Radiotherapy

Radiotherapy is the use of exact, carefully measured doses of high energy x-rays and other types of radiation, to treat cancer. The radiation does not stay in your body and it is perfectly safe for you to mix with children and adults.

Radiotherapy treatment is painless and should take between 10 and 20 minutes. It is similar to having an x-ray taken.

Radiotherapy can cure some cancers and can also reduce the chance of a cancer coming back after surgery. It may also be used to control a cancer or to help improve the symptoms of it.

There are two types of radiotherapy:

  • External Beam – given outside the body
  • Brachytherapy – given inside the body

Your doctor will discuss these with you, as appropriate, and decide which type will be most suitable for you.

If you have health problems, for example, diabetes, arthritis, or heart trouble, radiotherapy should not affect them in any way. However, if you think you may be pregnant, or if you have a pacemaker fitted, please tell the doctor or radiographer before they take any x-rays. If you are worried about any other illness or have any other concerns, please ask us.

Women between 12 and 55 years of age will be asked to confirm that they are not pregnant and the importance of not becoming pregnant while on treatment will be explained to them. This may seem an insensitive question to ask at this time, however, it is required by current legislation and is in place to protect the unborn child as the procedures used during diagnosis, planning and treatment require the use of radiation which can cause harm to the unborn baby.

Careful planning of your individual radiotherapy treatment reduces the dose received by the surrounding healthy tissue, other nearby organs and the risk of possible side effects from the treatment.

During your attendance for radiotherapy you will also have to see the doctor and/or Review Radiographer and may require other examinations, for example blood tests or x-rays to monitor your progress. Please allow some extra waiting time. Due to occasional machine maintenance and quality assurance it is not always possible to keep to a strict appointment system and delays may occur.

The treatment area and number of treatments depends on:

  • Your specific type of cancer and its position in your body
  • Any other treatment you have had.

Treatment is not routinely given on Saturdays and Sundays. Sometimes your doctor may make changes to your treatment plan as the treatment goes on. This is normal and your doctor or radiographer will discuss this with you.


  • Patient Journey Video

    A patient information video outlining what a person can expect from radiotherapy treatment has been launched by our radiotherapy department at the Cancer Centre with the support of Friends of the Cancer Centre.

    Over 250 people attend the Cancer Centre for radiotherapy treatment every day and the video has been created as a tool for these patients before they start their radiotherapy treatment to help break down some of the fear, uncertainty and misunderstanding that can often surround this form of cancer treatment.

    As well as explaining what exactly radiotherapy is, the video follows a patient from their arrival at the Cancer Centre, through the treatment planning process and shows what can be expected from the treatment itself.

    Useful information on parking passes, support services and other facilities in the hospital are also covered to ensure that the patient has all information available before their first appointment.

    Featuring staff from all areas within the radiotherapy department, the video was developed by the Information and Support Radiographer, Lindsey Anderson. She said, “Radiotherapy can be a really difficult time for patients as it’s a side of cancer treatment that is less well known, which can often lead to misunderstanding and fear for many patients. As a team we try to alleviate this through our monthly Information and Support Evenings, where patients, their relatives and friends can come to the Cancer Centre to meet the team and see what is involved at any point in their radiotherapy journey.”

  • How to find us

    Radiotherapy is given in the Radiotherapy Department on the ground floor of the Northern Ireland Cancer Centre, on Belfast City Hospital site.

    Getting to and from the hospital

    Where possible you will be expected to provide your own transport to and from the hospital.

    An ambulance can sometimes be provided if you have no transport. Please contact your family doctor to arrange this for your radiotherapy planning appointment (first attendance). Thereafter the transport can be arranged by staff within the radiotherapy department. This will be arranged for either morning or afternoon, dependent on your appointment time. If you need transport thereafter please let us know as soon as possible. Further information will be given as needed.

