THE PARTNERSHIP BETWEEN RADIATION AND MEDICAL ONCOLOGY

NURSES AND ITS BENEFIT TO PATIENTS

LEARNING OBJECTIVES

• Recall the myths of radiation and chemotherapy in order to help patients understand treatment better.

• State the roles of the radiation nurse and medical oncology nurse

• Repeat the steps of radiation treatment planning

• Identify skin care for patients with the four grades of radiation dermatitis

• Recall and share with patients alternative nutritional tube feedings and supplements

• Identify the components of long-term survivorship care

COORDINATING COMPLEX CANCER CARE DELIVERED BY MULTIPLE PROVIDERS

• This is challenging!

• The key is partnership

• This is best practice to help patients

achieve optimal outcomes

• We have to better understand each

other’s specialty

• Starting treatment right away

• Radiation is very painful

• Radiation will cause patient to be

radioactive

• Radiation therapy causes terrible

side effects

• There is no need or advantage

of radiation after complete removal of tumor

DISPELLING MYTHS AND MISCONCEPTIONS ABOUT RADIATION THERAPY

DISPELLING MYTHS AND MISCONCEPTIONS ABOUT CHEMOTHERAPY

• “It makes me toxic.”

• Every chemotherapy causes infertility

• “It is not worth it”

• “It will completely disrupt my life”

• “It isn’t working if I don’t have

unbearable side effects”

• Oral chemotherapy is easier than IV

chemotherapy

THE ROLE OF THE RADIATION ONCOLOGY NURSE

• Assessments and direct patient care

- Pre-treatment assessment

- Site specific side effects

- Brachytherapy procedures

• Communication

- Coordination of concurrent

chemoradiation

- OR procedures

- Dental needs for head and neck

cancer patients

• Education

- Acute and late side effects

- Skin care, nutrition & fatigue

• Emotional support / supportive

care

- Anxiety

- Ineffective coping

- Disturbed body image

- Sexual dysfunction

THE ROLE OF THE RADIATION ONCOLOGY NURSE

THE ROLE OF THE MEDICAL ONCOLOGY NURSE

• Assessment and direct patient care

- Collect samples for genetic testing

- Administration of complex therapies

- Prior authorizations for oral chemo and

support drugs

• Communication

- Organizing referrals, physical therapy,

lymphedema therapy

- Understanding therapy goals and treatment

schedules

- Identifying a time sequence in which side

effects generally occur

• Education

- Symptom management

- Immunosuppression

- Compliance

- Nurse triage

• Supportive care / emotional

support

- Connect patient with

resources / support groups

- Assist with pain management

THE ROLE OF THE MEDICAL ONCOLOGY NURSE

RADIATION TREATMENT

• Planning includes:

- Simulation

- Contouring targets

- Designing beam arrangements

• Simulation

- Position Patient: Immobilization with

masks and body cradles

- Image Patient: CT scan, fluoroscopy,

image fusion, 4-D CT

- Reference marks: Ink marks, tattoos

• Skin care is of paramount

importance

- It minimizes severe radiation

dermatitis

• Overall goal: Keep skin intact.

How?

- Minimize scratching and rubbing

- keeping skin moisturized

SKIN CARE DURING RADIATION THERAPY

GRADE 1 SKIN TOXICITY (FAINT ERYTHEMA OR DRY DESQUAMATION)

• Wash area with mild soap and water, non alcohol based: baby shampoo

• Taking sitz baths or soaking in the bathtub in warm water will help sooth perineal or anal skin, reduce

erythema and aid in itching

• Apply an unscented lotion to provide moisture and maintain skin integrity

• Aquaphor, eucerin, vitamin A & E ointment/cream, Aloe vera gels, dove soap

• Switching to a heavier oil-based product

that provides a skin barrier may be needed

• For areas of moist desquamation, barriers

or hydrogels may need to be considered.

Diaper rash ointments or zinc oxide may be

used in areas of patchy moist desquamation

• Normal saline compresses, vinegar soaks,

vaseline petroleum gauze, glucan Pro 3000

Do not use dry dressings

GRADE 2 SKIN TOXICITY (MODERATE TO BRISK ERYTHEMA OR PATCHY MOIST DESQUAMATION CONFINED TO SKIN FOLDS)

GRADE 3 SKIN TOXICITY (CONFLUENT MOIST DESQUAMATION OF > 1.5 CM DIAMETER AND NOT CONFINED TO SKIN FOLDS, PITTING EDEMA)

• Cleanse with room temperature normal Saline, which may be more soothing than water.

• Apply appropriate non adhesive dressings, mepilex, cuticerin

• Regularly assess for signs of infection

• Rarely occurs

• Emergent: requires immediate

medical attention

• Specialized wound care,

referrals to dermatologist or

wound care clinic debridement or

skin graft

GRADE 4 SKIN TOXICITY (SKIN NECROSIS OR ULCERATION OF FULL THICKNESS DERMIS)

57-YEAR-OLD STAGE IVA VULVAR SCC

• Picture of tumor during simulation scan.

• Clean with normal saline or soak in Epson salt bath.

• Pat dry

• Mix crushed flagyl tabs with GlucanPro 3000 cream and apply mixture to

(2) cuticerin (7.5 cm x 20 cm).

Place on cuticerin, medicine/cream to vaginal wound/skin breakdown and

place one cuticerin, medicine/cream to rectal wound/skin breakdown.

• Apply plain GlucanPRO 3000 cream to darkened/dry affected skin

around wound.

• Cover with (2) 7-1/2 x 8 ABD pads.

• Wrap with 4x4 1/8 yard Gauze Fluff Roll/Kerlix.

• Secure with 2-inch medipore H tape.

PATIENT DRESSING CHANGE

•

NUTRITION

• The incidence of nutritional problems is

higher with patients receiving both

chemo & radiation.

• 40-50% of Head and Neck cancer patients

experience swallowing difficulties

• 20% of patients with CNS tumors experience

persistent nausea or anorexia

• 60% of patients receiving treatment for tumors

in the thorax area report difficulty swallowing,

indigestion, early satiety and anorexia.

• 3-11% receiving treatment to abd / pelvic

regions have reported nutritional problems R/T

diarrhea or constipation

• Early nutritional intervention is

key.

• Consume high calorie high

protein diet

• Use commercial nutritional

supplements

• Websites that sell “real food”

tube feedings

• realfoodblends.com

• functionalformularies.com

• SPOHNC-recipe resource guide

NUTRITION

SURVIVORSHIP CARE

• As of January 2019, it is estimated that there are 16.9 million cancer survivors

• The number of cancer survivors is projected to grow to 26.1 million by 2040

• NIH- Division of Cancer Control and Population Sciences

• Intervention for consequences of

cancer and its treatments

• Medical and psychological late

effects

• Prevention of new cancers and late

effects of treatment

• Surveillance for primary cancer

recurrence and second primary

cancers

• Coordination between specialists

and primary care providers

LONG TERM SURVIVORSHIP CARE COMPONENTS

QUESTIONS