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Rad Chat is a forward-thinking global knowledge hub where healthcare professionals can advance their knowledge and expertise in radiotherapy and oncology by utilising the award winning, first therapeutic radiographer led oncology podcast and social media channels.
We're empowering healthcare professionals worldwide by providing free, CPD-accredited radiotherapy and oncology education, by sharing real-world experience, expert insights, best practice and patient perspectives, we're helping healthcare professionals’ advance cancer care and improve patient outcomes.
Naman Julka-Anderson (00:00)
Hello everyone and welcome to Rad Chat, founded by me, Naman Julka- Anderson.
Jo McNamara Rad Chat Host (00:04)
and me, Jo McNamara. So Rad Chat is a forward thinking global knowledge hub where healthcare professionals can advance their expertise in radiotherapy and oncology. Unlike traditional academic resources, we blend real world experience, expert insights, best practice, and of course, most importantly, patient perspectives.
Naman Julka-Anderson (00:23)
We make advanced knowledge engaging and accessible, supporting continuous learning and professional development without compromising patient care or personal time. By providing insights into both technical skills and career development, helping you progress confidently in your field and shape your professional future.
Jo McNamara Rad Chat Host (00:39)
Just to let you know, our episodes may contain sensitive and difficult topics that you may find distressing or triggering.
Naman Julka-Anderson (00:47)
This is episode 200, which is part of our Living Within Beyond Cancer series, where you'll be hearing from us talking about all things side effects of radiotherapy. Hi Jo, how are you?
Jo (00:58)
Hello, yeah, good thank you. How are you doing?
Naman Julka-Anderson (01:01)
All good. So tell us why do patients get side effects from radiotherapy?
Jo (01:07)
Okay, so I think before I jump straight into that, it is really important to kind of recognise that for today's episode, if you're listening as a patient or someone who knows someone going through radiotherapy, please do always check with your healthcare professionals. Naman and I, obviously as HCPC registered therapeutic radiographers, are really mindful of the fact that everyone has different experiences going through radiotherapy.
And this is very informative, largely directed because it's a CPD episode at our healthcare professionals. But we absolutely know that patients listen to these podcast episodes and it's important that they do recognise that, you know, everyone experiences radiotherapy and cancer treatments differently. So please do have a look at your consent form, see what radiotherapy side effects have been talked to you,
about and also consult with your radiotherapy team or your oncology team if you're at all worried about any side effects. But this episode is great to kind of get in to the nitty gritty and maybe remind any RTTs or therapeutic radiographers listening what happens at a biological level and also for those who are working in oncology who maybe don't know so much about radiotherapy, doing a little bit of a deep dive into
kind of what is happening ⁓ biologically as a consequence of radiotherapy. So to answer your question, sorry, you said I was gonna talk a lot, I always do, I apologise. When we talk about radiotherapy side effects, one of the big side effects that I've observed patients talk about and that the literature suggests is fatigue. And I think...
it's very much under reported. I don't know about you, Naman, but a lot of patients kind of say, I feel really tired and almost anticipate that they can't complain about that because maybe it's not as severe as other side effects or they don't even recognise that it is fatigue. And so I think a lot of patients do under report fatigue. Is that something that you've experienced in clinic?
Naman Julka-Anderson (03:10)
Yeah, I think so. And there's a difference between tiredness and fatigue as well. I think tiredness from having been on a run or something compared to fatigue, which lingers a bit longer is something we try and get across to patients.
Jo (03:23)
Yeah, absolutely. often as healthcare professionals, we kind of link the psychological or the lifestyle issues around fatigue. But actually there's a lot going on inside at a cellular level as a result of the ionising radiation. So radiotherapy uses very high ionising radiation. And essentially what's happening is you are creating single and double strand DNA breaks,
and that generates a reactive oxygen depletion within cells and that in itself causes a lot of cellular injury. So when we cause radiotherapy damage, essentially what happens is you create an inflammatory response and that can lead to then lots of systemic release of cytokines and that in itself can also affect the central nervous system and also
things like hypothalamic sleep regulation. It can also affect energy because of the fact that you're affecting things in the cells like the mitochondria, ATP production, you know, that kind of biological impact is all significant and contributing to this fatigue. So our body's going through an awful lot. We also have to recognise that for some people,
we might be treating areas that are actually marrow rich areas. So that actually means that, you if we're treating the spine or the pelvis or the sternum, actually there's going to be an element of subclinical bone marrow suppression, which can then affect red blood cell production. And that in itself can then cause fatigue as well. So there's lots of cumulative factors that can actually contribute to fatigue.
