Advice Following Radiotherapy – Breast

You may find that for a few weeks after your treatment has finished some side effects may get a little worse before starting to get better. Any side effects that occur during or shortly after radiotherapy should be temporary.

The time taken for these effects to settle can vary from one person to another. This patient leaflet contains some advice about early side effects (those that occur during or shortly after radiotherapy) that you may experience in the weeks after finishing radiotherapy and some information for after you have completed your radiotherapy treatment.

Contact

If you require further information or advice about managing any radiotherapy side effects or have any concerns or questions about your radiotherapy, please contact:

Advanced Practice Radiographer in Breast Radiotherapy
Poppy Howe: 01223 256710

This answerphone is for non-urgent messages, but the voicemail message provides alternative numbers should you have an urgent query.

What can I expect after my treatment finishes?

Skincare

Changes to the skin often peak a couple of weeks after treatment has finished but this can vary from person to person. We would suggest that you continue to follow the radiotherapy skincare advice that you were given for some time (3-4 weeks after radiotherapy is complete) as it may take a few weeks for the skin changes to settle. You can start to gradually reintroduce your usual products once you feel your skin is settling down. If irritation occurs wait a few more days and then try again.

Most people will experience only mild redness (erythema) of the skin but sometimes the skin can look quite red and even a dark red/brown colour in places and feel a bit sore. This is most likely to occur under the arm and/or along the bra line but could occur anywhere within the treated area. The nipple area may also appear darker at this time. The skin can sometimes feel itchy and flake, similar to the appearance following sunburn. Continued use of a moisturiser should help until the skin changes subside. It may be advisable to avoid highly perfumed moisturisers and use a moisturiser that is sodium lauryl sulphate low/free.

Very occasionally, some skin within the treated area may blister or become broken towards the end or after you have completed radiotherapy. This is called moist desquamation. Though this may be uncomfortable, and may be sore at the time, the broken skin heals and the skin changes should settle down. If you do develop broken skin after completing radiotherapy, it is advisable to see your GP or Practice Nurse and take this information sheet with you as you may require different cream or dressings for broken or blistered areas.

Please contact Poppy Howe, Advanced Practice Radiographer in Breast Radiotherapy (01223 256710) if you are concerned and require any further advice about this.

It is fine to go swimming both during and following radiotherapy, while you still have some changes to your skin, however this is not advisable if you have broken skin.

Your skin in the area treated with radiotherapy will be much more sensitive to sun exposure. We recommend covering the treated area completely for the first year, but always use high factor sunscreen (at least SPF 40-50). Sun beds should be avoided.

Skincare information for GP/nurse

Please find below a brief summary for the management of radiation induced skin changes in accordance with our departmental guidelines. For more details on the management of radiation induced skin reactions please visit the GP Connect Homepage on the Addenbrooke’s website (opens in a new tab).

• Erythema: Continue the use of a moisturiser (Epaderm/Aveeno or something similar). Flamigel RT can be used at the point of brisk erythema to help prevent moist desquamation. Some patients may be given this during their course of radiotherapy.
• Itchy dry desquamation: Flamigel RT or 1% hydrocortisone cream can be used. The hydrocortisone cream may help alleviate itching but should be used sparingly and should not be applied to broken skin.
• Moist desquamation: Topical products and/or dressings may be used depending on the size and/or location of broken skin.

Topical products advised include:

1% Flamazine cream, Flaminal Hydro, Flaminal Forte or Hydrogel such as Activheal gel dressing

Dressings advised include:

• Mesh dressings such as Atrauman or Adaptic touch with non-adhesive secondary dressing Tegaderm foam or Allevyn can be used.
• Alternatively, Flaminal Hydro or Forte can be applied to the area and covered with a non-adhesive dressing (as above).
• Allevyn Life comes in a flower like shape which has a silicone adhesive – It is advisable that a larger dressing is used than required to avoid the adhesive on the fragile skin – this can also be used with Flaminal Hydro or Forte. This may be appropriate to use in the inframammary fold.

Please note: It is advisable to avoid adhesive dressings or tapes on fragile skin within the treatment area as this is likely to cause extra trauma to the skin and delay the healing process. Use of comfifast/tubifast/netalast may be appropriate to hold dressings in place.

• Swab if signs of infection.

