1. Radiotherapy Issues Janice Fletcher Macmillan Clinical Nurse Specialist Radiotherapy Ninewells Hospital Dundee

3. Marker Seeds External Beam Intra-Operative Radiotherapy

4. Possible Toxicities Skin toxicities Depends on area treated Pain (H&N, Oesophageal) Diarrhoea (Pelvic) Nutritional compromise Breathlessness (Lung, Chest) Increased mucuous production Psychological issues Social issues

5. 80-90% patients will have some skin erythema 10-15% may progress to broken, moist desquamation Friction around collar area, previous surgery Visible Difficult to dress if broken  Intrasite requires secondary dressing  Mepilex ?Viable option Smoking and poor nutrition suggested as indicators for a worse skin reaction Skin Toxicities

10. Radiotherapy Toxicities Little Consensus of Appropriate Care Main Aim; Reduce Trauma Systemic Effects From Radiotherapy Toxicities Avoidance of High Fibre, High Fat Diet When Experiencing Diarrhoea Avoidance of Spicy Foods, Alcohol and Smoking to Reduce Oral Trauma

11. Mucosal Damage Adequate Pain Control –Orally, tablet/liquid, PEG, S/C Awareness of oral washes –Corsodyl is based in Alcohol and can be painful and drying to radiotherapy induced oral breakdown Risk of oral infections; –If concurrent chemotherapy, concern regarding systemic infection with low immunity

12. Dry Mouth 50-60% decrease in saliva in first week of radiotherapy Can increase pain, lack of appetite and increase incidence of infection Thick, sticky mucous problematic, causing retching Monitor/stop drugs that exacerbate dry mouth (amitriptyline, amiloride) Regular washes and drinks of water Oral balance gel, saliva replacement can be useful

13. Weight Loss Nutrition affects healing Multi dimensional reasons for weight loss Nutrition support early very important Early intervention (nutritional supplements and monitoring) can prevent more invasive interventions later (TPN, NG, PEG)

14. Pain Control Appropriate and early pain control essential Pain will effect nutritional intake WHO analgesic ladder Analgesics plus poor intake can induce severe constipation Lifestyle can affect analgesic compliance or prescribing