But it is really important, I think, to kind of talk to patients about the biological effects of radiotherapy. I know talking to colleagues, one of the big things that they always stress is just the time limits that radiographers, oncologists get to kind of spend and talk to their patients. And for any students listening, you know, this is important for you to recognise you probably get more time with patients. And talking about some of these biological effects can really help,
actually put into context why patients are experiencing what they're experiencing and reassure them if anything. You know if we kind of say yes fatigue you're going to feel more tired than usual it doesn't necessarily give people enough detail I don't think and to kind of understand and appreciate just what's going on inside the body. I suppose as well when we talk about side effects it's thinking about the fact that
for radiotherapy, it's an accumulation. So they won't necessarily feel fatigue straight away, but I certainly do know that some patients have reported that. And again, people react so differently with radiotherapy. I think some of the research now is starting to look at some of the genetic predisposition that people have as a response to radiation. And it's important to kind of not tar everyone with the same brush of,
you know, it'll be two weeks before you experience anything. It's not the case. And especially with dose and fractionation changes, when I start to think about some of the dose and fractionations that I used to deliver when I was fully clinical, that's vastly different now. So if you're, you know, my generation of radiographer and you're still talking to patients about when they are likely to experience side effects, we need to be mindful of those changes in dose and fractionation and how that can also impact
on some of these side effects that patients are likely to experience. So, you know, there's lots of inflammatory and metabolic processes that are happening at a biological level that is essentially why people will develop side effects such as fatigue. So, numbing. If we kind of then start to think about specifically, you know, common side effects.
and maybe who manages them from a patient's perspective, who are they likely to come into contact with and what kind of management strategies are people going to employ to help patients.
Naman Julka-Anderson (07:33)
Yeah, I'd like to point out the huge MDT, so the multidisciplinary team that we get to work with, but biased as I am as always, therapeutic radiographers are the best. We are the people to talk to you about radiotherapy and radiotherapy side effects. So ideally if patients are going through radiotherapy treatment, they'd have weekly on-treatment reviews. So that might be within the bunker itself with the on-treatment radiographers who are doing the treatment itself, or it could be with a review radiographer.
sometimes an advanced practitioner or a consultant, therapeutic radiographer. We love a different title in the radiotherapy and the NHS, but ultimately it's someone who's done a little bit more training to understand what happens in the body and externally and things like that and knows how to signpost. So I've been very fortunate to do different versions of that role. And I still think it's the best because you get to spend that extra time that you don't have on a machine one-to-one or with the family and carers and really go through things in like a structured format.
So you talk about fatigue or sex and intimacy or whatever it is. But sometimes in some departments, it's not always radiography. It could be one of the clinical nurse specialists or there might be a radiotherapy specific nurse. Same skill set, slightly different education, I guess. But we all have the same common goal of wanting to help the patients get through treatment as easy and smoothly as possible. And then sometimes you might also have a non-treatment review with either a
clinician, so if that's the oncologist itself or one of the specialist registrars who are in training who are at a specialist level and know what they're doing as well, but they're not quite the oncologist so they're not fully in charge of the treatment plan, but they are able to do everything as well. And I suppose one last aspect that maybe we always forget about as professionals is also people going through the treatment. They also help manage their own side effects while we're there to help guide, prescribe, support, do everything.
A lot of it needs some buy-in as well from the person in front of you. So yes, we can give you all the tools, but you might leave the department and not do anything. I think that's something that we do find challenging because we want to be able to help. You don't want to give too much information that you overload people, but at the same time, you need that kind of collaboration and shared decision-making so we can work together to help you.
Jo (09:47)
Yeah, really important. Maybe some behaviour change management training should be standard for lot of radiographers, I think, and oncologists to kind of help get that buy-in from patients.
So what management can patients expect or for anyone who's maybe supporting patients with side effects, what things do people kind of manage? there certain specialists in certain side effects?
Naman Julka-Anderson (10:19)
Yeah, suppose it depends on the treatment site and what type of treatment. So is it radiotherapy only? Have they had surgery? Is it chemotherapy and radiotherapy? Is it immunotherapy or hormone therapies? All these different aspects that kind of play into what side effects people experience. And exactly as you said, that a lot of the things that we do to our patients from radiotherapy is a cumulative. So towards the end of treatment or if not within the two, three weeks afterwards is when people kind of experience those side effects the most.
