Definition and Overview
Radiotherapy follow-up is an appointment with the patient’s medical team, which may be comprised of an oncologist and radiographer with the goal to assess the patient’s response to the treatment and its possible short and long-term side effects.
Radiotherapy is one of the most common treatment methods for cancer patients. It uses radioactive materials such as X-ray to destroy the DNA of cancer cells to keep it from spreading further. It can be performed externally or internally. External radiotherapy uses machines or electrons while internal radiotherapy requires the intake of a radioactive material usually in the form of fluid.
Like any other cancer treatment, radiotherapy can have moderate to serious side effects, including the damage to normal cells. However, it is still provided as experts believe that normal cells are more likely to self-heal than cancer cells. Further, new techniques are being designed to reduce the associated risks.
Who Should Undergo and Expected Results
A radiotherapy follow-up is always a part of a cancer patient’s post-treatment follow-up care.
Cancer is an unpredictable disease despite the huge advancements in its treatment, screening, management, and prevention. Depending on the person’s overall health condition, age, presence of other preexisting diseases, medical history, and even genetics, a patient may experience recurrence even after many years of remission. The relapse may also happen even if the patient is proclaimed to be cancer free, which, by oncological standards, is based on five years without any trace of the disease.
Patients react to radiotherapy in many different ways. Some are able to go back to their normal activities after the treatment is over. Others, on the other hand, have to deal with the side effects, which can include:
- Changes in the skin texture, quality, and color
- Permanent hair loss in the treated area
- Damaged blood vessels
- Lymphedema, or the buildup of fluid in the lymph nodes as the drainage channels become blocked
- Bladder incontinence
- Swelling of the limbs
- Difficulty in swallowing
- Shortness of breath
These changes may be permanent, long-term, or temporary.
The radiotherapy follow-up is carried out to:
- Determine the success rate of radiotherapy in terms of controlling or treating the disease
- Assess if more radiotherapy treatments have to be carried out in the future
- Know if the patient remains eligible to go through the procedure
- Identify the symptoms that are associated with the side effects of radiotherapy
- Evaluate the overall health of the patient after the treatment including his mental health
- Help the patient cope with the side effects of the treatment
- Provide advice to help the patient deal with the effect of the treatment and the disease itself
- Anticipate possible side effects of the treatment and implement appropriate preventive interventions
How Does the Procedure Work?
Every cancer patient works with a select team of health care providers, which include an oncologist (a specialist in the treatment of cancer), radiographer (the person who operates the machine and helps plan the treatment), and the surgeon.
Once the radiotherapy treatments are over, the patient proceeds to the follow-up care. At this point, the patient meets with the doctors, and together they talk about:
- Any symptoms felt by the patient
- The physical changes that are happening to the patient, like changes in the color of the skin or hair
- Any pain, including one that comes from untreated areas
- Possible limited mobility
- Medications taken and their effects on the patient’s health and life
During the follow-up care, the patient is expected to go through a series of exams to determine the effects of other treatments. If the patient is suspected to have cancer recurrence or the treatment is deemed not effective, the treatment plan will be adjusted accordingly.
The doctors will also evaluate the person’s mental health during the radiotherapy follow-up. Cancer affects every aspect of a person's life, including decreased self-confidence and poor optimism. The side effects of the treatment, like loss of hair, infertility, and change in skin color can potentially hurt a person’s self-esteem, leading to depression and anxiety. According to the National Cancer Institute, as many as 25% of cancer patients go through anxiety and depression during their diagnosis. Although it does not happen all the time, these mental disorders can trigger suicidal thoughts.
The schedule for the follow-up can significantly vary. Initially, the appointments are spaced one week apart. As the plan progresses, the interval may be longer, such as every three to six months. Then it proceeds to once or twice every year until the patient is declared cancer free or the side effects are effectively managed.
It is common during the radiotherapy follow-up for doctors to discuss their observations, concerns, and other information with the patient and his family, especially if the patient is suffering from the side effects of the treatment.
Possible Risks and Complications
Any kind of consultation or follow-up becomes more productive and helpful especially for the patient if he is comfortable dealing with the specialists. Otherwise, he may prefer to keep the symptoms to himself or not follow through with future follow-ups. This can be a huge problem since it can lead to the failure of disease management, including detection of a possible recurrence.
The radiotherapy follow-up care also involves not only discussions but also tests, which may be time-consuming, painful, and tiring for the patient. They may also increase the patient’s level of anxiety and depression as he tries to anticipate the possible results.
There is also the possibility that the patient may stop seeing his doctors particularly if the interval for each visit becomes lengthy.
Zemen EM, Schreiber EC, Tepper JE. Basics of radiation therapy. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2013:chap 27.
National Cancer Institute. Radiation therapy and you: support for people who have cancer. Available at: http://www.cancer.gov/cancertopics/coping/radiation-therapy-and-you.