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   a guide for patients
    and their families
   This booklet is the result of collaborative working
   between the Information Services for Black and Ethnic
   Minorities project at the Christie Hospital and Central
   Manchester Cancer Information and Support project
   at Central Manchester and Manchester Children’s
   University hospitals. The project leaders would like to
   thank the following groups and organisations for their
   advice and support in the production of this booklet: -

   The steering group of the Christie project

   Christie Hospital Patient Information department

   Christie Hospital working group looking at patient

   The New Opportunities Fund for providing funding

   This booklet is the copyright of the Christie Hospital
   NHS Trust

You’re on radiotherapy.
Feeling low, tired and sick?
You may be entitled to Disability Living Allowance
(for under 65s) or Attendance Allowance (65+)
This booklet is to tell you about radiotherapy.
The Christie Hospital is a specialised centre for
radiotherapy, and patients come for treatments that
are not available at general hospitals. If you are having
radiotherapy as an inpatient, please bring this booklet
with you.

This is a general introduction to radiotherapy. If you
would like more detailed information about your own
treatment, please ask the staff.

You may have heard about radiotherapy from people
you know, or from the patients in the hospital. Their
information may not apply to you. There are Christie
information leaflets and booklets listed on page 21.
Your referral to the Christie
A new booking system has been introduced for people
who are referred from their local hospital to the Christie
for radiotherapy. The staff will give you a leaflet
explaining what you should do:

■ telephone the Referral and Booking Information
   centre (0845 609 9876) two working days after your
   appointment with the Christie doctor at your local
   hospital to confirm your referral and discuss future

■ when the call is answered you will hear an automated

■ if you have a touch-tone phone, enter 80 to be
   transferred directly to the Christie Booking office-if
   you don’t, please wait for the operator to connect you

■ all calls are charged at a local rate

            Please note
            Mobile phones interfere with the treatment
            equipment. Do not bring them into the
            Radiotherapy Department. If you do have
            one with you, check that it is turned off!
what is radiotherapy?                  2

your first visit to the department     3

consent to treatment                   3

treatment preparation                  4

mould preparation                      5

your treatment                         5

some questions about treatments ....   8

what can the staff do to help?         12

side effects from treatment            13

what can you do to help?               16

appointments                           18

after care                             19

information                            20

    what is
    Radiotherapy is the use of exact, carefully measured
    doses of radiation to treat diseases. It is used to treat
    a wide variety of conditions including cancer, thyroid
    disorders, some blood disorders and certain types of

    The type of radiotherapy that most patients have is
                                x-ray therapy, where a machine
                                directs high-energy rays to the
                                precise area affected by your
                                illness. The rays are used only
                                to treat the affected area in
                                the body.

                                While not all machines look
                                alike, they all work in a similar
                                way. In fact, these machines
                                are just more powerful
                                versions of the x-ray machines
                                that are used to take pictures
    of chests, broken bones and so on.

    Radiotherapy is often given in several small doses over a
    specified period of days or weeks, but may be given in a
    single treatment.

    The staff who operate the radiotherapy machines are
    therapy radiographers. They are neither doctors nor
    nurses, but specially trained men and women.

your first visit to
the department
The medical specialist who will look after you is a clinical
oncologist. He or she will examine you and may arrange
for tests such as x-rays, scans and blood tests. These are
to check your general health, and to help decide on the
details of your treatment.

A team of doctors - consultants, registrars and senior
house officers - will care for you. This team will not
necessarily include the doctor who saw you first of all, but
one consultant will be responsible for your treatment.

In choosing your treatment, your doctor at the Christie
has carefully considered the nature of your illness,
and your particular needs. Once treatment has been
agreed with your clinical oncologist, we will list you for
treatment, and we will send you an appointment for
treatment preparation.

The preparation for treatment takes some time - in
some cases it may take up to 2 weeks or more. It is time
well spent, as the treatment is being tailored to your
particular needs.

