Managing side effects of radiotherapy

I am a Prostate Specialist Radiographer at the Christie Hospital in Manchester. I'm working to improve the experiences of prostate cancer patients undergoing radiotherapy. The Christie is the largest cancer centre in Europe and treats over 700 prostate cancer patients with radiotherapy each year.

Many men undergoing radiotherapy experience one or more side effects. My project looked at how these side effects were best managed by looking at the best care pathway for these men.

The need for this project arose for a number of reasons, including overcrowding of clinics and patients receiving different referrals to support services due to a there not being a clear pathway of care. Also patients were being reviewed by different members of staff and had to spend time explaining their situation and treatment history, which impacted on time they had available to discuss any side effects they were experiencing.

To address these issue I scoped out national practices on care pathways for patients undergoing radiotherapy. I worked with the Research and School of Oncology teams and the audit department to develop a short questionnaire which was sent to all Radiotherapy Department Heads. I then used this information to create an evidence based care plan for the management of side effects of radiotherapy. 

As a result of the scoping work we developed a radiographer-led review clinic. Patients undergoing treatment for prostate cancer were referred directly to me instead of consultant clinics. This meant that patients were able to see the same person at each meeting and didn't have to spend time explaining their history. It also meant that they had someone on site who is available whenever they needed support, rather than having to wait until their next appointment.

The new system meant patients' side effects could also be addressed much quicker, because as a radiographer I can look at the on-treatment scans and discuss urinary side effects to manage via medications proactively rather than reactively, and this in general may not only make the treatment most effective but limit the need for patients to require a new treatment plan which can cause delays.

This project has highlighted how much continuity of care can improve the experience of patients. The introduction of a radiographer-led review who is able to prescribe and treat conditions has had a huge impact on the management of side effects experienced by patients.

For example, one side effect men can experience is urinary toxicity which can affect urgency, frequency and flow. The radiotherapy can enlarge the bladder which can move the prostate out of the area being targeted. In my clinics I am able to spot side effects like this quickly and can prescribe medication which will prevent enlarging of the bladder so that the treatment remains effective.

Since opening the clinic:

• Patients have indicated that they are feeling better supported; they are able to see the same person for each appointment and know I am available on site if they need support.
• Treatment is more streamlined as it is no longer dependent on other clinic appointments and side effects can be addressed and treated quicker.
• There is a much greater consistency to the information and support services given to men.
• Staff have more time as this change in pathway provides more support for the team.

We are currently reviewing the impact the project has had, with the view to publishing the results and making recommendations for future radiotherapy practices on side effect management.

The advice I’d give others looking to set up something similar would be to get as much feedback and support from your peers and the wider medical team as possible. Get everyone on board and make sure they understand how the service will benefit their own work, so that when it is set up they start to use the service and refer their patients to you."

Across the UK we’re funding clinical nurse specialists, support workers, physiotherapists and more, to improve the care and support for men in their local areas. These professionals are working to redesign care pathways, expand or establish survivorship programmes, and have supported over 10,000 men since the programme started in 2012.

To find out more visit prostatecanceruk.org/healthroles