Thursday, January 30, 2020
Radiation Therapy Essay Example for Free
Radiation Therapy Essay ABSTRACT:      Radiation Therapy now enjoys its position as a therapeutic and an adjuvant therapy among the cancer patients and cases. The use of radiotherapy is a very serious decision which is taken after much thought about the patient’s case and requires much cooperation from the patient and support from the oncology team that provides it. Current oncology teams work together to create an environment which is both friendly for the patient as well as less confusing, so that the patient is able to go through the phase of treatment with out any complications. Each person in the radiology team takes care of a particular aspect of radiotherapy treatment, and together they ensure a good outcome and result for the patient. THE ROLE OF RADIATION THERAPY IN CANCER MANAGEMENT      Of the many methods used in today’s cancer treatment regimes, radiation therapy has become one of the crucial components of the therapy. The therapy where radiation rays are used to destroy cancer cells has now become an advanced field of research and development. This area has now become a separate area of specialization, and various developments are helping doctors give better prognosis to their patients. Due to minimized anxiety attacks among patients, they become more optimistic about recovery and are less distressed on the possibility of death. Patients of this kind of therapy have better psychological health and have less depressive symptoms caused by their disease.       Radiation therapy is not required to all cancer patients. It is not always involved in the management of all organs and body sites affected by cancer cells. This treatment is only recommended on certain types of cancer as other situations only call for surgical procedures in preventing further cancer metastasis and to eliminate cancer cells in the body.  An important adjuvant to cancer therapy, it is used as an alternative to surgical procedures that cannot be carried out on a patient. Radiation therapy is a common procedure in breast and lung cancers as well as in brain cancer, colorectal carcinomas and skin cancers of the face. (Florida Cancer Care News, 2006)      In the USA, the main issue of debate and concern among the clinicians is the poorer prognosis rates in the USA patients due to cancer when compared to other countries of Europe. This has been attributed to the type of care given in each country, and has led to intense concentration on methods that improve recovery outcomes.       These concerns have led to five areas of intense activity in the area of cancer therapy, as stated by Tattersall and Thomas, (1999). There are now multidisciplinary teams that specialize in one or two specific organs and provide treatment and care to those specific cancer patients. There have been increased efforts to improve the organizational setup of the cancer therapy and delivery setups. Clearer treatment goals now exist, along with increased awareness in the public about the different aspects of cancer, cancer therapy and the role of trials in the development of better alternatives and cures for the future. Now current research is aiming to derive benefits from matrix metallo proteinase inhibitors, gene therapies and cancer vaccines. (Tattersal and Thomas, 1999) All these areas of activity are hoped to increase the patient outcomes significantly in the future and help in creating better alternative solutions to cancer treatments. Team Members in Radiation Therapy Treatment Plans    The advancements in this field have led to increase in the number of professionals in this field. Each has a unique and an important role to play in the treatment procedure. The radiation therapists mainly work in conjunction with the medical doctor and with them discuss the individual cases that are considered for radiation therapy. Of these the suitable cases are selected and the radiation treatment is then started under the guidance of the radiation oncologist The decision making process in radiation therapy is absolutely critical, as the radiation oncologist decides the amount and intensity of the dose each patient will get according to the individual factors and more importantly the state of the cancer.     A radiation department in any organization will consist of multiple workers and members, each having a significant role to play in the treatment of the patient. These include the clinical oncologists or radiologists, the radiographers, radiation therapists and the dosimetrists, the physicist, the mould room technicians, the nursing staff, the students and the R.T aides and assistants and other members such as social workers, palliative care team, counselors, and secretaries and clerical staffs. (Cancer Backup, 2005 and American Society of Radiologic Technologists, 2007). Stimulation is the initial step in the radiation treatment where a radiation therapist takes x-ray images and utilize this to locate the tumor. Other methods such as CT scans can also be used in order to minimize tissue damage in the patient, ensuring that only the carcinogenic cells are destroyed. Together with a radiation oncologist and a dosimetrist, they customize a treatment plan for the patient (Radiation Therapists 2006). Both clinical oncologists and radiologists are concerned with minimal invasive methods in treating cancer cases. According to the Royal College of Radiologists (2007), radiologists are medical specialists that conduct imaging services in order to provide patients the proper diagnosis. Oncologists on the other hand are specialists trained to manage cancer in non-surgical forms of treatment. They usually recommend procedures such as chemotherapy, hormone therapy, and radioactive isotopes. After taking the image of the affected organ of the body, this is to be interpreted by another specialist in order to prescribe and execute the proper treatment. This is a task attended by professionals called radiographers (Radiography and Radiographers). Dosimetrists are primarily concerned on the proper dosage to be administered to a patient. They scan patients and use CT data or other measurements in order to provide patients the proper treatment plan (Medical Dosimetrists, 2004).     