Radiotherapy

 

“Quite a few of our ladies reported being taken by surprise at how they felt during the two or three weeks after treatment ended”

 

Radiotherapy is used to kill and control malignant cancer cells and is often given after surgery and/or chemotherapy in the treatment of breast cancer. It is also used in treating secondary breast cancer that has spread to other parts of the body. Not all breast cancer patients are given radiotherapy, but for those who do need it, we hope our summary may be useful.

 

    While we don’t want to worry women who are coming up to radiotherapy treatment, most of our group members agreed that knowing as much as they could about what’s to come is helpful in managing anxiety. Preparing and being aware of what may happen can feel overwhelming, but we would like to stress that for many, radiotherapy is a simple and effective treatment that causes very few problems.

 

    Occasionally we hear of radiotherapy teams not recommending the use of a moisturiser on the affected area, but most do suggest regular moisturising to help prevent the skin becoming too dry and irritated. Pure, perfume-free creams and lotions are best and 100% aloe vera gel is also a popular choice. Many women are told not to wear deodorants or perfumes during treatment.

 

    The most gruelling part of this treatment may be the daily treks to the hospital, as radiotherapy is most commonly delivered 5 days per week for a number of weeks. Although this timeline has changed a bit since the pandemic, with many of us receiving more concentrated doses in order to reduce the number of appointments. For women who don’t live near a hospital this is a very tiring time, with long drives or journeys by public transport adding to the fatigue that is commonly induced by the treatment itself. Machines appear to break down regularly, causing long waiting times, and many hospitals make appointments day by day which makes planning ahead difficult.

 

    Keeping well hydrated during treatment is recommended. Doing gentle exercise to keep the arms and shoulders moving is also encouraged as flexibility will help patients to lay still, in the same position every day, while the radiation is accurately targeted. The set-up appointment is often quite lengthy – this is when the machine settings are recorded. Women will often have a number of tiny dot tattoos to assist with lining up the machine each time they attend. Some women have to hold their breath while the radiation is applied to avoid damage to the heart and lungs, and many report that this is very difficult. A few practice runs are usually offered which is helpful for those daunted at the thought of this. However, we want to reassure you that it is do-able, even if it feels challenging. 

 

    Some women experience very little skin irritation from this treatment, others will find that their skin remains darker for some time afterwards. The burning effect can be quite severe and can last for a week or two after treatment ends. This is often the time that tiredness kicks in. In a lot of cases, radiotherapy will be the last stage in active treatment, and many women reported feeling flat and exhausted at this point. Good advice is not to book a holiday or strenuous activity directly after the end of treatment - a quiet recovery period might be preferable, with plenty of rest and hydration. On the other hand, many women reported sailing through radiotherapy, with many continuing to work and take part in their regular daily activities. 

 

    Until we are undergoing treatment, there is no real way of telling how it will affect us. Quite a few of our ladies reported being taken by surprise at how they felt during the two or three weeks after treatment ended. It seems that their medical teams were not good at warning them about this. Several say that had they known, they would have planned more rest, used more cream, drank more water, and so on.

    Post treatment problems may include costochondritis (inflammation of the ribs), sore itchy skin, tightness and stabbing pains. The radiotherapy penetrates deep inside the body so there is a huge amount of invisible healing going on as well as that which is visible on the outside.

    

    Radiotherapy for secondary breast cancer brings its own set of problems as areas other than the breast, underarm and neck are targeted. Examples include treatment to the throat, which can cause issues with eating, and radiotherapy to the brain, which can cause hair loss (often a mask has to be worn while the treatment is administered, which can be uncomfortable). Other side effects may be muscle weakness, diarrhoea, and memory impairment. It is often delivered as part of a complex treatment plan which will be individually tailored. For these women, treatment is ongoing for life.

 

    The emotional impact of radiotherapy can be difficult, as we tend to hear the phrase ‘radiotherapy is a doddle compared to chemo’ bandied around a lot. Some women found lying on the machine table undignified, particularly with male radiographers and some insensitive female ones, too. Most reported having kind and considerate nurses, though, who were understanding and supportive.

 

    Many women spoke about building in little treats to get them through the treatment, like coffee and cake on the way home, a chat with a friend, an afternoon nap, or watching a film. Behaving towards ourselves with kindness always makes a tough time a little easier.  It’s ok to find it hard, especially when we have been given so much to cope with already - getting through those weeks can be a real mental challenge.  Just try to relax, breathe and take one day at a time, knowing you are not alone and we all understand.