Breast changes

You may have experienced some breast tenderness and/or swelling during and after radiotherapy. If you have had a mastectomy, you may feel some tightness over the chest area and the ribs within the treated area and it may ache. It is not uncommon to experience some twinges, aches and sharp pains within the treated area. These are usually mild and often intermittent. It may take several weeks/months for these effects to settle down.

Fatigue

Tiredness can often peak a few weeks after treatment has completed and it may take some time for your energy levels to recover after treatment. You may find that you have less energy to do the things that you would normally do in the weeks following radiotherapy. This can be quite variable, ranging from none at all to extremely tired. Sometimes fatigue can persist for months, though this is not common, and you may continue to have times where some days it is worse than others. More information and advice on how to cope with and manage fatigue is available at the Macmillan Cancer Support website (opens in a new tab) or call their support line free on 0808 808 00 00 (Mon – Fri 9am – 8pm). Tha Maggies Centre may also be able to provide you with additional advice and guidance on how to manage fatigue and you may wish to contact them on 01223249220.

Emotional wellbeing

It can often be a daunting time following completion of treatment. You may experience a range of emotions; relief to be completing treatment but also anxiety, uncertainty and fear. For some people these feelings can continue or become more persistent and start to affect your general mood, close relationships and daily living.

You may find it helpful to talk to a member of the team looking after you or your GP who will also be able to tell you about local support groups. More information, advice and support is available at at the Macmillan Cancer Support website (opens in a new tab) or you can call their support line free on 0808 808 00 00 (Mon-Fri 9.00-17.00). Additional support can be sought through The Maggies Centre and you may find it helpful to discuss what options are available to you.

Follow up arrangements

Depending on the length of your radiotherapy treatment, you will either have a follow-up appointment in your last week of treatment (if you are having 3 weeks) or approximately 7-10 days after you have completed treatment (if you are having 1 week of treatment). If you are still on treatment when your review is scheduled, this will either be a face-to-face appointment or a telephone appointment. These appointments will be undertaken by either the Advanced Practice Radiographer or your Consultant.

A further appointment will be arranged for approximately three months after your radiotherapy has finished. This will be a telephone appointment that is likely to be from your local hospital you usually attend. If you have not already been given a date for this appointment, it should be posted to you. This appointment is usually to see how everything is settling down after the radiotherapy and to discuss how you are getting on with any other treatments that you are continuing. In addition to a clinic follow up appointment you may require annual follow up mammograms. This will depend on the type of surgery you have had. A member of the team looking after you will discuss any further follow up arrangements with you.

It is important to remember that side effects can vary from person to person. If when you have finished your treatment you develop a new symptom, are unsure about any symptoms you may be experiencing or have questions then you should either see your GP for advice or contact a member of the team looking after you.

Further information and support

There are plenty of supportive services available to you during this journey. These are available either as face-to-face, a telephone call or online. It is important that you review what is available and consider what is appropriate to you. You may not feel that you need any extra support, but is important to know that you are able to contact these services at any point after you finish treatment.

Little Lifts

A small local charity providing thoughtful and handpicked gifts to support people with breast cancer. They provide a little lift box for people undergoing treatment for primary and secondary breast cancer, whether that's during chemotherapy or radiotherapy. For more information about the charity please visit the little lifts website (opens in a new tab).

You are entitled to a Little Lifts Radiotherapy box. This should have been provided when you attended the radiotherapy department. If you have not received one of these, please contact our Cancer Support Service on Tel: 01223 271801 option 2 or e-mail information support who will be able to contact you.

The Maggies Centre in Cambridge

Maggies are a charity run support and information centre for people diagnosed with Cancer. They offer a range of freely available services that may assist you with your journey. They are available to help manage emotions, manage practicalities and assist in the management of symptoms and side-effects. For further information please visit their website the Maggies website (opens in a new tab) or give them a call on 01223 249220 (Mon-Fri 9am-5pm).

You can visit them at

Maggie's Cambridge

Addenbrooke's Hospital

21 Milton House

Puddicombe Way

Cambridge

CB2 0AD

Or email Maggies Cambridge to enquire about how they could help you.

If you would like a bit more information or an example schedule to highlight what is on offer then please ask your Advanced Clinical Practitioner or the Treatment Radiographers.

Macmillan Cancer Information and Support Service Pod

The Macmillan Cancer Information and support services or ‘The Pod’ is located within the Oncology department. This is a drop in service, so no appointment is necessary and they are available to offer support, advice and guidance to anyone affected by cancer. This service can help give advice and guidance with grant applications and referral and signposting to benefits advice.