The members of the radiation team that are outside of the department faculty but help in the procedures include the referring faculties, physicians, radiologists and emergency departments, the industry vendors, the patients and their family members, the instructors or directors of the radiology programs, the insurance companies, the governmental and regulatory agencies and the accrediting agencies, if applicable. (American Society of Radiologic Technologists, 2007)     The radiation team is perhaps the most integrated and interconnected team compared to other sections of the medical health care. The realization of the need for team work in reducing confusion, promoting smoothness and harmony in the care of the patient was realized long ago, however, it was not implemented fully in many medical and surgical areas. The results have shown lags or gaps in the treatment of care. Many of the current radiology departments have learned from the lessons of the past, and now term themselves as the radiology team who take care of the patient through all the stages of the radiotherapy treatment. (Kaprich, 2003) This has led to not only improvement in the care of the patients, but also in the hospital management and organization matters as well as job satisfaction levels. The level of communication between the different contributors of the department has improved and therefore, shows a much prompt and informed response in the care of various pa tients. (Kaprich, 2003) Radiation Therapists     Advancement of technology has given professionals access to different methods that enable the correct identification and location of cancer cells which are the specific targets of the ionizing energy of radiation and preventing tissue cell damage. With this directed and controlled use of radiation, there is a reduced manifestation of side effects due to the treatment patients receive, and there is an expedited recovery of patients. (M.D Anderson Cancer Center, 2007) Together with the doctor, a radiation therapist is responsible for the patients familiarization of the radiation treatment procedure. This will allow the patient to become aware of the possible problems that may arise and to answer any reservations that the patient may have. Therefore, a radiation therapist is expected to be present throughout the treatment period. Nurses in Radiation Oncology      The inclusion of nurses in this field of radiation oncology is fairly recent. However, this has now become an integrated and competent player in the caring of cancer patients in the radiology department.      The role of nurses have evolved in this field, as many of them have been tasked to carry out many of the advanced procedures in the treatment process. Both preoperative and operative care are executed by these nurses, making them indispensable in the success of the patients recovery.      Currently, the responsibilities given to the nursing staff include both basic and advanced tasks. The basic tasks include education and caring of the patient with in the department and helping others in carrying out researches and other projects. Nurses work towards creating an environment both among themselves and among the different staff members to create an open, friendly environment that ensures better outcomes. Along side, the nurses are responsible for their own education and growth within the field, and opportunities to increase and improve competencies within the staff. The nurses are therefore, working primarily in creating an environment that improves the patient care and outcomes, as well as improve the communication between the various contributors to the field. (Kaprich, 2003) In oncology, the roles of nurses in the treatment process is considered an integral part of the overall healthcare. The primary purpose of providing nursing care is to allow the patients to become independent through the development of their physical, psychical, and social abilities. It is significant in preserving, strengthening and protecting health, and nursing patients and rehabilitating them (Basic Principles of Nursing ). Physicists in the Field of Radiation Therapy     Another significant member of the team of professionals in radiation oncology are the physicists. This specialist is responsible for giving the patient optimum radiation therapy procedures that would ensure minimal health risks and maximum efficacy. Due to the delicate nature of their job, these physicists are expected to be highly professional and equipped with the proper training in conducting their tasks. Part of the job that physicists have is that they should select the proper radiation instruments to be used, the budget preparation and the sequence of procedure execution. Due to this technical knowledge, physicists are important in identifying and rectifying