ASTRO 2015

Care of patients receiving chemoradiation

Dr Theodore Hong - Massachusetts General Hospital, Boston, USA

Chemoradiation has become widely adopted for a number of solid tumours. There is ample level 1 evidence in multiple solid tumours demonstrating either improved local control or overall survival with concurrent chemoradiation. Specifically in the context of this nursing symposium what we tried to do was delineate the background of how we developed chemoradiation strategies historically and then explain the degree of evidence that we have regarding chemoradiation in different clinical situations – why do we give it concurrently versus sequentially? The reason why we thought that this was an important session for nursing is there is no doubt that concurrent radiation and chemotherapy leads to greater toxicity and often the nurses are the first responders to the increased toxicity burden that a patient has to carry. For that reason, we felt that it was important to explain why we made the decision to do the concurrent chemoradiation and we also spent some time talking about the site specific toxicities as well as the toxicities that are carried with the different chemotherapies and the importance for multidisciplinary communication and care between the physicians and the nurses and also between radiation and medical oncology in caring for these patients going through a challenging treatment regimen.

Are there some tumour types that are particularly associated with side effects caused by chemoradiation?

I would say that certainly for head and neck cancer and for gastrointestinal cancers there’s a fairly significant increase in the toxicity burden with the addition of chemotherapy but that’s also where we see a lot of the benefit of concurrent chemotherapy.

What are some of the toxicities that are seen?

It could be things like dehydration and nausea and fatigue which are some of the more global toxicities but some of the more site specific toxicities could be severe mucositis or esophagitis or diarrhoea or skin irritation.

What are some of the practicalities of managing toxicities related to chemoradiation?

What it really comes down to is being proactive and trying to anticipate the toxicities that your patient may have and trying to manage the toxicities when they come early rather than trying to play catch-up later. As I tell all of my patients, it’s easier for us to get ahead than it is for us to play catch-up and having communication with the patient and making sure that they understand that concept so they don’t ignore symptoms when they’re easily treatable is very important.

And do you have a final take-home message from the session?

The main issue is that it’s very important for the treatment team to work collaboratively to care for these patients.