So yeah, it depends. Maybe in the first week it might be more of a general chat. Towards the end there might be more intervention. So if we think of something called the biopsychosocial model, if I said that right, by Engle, good. I've read this so many times in lectures and talking about it as a lecturer as well, but that it's obviously the physical aspect is what we do physically to the skin reactions, impacts within internal anatomy, things like that.
There's also the psychological side. So as you touched on earlier that, you know, I'm having to go in for treatment. Is the treatment going to be on time? Is the treatment going to work? All of these other aspects that really affect someone's mental health as well, going through treatment. Then there's the social side. So maybe they haven't told their friends, haven't told their family or any of the economic aspects of it. So all of this as a review radiographer is something that I can manage. And I say manage because it could be prescribing medication. It could be...
referring to a wellbeing service or helping with some sort of grant to help financially. There's all these different aspects and I think that's why I love that side is maybe selfishly I want to be able to do everything I can to help people and not always kind of signpost on. And our CNSs, the clinical nurse specialists, will be able to do all of this at the same time. But obviously, as I said, every hospital department is slightly different with how they manage and what we can kind of get involved in. But ultimately, depending on where you are or where the person in front of you, their treatment is,
week by week or what type of treatment they're having. That will depend on what level of support might be needed. I'm sure you've had it when you've been clinical that some patients where you might anticipate they really need you, they don't need you at all. Whereas other people, they need you when you don't think or everyone's pain levels are different requirements and what's going on. And that's why it's really important to treat the whole of the person in front of you as opposed to just their cancer diagnosis.
Shall we go on to some tumour specific stuff?
Jo (12:53)
Go on then, hit me with it.
Naman Julka-Anderson (12:55)
Let's go with pelvis. Quite a big area, but what are some of the things that might affect anyone having pelvic radiotherapy?
Jo (12:57)
Okay.
Okay, so again, it totally depends on where we are specifically treating. And what I would suggest is that everyone familiarizes themselves with the RCR consent forms. They're brilliant in terms of being able to access and look at what the patients are receiving. What I would also suggest as well is to, if you have site specific interests, is to do some extra reading around those side effects.
But I would also stress, not just because we're Rad Chat, but to listen to some of the patient episodes about those site specific areas. Because although we know from the RCR consent forms what some of the typical side effects are, I actually think that I have a totally different perception now of side effects from the patient voice. So, you know,
I've experienced diarrhoea in my life and yes, it's not nice whilst you're going through it, but I think hearing from a patient who has diarrhoea for the rest of their life and that's part and parcel of them as a person and how they navigate their life now, I think is very, very different. And I think...
the perception of side effects varies significantly from person to person. think that's really important to kind of know. So I won't necessarily go through all of the side effects that people experience if they're having radiotherapy to the pelvis, but please do check out the RCR consent forms that we've linked along with the show notes to this episode. And what I would also talk a little bit about is maybe the fact that, you know,
depending on where we're treating will depend on the type of tissues that we're irradiating and the impact that they have. So as an example, if we are delivering radiotherapy to the prostate, we will typically irradiate a little bit of the rectum. And so as a result of that, patients can get radiation induced diarrhoea. And that's kind of a classic example of maybe some of the...
side effects that patients may experience as a result of the fact that we're treating tissues with a high cellular turnover and the mechanism will differ significantly between acute and late phases of those side effects as well and I think that's important to kind of recognise a lot of patients although they've signed consent forms and they've had chats with their oncologists they maybe don't really appreciate the fact that side effects can happen,
5, 10, 15, 20 years later. And similarly, we've seen patients and talked to patients about the fact that they've experienced late effects as early as a month after treatment. So, you know, there is a definite sliding scale and I think it's important to kind of recognise that as well. But typically what we find is that with radiotherapy, if we're treating in that area, we're causing apoptosis of
maybe some of the stem cells, which in itself will then shorten and impact on the whole intestines because of how things are moving through. And also what we can typically see with radiation induced changes is vascular changes. So our whole vascular system can be affected quite a lot with radiotherapy. And again, that doesn't always happen straight away.