problems that could possibly transpire. But this specialist is not confined in his technical role as his position requires that he collaborates with both oncologists and radiation therapists in determining the proper dosage, duration, timing, frequency and type of radiation therapy to be administered to a patient. Since the availability of x-rays, physicists have exploited this technology of medical imaging, which is vital to medical research advancement. Fundamental research in optics, acoustics, electromagnetism, and particle and nuclear physics have led to an array of indispensable medical tools. Magnetic resonance images, CAT scans, PET scans, and various types of radiotherapy are among the physics-based devices that help doctors diagnose and treat ailments ranging from broken bones to cancer. Ultrasound machines, for example, are made possible through our understanding of the physics of sound waves, and the prenatal images they produce are now so common that they are a cultural symbol of the joy of impending parenthood (Genetic Radiotherapy 2002). Cutting-edge techniques presented in the annual AAPM meeting scientific program will ultimately lead to tools as important to the medicine of tomorrow as x-ray and ultrasound images are today. (Asp et al, 1993)     The use of ionizing radiation in the radiation field has led to many questions raised about the safety margins of these procedures. As stated before, there is a fine line of division between the therapeutic effects of radiation and the adverse effects of the radiotherapy. In this regard, the role of dosimetrists is essential to delineate the amount of dose necessary for each case. Dosimetrists play a role in treatment planning, mould room technology, brachytherapy and sealed source management, in-vivo dosimetry, quality control of equipment, and IT support. (Radiotherapy Provision in England, 2006) Dosimetrists for Dose Determination     A dosimetrist is actually responsible for the delivery of the proper dosage to be given to a patient. They are subordinates to doctors who work in close communication with the patient as well as their families. The person who actually delivers the dose of radiation each day is known as dosimetrist. These work under the doctor or the oncologist and are in close communication with the patient as well as the family members of the patient. The radiation dose decided for a patient is given to him or her in divided portions. The session itself is a small one, but the radiation therapist is the one who delivers it and communicates any changes in the patient to the oncologist.  Mental Health Support for Cancer Patients      Radiation therapy is a big step of treatment in cancer patients and therefore, their mental and physical state is a very important clue and guide to the selectivity of the case for the therapy. Such patients begin one of the most difficult incidents of their lives by opting for radiotherapy. In this regard, they need the proper guidance, support, help and boost to help them get through the different stages of radiation therapy, and to improve chances of recovery. In many of such hospitals, the support programs are available which work with various social services to provide such cases with any required information they need. There are many things the patients undergo in this event. They either may undergo external radiation therapy treatment or an internal radiation treatment. In external radiation therapy, the patients are called to the radiation center 5 times a week and radiation is given to them. The two days off from radiation helps the normal cells to recup erate from the damage of the radiation procedure.      Patients after changing in hospital robes are asked to enter the radiation room especially designed for the purpose. After instructing the patient the proper position, the radiotherapist proceeds to his proper location where he would execute his task. The patient is asked to remain in a the said position where he is to receive a fixed radiation dose to the tumor affected area. After the completion of the session, the patient is then directed to leave and attend to normal daily matters. Patients in these stages undergo immense psychological as well as physical stress for which it is advised that they rest more to help the body restore itself in the normal manner. Since depression and anxiety are two most common features, the patients are advised to take part in activities that boost their morale and help them feel good about themselves. The support teams in this regard focus on providing and guiding patients to a good nutrition plan, to aid in better recovery from illness. Nausea is also among the problems that patients encounter but these can be easily handled through medication prescribed by your oncologist. Hair falling is another issue that usually resolves once chemotherapy is over. In summary, the radiation procedure is especially taxing for the patient who may need immense support and care at this crucial time, which becomes the responsibility of the family as well as the radiology team. (WebMD, 2007)  Internal Radiation Therapy     Internal radiation therapy is another frequent option chosen by the oncologist in the treatment plan of many cancer patients. The high dose rate radiation therapy is a type of this internal radiation therapy where radioactive source is removed between treatments. In this case, the source of radiation is placed in direct proximity to the cancer area and is applied with small sophisticated machinery. This is in