps lift and remove
debris or coating from your teeth and tongue. Do
not use very cold or hot water as this may cause
further discomfort. Rinse the mouth gently with
the Sodium bicarbonate solution,
do not swallow:
Add one (1) teaspoon of sodium bicarbonate
powder to one (1) glass of lukewarm water and
dissolve
• Mouthwashes like Listerine should be avoided as they contain alcohol and can cause a burning sensation
• When you use any mouthwash swish it around your mouth for at least 2-3 minutes
• Use mouthwashes twice a day from the start of your treatment. If you stop using a toothbrush use the mouthwashes at least four times a day after food and before retiring
Flossing
Flossing Is usually not advocated while having
radiotherapy because your mucous membranes
and gums become very sensitive and are
easily damaged.
Denture Care
It is essential that dentures are cleaned thoroughly
at least daily with a toothbrush or denture brush.
They should not be worn at night but left to
soak in warm water or a denture cleaner such as
Steradent. They should also be left out as often as
possible during the day, whenever a mouthwash
is being used, and during radiotherapy sessions.
The gums and areas under the denture should
also be brushed on a regular basis and the mouth
rinsed after all meals. Brushing stimulates the
gums and helps keep them firm and less likely
to harbour the micro-organisms which may lead
to irritation or infection. Removing accumulated
food debris limits irritation, staining and bad
breath Biotene®, Oral Balance moisturising gel
can be used on the fitting surface of the denture
to minimise irritation and may also improve
retention.
It is possible that, due to the increasing sensitivity
of your mouth, dentures may cause further
irritation. At the first sign of discomfort, the
7
denture should be removed and checked by a
dentist as adjustments or may be required.
Some radiation oncologists and dentists may
recommend you leave your dentures out when
treatment begins and until at least three weeks
after completion. If treatment is extensive you
may not be allowed to wear your dentures for six
to twelve months because of the damage they
may cause to your irradiated gums
Sore Throat & Mouth (Mucositis)
You can reduce the incidence and severity of a
sore throat and mouth by:
• Correcting any existing oral conditions before you start your radiotherapy
• Maintaining good mouth care during and after your treatment
• Maintaining good nutrition
A sore throat and mouth may occur in the
second or third week of treatment. The soreness
may stabilise toward the end of treatment, and
usually settles in 6 to 8 weeks after the treatment
is finished. Soreness develops as the lining of the
mouth becomes inflamed. To help you deal with
these symptoms
we suggest you:
• Do not smoke
• Limit or exclude alcohol
intake, as alcohol increases the irritation to the lining of your throat and mouth
• Continue with normal tooth brushing for as long as you can
• Clean your teeth regularly - after meals and at night before retiring
Dry Lips
Vaseline or lip balm applied frequently may help
dry lips. Using lanoline cream or paw paw on the
lips, particularly at night can help prevent dryness
which is exacerbated by mouth breathing.
Dry Mouth (Xerostomia)
Depending on the area being treated
radiotherapy and surgery to the salivary glands
8
can cause a dry mouth. This is a common and
irritating side effect of treatment that may be
a problem during radiotherapy and, for some
people, for a long time after treatment is over.
Some helpful suggestions:
• Drink plenty of liquids, at least five to six
glasses of water per day
• Use a drink bottle with water to wet your mouth
• Biotene Oral Balance gel or Orion Oralube
(saliva substitute) can be particularly helpful
• Keep a glass or jug of water by your bed for sipping during the night or on awakening
• Drink frequently while eating. This will make
chewing and swallowing easier and may
improve taste
• Use bland, non-spicy sauces and gravies
to moisten meals
• Moisten foods with butter or margarine
• Limit caffeine-containing coffee, tea and cola drinks
• Make sure your mouth feels clean and fresh
before starting a meal
• If the problem becomes severe, then using a
cool mist vaporiser while you sleep will
increase the moisture in the air
• Chew sugarless gum to help stimulate salivary flow
• Suck sugar-free lollies or drops to stimulate salivary glands
• Suck on water ice blocks
• ‘Sticky’ saliva can be relieved by carbonated soda water mouthwash which freshens your mouth and helps dissolve the saliva. Use a full glass at room temperature as a mouthwash at least four times a day
• Avoid smoky environments
• Sleep in an elevated position if saliva is “ropey”
Difficult or Painful Swallowing
Difficult (dysphagia) or painful (odynophagia)
swallowing usually appears during the third week
of treatment and will gradually improve after the
treatments are completed. The problem is the
result of inflammation of the lining of your mouth,
throat or gullet.