    Most people are treated as outpatients. You will be treated as an outpatient if you live within travelling distance and your doctor thinks you are well enough to travel each day. Please be aware, due to limited capacity, it may not be possible for us to facilitate your radiotherapy treatment appointments around other commitments you may have. We apologise for any inconvenience this may cause and really appreciate your patience and understanding on this matter.

    If you have a long distance to travel for treatment, there is a bed and breakfast facility [open Monday to Friday] for people who are self-caring. It is called Glenview and there is an assessment criteria for patients wishing to stay there. Each of the standard rooms are twin bedded to enable a relative [self-caring and aged 18 years plus] to stay, if desired. There is a charge for relatives using these facilities but there is no charge for patients.
    Sometimes people are admitted to the ward for part or all of their treatment. If this is necessary your treatment team will discuss it with you. There are four wards where the nurses are expert in any specialised care that you may need.

    The Cancer Centre, Belfast City Hospital has ‘open visiting’ on all wards, except Ward 2A, as long as it does not interfere with clinical activities, mealtimes, or with your wishes. Visiting within Ward 2A is restricted to 1-9pm.

    Routes to Belfast City Hospital

    Transport

    There are excellent public transport links to and from the Belfast City Hospital. Metro bus routes 9A and 9B pass the Lisburn Road entrance on a regular basis while route 92A bus takes you to the Donegall Road entrance.

    If you live outside the Belfast area, the simplest way to travel to the Cancer Centre may be by rail. The hospital is unique in having its own railway station where some 50 trains pass each day on the lines to Antrim, Bangor, L’Derry, Larne, Newry, Portadown and Portrush.

    Parking

    If you are attending as an outpatient for radiotherapy and travel by car, you are entitled to free on-site car parking. You will be issued with a single ticket when you attend for your radiotherapy planning appointment and a weekly ticket thereafter for the duration of your radiotherapy treatment.

    Please remember to ask for your free car parking ticket.

    • It is very important that you use the weekly ticket every day to enter the car park otherwise you will not be able to get out, apart from the first day of attendance or on a Monday.
    • During your radiotherapy treatment each ticket is valid for one week only.
    • If you encounter a problem exiting the car park please press the button for assistance.

    Parking is available:

    • Radiotherapy car park
      • This is accessed via the Lisburn Road (almost opposite to Claremont Street)
    • Car park No.1 opposite the Cancer Centre at the front of the Tower
      • The lower level is for disabled parking only
    • Car park No. 2 in front of the Blood Transfusion Building, towards the Donegall Road exit.
  • Staff

    Key members of the Radiotherapy Team:

    • Clinical Oncologist: A doctor that is trained in the use of radiotherapy and chemotherapy to treat cancer. They are responsible for overall patient care. Clinical Oncologists are supported by Specialist Registrars and Associate Specialists.
    • Therapy Radiographers: Male and female staff that are trained to deliver radiotherapy treatment and help patients cope with the daily physical and psychological demands of having radiotherapy. They work closely with the clinical oncologist and physicist.
    • Clinical Specialist Radiographers: Staff (brain, head & neck, breast and gynae, lung cancer and urology specialists) that are responsible for the coordination of the radiotherapy treatment and management of treatment related side effects.
      Review radiographer: Staff that is responsible for the clinical assessment and management of reactions. He/she liaise closely with the clinical oncologist, clinical specialist radiographer, treatment radiographers and other health care professionals.
    • Phlebotomist: Staff that are trained to draw blood from a patient for clinical or medical testing.
    • Information and Support Radiographer: Staff that support patients throughout radiotherapy. Patients or their carers can self-refer to this service or be referred by a healthcare professional for information. There are also information leaflets available.
    • Student Radiographers: The Cancer Centre is a training centre for therapeutic radiography students who may be present during treatment planning or treatment. Students will not be responsible for any part of treatment and will always be working under the supervision of fully trained radiographers. Patients can choose not have students present if they wish.
    • Physicists: Radiation experts that help to plan radiotherapy treatment. They also ensure the accuracy of the radiotherapy equipment used in the department.
    • Mould Room Technicians: Staff that produce moulds, tissue equivalent materials and special shielding as requested by the Clinical Oncologist.
    • Radiotherapy Nurses: Staff that provide wound and symptom management and liaison with district nursing as required.
    • Other members may include: Dieticians, speech and language therapists, physiotherapists, occupational therapists, social workers and the palliative medicine team.
  • Planning Appointment