contrast to the use of heavy extensive radiation and machinery that is used in external radiation procedures. The substances used in these instances include iodine, cesium, iridium, phosphorus and palladium etc. This treatment has been given many names and is also known as brachytherapy, implant radiation therapy, interstitial, intracavitary or passage radiation. Internal radiation therapy however is a procedure that requires hospital care and attention, as well as isolation, for in this therapy; other people may get exposed to high radiation levels. Therefore, many cases of these may keep the patients for a day or two, during which the affect of the radiation substance would have worn off, and become useless. (Cancer Source, 2007)      It is important that once radiation therapy is carried out, the patient is seen and advised further about the future therapies or treatments. This is an essential part of the treatment modality. Mostly prior to the radiation therapy, the oncologist and the radiation therapist carry out the discussion about the possible side effects of the therapy and what a patient may expect afterwards. The doctor emphasizes the need of follow up care and the role of the patient to show up in time. These include many procedures, including regular medical checkups, screening and diagnostic procedures, endoscopy, blood work etc. All these help the clinician check on the health of the patient and the recovery status, and whether any complication is arising. The patients are asked about the status of their health and any signs and symptoms that the patient may be feeling. Patient is asked about pain, or any physical difficulty being experienced in daily routine. He or she is asked frequently about any medications, supplements and the dietary habits he or she is conducting. Emotional issues and problems as well as family histories are also taken into account in these visits. Such patients may be called after two months of the radiotherapy, and then asked about the status and any necessary investigations may be carried out. These visits may be tapered down to once a year if the prognosis is good and the patient is recovering successfully. The patients are however, asked to maintain the record of their illness and all of the treatment modalities carried out including medications and previous test results for future references. (National Cancer Institute, 2007) Effect of Radiotherapy on Nutritional State of Cancer Patients     Nutrition is a very important aspect in proceeding with the treatment. There are currently many studies conducted in determining the proper nutrition a cancer patient must receive. This is due to the fact that cancer treatments cause high energy expenditure among patients, leaving then in nutritional deficiency as they undergo radiation therapy. Several factors contribute to this problem. First is the fatigue that develops as a result of the treatment, which takes away the ability of the patient to take balanced nutrition. Second is the lack of hunger in such patients and third is the increased vomiting and nausea that these patients encounter during the treatment phase. In all these scenarios, the net result is the reduction in the nutritional capacity of the patients. This is especially true for patients who have cancers of the oral cavity, pharynx, esophagus or the gastrointestinal tract. Dietary and/or external supplementary nutritional sources are extremely important in such cases. Isenring, Capra and Bauer in 2004, claimed that nutritional therapy is an essential feature of the patient recovery plan in cancer radiotherapy. (Isenring et al, 2004)     Researches conducted reveal the negative impact of radiation therapy on the patients nutritional health. There are obvious evidences that nutritional deficiencies are common to cancer patients, especially those suffering from cancer of the GI tract. Due to the imbalance between food intake and energy loss, malnutrition is inevitable. Most patients suffer from malnutrition in the radiation phase, because of this many hospitals now recommend that a compulsory health program be imposed on patients to ensure the proper provision of their nutrition. There are different claims as how to properly design these programs. Some suggest that amino acids and essential fatty acids are important in increasing bodys defenses and to improve patient recovery. A reduced fat diet, live yoghurt and fermented milk product use are now one of the most important components in the cancer nutrition plan. (Internet Health Library, 2007)     Studies indicate the biggest danger due to malnutrition is the intense weight loss that the patient suffers from, which can lead to increased morbidity and mortality rates, reduction of the body’s defense systems and increased possibility of the return of the cancer, should any remaining cancerous tissue remains. While initial weight loss is of no serious consequence, continued weight reduction is a sign of concern. For many of the symptoms that the patient encounters, the options are presented for the specific issue. For example, mouth dryness is a common problem for the cancer patients. This increases their chances of oral infections, and therefore, patients are advised to chew on sugarless gums, increased intake of water, and using high moisture foods and fruits. Patients are advised to take small but frequent meals that are low on fat, to aid in digestion. Appetite stimulants are another good method of improving diet and appetite in such patients. Iron supplementation