Oncology nurses are a vital source of education and support for patients undergoing radiation therapy, enabling patients to complete therapy and minimize side effects, Richard L.S. Jennelle, MD, of the Keck School of Medicine at the University of Southern California in Los Angeles, said during a session on Thursday, April 11, 2019, at the ONS 44th Annual Congress in Anaheim, CA.

A Team Approach

Radiation therapy is an inherently interprofessional practice that requires timely communication among all members of the care team, Jennelle said. Invoking the maxim “good, fast, cheap—you can only pick two,” He said that quality assurance is essential to ensuring the safety and effectiveness of modern radiation therapy. Although rarely visible to anyone outside the radiation oncology department, quality assurance overlays every stage of radiation therapy from the initial consultation through the planning and administration of treatment as well as follow-up and survivorship care.

Because radiation oncology is usually a tertiary referral specialty, patient evaluations and diagnoses are usually mostly complete before the initial radiation oncology consultation occurs. Issues considered in that consultation will include the goal of treatment (i.e., cure or palliation), treatment targets, optimal treatment modality, how to coordinate and integrate multimodality care, and patient education concerning what to expect and how to provide self care.

Thinking ahead is essential to success in radiation oncology, Jennelle said. Using the analogy of an airplane pilot, he said, “You don’t fly the plane where it is—you fly it where it will be in 10 minutes.” Treatments are carefully planned to identify and outline both the targets and the normal tissues that need to be protected. Much of this work is performed behind the scenes by radiation therapy physicists and certified medical dosimetrists, vital members of the radiation oncology team whom nurses and patients never see.

A Primer on Radiation Therapy

Fundamentally, radiation is a kind of light, most of which simply passes through the body, while a little stays behind. It’s used in cancer treatment because it does more damage to tumors than to normal tissue.

Conventional three-dimensional radiation therapy uses computed tomography-based treatment planning to deliver an external beam. Intensity-modulated radiation therapy involves thin beams of varying-intensity radiation that are aimed at a tumor from multiple angles, which reduces damage to nearby healthy tissues.

Stereotactic radiotherapies use highly focused radiation beams to ablate anything in the target area. This radiation therapy modality may be thought of as a substitute for surgery. A frame is often employed to ensure rigid immobilization.

With brachytherapy, sealed radioactive sources are placed in the treatment area. It may be low dose, in which the sources emit a small amount of radiation continuously over a period of days, or high dose, in which more highly radioactive sources are placed inside or near a tumor and then removed at the end of each treatment session.