    Consent

    Radiotherapy treatment is tailored to the needs of each patient. Planning treatment has a number of steps and therefore can take some time.

    Before a patient commences radiotherapy they will be given an appointment with a doctor. The doctor will explain:

    • The planning process
    • Treatment
    • Possible side effects from the treatment

    Doctors will not advise patients to have any treatment unless the benefits of the treatment are greater than the known risks. If a patient is to proceed with treatment they must provide their consent.

    Find out more about the consent process.

    Women between 12 and 55 years of age will be asked to confirm that they are not pregnant and the importance of not becoming pregnant while on treatment will be explained to them. This may seem an insensitive question to ask at this time, however, it is required by current legislation and is in place to protect the unborn child as the procedures used during diagnosis, planning and treatment require the use of radiation which can cause harm to the unborn baby.

    More information (source Public Health England)

    Planning

    This is usually your first appointment with us and during it the doctor will ask you to sign a consent form.

    In doing this you are confirming that you have been given information about radiotherapy, including its risks and benefits, and that you have given permission for your radiotherapy treatment to go ahead.

    For the planning process patients may need to remove some items of clothing depending on the area of the body being treated.

    Every effort will be made to respect patient privacy and they will be covered up as much as possible.

    It may take up to two hours and will involve one or all of the following:

    Mould Room

    If you are having an area around your head or neck treated, a special mould will be made in the Mould Room for you to wear during your planning and treatment appointments. It is not always easy to keep your head still, even for a short time. The mould will keep your head still and in the same position during your treatment each day.

    As part of the preparation for the mould you may need to attend the hospital several times before your treatment can start. Ideally facial hair should be removed before attending the mould room.

    The mould room staff will explain everything to you.

    CT Simulator

    This machine is very similar to a CT scanner; it is specifically designed for planning radiotherapy treatment. If you need any special preparation for this appointment you will be advised before you attend.

    We may need to give you an oral or injected contrast (dye). This will help us to see the area we want to treat more clearly. You will be advised if we need to do this. The pictures from the scan will be used to produce an individual plan of your treatment.

    During the planning session the radiographers will draw some marks on your skin with a pen. Permanent marks, like tiny black freckles, will also need to be made. These will help the radiographers set you up in the correct position for treatment every day. If you wear a special mould for your treatment, the marks will be drawn onto this, instead of your skin, before your scan.

    There will be no results from this scan as it is only used to plan your radiotherapy.

    Simulator

    The Simulator is a large x-ray machine similar to the treatment machines. You will lie in the position we need you to be in for treatment. The radiographers will take some x-rays to check that your treatment position is exactly as your doctor has planned.

    What happens next?

    After your planning appointment your doctor, with the help of the radiographers and physics team, may spend a number of weeks designing your radiotherapy treatment.

    In most cases you will be contacted at a later date, by telephone or letter, with details of your first radiotherapy treatment appointment. You will be given a list of further appointments on your first day of treatment.

    General Advice:

    • Look after yourself really well
    • Eat well and drink lots of fluids, as advised by your treatment team
    • Care for the treated area as advised
    • Do not remove the skin marks defining your treatment area unless advised to do so by the radiographers
    • Talk to us if you are worried or concerned about anything
    • Do not compare your treatment with others – it has been tailored to suit you
    • Do not compare side effects with others – remember your treatment may not be the same and everyone reacts differently.
  • Treatment

    Once planning is complete, patients will receive an appointment to start treatment from the radiotherapy booking office via letter or phonecall. Patients will be given a list of further appointments on their first day of treatment and the radiographers will try to accommodate requests, however this is not always possible. Patients who require transport should let radiographers know as this takes time to organise.

