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Radiation therapy in palliative care

The role of radiation therapy in palliative care
Hi! So could you introduce yourself to us, please, and tell us a little bit about your role? Yeah, so my name is Donal Buggy. I work with the Irish Cancer Society, and I am Head of Services and Advocacy there. So we deliver a range of services to cancer patients, be they surgical patients, chemotherapy patients, or, indeed, radiation oncology patients. As you know, radiation oncology has a large role to play in palliation of patients. And what kind of supports do cancer societies offer these patients and their families where a cure is not really an option?
Yeah, well there’s I suppose, a couple of things I would say in relation to that, is that quality of life, that I talked about earlier from a survivorship perspective, should be considered even in end of life, even in patients where treatment is given for non-curative intent, that exercise, diet, all these things are things that can be important right up into the last weeks and months of life. Another significant aspect of that is the managing the, I suppose, the psychological consequences of the treatment, being able to provide counselling support, spiritual support, being able to look after not just the family– the cancer patient, but also their family. You know, what are the conversations they’re going to have with their children?
What are the conversations they’re going to have with their peers? How can they manage the time that they have available to them? And you know, for many patients now who are metastatic, who have advanced cancer, they can live for significant periods of time. So it’s thinking about, well, what are the things that I need to incorporate into my life to improve my quality of life over that period of time?

Many patients hear the word “palliative’ and fear that it means it is the end of their life. However, palliative radiation therapy refers to the therapy which can bring relief to distressing symptoms of cancer, slow down its course, and improve quality of life. This type of care should be introduced as early as possible and in such a situation, palliative therapy, together with basic oncological treatment, can prolong the patient’s life.

Changing the perception of palliative care

Nowadays, cancer is perceived as a chronic disease. It may not always be possible to cure it radically; however, it does not necessarily mean the end of life. Accepting this fact is one of the key moments in the therapy.

Rediscovering the joy of life in the new, more difficult situation may seem hard to achieve, but it is worth fighting for.

If it is not possible to retain the same level of activity because of the progress of the disease – the palliative treatment, by eliminating the symptoms, helps patients to discover other, pleasant aspects of life: a conversation with family members or close friends, reading a book or a leisurely walk.

How does radiation therapy help in palliative care?

Palliative radiation therapy is used mostly in the case of painful metastases, or secondary cancer to bones, practically in all locations. This treatment allows for complete elimination or at least significant reduction of pain. This, in turn, often means that we need to administer fewer analgesics (pain-relieving drugs), which has a very positive impact on the mental wellbeing of the patient. The relief in pain may last up to several months and the radiation therapy can be repeated.

Palliative radiation therapy is also given in order to reduce the tumour size, which can cause pain by compressing or damaging tissue, and infiltrating nerves. Tumours may cause bleeding from tumour blood vessels or by destroying nearby blood vessels. Radiation therapy can reduce both the frequency and intensity of bleeding, preventing secondary anaemia and weakness of the patient.

Immediate radiation therapy also helps in difficult, urgent situations, which require consultation with a radiation oncologist. These include compression of the spinal cord by fractured or invaded bones in the spine, or a syndrome known as superior vena cava obstruction, which causes breathlessness as it blocks the blood flow in the upper part of the body.

Palliative radiation therapy can also help in cases where tumours have spread to the brain (known as brain metastases), or in some tumours that have started in the brain, where cure is not the intended treatment. These can sometimes produce unpleasant neurological symptoms such as epileptic seizures, headaches, or visual disturbances. Palliative radiation therapy to the whole brain can offer relief and improve the comfort of everyday life. If there are many tumour regions in the brain, the whole brain undergoes irradiation, and when there are few tumour regions – only the metastases can be irradiated, using stereotactic radiation therapy.

What do new technologies in palliative radiation therapy offer?

Standard external beam radiation therapy (EBRT) is currently used for treating bone metastases with a single treatment. The short preparation and irradiation time improves the comfort of patients considerably. Additionally, a single treatment means that there is no need for frequent hospital visits.

Stereotactic radiation therapy of metastases allows a higher dose to be administered once or extended to a few days of treatment. Currently, the possibility of treating a few metastases at the same time using stereotactic radiation therapy is being investigated.

Brachytherapy, where we place the radioactive source directly in the tumour or in very close vicinity can be used to treat tumours blocking the bronchi in the lungs, allowing for a reduction in breathlessness. It is also useful in unblocking the oesophagus and enables the patient to return to eating food.

Palliative radiation therapy is a very useful therapy offered to patients at a chronic stage of cancer. It involves the contribution of many specialists including radiation oncologists. The choice of the optimum treatments and their sequence is always a decision taken by a team of experts made of not only physicians but also psychologists, nutritionists, social workers and coordinators assisting families and carers.

The words “palliative treatment” can cause fear and they should not. This is therapy of a certain stage of a disease, targeted fully at improving the quality of life and maintaining patient dignity in every situation.

Joanna Kazmierska
Joanna is a Radiation Oncologist at the Greater Poland Cancer Center in Poznan, Poland.
Joanna Kazmierska
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