So when we start to think about, I don't know, the bowel itself, sometimes we can affect absorption and actually we can increase the amount of secretions and that's what causes that watery diarrhoea. So, you know, there's so much that's actually happening, but I think it's important to think about the progressive vascular changes that potentially we actually cause, you know, late effects and a more severe...
side effect could be ischaemia and that's something to kind of be aware of. Also thinking about fibroblasts so we can cause fibrosis as a result of radiotherapy which again can be kind of a short late effect of radiation therapy and fibroblasts will typically lay down that collagen and that can thicken the bowel wall and reduce elasticity.
So strictures can happen, it can affect the mobility of the bowel itself and the rectum and the transit time of which you actually have for fecal matter to pass through the rectum. And so lots of damage can happen in that area. And when we start to talk about the bowels a little bit more, we can also then recognise actually it can impact quite significantly on the absorption of nutrients. So that then can have a much wider impact.
When we talk about diarrhoea, it's not really just diarrhoea, there's so much else happening. And I think that's one of the big things to kind of be aware of really. And again, you know, I wouldn't be expecting us to talk about, I don't know, crypt cells with our patients, but I think us having a good knowledge of what the biological processes are will hopefully help to explain why patients get diarrhoea or when they might get diarrhoea in the future. So.
I'm not going to go through all the side effects, but definitely please do check out the RCR consent forms.
So Naman, now head and neck specialist. What head and neck side effects can patients expect and how from a RTT oncologist perspective can we help to manage and support patients going through some of those side effects?
Naman Julka-Anderson (18:43)
Thanks. Yeah, so head and neck cancers are quite a gruelling treatment pathway. So normally chemo radiation, five, six weeks of radiotherapy, and they might even have surgery beforehand and things like that. So prehab is kind of where this really helps is making sure that a few weeks before treatment, you're able to have a full on MDT approach. So dietitian, speech and language therapist, CNS, and if possible, radiographer like me,
to be in the room so you get a baseline weight, find out what they're eating, swallowing, things like that, yeah, like you, I'm not going to go through the long list, but one of the big ones that we always talk about is dry mouth and thick mucus. So it affects the glands that make saliva. Radiation does. So ⁓ as much as we can avoid it by shielding and things like that. There's always going to be some aspects of kind of saliva production that's affected. So...
Yeah, dry mouth is something that patients struggle with during treatment, but also post-treatment, so late effects, which could be between three to six months post up to 20 plus years, exactly like you said before. But it can be temporary or permanent. And I think dry mouth is one that patients talk about as one of the really challenging late effects as well, because obviously if there's no saliva in your mouth, it's dry. You wake up in the night, you're feeling like your mouth is really dry, almost like a desert. You're not able to eat and drink properly.
Sex and intimacy is one. I can't believe Jo didn't bring that up already so far in this episode, something that hasn't really been studied enough, not having saliva, you can struggle to kiss or oral sex and things like that. These are all the big changes that unfortunately we are affecting and causing, but the mucus production is the mucus lining and stuff being irritated due to the radiation. So if you think of, for example, as a parallel of someone burnt something on the surface,
becomes a bit moist that similar kind of processes what's going on inside so down your foot in the food pipe and things like that and that mucus stick and thick normally in the mornings it's the worst so having been lying flat then people have to kind of hack it up or cough it up but that can obviously be irritated and irritable more for the throat just because of pain and stuff but yeah I dry mouth is the one that is also quite difficult to
tackle because if people are struggling with ulcers or pain in their mouth, water might not be the most important thing to put in there or trying to do a salt water rinse or any other kind of agents that we use. But it's really, important to try and look after that dryness in the mouth because it impacts the food intake and nutrition and things like that. Yeah, every time I talk about this now in the past few weeks since I've started this job, I realize I really enjoy head and neck. Such a difficult area, but ⁓
Jo (21:19)
That's
lucky.
Naman Julka-Anderson (21:22)
Yeah, I know. Obviously, duh. But yeah, it's nice. So suppose one other thing to talk about is weight loss. A lot of our patients might joke and say, oh, yeah, it's really great. I've lost a few pounds here and there due to the treatment. But actually, for head and neck cancers, it's one that we want to avoid. I'd probably say the most out of any other treatment because we use some sort of thermoplastic mask or an open face mask. And actually, we can really see the difference of any
weight loss. So yeah, when there's a gap and there's any air that's being treated, the dose of radiation that's been given needs to be changed or replanned just because of the way it's been designed. Obviously, if there's no actual kind of edge of your body there, it might be that we're overdosing some areas for some patients and maybe underdosing and things like that. that's where that prehab really is really important to get in the baseline weight, ensuring that you're having full fat ice creams, all the good stuff to keep you going.
until you start treatment and then we might have to look at different things like nutritional supplements obviously which are also quite high in sugar but high calorie whether that's through a peg or a rig tube or really and things like that and then I think something like you kind of alluded to earlier is actually even though patients finish treatment it doesn't mean that everything just stops it does continue and it can continue for some months sometimes even years for some people there are patients that I've seen or come across that
They're not able to maintain their weight fully for a few years, having still not been able to come off those high energy drinks and stuff like that. So, yeah, so much to talk about, Jo. Not enough time.