Systemic Pain Control for Swallowing
If tolerated:
• Soluble Panadol or Soluble Panadeine: 2 tablets dissolved in a glass of water, gargle and swallow thirty minutes before meals and retiring to bed
• Your radiation oncologist may prescribe you a specific medication to help relieve your pain such as Panadeine Forte tablets or morphine mixture (Ordine)
• Mucaine suspension (with local anaesthetic) just before eating and retiring
• Iced water sipped slowly before meals can act as a mild pain killer
Topical Pain Control for Swallowing
The following may be suggested or prescribed:
• Oral-Sed Jel is available at pharmacies without prescription - apply every three hours, massage into gums
• Difflam-C anti-inflammatory, antiseptic solution, alcohol free, colour free. 100ml. Use as gargle or mouth rinse 5-15ml used for 30 seconds ap
proximately every 2 hours. Can be diluted if there is local stinging or burning. Do not swal
low
• Difflam Mouth Gel. Temporary relief of painful mouth ulcers, sore gums. Apply to sore area every 2-3 hours, maximum 12 times/day. (Also comes as Difflam sugar free lozenges)
• If you experience severe coughing just after eating or ‘sense’ the food not going down the right way – contact your radiation oncologist immediately
• Xylocaine ointment. Apply directly to sore areas. Can be purchased from pharmacies without prescription
• Xylocaine Viscous mouth rinses (or Lignocaine) is a pink sweet local anaesthetic. Use 5-15ml undiluted, every 3 hours, no more than 120ml in 24 hours. Swish around mouth for 30 seconds and then spit out. Occasionally the Radiation oncologist may suggest diluting Xylocaine Viscous so it can be swallowed
• Amethocaine 2% in 100mls. Paint onto sore areas in mouth – use cotton buds, do not swallow. It can be used as a rinse, 3- 5ml (may be diluted as required) 15 minutes before meals and at night before sleeping, do not swallow
Some helpful suggestions are:
• Choose foods that are soft and smooth, eg eggs, baked fish with sauce, canned fruit, cream, soups, pasta dishes, custard, puddings, ice cream, mornays, casseroles and porridge
• Blend, mince or chop food finely to reduce
the need to chew
• Sauces, gravies, custard or cream can be added to foods to make them moist but not too sticky
• Avoid rough, crunchy foods eg crackers, crisps, nuts
• Biscuits, bread and other dry foods can be
made softer by dipping them in drinks such as milk and soup
• Avoid foods that sting your mouth or throat,
such as fruit juices (eg orange, pineapple, grapefruit), vinegar, spices, very salty foods
• Avoid very hot food/drinks
• Mashed potatoes, cooked rice and peanut
butter will often stick in your throat. Whole or
cubed boiled potato and noodles may go
down more easily
• Use a straw for drinking to avoid irritating
sores or causing pain
• Artificial saliva (Biotene oral balance or Orion Oralube) assists swallowing. These are available without a script at pharmacies
• Drinking high energy/high protein drinks can help
• Eat frequent small portions of food. “Graze”
rather than eating large meals (for example 6-8 meals a day)
• Consult with a dietician or attend a group session organised at one of our sites
9
• Sometimes thickening fluids with special gum or starch thickeners can make them easier to swallow
Taste Changes (Mouth Blindness)
Your sense of taste may change during
radiotherapy. This will generally improve two to
six months after treatment is completed. Many
factors influence taste, for example colour, smell,
and emotional state. There are four primary
sensations – sour, sweet, salty and bitter. Taste
changes can be due to alterations to the coating
of your tongue, oral thrush or medications you are
taking.
Some helpful suggestions:
• Lemon tea and drinks can relieve
a dry mouth
• Cold foods if the smell of food is bothering you
• Experiment with foods, as you may like some that previously you did not
• Marinate meat if it has a strange taste, or alter
natively substitute it with another protein food such as fish, chicken, tofu, eggs or cheese
• A straw can be used to bypass taste buds
Thrush
You may develop a condition in your mouth
called oral thrush, while you are receiving
treatment. It occurs when the protective barrier
of the oral cavity is damaged. It looks like white
curd patches on the tongue and mucosa and can
move down into the oesophagus. It will increase
the severity of your sore throat and pain on
swallowing if left untreated.
