As the complexity of cancer treatment plans evolves, radiotherapy continues to be an integral part of many antineoplastic regimens.
Not only is radiotherapy used as definitive treatment for malignant conditions, but it is also commonly used to improve the effects of surgery or chemotherapy in the neoadjuvant and adjuvant settings or as part of a combination regimen. As research emerges, we are learning that radiotherapy and immunotherapy may be synergistic and help prevent tumor cells from evading the immune response.
Given the mechanism of action of radiotherapy and the growing number of possibilities for its use, it remains a standard of care for patients with varying goals of treatment. In addition to its curative intent, radiation is commonly used in the palliative care setting to improve pain and other side effects associated with tumor size, location, and compression. In fact, as oncology nurses coordinate and advocate for care throughout the disease trajectory, it is important to note that 30%–50% of patients undergoing radiotherapy are doing so for palliation of symptoms and to promote quality of life. Even a single dose of radiotherapy is very effective in providing some degree of pain relief.
Local and Systemic Effects of Radiotherapy
Similar to chemotherapy, radiotherapy does not distinguish healthy from cancerous cells, and it primarily affects rapidly dividing cells. Consequently, some of the same side effects and treatment sequelae are observed with the two antineoplastic therapies, and when given together as part of a combination treatment plan, side effects may be more problematic. However, radiotherapy side effects are not systemic and are likely to depend on the radiation field and organs at risk.
In planning for patient care based on radiation treatment schedule, it is vital for nurses to understand the body tissues and organs likely to be impacted by the radiation field and when. Some tissues respond acutely to radiation (e.g., bone marrow, reproductive organs, lymph nodes, salivary glands, small bowel, stomach, colon, oral mucosa, larynx, esophagus, arterioles, skin, bladder), and effects are seen within hours to days. Subactuely responding tissues (e.g., lungs, liver, kidneys, heart, spinal cord, brain) show effects in the weeks to months following treatment. What is extremely important for nurses to consider are the late-responding tissues (e.g., lymph vessels, thyroid, pituitary gland, breasts, bones, cartilage, pancreas, uterus, bile ducts), which may not manifest for months to years after radiation has completed.
Integrating Radiotherapy Into the Full Treatment Plan
As medicine becomes more personalized, experts are projecting that the use of radiotherapy in cancer treatment plans will increase by 22%. Nurses know that treatment plans must encompass holistic care to address acute and late effects of treatment and the psychosocial, religious, and spiritual impacts on care, regardless of the treatment goals.
Depending on treatment location, dose intensity, and expected patient tolerance of treatment, nurses help patients receiving radiation navigate other medical specialties and disciplines such as cardiology, pulmonology, endocrinology, physical and occupational therapy, and nutritional support. Nurses are instrumental in identifying the need to involve other providers and members of the healthcare team to optimize outcomes and quality of life.