Thought of radiotherapy depresses cancer patients

Maria Endah Hulupi, The Jakarta Post, Jakarta

"I was scared and shocked when my doctor told me I had cancer. Then he mentioned radiotherapy to treat the disease. It was really depressing," said Narto, who has nasopharynx cancer.

Many cancer patients react the same way to radiotherapy, especially since there is so little information about it readily available.

The head of the radiotherapy unit Dharmais Cancer Hospital in West Jakarta, Defrizal, said the shock and fear were understandable.

"But with proper preparation, radiotherapy can produce optimal benefits with minimal side effects," he said.

He said several doctors from various fields of expertise usually teamed up to treat patients with radiotherapy in order to ensure comprehensive treatment.

Radiotherapy is one of three cancer treatments, the other two being surgery and chemotherapy. Radiotherapy uses radiation to destroy cancer cells.

At Dharmais Cancer Hospital, radiotherapy has been used to treat the 10 most common cancers, including cervix, breast, thyroid, rectum, prostate, nasopharynx and lung cancers. Between 80 and 90 patients receive radiotherapy every day at the hospital.

Defrizal said doctors may give radiotherapy not only for curative treatment but also for palliative treatment to ease a patient's suffering.

Beside destroying cancerous cells, radiotherapy also has an effect on the surrounding normal cells, exposing patients to possible side effects, especially in the area of the body being treated, like skin irritation, dry mouth and diarrhea.

There are three types of radiotherapy: brachytherapy, external and internal radiotherapy.

Brachytherapy, also called contact therapy, is performed by placing the radioactive material close to the tumor then implanting it inside the tumor (for patients with tongue cancer, for example) or placing it inside the affected organ, like in the case of cancer of the cervix or uterus.

"Brachytherapy is given as a booster to external radiation so that the side effects of radiation can be reduced but at the same time increase its effectiveness at the location of the tumor," Defrizal said.

External radiotherapy is given by placing radioactive material at least 30 centimeters from the targeted area. Preparation needed for this therapy depends on the location of the cancer.

Before undergoing external radiotherapy to the head and neck area, patients must have good oral hygiene and healthy teeth as the treatment make a patient's mouth dry, which would expose them to fungal infection.

"Wearing a facial mask would be helpful for patients whose face or upper neck areas have been marked by doctors for treatment," Defrizal said.

For external radiation to the chest area, a patient needs to be able to lay on his/her back, lift her arms shoulder height (for breast cancer patients), plus the surgical wound needs to be completely healed (if he or she underwent surgical treatment).

For radiation to the stomach area, a patient has to be able to lay on his/her back or chest comfortably. Any surgical wound must be completely healed, plus the patient can only be given soft and nutritious food, since the treatment may cause digestive problems, like diarrhea or constipation.

"All patients must undergo simulation at the simulator ward so that they know what to expect. They must also have their blood checked to monitor the recovery process," Defrizal said.

Radiation for internal radiotherapy is conducted by giving radioactive liquid either by mouth or through an intravenous injection.

Before receiving internal radiation, a patient must stop taking certain medications like thyrax and must be able to take care of his/her own needs since he/she will be nursed in a special isolation ward.

Defrizal said it is important for a patient to have his/her blood and lungs checked and for them to fast for eight hours prior to treatment.

"The patients will also have their teeth molded for dental protection," he said.

A patient may receive several radiation treatments, but periodic follow-ups after the treatment is important to monitor progress.