    First day of treatment

    The first day of treatment is often the longest. Radiographers will give advice to patients about what to expect during treatment. This includes general information about delivery of treatment, management of side effects and any other information patients may require. This information and advice should be carefully followed.

    The radiographer will ask patients to confirm their name, address and date of birth on each day of treatment. This is a safety requirement. For women aged between 12 and 55 the radiographer will stress the importance of not becoming pregnant during treatment and the importance of informing the medical staff of any suspected pregnancy at any stage of treatment. Patients will be asked to sign a separate form regarding this information to ensure that they fully understand it.

    Patients will receive a lot of information on the first day and radiographers will be available throughout treatment to answer any questions.

    Delivery of Treatment

    Before each treatment, patients will be carefully positioned by the radiographer. This may take some time but ensures that the radiation is accurately targeted. Images are routinely taken to check the patient’s position is correct.

    When the patient is in the correct position, the radiographers will leave the room and a buzzer will sound. This means that treatment is about to start. The radiographer will be able to hear and see the patient at all times. Patients can gain the attention of the radiographers by raising their hand only. It is very important for the patient to remain still during treatment even when it appears that nothing is happening. This is all part of the process to ensure that treatment is delivered safely and accurately. Once the treatment is complete, patients will be instructed by the radiographer when they can move again or sit up.

    Patients will not see or feel anything during treatment and it is similar to having an x-ray. Having radiotherapy treatment will not make patients radioactive because no radioactive material gets inside the body.

    During Treatment

    During the course of treament, patients will regularly see a doctor or a specialist radiographer. These assessments are part of the routine treatment and allows medical staff to measure progress and to refer patients to any available support services. It also gives an opportunity for patients to ask questions.

  • Side effects

    Skin

    The skin in the treated area sometimes becomes red and sore and it may become itchy, similar to sunburn. We will provide cream to help with any discomfort. Occasionally if the skin reaction is severe, your treatment may be delayed for a short time to allow the skin to recover. This is a normal situation so do not worry if it happens to you. Following treatment, any redness of the skin will eventually fade.

    You may attend the Radiotherapy Nursing Department as part of your skin care during treatment. If your radiotherapy treatment appointment is after 4pm and you have/or need an appointment with the Radiotherapy Nurses, please inform the reception staff, as this service is only available until 5pm.

    General advice during radiotherapy:
    • Wear loose, comfortable clothing around the treatment area; cotton is preferable next to the skin. Sometimes the ink marks can smudge onto your clothing so it is best not to wear anything too special while having your treatment
    • Try to avoid treated surfaces rubbing together. A folded cotton handkerchief between two surfaces will help to avoid friction.
    Advice about washing the treated area:

    Please follow the advice below during treatment and until any reaction settles:

    • Gently wash the treated skin surface in warm (not hot) water
    • If your treated skin is red or broken do not use shower gels, bubble baths, creams, body lotions, moisturisers, deodorants or perfumed soaps
    • Showering or immersion in a warm bath is allowed (do not soak in the bath)
    • Avoid using a flannel, sponge or shower puff on the treated area
    • Pat dry gently with a soft towel.
    Skincare
    • Do not apply any cosmetic products within the treatment area
    • Apply the recommended cream to the treatment area once or twice per day initially. Increasing to three or four times daily as treatment proceeds. If you need more cream, or further advice about applying it, please ask your treatment radiographers
    • Do not use any preparation or cream on the treated skin except those recommended by the staff
    • Avoid hot water bottles, ‘rubs’ or any form of heat on the treated skin
    • Avoid ice packs on the treated skin
    • Avoid direct sunshine or wind on the treated skin
    • Avoid swimming in salt water or chlorinated swimming pools during the course of treatment until any skin reaction has settled.
    • If receiving treatment to the head and neck will be advised not to wet shave but can use an electric shaver instead.