is advised to counter the effects of anemia, exercise may help in dealing with changes like menopausal states which cannot be given estrogen therapies. Patients in cancer cases tend to opt for more supplements and become less careful about the food that they eat. This should be the other way round, for natural food is the best nutritional supplement and helps in recovery faster. Fruits and vegetables are a high source of vitamins and minerals and can help in the recovery of the patients’ appetites. (Cancer Journal for Clinician, 2001) Physical and Mental Health Maintenance     As stated before, the cancer therapy is an intensely physically as well as emotionally demanding phase of treatment to a patient. In such circumstances, the need is for intense emotional support and encouragement. It is estimated that up to 40% of the patients may experience immense emotional distress during the cancer treatment, and therefore identification with proper counseling and guidance is very important for such cases. (Sollner et al, 2001) The problem lies in the correct identification of the cases undergoing distress and to understand the severity of the issue before hand. Many of the oncologists however, are unable to identify cases of distress which may cause complications at a later date. (Sollner et al, 2001) It is very important that oncologists are able to identify such cases and work accordingly for the benefit of the patient. Many social support groups are available in the hospitals that aim to help and guide the patients as well as their families t o better radiotherapy experience.       The concept of hospice has been indeed one of the methods with which care can be given to patients undergoing therapy. Somewhat of a recent concept in oncology care, hospice care has fast become a popular method among the patients. While hospice care is a good method, there are only three percent of the total cancer patients in a hospital that undergo radiation therapy. The issues here are different as the approvals for radiation are hard to get for the patient. Most of the hospice patients are senior age individuals with a mean age of 63 years admitted in the UK hospitals. (Lutz, Ashworth and Connor, 2005)     The use of hospice care therefore becomes a complicated issue when decision to conduct radiotherapy for such individuals is considered. Many of the patients in this regard are actually cases of terminal cancer who need palliative care through radiotherapy. It is important to address the need of the dying patients and to provide them with the necessary care to help them get through the process with as minimum pain as possible. (Lutz, Ashworth and Connor, 2005)      Usually there are three kinds of patients that undergo hospice care during radiotherapy. The first are those patients who do not have any one to take care of them during their radiotherapy session, and therefore the hospital provides it to them. The second are the patients who do not forgo the hospital admission, and third are those who are getting parenteral and tube nutrition, radiotherapy and chemotherapy and are getting transfusions. (Lorenz et al, 2004) In many of such cases the patients may have difficulty getting admission in the hospitals, despite falling into one of the above three categories. Access in such cases needs to be made smoother for the patients. (Lorenz et al, 2004)     Current hospices are now a combination of inpatient and home care services. In the past this was not the case. Hospices and palliative care were considered a separate department and were accordingly handled. The development in this area has led to modern hospices with a home like feel for the patients to help them recover and feel psychologically better. It is to remember that hospice care in many patients is essentially palliative care, and includes symptom control, effective communication between patients and the doctors, rehabilitation and continuation of care, terminal care, support provision in bereavement, education and research.(Neill and Fallon, 1997) In other words current hospice is a refuge, a recuperant and an area of research all combined. Palliative care is again the domain of specialists in oncology and in other disciplines so as to give the best care there is possible to the patient. In cancer terminal patients, many efforts are carried out to make the stay of the patient more comfortable. After thorough evaluation and identifying the cause of pain in such patients, the administration of analgesics is undertaken. While primary drugs remain the same during the course of the treatment, the secondary drugs or the adjuvant drugs are added as the case may need. These may include some other drugs depending on the patient symptoms such as steroids, anti inflammatories, antidepressants, anti convulsants, and anti arrhythmic drugs. Issues of tolerance and toxicity are taken very seriously and patient progress in this regard is taken under constant observation. (Neill and Fallon, 1997)      There are many reasons cited by the patients about their preference of hospice care to home care. These include high professional care, easy to communicate and clarify issues of health and cancer stages, ease in the visitation in between the radiotherapy sessions with ample time for rest, and provision of support to the patient as well as the family members in the hospital settings. Such patients were satisfied about the exclusive team of care givers in the radiotherapy department, and a faculty that focuses on cancer patients only. However, areas