Palliative radiotherapy for bone pain

This leaflet contains information about your radiotherapy treatment. It tells you about the different stages of your treatment as well as the commonly seen side effects and how to cope with them.

Why am I having radiotherapy?

Your doctor has suggested radiotherapy as a treatment to relieve bone pain caused by cancer that has spread into the bone. The areas of cancer cells in the bone are called bone metastases or secondary bone cancer and can cause areas of weakness and pain. Not all bone deposits need treatment, sometimes only those causing pain are treated. Radiotherapy can also strengthen the bones, making them less likely to break. Having the treatment may slow down the cancer and give you a better quality of life by reducing the pain, but it will not cure your cancer.

What is radiotherapy?

Radiotherapy uses carefully measured doses of strong x-rays to treat diseases. It is given by therapy radiographers and works by causing damage to cells within the body. Cancer cells are much less able than normal cells to repair the damage, so more of the cancer cells will be destroyed.

How is the radiotherapy planned?

Radiotherapy treatment is tailored to the individual patient and requires careful planning. The first appointment involves a computed tomography (CT) scan in the radiotherapy department where tiny permanent marks (referred to as 'tattoos'), are made on your skin. These are important reference marks used by the radiographers to accurately deliver your treatment. The radiographers will also take your photograph, which is used as a safety check each day prior to your treatment. The specialist cancer doctor (oncologist) will use the CT images to decide upon the area requiring treatment.

What happens during treatment?

Before your first radiotherapy treatment, a member of the team that will be treating you will have a discussion with you. This will cover what you can expect to happen each day when you have your radiotherapy and how to minimise any side effects that it may cause. They will also check that you are happy to go ahead with your radiotherapy and this is an ideal opportunity to ask any further questions that you might have.

Inside the treatment room, the radiographers will position you correctly on the treatment couch before leaving the room to switch the machine on. You will be alone in the treatment room but the radiographers will be watching you over the closed circuit television camera system. They can also talk to you through an intercom if you want them to. If you need help, raise your arm. The machine can be switched off and the radiographers can come and assist you.

The radiotherapy machines are quite large but they don’t actually touch you. Each treatment session takes about 10 minutes. The machines make a buzzing sound when switched on, but radiotherapy is completely painless. You will not be radioactive afterwards and are safe to mix with other people including children and pregnant women.

If required, please remember to bring your painkillers with you, so that you can take a dose if you need to while you are at the hospital.

Superficial radiotherapy

Superficial radiotherapy uses x-rays at a lower energy. It is delivered by a smaller treatment machine and is very useful for treating bones that lie just beneath the skin such as the ribs, sternum and clavicle. A CT planning scan is not required in this case and the area for treatment is marked on the skin with marker pen on the day of treatment. As the treatment is prepared and delivered at the same time, this appointment usually takes about an hour.

How many treatments will I have?

Your doctor will decide the most appropriate course of treatment for you. Most patients require only one treatment, although five sessions are sometimes required.

How are treatment appointments arranged?

We will accommodate your time preference wherever possible. Please try to be as flexible as you can and give priority to your radiotherapy treatment sessions over other general appointments. If you are scheduled to have multiple treatments, the time may vary slightly each day due to the number of patients on the unit.

Patients are not routinely seen by the doctor while on treatment. However if you would like to be seen by a member of your treatment team at any point, just ask one of the treatment radiographers.

What are the side effects of treatment?

Some of the commonly seen side effects from radiotherapy are listed below, but even these can vary between people depending on the area being treated and the radiation dose required. Side effects tend to appear within a week and then gradually subside. You might also experience other side effects not listed here. If these are a source of concern, please contact the team.

Tiredness

Tiredness is one of the most common side effects of radiotherapy. Listen to your body. You may need to rest and relax more than usual, particularly if you are travelling long distances to the hospital. However, it is good to maintain a level of activity such as gentle walking, if you feel able. If needed, don’t be afraid to ask friends and family for help.

Pain

You may become aware of an increased aching in the treated area. This is a temporary reaction to the radiotherapy and doesn’t affect everyone. It is important to keep taking your painkillers regularly. Improvement in pain is usually gradual and you should not be in too much of a hurry to reduce or stop your painkillers. When your pain has decreased it may be possible to gradually reduce the dose of your pain killing medications. Your doctor / nurse / specialist radiographer will be able to advise you.

Skin reaction

Radiotherapy will only affect your skin within the treated area. You may notice that the skin here becomes more sensitive, slightly red, warm, itchy or dry. This may occur after the treatment has finished. We advise you to:

• Wash daily with a mild soap and warm water then pat dry with a clean soft towel.
• Apply a gentle, unperfumed moisturiser to the treated area twice a day, such as E45® or Diprobase®.
• Deodorant may be used.
• Try to avoid sun exposure on the treated area where possible and for about one year after treatment.
• Swimming in chlorinated pools is permitted, but rinse skin well with water afterwards and stop if irritation occurs.

Hair loss

You will only lose hair within the treated area. The hair usually grows back, but, very occasionally, this is permanent.

Nausea and vomiting

Nausea (feeling sick) and vomiting (being sick) are less common but can sometimes occur if the treatment area is close to the stomach, bowel or liver. Nausea and vomiting can be controlled with effective anti-sickness drugs if required.

Bowel disturbances

Bowel disturbances are less common in most patients. However, if your treatment area includes a large area of the pelvis you may notice that your bowels become looser for a few days after the radiotherapy.

Loss of appetite

You may feel less like eating when you have radiotherapy. Try to eat high-calorie small meals and snacks regularly throughout the day. Drink plenty of fluids to stay well hydrated. Nutritional supplements and fortified drinks can also help if needed.

After treatment ends

Radiotherapy can continue to have a beneficial effect for some weeks after the completion of treatment. Any side effects may persist for seven to 10 days before they start to settle down.

You will normally receive a follow up appointment for six weeks after the end of treatment to see the oncology doctor. This is to see how you are and that the side effects have subsided. Some patients are followed up by their GP.

If you have any problems, or notice any new symptoms, please contact your specialist nurse or radiographer. You don’t have to wait until your next scheduled appointment.

Contact information

If you have any worries or questions about your treatment, please do not hesitate to contact one of your treatment team or the department on the numbers below.

• Radiotherapy reception, Addenbrooke’s: 01223 216 634
• Oncology reception, Addenbrooke’s: 01223 216 551 / 216 552
• Addenbrooke’s emergency 24-hour helpline for oncology patients: 01223 274 224

Further information and support

Macmillan Information Pod

The Macmillan Pod at Addenbrooke’s, located in Oncology, level 2, offers support, advice and information for anyone affected by cancer. They offer assistance with blue badge and Macmillan grant applications, and help with referrals and signposting to benefits advice. The service will also help find local support groups and self-management courses.

Drop by Monday to Friday to pick up information or to speak with an information specialist. Or you can call on 01223 274 801, or visit the Macmillan website (opens in a new tab).

Maggie's Wallace

Maggie’s Wallace (opens in a new tab) is on the CUH campus. It provides free practical, emotional and social support for people with cancer and their family and friends. Their programme of support includes clinical psychology, nutrition, benefits advice and exercise, courses pre and post treatment and complementary treatments.

Cancer support specialists are on hand Monday to Friday 09:00 (9am) to 17:00 (5pm). No appointment is required.

21 Milton House, Puddicombe Way, Cambridge, CB2 0AD
01223 249 220