What you should know about radiation oncology treatments

Most people know that, if they are diagnosed with cancer, radiation oncology treatments may be a part of their overall care plan. But what does that entail?

We asked Radiation Oncologist Molly Sullivan, MD, who practices at Cape Cod Hospital in Hyannis and Falmouth Hospital what patients should know about the procedure. 

Every Patient is Different

The first thing patients need to understand about radiation oncology treatments is that every patient is different, and their treatment is tailored to their particular case, she said.

One patient’s cancer treatment might begin with surgery followed by chemotherapy that is then followed by radiation. Someone else with the same type of cancer, that is in a more advanced stage, might start with radiation first to shrink the tumor.

“There isn’t a hard and fast rule,” Dr. Sullivan explained. “It’s not uncommon for a person who is being treated for seven weeks to be sitting next to an individual being treated for one week or two weeks. Even amongst one of our more common diagnoses like breast cancer, someone might be on treatment for just three weeks but there could be another person on treatment for six and a half.”

Treatment plans depend on where the cancer is and in what stage it is when it’s diagnosed. Treatment decisions are made at the time of the initial consultation and finalized at the time of treatment planning. They are often done in concert with a collaborative physician(s), if they are going to receive both radiation, chemotherapy and/or surgery. Each specialty makes the final decision regarding the treatment process for their particular aspect of the plan.

The first time Dr. Sullivan meets with a patient for the 60-minute initial consultation, she obtains a detailed medical history and physical exam. Then she talks about treatment options and reviews the benefits of radiation and why she does or does not recommend it in their case. She also explains the treatment process and potential side effects. Sometimes she orders additional X-rays or imaging as part of what is known as the ‘staging workup.’

There can be a lot of information to take in, so she recommends bringing a family member or a friend to that appointment.

“For a consultation, it’s always good to have a second set of ears,” she said.

Planning Process

About a week after the consultation, the patient is scheduled for a 60-minute treatment planning session. This is when Dr. Sullivan maps out the area of the body that is going to be treated. This process includes a treatment planning CT scan that is done right in the radiation oncology department.

At this point, many patients will get small tattoos that are used for daily setup verifications to ensure that the radiation goes to the precise point it is needed. Patients with certain kinds of cancers, such as head and neck, are fitted with immobilization devices. These patients don’t need the tattoos because the device itself is marked.

“There are various devices that are used at the time of treatment planning to assure that people set up in the same manner consistently,” Dr. Sullivan said. “We want a very consistent daily setup.”

The patient leaves the treatment planning session with a schedule of the dates and times for all of their radiation appointments, which usually begin about one to two weeks after the treatment planning session, depending on the complexity of the radiation plan.

Treatment

Once they have begun, treatments occur daily, Monday through Friday, excluding holidays. Once a patient begins treatment it is very important to stay on course and keep all appointments, Dr. Sullivan said. Treatment breaks are discouraged.

“The amount of time that they spend here in the department is usually an hour or less,” Dr. Sullivan said. “The treatments themselves are just a matter of minutes. They’re in and out of the treatment room generally within 15 minutes, but there is time changing clothes and waiting for their turn on the machine, so I usually tell patients to allocate us 45 minutes to an hour. The treatments themselves are painless. It’s like getting a chest X-ray, but takes a bit longer.”

Patients can drive themselves to their treatments and continue with their normal daily activities. Many people maintain their full-time jobs while undergoing treatment.

Even though the dose of radiation is the same every day, the cumulative effect of treatments means that people might feel worse on Friday than they do on Monday. It’s important to know that any side effect can continue to worsen for one to two weeks after treatment ends, Dr. Sullivan said.

Patients are given a complete list of possible side effects at their treatment planning session, so they know what to expect for their specific type of cancer. Patients are also evaluated weekly by their physician while on treatment in order to discuss the presence and management of side effects.

“The side effects depend on the area of the body that we’re treating,” Dr. Sullivan said. “All of the side effects are cumulative, so they might not notice anything the first week or two of treatment. The most common one is fatigue.”

After Treatment

Once treatment has ended, radiation oncologists continue to follow with their patients’ long term, often alternating appointments with other specialties such as the surgeon, the medical oncologist and the specialty doctor for the area of the body that is affected.

As difficult as a cancer diagnosis is, Dr. Sullivan said that most patients doing radiation treatment find a sense of warm comradery with their fellow patients because they all sit together while waiting for the treatment. Lasting friendships are not uncommon.

“There’s actually a fairly upbeat social atmosphere in the department of radiation oncology,” she said. “Most people meet new friends and it’s a supportive group of folks who have a really great outlook regardless of if they are being treated for cure or if they are being treated for palliative intent. The patients tend to be very supportive of each other.”

Note: Due to the COVID-19 pandemic, processes at Cape Cod Healthcare Radiation Services locations have changed. Patients now wait in their cars and are called in individually for treatment. Patients are no longer able to be accompanied by a family member or friend. The process is being evaluated on an ongoing basis, as the outbreak continues.