Online websites

Macmillan website (opens in a new tab)

Breast Cancer Care website (opens in a new tab)

Breast Cancer Now website (opens in a new tab)

Cancer Research UK Website (opens in a new tab)

Mobile Apps

Sleepio (for poor sleep and insomnia, addresses unique needs with a personalised programme, featuring sessions with step by step guidance through evidence based techniques, available night or day. In a clinical ttrail, 76% of patients experienced improvement in their sleep.) See the Sleepio - Macmillan website (opens in a new tab)

Daylight (for worry and anxiety, helps people gain control over their anxiety with personalised therapeutic content. Its available when it's needed the most, providing you with evidence based techniques to cope in the moment. In a clinical trial, 71% patients experienced reductions in anxiety). See the trydaylight - Macmillan website (opens in a new tab)

REACT program

Rehabilitation and Exercise during Addenbrookes Cancer Treatment is a service freely available to all patients undergoing cancer treatment at Addenbrookes. It is led by a Specialist Team of Physiotherapists and Cancer Exercise Specialists.

The programme offers supervised exercise opportunities for patients and aims to keep patients physically active throughout their cancer journey. It can also reduce the likelihood and severity of side-effects associated with cancer treatments.

The REACT programme includes individual exercise assessments/exercise counselling, group cardiovascular circuit style classes, standalone education sessions and short course to include;

• Breast Cancer Recovery
• Lymphoedema Prevention
• Boost your bones (Exercise for Healthy Bones)
• Strength and Balance
• Pilates
• Tai Chi
• Yoga
• Zumba
• Nordic walking/outdoor exercise

To find out more information about this service please speak to the breast care nurses or advanced clinical practitioner who can place a referral for you.

The Royal Osteoporosis Society

The Royal Osteoporosis Society is a great website (opens in a new tab) to refer to if you require information, support or advice on your bone health. This may only be applicable to some individuals who are on hormone treatments and whose bone density has shown osteopenia/osteoporosis. If you require more information, please contact your local breast care nurse for more information.

How to get involved

We believe that involving patients and carers can help us improve the services we provide.

There are many ways that you can get involved and help us improve the services we provide. For further information you can visit our website to read more about the following;

• Patient and Carer User Groups
• Cancer Participation Group
• My Chart Stakeholder Group
• Outpatient Experience Group
• Reader Panel – Patient information
• The CUH PPI Panel

Just want to say thank you? How you can support Addenbrooke’s and the Rosie hospitals.

In our busy hospital, our dedicated staff do amazing things every day. Of course, they never expect thanks, however, we know that many patients want to express their gratitude for the wonderful care they have received.

Here are five ways to do just that.

Make sure great work gets recognised

Our Patient Advice and Liaison Service (PALS) would be delighted to receive your thanks for a job well done and will share your feedback with the staff involved.

Tel: 01223 216756 12:00 to 16:00 Monday to Friday

E-mail CUH PALS

Addenbrooke's Charitable Trust (ACT)

You can help us make Addenbrooke’s and the Rosie hospitals even better.

Did you know we have our own charity, Addenbrooke’s Charitable Trust (opens in a new tab)? Whether you can donate, fundraise or volunteer your time, you can help change and save lives every day.

Tel: 01223 217757

E-mail CUH ACT

Staff awards

Nominate an individual or a team for our monthly You Made a Difference Award, a little public recognition goes a long way.

Tel: 01223 274775

E-mail CUH - You Made a Difference

Become a member of the Foundation Trust

Become a member of the Foundation Trust and have your say about the issues that matter to you and help shape the future of patient care at Addenbrooke’s.

Tel:01223 216756

e-mail CUH Foundation

Become a hospital volunteer

Our volunteers (opens in a new tab) occupy a special place in our hearts. If you have time to give, there’s a volunteer role for you.

Tel: 01223 586616

e-mail CUH Volunteer

Support closer to home

If you require information about other support services available to you locally please ask a member of the team. This can often also be accessed via your GP who can support you directly or if appropriate refer you to another health care professional.

More information about breast cancer and radiotherapy can be obtained through the following organisations:

Macmillan Cancer Support Website (opens in a new tab)

Breast Cancer Care Website (opens in a new tab)

Breast Cancer Now Website (opens in a new tab)

Cancer Research UK Website (opens in a new tab)