of dissatisfaction among the patients include the problems encountered with the radiation units and machines, occasional lack of communication between the various members of the staff leading to problems in care provision, and problems in transporting patients from one department to the next. (Gavin et al, 2002) CONCLUSIONS:     Radiotherapy is a field of intensive research and activity and is undergoing many changes and developments. Now there is a shift and interest from the conventional external beam radiotherapy procedures and there is more emphasis on the use of fractionation doses rather than single ones. This is especially seen to be beneficial for cases of head and neck cancers and improve the prognosis of the patients, as well as give them ample time to recover during the procedures. Some of the rules however, follow. For example the dosage of radiation is decided depending upon the size of the tumor mass. The larger the mass, the more it must receive the dosage of the radiation. Other methods of providing doses include hyperfractionation, which is twice daily delivery of the radiation, the accelerated fractionation, which aims to decrease the treatment period and to prevent the tumor from regrowing. Some of the techniques employed that prove to have relatively positive impacts are the concomitant boost technique, given once a day for three and a half weeks and twice a day in the final two week period, and the accelerated hyperfrationation, which combines the effects of both hyperfractionation and acclerated dosing. (Chow et al, 2001)  Oxygenation of tumor is also considered for treatment. It has been established that oxygen has the ability to modify radiation damage, that in malignant tumors, both oxygenation and tumor cell proliferation determine local tumor management after radiotherapy. However, there are currently insufficient explanations in correlating oxygenation status and tumor cell kinetics (Nordsmark et al. 1996). But according to the Mayo Foundation for Medical Education and Research (2005), Oxygen therapy uses ozone or hydrogen peroxide to supposedly add extra oxygen to your body. Proponents believe cancer cells need a low-oxygen environment to survive, and that flooding your body with extra oxygen will kill cancer cells. Ozone gas can be mixed with water or air, and users usually drink or inhale the solution. It can also be injected into a muscle. Hydrogen peroxide is sometimes injected into a vein, though it can also be administered rectally. Oxygen therapy hasnt been studied in people. Hydrogen peroxide bubbles in the blood can block blood flow and lead to death. An alternative cure or disease management for cancer patients is for them to undergo surgical procedures. This can be done for several reasons, it can be preventive or prophylactic, for diagnostic, staging, curative, and others. It is one of the oldest forms of cancer treatment that removes tumor and saves normal tissues (American Cancer Society 2007).       Current treatment regimes are now utilizing the use of more sophisticated machinery that is able to specify the location of the tumor and provide therapy to that area only, so as to prevent damage to the normal tissues. The external beam therapy advancements are leading to improvements in the outcomes of the cancer patients and therefore is becoming a widely used procedure in cancer therapy. Internal radiation therapy is somewhat limited to the surgical procedures, where removal of the tumor is promptly followed by radiation therapy to ensure the removal of any viable cancer cells.        Cancer chemotherapy is advancing at a rapid rate and is now a need for the future. The increase in the rates of cancers worldwide has led to the formation of specified task forces aimed to identify the similarities of the problems faced by the patients, their families as well as the doctors in the care of such cases. With the increased length of the treatment with frequent recalls and visits, it is important that such treatments be carried out in coordination with the different members of the radiology team. The roles of the various team members are important and each has a very important role to contribute in the cancer care.      The introduction of social programs is a very positive effort by the health care administrations which aim to educate and help the patients during the various phases of the cancer treatments. The understanding of the physical and emotional distress and needs of the patients and rectifying it helps to improve the outcomes many times and ensures the best of treatment provision. The role of nutrition as mentioned above is again a contributing factor in the rehabilitation of the patient and can help in speedier recovery. In short, radiotherapy is a major decision for a cancer patient which needs to be taken into account during all stages of the therapy with proper support and guidance for better outcomes. REFERENCES The American Society of Radiologic Technologists. The Interdisciplinary Team in Radiological Technology .  http://www.asrt.org/content/RecruitmentRetention/RetentionTools/Interdisciplinary_Team.aspx Lloyd Asp, Morris Bank, Theodore Fields, William Hendee, Douglas Jones, Cohn Orton, Vincent Sampiere, George Starckschall, K. David Steidley and Bruce Thomadsen, 1993. The Role of a Physicist in Radiation Oncology. American Association of Physics in Medicine by the American Institute of Physics. Cancer Backup, 2005. Staff in Radiotherapy Department. 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