Jo (22:58)
I
I do think as well, especially with head and neck patients when potentially they're getting mucositis, it's the fact that...
potentially you're colonising more bacteria and that in itself from a biological perspective is then going to cause that inflammation. So actually it's not the radiotherapy that's causing the inflammation anymore, it's the bacteria. And so the two compounding factors can then create almost like the perfect storm. But I think as well, when we start to think about, you know, the late effects, it's important to think about the fact that for mucositis that
inflammatory cascade and the secondary biological effects are usually much later as well. So again, of elongate potentially some of the side effects that these patients are going to experience. So my empathy for...
the side effects that these patients have to experience is huge really. I think we're friends with a lot of patients who've gone through radiotherapy for head and neck cancers and seeing around how quality of life has been impacted and also essentially looking at how they manage,
their quality of life, but also the ongoing consequences of treatment is a lot. just something as a therapeutic radiographer I'd never ever thought about, never, until doing rad chat and hearing patients talking about what you've kind of said from a side effect perspective. So definitely a category of patients where if we're going to implement prehab anywhere, that would be great place to start, wouldn't it?
Naman Julka-Anderson (24:34)
Absolutely, and you've got a good module if anyone wants to go and apply right.
I If we move on then to chest area to cover anything specific.
Jo (24:45)
Yeah so I think obviously please do refer to the RCR consent forms they go through all of the detailed side effects but one thing that I have noticed from doing rad chat and liaising much more with patients is the fact that lots of patients who have an intact breast are starting to notice changes
to the shape and to pain in the breast tissue, which can be really, really worrying, especially if they have essentially been diagnosed as a consequence of lumpy breasts or changing in kind of the texture of the breast.
breast or skin changes. So I think, you know, that's something that patients can be really concerned about as they're going through treatment or just after treatment's finished. So obviously it's a combination of the acute inflammatory response to radiotherapy, but also long-term tissue remodelling as well as a consequence of radiotherapy. So.
The radiation will actually damage the epithelial cells, create fibroblasts, also the microvascular structures within the breast tissue will actually be affected as well. When we get an inflammatory response, as I've said before, you can get that vascular change.
And ⁓ you can see that quite a lot in the chest area. Patients who've had radiotherapy typically will get terectentasia, where you can see the capillaries that have dilated as a result of those vascular changes in relation to radiotherapy. So what you can also get as well is kind of fluid leakage between the interstitial spaces and oedema.
A lot of patients report about heaviness and pain to the breast itself. And that often is described as swollen, tight, bruised feeling for patients. And that is very normal, but it is typically as a result of the inflammation and the fibroblasts being produced and that radiation fibrosis. So there are lots of kind of management,
options available for patients to investigate and talk to their teams about. Massage is supposed to be really good and something that again I don't necessarily think healthcare professionals, even therapeutic radiographers necessarily feel confident in actually talking to patients about because we worry about lymph nodes. I don't know if that's something that you've come across ⁓ in your clinical practice but
you know, when I've talked to physios a lot, they're like, we don't go near oncology patients because of the fact that, you know, lymph nodes, if there's any tumor cells in there, we're going to spread them around. But actually, I think we're also then doing a disservice to our patients who potentially have got an auxiliary node clearance and everything. And, you know, they're having this radiotherapy as an insurance policy,
that we're then kind of doing this damage, but we're not giving them any management options. So there are some amazing Instagram physiotherapists that specialists on oncology and we will link those within the podcast show notes. Again, who talk about lymphatic drainage and also compression and also massage for treating some of this kind of.
heaviness and also the kind of oedema that potentially patients may experience as a result of radiotherapy.
Naman Julka-Anderson (28:09)
Yeah, and I think just to add to it that a lot of body confidence kind of gaining again post-surgery or post-cancer treatments that self-massage there is some kind of anecdotal evidence that it helps improve looking at your body again or feeling comfortable touching that scar area or things like that. So yeah, and it does really help. And yeah, obviously going to your oncologist to get a letter if you need to get a massage or something afterwards, that's something we've done.
say it's safe but some people are quite confident to do it otherwise anyway.
