Preparing for Chemoradiotherapy

CURE, Spring 2013, Volume 12, Issue 1

Preparing in advance and learning what to expect with chemoradiotherapy, patients can make the treatment easier and more tolerable.

CRT can be a little more intense than receiving chemotherapy and radiation at separate timepoints, but the experience will vary considerably from patient to patient, depending on the type of cancer, the chemotherapy drugs used, the intensity of radiation and other individual factors. But preparing in advance and learning what to expect on the road ahead can make the experience easier and more tolerable.

For example, if treatment is for head and neck cancer, a percutaneous endoscopic gastrostomy (PEG) tube may be needed to provide adequate nutrition during treatment. This is an invasive procedure in its own right, and the pros and cons of prophylactic placement should be discussed. Patients should also familiarize themselves with common side effects of CRT for their particular cancer type, and ways of managing them. For example, cystitis (inflammation of the bladder) is sometimes a side effect in treating bladder cancer, and proctitis (inflammation of the rectum) in treating rectal cancer, and mucositis (mouth sores) and dermatitis in treating head and neck cancers.

The National Cancer Institute’s website (cancer.gov) has information on many cancer types and treatments, as does the American Cancer Society (cancer.org). There are foundations and advocacy groups for individual cancer types, as well, which offer information about the disease and therapy, and what patients may expect once they begin their treatment. For details, visit curetoday.com/toolbox. It is essential for patients to keep their care team appraised of significant side effects, especially those that interfere with eating or fluid intake. In some cases, a nurse navigator or social worker may be available to guide patients to additional sources of support and information.

“I also highly recommend reaching out to other patients who have your same cancer,” says Ronald Huang, a patient with lung cancer who lives in Seattle. “It was helpful for me to talk through the logistics and details of getting through treatment with other patients who received the same treatment as me. They can also help you prepare psychologically and help you get through treatment later on.

“It is also important to plan ahead, and make things as easy as possible for yourself,” Huang adds. For example, patients should select a radiation schedule that works best for them, and also plan for days when help is needed to get to appointments.

Huang also recommends, if possible, taking some time off after the first few chemotherapy sessions in order to gauge tolerance and side effects. The same holds true for radiation, he says, “You’ll also want to be flexible with your schedule two to three weeks after radiation in case you do develop bad side effects.”

Finally, Huang also believes that it is important to have a positive attitude going into therapy. “It doesn’t have to be all the time, but you have to find ways to remind yourself that things will eventually get better.”