 Consent to treatment
 The doctors, clinic nurses and specialist radiographers will normally give you some
 written information to back up what they have said about your treatment. At the time
 your treatment is being planned, you will have a further opportunity to discuss anything
 that you do not understand, or any anxieties you may have, before you actually start.
 For some radiotherapy treatments, you may be asked to sign a consent form agreeing to
 accept the treatment that you are being offered. The basis of the agreement is that you
 have had the Christie’s written description of the proposed treatment, and that you have
 been given an opportunity to discuss any concerns.

                   Treatment preparation may be done on a
                   special x-ray machine called a simulator
                   (see left) or on a C.T. Scanner (see below).
                   Often, purple marks are put on your skin
                   with a special pen so that x-rays can be
                   focused accurately. The marks may rub
                   off a little onto clothing. Do not worry too
                   much if they do - they will wash out -but it
                   might be sensible to wear older clothing.
                   The radiographers will explain how you
                   can keep the treated area clean, and will
    tell you when you can wash the marks off. During the
    preparation stage the marks may be visible if you are
    having your head, neck or chest treated, so you may
    want to bring a scarf with you.

    Once the treatment is planned, tiny permanent marks the
    size of a pinprick are made on the skin. The purple pen
    marks will gradually fade away.

mould preparation
It is sometimes necessary to have a plastic mould to fit
the treated area (head, neck or hand). The mould helps us
to ensure that the treatment is delivered accurately each
time. Treatment marks are put on the mould so it is not
normally necessary to put marks on your skin. As part of
the preparation for the mould, you will need to attend the
hospital several times before your treatment can start.
The number of visits depends on the type of mould you
are having. Different types of moulds are used for various
treatments and the Mould Room staff will explain the
procedure when you come for your first visit.

your treatment
On the day of your first treatment, you will come to
the Radiotherapy department. If you are an inpatient,
you may be collected by a male or female therapy care
assistant. They wear white uniforms
with red epaulettes or red trim.

You may have already visited this
department as part of the preparation
for treatment, and met some of the
therapy radiographers. They are easy to
recognise in their white uniforms with
maroon epaulettes (males) or maroon
trim (females). The radiographers will
be giving you the precise treatment

    prescribed by the doctor. They will explain to you what is
    going to happen before they take you into the treatment

    You may be asked to change in a cubicle or to remove or
    loosen any clothing that covers the area being treated.
    You will also need to remove jewellery from the area being
    treated. The radiographer will help you onto the treatment
    bed and will then adjust both the bed and the machine to
    the exact positions that are needed. They will try to make
                        you comfortable as you will be asked
                        to keep as still as possible for a few
                        minutes during treatment.

                        The radiotherapy machines are quite
                        big, and if you have never seen
                        them before, you might feel anxious.
                        But there is no need to worry - the
                        treatment is absolutely painless. It
                        is just like having an x-ray picture
                        taken. The treatment only lasts a
                        few minutes. However, the treatment
                        session may take about 15 minutes,
                        allowing time for changing and the
                        machine to be set up.

                        The therapy radiographers operate the
                        machines from outside the room. When
                        all the adjustments have been made,
                        they will leave the room while you have

your treatment. It is the only time you will be alone, but
even then, the radiographers will be watching you carefully
on a closed circuit television system . If for any reason
you need them, just wave your hand to them and they will
interrupt the treatment and come in to you immediately.

Some people are worried that they will be completely
enclosed by the machine - this will not happen. The
overhead section of the machine can rotate, but nothing
will press down on you. Most machines make a buzzing
noise when they are operating. This is how you will know

                                                               ❝ I was the
when the treatment is happening.

After a few minutes, your treatment will be over for that     amazed at
day. This routine will go on each working day until your       simplicity
course of treatment is finished. The prescribed radiation        of the
dose and the number of days over which it is given varies
between patients. There is not normally radiotherapy
treatment on Saturdays and Sundays, and this is taken
into account when your treatment is planned.