Some helpful suggestions:
• Regular mouth care
• Anti-fungal medication such as Nilstat
drops - 1ml after food, mouth care
and mouthwashes
• Fungalin lozenges – suck 1 lozenge
after food and mouth care
• Increase daily fluid intake
10
Cough
Treatment may cause irritation which can make
you cough. A cough mixture may be necessary.
Voice Change (Laryngitis)
After two or three weeks of treatment you may
experience intermittent hoarseness and sore ears.
Whispered speech may develop with throat pain.
This usually improves at completion of treatment
but sometimes never returns to normal.Marked
Neck Swelling
Transient tenderness and occasionally marked
swelling of the salivary glands may occur within
a few hours after the first dose of radiotherapy
to the head and neck. This early reaction usually
subsides within a few days, however, temporarily
it can be painful requiring pain relief.
Dry Nose
Dry nasal passages can occur. The nasal passage
can be moistened with:
• Nozoil spray - follow special instructions
• Sterimar Sea Water Microspray
• Lanoline just inside nostrils
Lack of Appetite
Is a common problem. You may eat less because
you just do not feel hungry, food may taste
different, you may have problems with nausea,
have difficulty eating, you may be depressed, or
be less active than usual. Your body still requires
food and therefore you should look at ways
of increasing your food intake. Regaining your
appetite often boosts your whole outlook; you
should regard nutrition as an important part of
your treatment.
When to eat:
• Eat your largest meal at the time of day that you feel the best. This is often breakfast
• Eat meals before taking medication that are known to cause nausea or ‘upset your stomach’
• Don’t skip meals. An empty stomach can make you feel nauseous.
At least have a small snack
Before you eat:
• Rinse your mouth
• Nausea can sometimes be avoided or relieved
if you practice relaxation techniques
• Make meal times an enjoyable time eg wear
loose fitting clothes, eat in the fresh air, eat with
family or friends
What to eat:
• Eat small amounts often, rather than 3 large meals a day as most people can not eat as much at one time
• Eat and drink slowly
• After a sleep eat some dry, salty, crackers or thin crisp toast before activity (if your mouth is not sore)
• Cool foods are often more appealing. Try sand
wiches, salads and cold milk pudding
• Avoid strong food odours such as cabbage and coffee
• If possible avoid the kitchen when food is being prepared
• Avoid favourite foods during nausea, or before chemotherapy. This will help to stop you from developing a distaste for these foods
• Avoid greasy or fatty foods
• Small quantities of salty foods (such as crackers or soup) or sour or tart foods (such as lemon or citrus foods) may help reduce nausea
• If you can not manage solid foods try liquids eg soft drinks, cordial, clear soup, jelly, flavoured ice blocks
After you eat:
• Rest after meals but avoid lying flat. Use pillows
to keep your head and shoulders slightly raised if you lie down
Practical Suggestions
• Use high protein milk instead of plain milk in
drinks, on cereals and in cooking. ½ to ¾ cup
(60-90gms) skim milk powder, plus 2 ½ cups
(600mls) whole milk (full cream). Blend
thoroughly
• Porridge, semolina, soups and jellies can be made with milk (or fruit juice) instead of water
• Glucose is less sweet than sugar. Glucose
supplements (eg Glucodin and glucose
polymers eg Polyjoule, Polycose and Polycal) can be added in greater amounts to fruit juices, soups, milk drinks, soft drinks and mineral water
• Butter, margarine, and cream can be added to
soup, hot cereals, gravy sauces, vegetables and
desserts, without changing the flavour
significantly
• Serve foods as attractively as possible, with small portions of a variety of foods on a plate, rather than filling the plate to capacity. (You can take a second serving later - large helpings may
be daunting)
• Drink nourishing fluids eg: Milk - add eggs, ice
cream, extra skim milk powder or flavouring
• Yoghurt and fruit nectar blend into
a refreshing drink
• Fruit juice, lemonade, Lucozade, cordial - all
provide energy (although no protein) - Glucodin
or Polyjoule or Polycose can be added
The following dishes are all high in energy and
protein, they are soft and easy to eat:
Main Meals
Desserts
Avocados Cheese cake
Cheese/savoury sauces Chocolate mousse
Cheese soufflé Cream sponge
Creamed tripe Crème caramel
Creamy scrambled eggs Fruit flummery
Egg and bacon pie Lemon meringue pie
Egg combo Milk puddings
Lasagne Baked custard
Macaroni cheese Trifle
Omelette Bread and butter pudding
Pate Creamed rice/sago
Pancakes with savoury fillings Junket
Quiche Jelly made with milk
Shepherds pie Pavlova
Spaghetti bolognaise Pie/pudding with custard
Tuna mornay
11
Commercial Supplements
Commercial drinks that are supplemented with
extra protein, vitamins and minerals eg Sustagen,
Ensure, Proform Resource or Nutridrink can be
helpful to supplement or even replace meals.
