At a glance
- How long will each of the treatments take, assuming no delays?
- What is the target area?
- How often will it need to be administered?
- Ask what side effects are expected.
- Ask if there are any side effects that you should be particularly aware of – such as life altering.
- Ask what to do if you experience side effects.
- Ask what you can do to improve outcome.
- Ask how you can aid recovery/healing.
- Ask what cream(s) to use before and after treatment.
- Ask if your partner should stop or start anything, such as medicines or food.
The size, grade and position of Jen’s tumour (49 mm, offset from but near to the nipple of the left breast) meant the skin, subcutaneous tissue and chest wall muscle was still at risk of reforming cancer, despite both breasts being removed. She was advised that radiotherapy reduced recurrence by an additional 5%. We figured, taking the preventative hormone therapy into consideration as well, it was a good percentage to knock off, so Jen opted for the therapy. Notwithstanding that the radiotherapy could cause cancer later in life. Gah!
Because of work commitments, I couldn’t take the three hours out of each of the 15 days of treatment (our hospital was an hour away), and so I wasn’t able to be with Jen for every session, much to my frustration. It was the only time, besides the Macmillan ‘Look Good Feel Good’ session, where I wasn’t with Jen for every appointment. However, family who, up to that point, had been gagging to help, stepped in and took turns taking Jen. I was there for the first appointment, the middle one and the last one. It’s worth noting that radiotherapy was the least unpleasant of the ‘big three’ treatments though it’s not without its discomforts.
One of the problems we faced was Jen’s fatigue. She was still healing from the chemotherapy and surgery and we were told that the radiotherapy would only compound it. So, she wasn’t safely able to drive herself. I mean she could have, but we considered the risk too great, plus she would be there alone for most of the sessions and that was less than ideal. So we called on family to help, which they gladly did. In fact, they all wanted to help so much but, beyond continual love, emotional support, flowers and care packages, which of course were deeply appreciated, there was little they could do to help fix Jen. So Jen suggested a rota and my Mum, and two Aunties eagerly agreed. Jen’s folks would have helped too but they were too far away.
The area to be treated had to be fully healed before radiotherapy could begin, as exposing wounds to radiation can slow healing. There was one tiny area where the three incisions met in the middle that had a miniscule scab that we all had to keep an eye on but it was considered safe to go ahead.
Approximately one month before the radiotherapy began, Jen went to the radiotherapy unit to be ‘mapped’. This involved detailed scans of the target area – that is, the area to be exposed to the radiation – along with three tiny, permanent tattoos which would be used for future targeting. The machine used was a formidable piece of equipment (Jen took a picture for me) and had a strange set of arm and leg stirrups which were carefully measured, with Jen in position, so it could be set exactly for each session.
Jen needed to stay in the same position for each session. She found it uncomfortable but not painfully so. Imagine having to lean on the same arm for 20 minutes until it gets pins and needles – something like that. She didn’t feel the radiotherapy ‘doses’ when they were administered, but the skin in the targeted area did start to change colour. Because she was bare chested during the sessions and because the room was heavily air-conditioned to ensure adequate machine cooling, she was cold, so she took a small microfibre blanket in with her to keep her legs warm.
By the 15th session, Jen was wiped out physically. She very much lacked energy and her normal get up and go. Mercifully there was no sensation in the targeted area due to the nerve damage caused by the surgery, so she couldn’t feel the damage to the skin. I would liken it to severe sunburn, and it was largely treated as such.
After each session, Jen would get home, expose her shapely new breasts to the bedroom (and me), and slather them in Aloe Vera gel. Then she’d leave them to air. At all other times, she used Aveeno moisturiser but moved on to E45 cream as she preferred it. There are other products, such as E45 spray, as well as R1 and R2 products, but we think the ones Jen used worked well. Jen kept the Aloe Vera gel in the fridge. Not because she could necessarily feel the cooling effect, but because she thought the cooling action would help limit damage from the radiation.
We were told that the side effects would ‘peak’ around two to three weeks after the final dose was administered, then healing would begin again in earnest. My observations suggested it was around two weeks. We noticed some slight blistering of the skin around week two (following the final dose) and ‘Hydrogel’ was prescribed.
It took a few more weeks for her dark purple breast to return to normal. Now it looks faintly more tanned than the other. Nothing obvious but definitely a shade darker if you’re looking for it.
Of all the treatments, Jen found radiotherapy to be the ‘easiest’. Of course, it took a toll on her strength and slowed her healing for a time, but she recovered well once her body was given time to ‘catch up’ with what was happening to it (my interpretation).
Jen wasn’t fully recovered after eight weeks, but she was well enough to make a phased return to work.
You’re going to have to sort the logistics of going to and from each session, and the sessions will be every day for a set period of time. Generally, the sessions don’t take long in themselves but, as with all things that involve lots of people, there are often delays. So make sure you take provisions in case you’re there for longer than anticipated. I’d suggest at least some snacks, drinks and entertainment.
Make sure you leave with plenty of time to allow for traffic incidents. That will help keep things calm on the way there – anything that reduces stress levels is a good thing, after all.
You won’t be able to go into the treatment room with your partner, but you can be with her the rest of the time.
Give your partner plenty of time and space to recover – she’ll tire very easily and very quickly for some weeks after treatment finishes and the effects are cumulative, which means they’ll get marginally worse after each treatment.
Obviously, recovery times are different for each person and will depend very much on the treatments your partner has been given as to how much stuffing has been knocked out of her. Make allowances for emotional imbalances and just keep on giving her love and as much understanding as you possibly can. Let her rebuild at her own pace – I had to keep Jen grounded as she would often push herself too hard and thus was regularly frustrated by her limitations. So, keep tabs on your partner’s activities and make sure she gets plenty of rest and takes regular breaks.
You can also help keep an eye on the general health of your partner’s skin, as well as help apply the various creams and gels. It’s a good way of maintaining intimacy, confidence and trust between you and your partner.
Dealing with side effects
Your partner should avoid skin creams with sunblock and antiperspirants before each radiotherapy dose – they contain dioxides like titanium and aluminium. She should ALWAYS check with the radiologist as to what creams she plans to use.
Also discuss medications with the radiologist. Some medicines can cause the skin to be more sensitive which could cause an adverse reaction.
Wounds are slower to heal and can be made worse by radiation, so make sure the radiologist is made aware of any wounds your partner may have. Don’t assume that because your partner has had surgery that the radiologist will be aware of any incisions. Discuss any areas that are still healing as they can be worsened by the radiation.
The following is a list of the possible side effects your partner may encounter:
As this is radiation we’re dealing with here, the burns are very similar to sunburn. Think red, itchy and/or sore. Making certain your partner applies aloe vera gel as soon after each session as possible will help reduce damage and discomfort. Using unperfumed mild soap and patting dry the skin after washing will also help prevent the skin from being aggravated. Moisturising the skin, protecting it from sunlight with high SPF sunblock and wearing comfortable, loose fitting clothes made of natural fibres such as cotton will also help.
Again, as with sunburn, some blisters can form. It’s worth flagging them with the radiologist, especially if they are large.
The effects of radiotherapy are cumulative, so your partner will potentially become more tired as treatment progresses.
This is where the targeted tissue tightens or hardens via scarring, which can cause the area around a breast implant or reconstructed breast to become too tight for the implant. This may not happen immediately and can even be a year or more later. A smaller implant may be possible although in some cases the implant must be removed.
While organ damage is rare, it’s still a possibility. The radiography team will take steps to reduce the risk of this, through body positioning, careful measurement, accurate targeting, administering the dose while your partner holds her breath, keeping the heart away from the target area and so forth.