The radiographer will give you
information about who to contact
if you have any problems during

Your treatment appointment time
may vary from day to day for a
variety of reasons. Please discuss
this with the therapy radiographers
on your treatment unit.

                some questions
                about treatments
                Will it hurt?
❝    I was
surprised how
                No. You will feel no pain at all while you are actually
                having your treatment.
  quick and
   painless     How does it actually work?
    it was      Our bodies are made up of cells, and all cells have the
                capacity to divide. If radiation hits a cell that is dividing,
                it will be damaged. The radiotherapy destroys the cancer
                cells in the treated area. Although normal cells are also
                affected, they can repair themselves more effectively
                than the cancer cells.

                Will I lose my hair?
                Not unless your head is being treated. You may lose
                          body hair in the area being treated and this
                                           hair loss can sometimes begin
                                              during and after treatment.
                                              But it usually starts to grows
                                            back some time after treatment
                                         is finished. Wigs are available
                                    through the hospital, if needed. Loss
                of hair happens more often with chemotherapy (drug
                treatment), and even then, it does grow back.

                Is it safe?
                Uncontrolled radiation can be dangerous but radiation
                used in medical treatment is given in controlled, carefully
                measured doses. The aim is to treat the illness without
                harming the patient.

Will I be radio-active?
No. Patients treated by x-rays do not become radio-         ❝ Not as as
active. The radiation does not stay in your body after
treatment, so you cannot do anyone else any harm. It
is perfectly safe for you to mix with other people and to
have visitors if you are on the wards.

However, as some people are treated with radio-active
substances on the ward, there may be some restriction
on visiting patients on the ward. Pregnant women should
always check with the ward sister before entering the
ward. For the same reason, children are not encouraged
to visit the wards. Patients who are fit enough can
meet their families in the Oak Road foyer or in the
conservatory and gardens.

I already have problems with my health.
Will radiotherapy treatment make them
No, but some health problems such as diabetes, need
to be monitored more closely during radiotherapy. Ask
your doctor if you are worried about any other health

If I have to stay in hospital, can I
go home for the weekend?
Yes, if your doctor thinks that you are well
enough, but you must make your own
transport arrangements to go home and

     come back to hospital. At the present time on Oak House
     ward you can go on weekend leave after your treatment
     on Friday, and return in good time for your treatment
     on Monday - the ward re-opens at 7.30am on Monday
     morning. The times of weekend leave vary on other
     wards, so please check with the nurse in charge of the
     ward about the time you need to return.

     As an inpatient, when will I have my
           The radiographers will give you a leaflet on
               your first appointment at the radiotherapy
                 department, explaining how many treatments
                    you will have and the date of your last
                      treatment. Unfortunately, they cannot
                     always give you an exact appointment
                    time for the next day’s treatment, but
                 you will be told whether this will be in the
             morning or afternoon. They will give you an
         appointment time whenever possible.

     If you have a morning appointment please stay on
     the ward until after your treatment, but if you have an
     afternoon appointment you may leave the ward in the
     morning. You must check with your ward sister first.

     Can I be treated as an outpatient?
     Yes, if you live within travelling distance, if your doctor
     thinks you are well enough. Some people continue to

work, but you may find it difficult to go out to work, run
the home and cope with treatment as well. After daily
travel and treatment, you will almost certainly feel tired
and need to rest. Space in the waiting area is limited,
please only bring one person with you.

Can I get transport to the hospital?
If you are unable to use public transport and have no
other means of travelling to the hospital, you may
be able to use hospital transport. This has to be for
medical or social reasons. If you have not attended the
Christie hospital before and you need transport, your
GP can arrange your transport for your first visit. For
following visits you should book your transport
at the Ambulance Transport desk located in
the Outpatients department at the hospital.
You may bring one other person with you if
your GP or the hospital thinks that there
is a medical or social reason for this.
However if you have to be kept in hospital, the person
who travelled with you to the hospital will have to make
his or her own way back home.

