The field of radiation therapy has come a long way since the introduction of x-rays in 1896. Radiation therapy is now used in nearly 50% of all cancer cases and contributes to 40% of curative treatment. With recent advancements in computing technology, scanning, imaging, and robotic precision, radiation therapy has grown by leaps and bounds. 

The evolution of radiation therapy has impacted millions of patients. Although not every oncology nurse is specialized in radiation therapy, at one point or another, many will care for a patient currently undergoing or who has recently received radiation therapy. It’s important to understand the radiation field and the changes in the landscape of radiation therapy over the past few years. 

Who’s on the Radiation Oncology Team?

  • Radiation oncologist 
  • Radiation oncology nurse
  • Medical radiation physicist
  • Radiation therapist
  • Dosimetrist
  • Social worker
  • Dietician

Dispelling Radiation Myths and Misconceptions

According to ONS member Amy Avellino, MS, RN, director of clinical operations of radiation oncology at the Hospital of the University of Pennsylvania in Philadelphia, “Patients often have the misconception that it’s painful, that they’ll glow in the dark, or that they’ll suffer a radiation burn.” 

To dispel these myths, ONS member Mary Ellyn Witt, MS, RN, AOCN®, who works at the University of Chicago Comprehensive Cancer Center at Silver Cross in New Lenox, IL, says that it’s important to assess a patient’s level of scientific understanding. 

“I try to evaluate how technical of an explanation the patient and family may need,” Witt says. “If they want a more scientific explanation, I explain that the radiation beam is a high-energy x-ray that destroys the cancer cells’ ability to make more cancer cells.” She notes, however, that she’s used various metaphors and explanations to help patients understand their radiation journey. 

Because radiation therapy can come in many different forms, Avellino says that she educates her patients on their specific treatment protocols. 

“When instructing patients through their treatment plan, it’s important for them to understand the details,” Avellino says. “They need to commit to the treatment schedule, which is often daily for two to nine weeks. It’s important to understand patient-specific side effects; have social support for transportation, child care, and work; and understand that they need to notify the medical team at the onset of any new symptoms.” 

Witt concurs. “Verbal communication is so important. You can give patients and families a ton of information and computer sites to tap into, but they need your time and your patience.” She adds that patient comprehension during a new diagnosis can be limited, especially considering the possible stressors they’re facing. 

“Weekly on-treatment visits are so important. That’s nursing’s time for assessment and more teaching. Often the nurse needs to repeat the same information over and over again, but that is how we get our patients through treatment safely and with as much comfort as possible,” Witt says.

ONS Putting Evidence Into Practice Resources for Radiation Side Effects

  • Fatigue: Encourage patients to engage in physical activity as it suits their condition. Evidence shows that even a small amount of physical activity can help fight fatigue.
  • Radiodermitis: Educate patients on important skin hygiene techniques and avoiding deodorant that contains aluminum. Consider recommending the use of calendula and silver sulfadiazine.
  • Radiation-induced diarrhea: Acute radiation enteritis is seen in nearly 70% of patients receiving radiation. Consider educating them on the use of psyllium fiber as a way to mitigate this symptom.

Defining the Role of Radiation Nurses

Radiation oncology, as a science and profession, has evolved throughout the years. Witt notes, “In the past, it wasn’t unusual for radiation departments to function without a nurse. The common thought was that if a department had radiation therapists, why did they need a nurse?” 

But times have changed, and the role of the radiation nurse is now recognized as an integral part of radiation oncology. 

“It took many years for the role of nursing to be respected in radiation oncology. We’re now recognized for our ability to assess our patients’ needs, educate them about radiation therapy, manage their symptoms and pain, and become their advocate,” Witt says. “The ONS Radiation Community, formerly the Radiation Special Interest Group, supports radiation nurses to achieve the respect they deserve and to function within an evidence-based practice model.”

The Growing Landscape of Radiation Therapies

As radiation nurses’ role became more clearly defined, so too did the science of delivering radiation to patients. Stereotactic body radiation therapy (SBRT), a form of external-beam therapy, delivers a high-powered, concentrated dose of radiation directly to a targeted area with little scatter to healthy tissue. 

With newer imaging technologies, healthcare providers are now able to target cancerous areas more effectively, thus limiting damage to healthy, noncancerous tissue. SBRT has been particularly promising when treating pancreatic cancer, especially when it’s combined with chemotherapy. 

ONS member Amy Avellino, MS, RN, director of clinical operations of radiation oncology at the Hospital of the University of Pennsylvania in Philadelphia.

“Radiation therapy has evolved throughout the course of my career in a few different ways,” Avellino says. “Techniques have improved for minimizing dosing, sparing healthy tissue, and decreasing toxicity through intensity-modulated radiation therapy, SBRT, and proton therapy.” 

New technologies aren’t the only things that have changed. “The past few years have seen improvements to symptom management and integrative medicine as well,” Avellino says. “Targeted therapies have decreased toxicity and allowed for more intense multimodality therapy—chemotherapy and radiation.” 

Likewise for Witt, new information is evolving her practice. “A better understanding of tumor biology has challenged the concept of reducing the total dose of radiation and still achieving a cure,” Witt notes. “Tumors that are positive for human papillomavirus (HPV) virus are more sensitive to radiation. Reducing the cumulative radiation dose with HPV-positive head and neck tumors can achieve cure and reduce the chronic toxicity that patients have to deal with in their survivorship years.”

Looking Forward to New Discoveries

Radiation, like many fields in oncology, has been through a number of paradigm shifts—each time making strides to improve patient outcomes and increase the quality of care. For Witt and Avellino, the potential for change in radiation oncology could be limitless. 

“The benefits of combining traditional chemotherapy with radiation have been recognized for some time,” Witt says. “But new on the horizon is combining immunotherapy with radiation.” 

“There’s great potential for improved delivery and dosing systems in the future,” Avellino says. “We’re hoping to use proven treatment modalities in new and innovative ways.” 

In an oncology field that’s constantly evolving and refining itself through research and evidence-based practice, the next discovery could be just around the corner.