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This page has been written for patients who are having radiotherapy for bone pain. It describes what the treatment involves, describes side-effects you may experience during and after treatment, and how best to cope with them.
We understand this is a worrying time for patients and their families, and we hope this page can help to answer any questions you have. If you have any questions about the treatment or information on this page, please speak to the team looking after you. We are here to help.
Your doctor may have suggested a short course of radiotherapy as a treatment to relieve bone pain caused by cancer that has spread to the bones. The areas of cancer cells in the bone are called secondary bone cancer, bone metastases, or bone secondaries. Radiotherapy is often used to control pain due to bone secondaries. Not all bone secondaries require treatment, usually only those that are causing pain. Depending on your type of cancer, other treatments may also be used, such as hormone treatment or chemotherapy.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law, we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to having the procedure and understand what it involves.
Staff will explain all the risks, benefits, and possible alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak to the team looking after you.
During your time with us we aim to provide the highest standards of care and support you in your decisions regarding your treatment. We will respect your dignity, individuality, and personal preferences.
Your care will be managed and given by therapeutic radiographers, doctors, and nurses. You will meet both male and female healthcare professionals. If you have any concerns about this, please talk to the radiographers about it. We try to be sensitive to your needs, so please do not hesitate to discuss things with the team caring for you.
Radiotherapy is the specialised treatment of cancer (and some other diseases) using high energy radiation beams. These can either be x-rays (also called photons), electrons or protons. X-rays and electrons are delivered from a machine called a linear accelerator whilst protons are delivered from a machine called a cyclotron.
Radiotherapy does not hurt, and it will not make you radioactive. You will be completely safe to be around family, friends, and pregnant people. You will feel nothing from the treatment and the machine will not touch you. The most important thing is for you to lie very still for treatment.
Radiotherapy has several clear benefits:
- Radiotherapy can help to relieve pain from bone secondaries.
- Radiotherapy can help make bones stronger and less likely to break.
- Radiotherapy can also treat bones that have fractured.
- Radiotherapy may slow down your cancer and give you a better quality of life.
Before beginning radiotherapy, your treatment must be carefully planned. Your first visit will be to the radiotherapy pre-treatment department. At this appointment you will have a CT scan, to gain information of the area to be treated whilst you are lying in the treatment position.
When it is time for your scan the radiographers will take you in to the CT scanner room. The radiographers are there to explain the procedure and to answer any questions you may have. You will be asked to change into a hospital gown and remove all clothing from the area to be treated. The radiographers will ask you to lie on the CT couch with supports under your head and knees. Please tell the radiographers if you are uncomfortable and they will adjust your position appropriately.
Using a felt-tip pen, the radiographers will place some temporary marks on your skin and take some measurements. These are for reference only and can be removed when you go home. Sticky wire will be placed around the treatment area and at various landmarks of the treatment area. The radiographers will then leave the room to perform the CT scan.
You will feel the bed move in and out of the scanner. You will pass through the scanner several times. The radiographers will be watching you the entire time. When the scan is done, and the radiographers have checked the images they will re-enter the room. With your permission, the radiographers will make a very small dot on your skin. This is not very noticeable, but it is an important way of ensuring treatment accuracy. The dot is permanent and is done by placing ink on your skin and then gently scratching the surface of the skin with a fine needle.
You won’t feel anything during the scan. All we ask is that you lie still and breathe normally. After the scan is completed, you will be free to leave. Before you go, you will be given an appointment card with the date and time for your next visit, which will be your first treatment.
If you are having radiotherapy to painful bones in your skull or neck, you will also need to have a plastic mask (also called an immobilisation mask) made to help you keep still during treatment. The radiographers will discuss this with you, if it is relevant to you.
For some patients who may require radiotherapy to painful ribs, and other bones close to the skin, we do not need to do a CT scan. Your radiotherapy doctor will simply draw around the painful area, and the radiographers will take measurements and pictures of the area to be treated.
Your radiotherapy treatment is daily, Monday to Friday. You may have a single treatment or a course of daily treatments for up to three weeks. Your radiotherapy doctor will have already told you how many treatments you will be having.
Your treatment will be on a machine called a Linear Accelerator (Linac) or, if you are having radiotherapy to the ribs or to painful bones close to the skin surface, your treatment will be delivered by a superficial X-ray machine.
The treatment radiographers will explain the procedure to you and answer any questions you may have. The radiographers will ask you to lie on the treatment couch in the position you were at your planning appointment. They will ensure you are in the correct position and when final verbal checks have been made, the radiographers will leave the room.