You may be entitled to help with travel costs. Ask at the
Post Office or local DSS for leaflet HC1 ‘Help with health
costs’. Other financial help may be available through the
Christie social work department.

If you live too far away to travel daily but you are
otherwise fit, you may be allocated a bed in Oak House,

     our hotel ward, if space is available. Here, as on most
     wards, you will be able to wear your own clothes and can
     go out, once you have had your treatment for the day.
     Check with the nurse in charge before you leave the ward.

     Can I be treated early on a Friday?
     No, unfortunately we cannot guarantee this, as other patients
     would like an early appointment too. If this is going to cause
     you serious difficulty, please speak to the radiographers.

      If you are being treated as an outpatient, you will
      have to pay for your prescriptions unless you are
      exempt. If you think you will need more than 5 items
      in the next 4 months, you will find it cheaper to buy a
      season ticket. Ask for details at the Christie pharmacy

     what can the staff
     do to help?
            It is part of the staff’s job to help you through
            any side effects you may have. If you feel
            uncomfortable in any way, do mention it to the
            doctor, the nurses or the radiographers. They all
            want you to be as comfortable as possible.

            Please remember, do not hesitate to ask the staff
            if you have any problems or concerns - however
     trivial these may seem.

side effects from
Side effects from radiotherapy vary. Some people have
hardly any side effects, even though radiation is a strong
treatment. Any side effects you get will depend on
which part of your body is treated, and on the number of
treatments you have. You will be given information about
possible side effects for the specific areas being treated.
Even people who have had very similar treatments can
have different side effects.

You will probably notice the side effects during the
second half of your course of treatment. These may well
continue after you have finished your treatment, but they
should gradually fade over the first 4 to 6 weeks.

Common effects of radiotherapy
Sore skin:
The skin can become red, sore or
itchy in the treatment area. Some
people describe the soreness
as being like sunburn. This will
depend partly on the type of machine that
you are treated on. Ask the radiographers for
advice, as it is easier to minimise any reaction if we look
after the skin early on.

This also depends on which part of the body has been
treated. If you do experience sickness please tell the
radiographers - you may be prescribed medication.

     You may feel a sense of fatigue or have less energy
     during and after your course of treatment - just as you
     would when recovering from an operation. You can help
     yourself by taking time to rest and relax. Do rest before
     you get tired. Do not be afraid of asking family and
     friends for help. Some patients find that it helps to have
     a short rest each day after having their treatment.

     Difficulty with swallowing:
     Radiotherapy to the head and neck area or upper
                 chest can cause a temporary difficulty with
                       swallowing. Tell your radiographer if
                        you are having problems - you may
                        need medicine to help with this.
                         The booklet ‘Eating: Help Yourself’
                         has useful advice on eating when
                         swallowing is difficult. (This booklet
                        is only available in English)

     Stiffness of joints and muscles:
     Radiotherapy can cause tightness of muscles and
     stiffness of joints. There may also be swelling and
     soreness in the treated area during and immediately after
     your course of treatment. If you are concerned about
     any of these problems, please contact the Physiotherapy
     department on 0161 446 3795.

The Physiotherapy department runs exercise classes for
patients having radiotherapy to the breast area
and a general exercise class for inpatients having
lengthy radiotherapy treatment. There is also a
weekly relaxation class in the Rehabilitation
Unit which is open to all patients. For further
details phone 0161 446 3795.

Late or permanent reactions
It is possible for some types of reaction to occur months
or years after the treatment has finished, although this is
less common these days because of recent improvements
in treatment. Your doctor at the Christie will discuss
any possible late effects with you, and give you further
written information about them if they are at all likely to

Other side effects may appear, depending on the part of
the body that has been treated. The radiographers will
tell you what to expect. If you have any queries after your
treatment, before your follow-up appointment you can
ring the Radiotherapy department on 0161-446 3485 and
ask to speak to a radiographer.