Jo (28:42)
Yeah, I definitely had never appreciated that until I'd had my thyroidectomy and I used to hate, absolutely hate, I brought bio oil to try and reduce the scar and I just used to avoid it like the plague. Like I don't think I touched my neck for six months after I had that surgery because I was just like I don't want to go near it. So it's funny how you disassociate or you know some people are absolutely fine but yeah it's
weird and I'd never thought about the psychological aspect of it.
But you'd think that being a therapeutic radiographer, I'd be a bit more like, no, massage is really good. And you need to be kind of really proficient at putting on your creams and reduce your scarring and stuff like that. But that was not, that was not on my radar. And if anything, I just wanted to forget it and move on and, you know, stick a big plaster on it, which I technically did. Luckily it was COVID, stuck a big plaster on it and I didn't have to worry about it. But isn't it funny how we kind of say these things to patients, but
sometimes there's a reason why maybe they're not following through or doing maybe some of the management suggestions that we're offering. Also as well with kind of chest area we might be treating the lung tissue and I think it's important to kind of think about the long-term side effects for
for lung tissue, we try and minimise that as much as we possibly can do just because of the risk of damage to the lungs and the fibrosis that potentially can incur and that can obviously then affect our breathing. Sometimes we do treat a small amount of lung when we're treating breast tissue and that in itself can cause an irritable cough during treatment but can also develop afterwards. So again, it's just kind of being aware of any
tissue that we are treating we could potentially damage and that in itself could then cause a side effect. So everyone's tissues are different but kind of...
looking at the side effects but then thinking about how you can talk to patients about those side effects day to day I think is really important. So how can you in and out of the maze start to talk to patients about maybe some of the long-term side effects that they may experience? I absolutely know that for a lot of radiographers that won't be something that they typically do day in day out but
from the patients that we've spoken to and worked with through Rad Chat and the other charities that we work with, we know that that's what they kind of need and want. And absolutely patients might shut us down at that point. It's not the right time for them. But I think having an appreciation for things that they might experience after treatment can sometimes help prepare them. If not, you know, in terms of the physical impact, maybe psychologically.
Naman Julka-Anderson (31:29)
Yeah.
Jo (31:29)
I don't know
if you if you kind of feel that as well.
Naman Julka-Anderson (31:32)
Yeah, I think kind of what I was trying to say earlier without being too controversial back is obviously using that maze time as like making every contact count. It is important, but I think to your point about talking about late effects, I think my experience of working with some people, they don't necessarily want to talk about it because there's so much and it's scary to talk about. That was definitely me as a baby radiographer. I didn't want to talk about all these things that might happen later on because they're still waiting to see if the treatment is going to work.
But at the same time, some patients, I remember doing reviews and at the end, like an end of treatment review, going through like the Macmillan end of treatment, sorry, the Macmillan late effects booklet. And they were to say, I don't want this. I don't want to read about it. I don't want to know anything. So it's such a like fine balance of wanting to give all the information and probably also legally that we need to give this information to patients. And that's how I used to try and frame it and say, look, I understand you don't want lots of info, but I need to tell you about these risks and things to look out for
in next few months but also in the next few years and that you should keep self-checking and things like that. Yeah, it's a difficult one because some people don't want to know anything, some people want to know everything and you want to be able to give everything but it's not always that easy either.
Jo (32:46)
It is about asking the question though, isn't it? Like asking your patients how much information do you want to know? I think that's really, really important.
Naman Julka-Anderson (32:56)
Your dog's got a good viewpoint there as well in the background.
Jo (32:58)
⁓
He loves listening to me talk about side effects. ⁓
Naman Julka-Anderson (33:03)
I'm sure.
So suppose if we do the last bit about secondary malignancies, what sort of secondary cancers we treat with radiotherapy and what side effects might they experience?