To give you the best treatment, you will be treated from several different angles. The linear accelerator will move around you but will not touch you. Treatment times vary, depending on the dose prescribed by the doctor, but on average are about 10-15 minutes long. You will feel nothing whilst the treatment is on. The treatment machine will make a beeping noise, but you will not feel anything. It is important that you breathe normally and remain relaxed. The radiographers will be watching you at all times on a closed-circuit television. If you need them at any time during your treatment, please raise your arm.
If you are having treatment on the superficial X-ray machine, you will be lying on a soft treatment couch. The radiographers will check the marks drawn on your skin and the treatment machine will be brought into position. A metal applicator will come to rest gently on your skin. It is important that you keep still during the setting up process and treatment. Once everything is in the correct position, the radiographers will leave the room and close the treatment room door. The radiographers will be watching you the entire time on a closed-circuit television. If you need them at any time during your treatment, please raise your arm.
Once the treatment is over the radiographers will come back into the room, move the treatment machine, and you will be free to go home.
Radiotherapy for bone pain is aiming to relieve symptoms and the side effects of treatment are usually mild. There will be some side effects, which may gradually appear during your course of radiotherapy. Most side effects are usually of short duration and depend on the part of your body being treated and the dose of radiotherapy prescribed.
Skin changes
Your skin in the area being treated will gradually change colour. Your skin will become pink/red or darker, depending on your skin colour. You may get some dry peeling of the skin in the treatment area, which may become flaky and itchy. During treatment we advise that you wash normally using warm water and the soap products you would normally use. Gently pat your skin dry with a soft towel.
Radiotherapy skin reactions cannot be prevented, but to minimise any skin irritation we recommend using a moisturiser of your choice. Use the moisturiser frequently and gently smooth it on to your skin until it is absorbed. You do not need to wipe the moisturiser off before treatment, but please do not apply moisturiser immediately before their treatment.
If your skin becomes irritated, stop using the moisturiser. You will be referred to the radiotherapy review team for appropriate skin care. If you do not use a moisturiser, speak to the radiographers and they will be able to suggest a few options.
Feeling sick
If you are having radiotherapy to the ribs, spine or pelvic area you may feel sick during treatment. You will be prescribed anti-sickness medication by your doctor to take before each treatment. If you are still feeling sick, or being sick, please tell your treatment team.
Sore throat
If you are having radiotherapy to your cervical or thoracic spine, you may find that your throat and gullet may become sore during treatment and for a few days afterwards. Try to maintain your normal diet, but if you are finding it difficult to swallow food, please tell your treatment team, who will advise you.
Diarrhoea
If you are having radiotherapy to the bones in your pelvis you may temporarily experience some diarrhoea. Increase the amount you drink if this happens and speak to the radiographers treating you. They will be able to give you further advice if it continues.
Tiredness
Tiredness is a very common side effect of radiotherapy. You may feel more tired than usual and have less energy, both during and after treatment. Do not worry, this is normal. It is usually a combination of travelling to hospital every day, the side effects of treatment, coping with a diagnosis of a tumour and continuing with normal life. Fatigue usually improves between six months to a year after treatment.
We recommend that you listen to your body. Do as much as you feel you can and rest when you need to. Pick out the things that you enjoy and try to ask others for help with other tasks. Try to get a good night’s sleep where possible. Have enough water to drink to prevent tiredness from dehydration. Gentle exercise has been found to improve fatigue levels in patients and we would recommend walking as a good form of exercise.
Please tell us if you are finding things difficult, as we will be able to offer practical advice and information.
Pain
The radiotherapy can sometimes cause a flare-up of your bone pain. If this happens, you may need to temporarily increase your pain medication.
Please remember, radiotherapy is not an immediate answer to pain. It can take 7-10 days for radiotherapy to start reducing bone pain. Some people find their pain goes completely, and most people notice some improvement. It may take up to four to six weeks for you to get the full benefit of radiotherapy. During this time, it is important that you continue taking the painkiller prescribed by your doctor. As your pain improves, it is important to discuss reducing the dose of painkillers with your doctor, specialist nurse or GP.
We hope that you have found this leaflet helpful. If you have any questions or other worries and would like to speak to someone, please ask a member of staff.
Radiotherapy Review Team (via Radiotherapy Reception)
Radiotherapy Reception
Macmillan Radiotherapy Support Worker
Out of hours oncology advice number (available 24 hours)
If you have any concerns that you would like to discuss in confidence, please contact our PALS (Patient Advice and Liaison Service) for information and advice.
Maggies (Providing cancer information and support in centres across the UK and online)
Shine Cancer Support (cancer support for adults in their 20s, 30s and 40s)
Trekstock (cancer support for adults in their 20s and 30s)
OUTpatients (cancer support for LGBTIQ+ community)
e: cancerline
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Page last updated: 04 September 2024
Review due: 01 July 2025