 Radiotherapy can also affect the heart and lungs. There
 is also a small increased risk of a second cancer. If this
 applies to you, your doctor at the Christie will discuss
 this with you in full.

     what can you do
     to help?
     ■ Do not use any moisturisers, make-up, deodorants,
        perfumed soap or talcum powder on the part of your
        skin which is being treated . Only use creams or
        ointments that have been prescribed by your doctor.
        Men should not use pre-electric or aftershave, if they
        are having treatment to the face or neck. Johnson’s
        baby products and Simple soap are safe to use. Keep
        on using unperfumed toiletries whilst your skin is

     ■ Wash the treated skin gently with warm water, and
        pat dry with a soft towel.

     ■ As far as clothing is concerned, wear something loose
        and comfortable. Cotton is best next to the treated
        skin - better than man-made material.

     ■ Men who are having part of their head, face or neck
        treated will be advised not to wet shave. Check this
        with the staff when you come in to hospital. Please
        remember to bring an electric razor with you.

     ■ Keep the area of skin that has been treated away
        from direct heat, such as sunlamps, hair-dryers and
                direct sunlight. You should take extra care of
                  your skin during treatment and as long as the
                  reaction lasts. Your skin may always be more
                   sensitive, so you may need to take extra
                  care in the sun, even after your treatment has
            finished. You can use high protection factor sun-
        cream on the treated area.

■ Drink plenty of fluids - for example, water, tea, cool
   drinks, milk. Take nourishing fluids such as Complan
   or Build-up, if your appetite is poor. Some special
   meal replacement drinks are available on prescription
   - ask the dietitian or your GP for more information.

■ Eating difficulties - for more information about
   nutrition ask for a copy of ‘Eating: Help Yourself’.

           For more information ....
     You may have particular queries that are
    not answered here. Please do not hesitate
                to ask the staff.

     relatives and
     Please share this booklet with your family and friends. It
     is important that they feel well-informed and understand
     what is happening. Families and carers can have a role
     in helping you. There are also videos on radiotherapy
     in Bengali, Gujarati Hindi and Urdu. You can borrow the
     videos from the Cancer Information centre.

     Once you are having treatment, if you have problems
           with your appointment please contact the
             Radiotherapy Department at the Christie as soon
                 as possible. Ring 0161-446 3485 or 3500. It
                   is helpful if you can quote your hospital
                   number - it will be on your appointment
                  card or letter.

            If your follow-up appointment is inconvenient,
     please contact the Health Records Manager on 0161-446
     3346 or 3347. Or you could write to The Health Records
     Manager, Christie Hospital NHS Trust, Withington,
     Manchester M20 4BX. If you do write, please make
     sure that your letter arrives well in advance of your
     appointment, as this will make it easier to arrange
     another appointment for you.

     If you change your address, please let the Health Records
     Department staff know your new address - and the
     address of your new family doctor.

after care
Inpatients should be able to go home as soon as
their course of treatment is finished, or very shortly
afterwards. The Discharge Planning Team will arrange for
a district nurse to visit you at home, if this is necessary.

After you have finished your treatment, you will be told
the arrangements for your first follow-up visit to an
outpatient clinic. This visit is for the clinical oncologist
to see how the treatment is working and how any side
effects are settling down. Most patients continue to be
followed up at an outpatient clinic for several years.

Some people go back to the Christie for their follow-
up visits. Other people go back to a hospital near their
home, where they will usually see a visiting
Christie doctor. It may be possible to choose
the arrangement that suits you and your

If you have any problems before you are
due for your first visit back to the hospital, ask your
family doctor for advice. If you were an inpatient you
could also ring up your ward at the Christie and speak to
a senior nurse. If you have any problems after your first
outpatient visit, contact your family doctor straight away
rather than wait for your next appointment. Your doctor
may want to arrange an earlier one.

