External beam radiotherapy (EBRT) to secondary bone cancer

You may find it useful to read our booklet called ‘Radiotherapy’.

If you use walking aids, wheelchairs etc. bring them with you, if possible, when you attend. When you arrive, if you require assistance or need a wheelchair, please ask at the reception desk in the front entrance.  It is also a good idea to take a list of your current medications with you, along with any medications you may require whilst at any appointments (including pain relief).

The first appointment is at the pre-treatment department, called Planning, at Clatterbridge Cancer Centre - Liverpool or Wirral. The exact area to be treated is defined and measured by taking images using a CT scanner. This is a simple and painless procedure and you should breathe normally throughout. The staff will draw some pen marks onto your skin and then ask for your permission to make some permanent small tattoo marks. For the majority of people, the planning procedure takes 10-15 minutes.

Following an assessment of your needs and the technical details of the treatment, we will confirm the date you will start your radiotherapy. Most people will start radiotherapy a few days later. We will give you a printed list of appointments.

Those starting treatment the same day should expect to be at the hospital for a few hours, so please bring any medication with you. You should eat and drink normally before you attend and while you are waiting. If you live locally and have brought yourself for the appointment, rather than using hospital transport, you can choose to go home and return later in the day if you wish.

Depending on suitability, your treatment will be at one of our three sites - Clatterbridge Cancer Centre in Liverpool, Wirral or Aintree. Your preferred site can be discussed with your radiotherapy team but cannot be guaranteed.  

The treatment procedure is in the same position as the planning scan and takes around10 - 20 minutes in total. It is painless and again you should breathe normally throughout.  

You are not made radioactive as a result of the treatment and following treatment you are safe to mix with others including children and pregnant women.

Listed below are the most frequently occurring side effects; some are dependent upon the area of the body treated. We will discuss possible side effects again when you attend.  Frequently, we give you extra medicines to help with these effects though this may not be necessary, depending upon which medicines you may already be taking. 

Pain flare

Within the first few days, you may notice a temporary increase in pain in the treated area,particularly if you have a single treatment. During this time, if any pain is not under control with your usual medicines, you should contact your GP, District or Macmillan Nurse or contact the Clatterbridge Cancer Centre Hotline 0800 169 5555.

Skin reaction

Following a single treatment, it is possible to have a mild skin reaction. Having fractionated treatment increases the chance of having a more marked skin reaction (the skin may become dry, pink and tender). It will settle a few weeks after treatment. If the skin becomes irritated, you can use your usual moisturiser to soothe it.

Tiredness

This is a common problem with secondary bone cancer and for many, following radiotherapy, it may be more troublesome for a short time. To help with this it is a good idea to keep activity to a manageable level and plan rest breaks into your routine.

Sickness and nausea

Depending on the area being treated you may also feel nauseous following radiotherapy. Your treating team will discuss this potential side effect with you and provide you with medication to support where necessary.

Bowel effects

When treating the bones within the abdomen or pelvic areas, you may notice that your bowel motions become more frequent and loose for a short time (Diarrhoea). This occurs because we cannot avoid bowel which lies in front of/close to the bone(s) receiving treatment. 

Bladder effects

Radiotherapy to the pelvic bones can sometimes include treating some of the bladder, which may cause temporary symptoms, e.g. the need to pass urine more frequently and discomfort. It is a good idea to drink more fluid until the symptoms settle.

Sore throat/swallow

When the back bones (spine) of your chest or neck area are treated, it is possible that your gullet/throat could become a little sore for a short time as these areas lie in front of the spine and may receive some radiation dose. If this soreness is troublesome, painkillers may be helpful as well as eating softer foods and avoiding very hot or very cold food and drink until it settles.

Cough / Shortness of breath

When treating the bones in the chest, we may cause some irritation to the lungs leading to a mild cough or some shortness of breath.  This will settle a few days after treatment has completed.  Your treating team will discuss this side effect with you

Following treatment, most people get full or partial relief of symptoms. You may notice the start of the change about 10 days after your radiotherapy is complete. A noticeable improvement may occur after a few more weeks, though for some it may take many weeks to notice a marked improvement. Unfortunately in some cases the radiotherapy may have little or no effect.

Most people will have a follow-up appointment with their Oncology team, local treating team or palliative care team. If you are taking medication for pain relief, your treating team will discuss ways of reducing it, if appropriate. If you have a Macmillan/District Nurse or GP attending to you, they may already have started this process. 

If you develop persistent pain or discomfort in any other areas, please mention it to your health care team.

Depending upon the response to treatment, you may want to consider the following:

• Use of a walking aid or wheelchair.  Discuss this with your GP, who can refer you for an assessment. The Red Cross society can also provide wheelchairs on loan.
• Applying for a Disabled Parking Badge. Contact your local council, who will advise you on the process 

If you have secondary bone cancer, you may be entitled to certain disability benefits, e.g. Personal Independence Payment, if you are under pension age or Attendance Allowance, if you are over pension age.

We have a Macmillan Information and Support Centre who can refer you to the benefits service for advice regarding entitlement to ensure that you do not miss out on financial support. Please ask a health care professional looking after you to make the referral on your behalf or visit the centre.  

There are other sources of benefits advice, e.g. Macmillan Cancer Support telephone helpline on 0808 808 0000, your local Citizens Advice Bureau, local council advice service or other advice agencies. 

Macmillan booklets about coping and living with cancer and treatment side effects are available free of charge. These can be ordered by telephoning 0808 808 0000 or by visiting one of the Macmillan Cancer Information & Support Centres (located in the main entrance at the Clatterbridge Cancer Centres at Liverpool, Wirral and Aintree).

Some people and their carers find support groups are helpful; contact the Macmillan Information Centre for details. 

Alternatively, if you are familiar with using the internet, the major cancer charities often have online communities.