Jo (33:23)
Yeah, so I suppose radiotherapy is really effective for...
managing things like bone pain from bone metastases, also from areas of the body that potentially are bleeding or have a risk of bleeding quite profusely. So it's a really effective treatment for secondary malignancies and also emergencies. So things like spinal cord compression, superior vena cava obstruction, guidelines have changed over the past few years as well in terms of the processes that
our patients actually go through and the processes that the healthcare professionals essentially kind of have to follow with dealing with those emergencies but I think it's just making sure that everyone is aware who works in oncology just how effective it can be because again lots of patients don't necessarily know that they can have radiotherapy for secondary malignancies
patients get wary because they think they can only have a certain dose and that certain dose is actually limited to the area. So depending on where we are treating in the body, every single tissue will have a different what we call tolerance dose. And so, you know, if we're treating in the head and neck region, the actual dose we can go to may be very, very different to what you can go to in the pelvic area. So that's kind of what we're governed to. But if you're treating, I don't know, say a breast cancer,
and then actually someone got a bone metastasis in their femur, that means we can actually deliver a high dose to that area as well. from a patient's perspective sometimes there's a bit of kind of unappreciation for how radiotherapy can be used in that way. They kind of think they've reached their maximum dose of radiotherapy, can never have it again.
Naman Julka-Anderson (35:11)
Yeah, and there is also re-irradiation, which is definitely probably a whole series in itself to talk about. But they are options, but they're very specific and very tight guidelines and things like that.
Coming to the end, Jo, I feel like we probably could talk for the rest of the day on this topic. But what's one thing about radiotherapy you hope for people to take away?
Jo (35:31)
goes quickly. Of course we could.
So I just think if anything, actually going back and going through the RCR consent forms that we see day in, day out and take for granted that we know what the side effects are, but translating that into what are the hints and tips that we can give our patients and how can we phrase it? You know, if you're worried about talking to patients about side effects, short and long term side effects, start to think, well, how can I start to integrate it into conversations that I have? have and role model it for peers and colleagues. I think it's really important and ultimately asking our patients what they want. you know, talking to Mrs Smith about, you know, what is she expecting and does she want more information about short and long term side effects and giving snippets of information that potentially could help and support our patients with managing some of those side effects I think is really important as well. What about you, Naman?
Naman Julka-Anderson (36:39)
Treatment plans, I'd really like to see people be more confident to talk about it or show aspects of it to our patients, whether that's at the beginning or at the end, I think it's really important. We are highly qualified professionals as therapeutic radiographers to go through this. We know where all the pretty colours are on a treatment plan, how to talk it through. And actually every time I've done it with a patient, they really appreciate being visually able to see what's happening.
I think it again, quite prevalent for head and neck cancers where you do see patients losing weight and not understanding why they need to keep their nutrition up, showing them the difference from their scan to like today where they've lost lots of weight and it's becoming kind of dangerously low. It's just a visual representation I think is great. And obviously now I'm in the late effects kind of era. It's going to really help showcase other professionals why there's a need for late effects services, input
what we do to our patients and why, know, how amazing it is that everyone is living a lot longer post-treatment, we need to be able to manage them for a lot longer and better. And yeah, I think we are central to that. And I kind of have to say that because it's my job as well now, but at the same time, I just think it's really important to like, we've trained to do this, we know what the pretty colours are, use it, use that data and show people, you know, what we actually do to our patients.
Jo (38:02)
It's interesting isn't it because we suggest that to some of our patients and some departments, some radiographers don't allow patients to see their radiotherapy treatment plan so yeah it's interesting, definitely worthwhile from a visual.
Naman Julka-Anderson (38:15)
Put a freedom of information request in if that's what's needed. I've helped a couple of
patients do that because they wanted to just have it and showcase to their GP, stop the gaslighting, like it's your legal right. Yeah, I wish every patient would get access to it, even if it's not like every single aspect of it, but just an overview so they can see it, like it's your body. That's another controversial opinion, I guess. But I feel like I know there's a lot of other people who agree.
Jo (38:38)
We're full of them today!
Naman Julka-Anderson (38:42)
Yeah. Well, thanks everyone for listening to our chat with me and Jo. It's been nice to just have a chat. I don't think we've done this in a while, apart from on multiple voice notes or evening chats and stuff like that. So hopefully you've enjoyed it and you can use some of it for your CPD and learning. Our next guest, our guest, I should say, to feature will be Hayley Gibson, Hayley Snowden and Sue Ormisher as part of our education and workforce development series talking about how they tackling health inequalities in their region. So thanks all for listening and take care.
Jo (39:15)
Thank you!
Naman Julka-Anderson (39:16)
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Jo McNamara Rad Chat Host (39:32)
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Jo McNamara Rad Chat Host (39:58)
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Naman Julka-Anderson (40:15)
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