They should be used as an addition to usual food
to boost protein and energy intake. Some can be
used as a complete replacement for meals, it is
best to discuss with your dietician.
There are three commercial drinks (Abbott
Prosure, Resource Support and Nutricia FortiCare)
that have been shown to have some benefits
in some patients with cancer. It has been
demonstrated that certain cancers can cause
changes in your metabolism and decrease your
appetite, which leads to your body burning more
calories and increasing tissue breakdown. This is
called cancer cachexia. Research has shown that
taking a nutritional drink containing an omega-3
fatty acid (EPA) together with additional protein
and nutrients may slow down these metabolic
changes.
ProSure, Support and FortiCare combine EPA
protein in a high energy drink to help patients
gain weight and strength, if they consume at least
two packs a day. Discuss with your dietician.
Tube Feeding
Depending on the site being treated, the severity
and degree of symptoms and the number of side
effects (each patient responds differently), the
Radiation oncologist may ‘recommend’ a feeding
tube.
A feeding tube can be inserted via two means.
1.Nasogastric tube; this is a thin long tube inserted via the nostril into the stomach.
2.PEG tube; this is a medical procedure in which
a tube is passed directly into the stomach via a small insertion through the adominal wall.
Both procedures are done as an in-patient and in
some case may require a few days in hospital.
12
Nausea
Some helpful suggestions:
• Sip water
• Flat dry ginger ale or lemonade
• Nibble dry biscuits
• Slowly increase food/fluid intake
• Avoid fatty foods
• Medication such as Maxolon (Pramin), Stemetil or Zofran
• 5-6 glasses of water per day
• Increase dietary fibre
• Regular exercise
Constipation
May be a problem due to inadequate fluid intake
or dietary fibre, some medications or decrease in
exercise.
Some helpful suggestions to increase dietary fibre:
• Wholegrain breakfast cereal eg Weeties, Weet
bix, porridge etc or a bran cereal
• Add bran to gravies, mornays, omelettes, soups, rissoles, meat loaves, stewed fruit, crumbing mixtures, breakfast cereals
• Blend fresh fruit in a milkshake
• Eat wholegrain bread, biscuits and use whole
meal flour in cooking
• Grate raw fruits into custards, or adding dried fruits to milk puddings
• Prune juice
• Have a warm drink early in the morning
• Medications such as Coloxyl with Senna, Sor
bilax or Lactulose
Chemotherapy
Patients with head and neck cancer may
have chemotherapy at the same time as the
radiotherapy. If you are having chemotherapy it
may make the side effects of the radiotherapy
worse. The chemotherapy will be ordered by the
Medical Oncologist and separate instructions
will be given for this. The Medical Oncologist will
see you regularly to monitor the chemotherapy
effects.
Smoking
While receiving radiotherapy smoking will
increase mouth and throat irritation and may
make the treatment less effective. Information
about quitting is available from the Cancer
Council of South Australia through their Quit
program. Please ask your radiation oncologist or
nursing staff for help with quitting for life.
Tiredness (Fatigue)
This is a common symptom and can be due
to surgery, chemotherapy, loss of weight, and
change to daily living activities. Some helpful
suggestions:
• Daily rest in bed
• Light exercise as tolerated
• Well balanced and nutritional diet
Skin Reaction
Radiotherapy may cause a reaction within the
treatment area. Temporary or permanent loss of
hair may occur within the treatment area.
Some helpful suggestions:
• Treat skin gently
• Wear loose cotton clothing and avoid stiff shirt/
blouse collars
• Avoid talcum powder
• Moisturise skin with sorbolene cream (without perfume or alcohol).
• Wash with a mild soap,
or sorbolene cream
• Pat dry with a soft clean towel, do not rub
• Avoid hot/cold packs
• Protect skin from sunlight
• Use an electric razor
• Avoid perfumes and aftershave
• If you wish to use other skin products discuss these with your radiation oncologist or nurse
Your Feelings
Sometimes, coping with your feelings, can seem
to be the most difficult part of your treatment.