    Fatigue (extreme tiredness)

    You may find you are more tired during your treatment. Listen to your body, continue with normal activities if you feel able but allow yourself some extra time to rest.

    Fatigue can last some time after treatment has finished. Combining rest with gentle exercise, such as a short walk, drinking plenty of water and eating a healthy diet can help. Some people are able to continue working but others may find they are too tired.

    Remember, please inform the doctor/radiographer treating you or the ward staff about any reactions or side effects you experience.

    Nausea

    Most people do not experience nausea or vomiting during treatment – it depends on the part of the body being treated.

    Patients should tell a radiographer if they experience nausea or vomiting. Anti-sickness tablets can be prescribed for nausea. Persistent vomiting can cause dehydration and needs to be treated.

    Diarrhoea/ Bowel Looseness

    This is a common side effect of treatment for patients receiving treatment to the pelvic area.Patients should tell a radiographer if they experience diarrhoea or bowel looseness.

    Cystitis

    This is a common side effect of treatment to the pelvic area and can be recognised by the following symptoms:

    • A raised temperature
    • Increased frequency of passing water
    • Feeling of pressure in the lower abdomen region
    • Burning or pain on passing of water,
    • Cloudy urine, blood in the urine (haematuria) or strong smelling urine.

    If any of these symptoms occur, a radiographer should be told. The most common treatment is a course of antibiotics.

    It is important to drink plenty of water during treatment. It keeps the body well hydrated and flushes out toxins.

    Hair Loss

    With radiotherapy hair loss only occurs in the area that is being treated. Most hair loss due to radiotherapy is usually temporary and should start to grow back within 2-3 months. Occasionally hair loss can last longer or become permanent, the radiotherapy team will discuss this with you.

    If treatment results in hair loss, a referral form will be given to the patient for a consultation with a cosmetician (hairdresser). The cosmetician can supply patients with a wig from a selected range of styles free of charge. Information on this is available from radiographers.

    For information about Wig Fitting Services available for cancer patients in the Belfast Health and Social Care Trust contact the Wig Fitting Team at the Macmillan Support and Information Centre by:

    Telephone: 028 9063 8979 or 028 9592 2070

    Email: cancer.info@belfasttrust.hscni.net

    Drop In to Our Centre: 77-81 Lisburn Road, Belfast,BT9 7AB.

    Discomfort on swallowing, Loss of Appetite and Weight Loss

    If the neck or chest is part of the body being treated, the oesophagus (gullet) may become inflamed causing discomfort on swallowing.

    Sometimes patients can also lose their appetite during their treatment but stress and anxiety may also affect appetite.

    Patients should tell a radiographer of any weight loss and loss of appetite as they can make referrals to support services.

    Read more information on healthy eating and building up your diet

  • After Radiotherapy

    On your last day of radiotherapy you should be given a leaflet called “Information for patients who have completed a course of radiotherapy”. Please ask one of your treatment radiographers if you need more information about this.

    After you finish radiotherapy treatment it may take a number of weeks before some of the side effects settle down. Your doctor will be arranging to see you at regular intervals. You will be sent a review appointment in due course.

    Please check your appointment letter very carefully as your appointment may not be at the Belfast City Hospital. This review appointment allows the doctor to see how you are after finishing your radiotherapy treatment

  • Additional Information

    Inpatient advice

    All planned radiotherapy patients are advised to attend Level 3, Cancer Centre and report to reception by 3pm. The Patient Flow Team, or Level 3 Receptionist, will let the patient know as soon as a bed becomes available.