     Information Centre
     A wide range of free information about treatment and
     support services is available to you, your carer and family
     member at the Cancer Information Centre. The booklets
     are produced by CancerBACUP, Britain’s leading cancer
     information charity, by the Christie Hospital (page 21)
     and by local support groups. A CancerBACUP nurse is
     there to help you find the information you need.

     The centre is usually open Monday to Friday between
     10.00am and 4.00 pm, but please telephone before
     making a special journey. The Information centre
     telephone number is 0161 446 8100, and the
     CancerBACUP freephone number is 0808 800 1234.
     CancerBACUP also offers a telephone interpreting service.
     When phoning the freephone helpline number 0808 800
     1234 let the nurse who answers know what language you
     need. Or you can telephone one of the freephone numbers
     below, which will put you through to an interpreter who
     will then connect you to a CancerBACUP nurse.

     CancerBACUP booklets:
         ■ Arabic ___    freephone   ____   0808   800   0130
         ■ Bengali ___   freephone   ____   0808   800   0131
         ■ Cantonese     freephone   ____   0808   800   0132
         ■ French ____   freephone   ____   0808   800   0133
         ■ Greek ____    freephone   ____   0808   800   0134
         ■ Gujarati __   freephone   ____   0808   800   0135
         ■ Hindi _____   freephone   ____   0808   800   0136
         ■ Polish ____   freephone   ____   0808   800   0137
         ■ Punjabi ___   freephone   ____   0808   800   0138
         ■ Turkish ___   freephone   ____   0808   800   0139
         ■ Urdu _____    freephone   ____   0808   800   0140
         ■ Vietnamese    freephone   ____   0808   800   0141

Christie hospital
The Christie hospital produces a range of patient
information booklets and videos, which are free to patients
attending the Christie. At present all the information is
only available in English except for one booklet in Chinese
and Urdu which list support organisations and information
for Black and Ethnic Minority patients at the Christie
Hospital (This booklet is also available in English).

Listed below is a selection of information available. If
you are an in-patient and you would like a copy of any
of the booklets please ask the ward staff. If you are an
outpatient please ask your nurse, doctor or radiographer.
■ Videos: ‘Radiotherapy to the head and neck’ &
  ‘Radiotherapy: a guide for patients and their families’
  Videos can be borrowed to watch at home. Ask on the
  ward, the staff in outpatients or Radiotherapy Department.
■ More detailed information on treatment and side effects
  is available for: radiotherapy to the pelvis for urinary
  tumours, gynaecological and bowel tumours; radiotherapy
  after breast surgery and radiotherapy to the head and neck.
■ Where to get help: services for people with cancer
  Discusses sources of help when you have cancer, where to
  go for financial help and cancer support groups.
■ Chemotherapy: a Christie Hospital guide
  Information about what chemotherapy is, how it is given
  and how to cope with side effects.
■ Eating: Help Yourself
  Gives advice on eating problems when you don’t feel well
  and you are having treatment. “Advice about soft and
  liquid foods” and “Nutritional supplements” also give
  helpful advice on diet.
Patients, relatives and carers are welcome to visit the
Cancer Information Centre on the glass link corridor for
booklets and information.

     Christie website
       Many of the Christie booklets and a list of UK
            help groups are available on the Christie
             website, the address is below.

             You can also access other patient
               information sites in the UK such as
                   CancerBACUP and Cancerhelp UK via
                    the Christie website.

                  Christie Website

The quotes about treatment in this booklet come from patients who had
                 radiotherapy at the Christie in 1999


              Visit the Cancer Information Centre
          on the glass link corridor near Oak Road
                      Open: Monday to Friday
   Opening times can vary, please ring to check before making a special journey

           Tel: 0161 446 8100 Email:

Christie Hospital Patient Information Service - February 2004
 Tel: 0161 446 3000

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