Your mouth is an important part of your
appearance; if your mouth is uncomfortable or
feels unclean, it can be difficult to feel confident
that you look good. If you are worried about an
unpleasant odour and cleaning your teeth is
painful, you might be reluctant to get too close to
people or to kiss them.
A sore or dry mouth can interfere with your
general pleasure in the taste and texture of food,
and can make talking difficult. Above all, a painful
mouth can make you feel irritable or depressed
at times.
Emotions are a natural safety valve and may
swing from one extreme to another, from hope
to hopelessness, from acceptance to anger or
sadness. This is normal and there is no single
‘correct’ way to deal with them.
Many people find that sharing feelings can help
them to manage, others prefer to keep them to
themselves. It can be useful to let close friends
and family know of any physical problems that
you are having so that they can understand why
you might be irritable or quiet.
Feelings of anxiety and depression may occur due
to many factors such as a change in your routine,
difficulty with eating and talking, worries about
the future and/or side effects of the radiotherapy.
What is most important is that you do not suffer
unnecessarily. Problems with your mouth can
be prevented, treated or relieved so do let your
radiation oncologist, nurse or dentist know of any
symptoms and remember that most problems will
resolve once you have finished your treatment.
The radiation oncologist can refer you to a Clinical
Psychologist.
Accessing a Dietitian
Adelaide Radiotherapy Centre hosts weekly group
information sessions. These last for one hour
and are presented by a qualified dietitian who
specialises in oncology. Some people will also
benefit from individual assesment by a dietitian.
This can be enabled by your radiation oncologist
or nurse.
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Treatment - Post Radiotherapy
Mouth care should be continued even after your
treatment is completed, as some side effects
persist for several weeks or can be permanent.
Regular follow up appointments are essential
because your Doctor will want to check the
effectiveness of the treatment and any problems
you may be having.
You should inform your dentist at your next
check up that you have had radiation treatment
to the head and neck area. If ental extraction is
necessary ask your dentist to ring the radiation
oncologist to obtain the relevant details. Most
dentists will explore every avenue after a patient
has had radiotherapy to the head and neck
before extracting a tooth if it is in the treatment
area. A healthy mouth is essential to prevent
complications of therapy.
The important issues post radiotherapy revolve
around a continued Fluoride Prevention Program,
appropriate review and maintenance of oral
health. Radiation induced caries are always
possible and need to be dealt with primarily by
prevention.
Weekend Help
There is always a radiation oncologist on-call
on the weekends and public holidays. If you
believe that you have an urgent treatment related
problem you can speak to the on-call Doctor by
telephoning any of our listed phone numbers on
the back page of this booklet.
Cancer Council SA
Alternatively you may like to speak to a cancer
council nurse about their cancer information and
support services; if so, you can call Cancer Council
SA on 13 11 20, 8:30 am - 5:30 pm Monday - Friday
or email them on [email protected].
14
How we produce our information
All of our booklets are produced by staff
at Adelaide Radiotherapy Centre and this
information is not sponsored or influenced in
anyway. Every effort is made to ensure that the
information included in this booklet is accurate
and complete and we hope that it will add to any
professional advice you have had. All our booklets
are evidence based where appropriate and they
are regularly reviewed and updated. If you are
concerned about your health in any way, you
should consult your radiation oncologist, radiation
therapist or nurse.
About Adelaide Radiotherapy Centre
GenesisCare’s South Australian cancer care practice, Adelaide Radiotherapy Centre (ARC), is the leading
provider of radiotherapy services in the State.
In addition to our 4 treatment sites in metropolitan Adelaide, ARC’s radiation oncologists provide weekly
consultations sessions at the North Adelaide Oncology group as well as a comprehensive visiting
medical officer service to the public sector hospital system at The Queen Elizabeth Hospital, Flinders
Medical Centre, Royal Adelaide Hospital, Women’s and Children’s Hospital and the Repatriation General
Hospital. Access to our radiation oncologists’ clinical expertise is also available through our consulting
clinics in Whyalla, Murray Bridge, and Wallaroo.
Locations
Adelaide
Tennyson Centre
352 South Terrace
520 South Road
Adelaide, SA 5000
Kurralta Park, SA 5037
Telephone (08) 8228 6700
Telephone (08) 8375 3200
Flinders Private Hospital
Calvary Central Districts Hospital
1 Flinders Drive
25-37 Jarvis Road
Bedford Park, SA 5042
Elizabeth Vale, SA 5112
Telephone (08) 8179 5500
Telephone (08) 7285 6400
www.adradcentre.com.au
Revised October 2014