    There is a waiting area with tea and coffee making facilities and the buzzer also works anywhere in the hospital grounds e.g. the coffee shops, dining room or car parks. Staff at the reception should be told if a patient is leaving the waiting area.

    When ready, the nursing team will take the patient into the assessment area and talk them through the admission procedure.

    Inpatients receiving radiotherapy are collected from the ward by a porter and taken down to the Radiotherapy Department where they receive treatment.

    General information about the wards in the Cancer Centre

    • Open visiting is only on wards 2B, 3A and 3B. Ward 2A visiting is from 1pm onwards. Children under 12 years should be supervised at all times.
    • If your friends or relatives have flu like symptoms or are suffering from vomiting or diarrhoea they should contact the nurse in charge before visiting.
    • There are telephones and televisions at each bed which are operated by Patient Line, payment cards are available on level 2.
    • Staff should be informed if a patient is leaving the ward for any reason.
    • If you or your next of kin wish to speak to a doctor please ask your nurse and they will organise this for you.
    • Patients should bring a list of all their current mediation, there is no need to bring the tablets. If the tablets are brought they will be sent home or kept with nursing staff for safe keeping.

    Toilet facilities

    • 1 either side of the Treatment Reception desk
    • 1 beside the Portering Station
    • 2 at the back of the Radiotherapy Reception waiting room
    • 2 at the entrance to the Radiology corridor, past main front Reception

    Glenview Accommodation

    Glenview is a bed and breakfast facility (open Monday to Friday, it is not opened on Bank Holidays) for people who are self caring and have long distances to travel for treatment.

    A second bed is provided in each room to enable a relative to stay but they must be over 18 years and self caring. There will be a charge for relatives using these facilities but there is no charge for patients.

    There is an assessment criteria for patients wishing to stay in Glenview, this assessment will be carried out by the radiotherapy nurses, suitable patients will be placed on the waiting list for a bed.

    Transport

    If transport is needed for the first appointment patients should contact their GP to arrange this. Any patients who are unable to arrange daily transport for their treatment should let a radiographer know. Transport will either be in the morning or afternoon depending on where a patient lives. A carer may be booked on with a patient if required. However, this space cannot be guaranteed.

    • For morning transport patients need to be ready by 8.30am.
    • For afternoon transport patients need to be ready by 12.30pm.

    Patient Information Evenings

    The process of radiotherapy can be a tough one for patients to explain to their loved ones – masks, leaves of lead, and lasers must conjure up all sorts of images.

    Radiotherapy Patient Information Evenings aim to improve patients’ and carers’ overall radiotherapy experience, drawing attention to sources of help and support available to them, and reducing overall levels of anxiety. They demystify radiotherapy for relatives and carers who otherwise would not have access to parts of the journey, such as seeing the inside of a treatment room.

    Supported by Friends of the Cancer Centre, the open evenings are a team effort. Cleaners, receptionists, pre-treatment and treatment radiographers, managers, and other AHP’s (both internal and external) all play a vital role in supporting and facilitating the radiotherapy patient information evenings. Our management have demonstrated their on-going commitment by facilitating time-in-lieu for those staff involved.

    We hope it shows that we value the patients and their carers as the most important members of our team.

    The evenings are held on the 3rd Tuesday of each month at 7pm and usually last just over an hour. In the event that the 3rd Tuesday falls on a Bank Holiday, the open evening will take place on the 4th Tuesday.

    GP open evening pilot – under development

    The main aim behind this project is to raise awareness of radiotherapy with GPs, many of whom will have no understanding about radiotherapy, its process or what a radiotherapy machine might look like. It is another means of sharing our knowledge, using a team approach, to help alleviate patients’ anxiety wherever possible.

    The idea came about through our monthly patient information evenings where a relative, who was a GP, said he found the experience invaluable, not just personally but professionally.

    We are currently developing our format and defining our pilot group and hope to can run a pilot evening during the first half of 2017. If all goes well it is hoped this will be a regular event.