Your oncologist has advised a course of radiotherapy to your chest as part of your treatment for lung cancer.  This information has been written to help answer some of the questions you may have about the side effects of radiotherapy.
 
We hope you will find this helpful but if you have any further questions relating to your treatment, please do not hesitate to ask your radiographer, CHART Radiographer, Roy Castle Lung Cancer Nurse or your oncologist at the Northern Centre for Cancer Treatment (NCCT) or your key worker.

What is CHART?

Continuous Hyperfractionated Accelerated Radiotherapy

Continuous radiotherapy. Treatment is given every day for twelve days 
 
Hyperfractionated. The total dose of radiation to be delivered to the tumour is given in many small fractions of treatments 
 
Accelerated. Treatment is given over a short period of time 
 
Radiotherapy Treatment
 
CHART is the name given to the particular radiotherapy programme you will receive which involves giving many small doses of radiation in a short period of time to patients who have a certain type of lung cancer.
 
You will be treated three times a day at 8am, 2pm and 8pm for twelve consecutive days starting on a Monday morning and finishing the Friday evening of the second week. This particular radiotherapy programme will involve treating you over a weekend.
 
If you live more than four miles from the hospital it may be more practical for you to stay at NCCT for the duration of your treatment. This is so you can arrive on time, as it is very important your treatment is given at the exact times as requested by the lung team.
 

Early side effects are temporary and affect most patients. The side effects generally develop during the second half of the course of treatment or after treatment has finished. Sometimes side effects can last for several weeks however usually settle within three to four months. 
 
Effects on the skin 
 
Towards the end of treatment some patients may experience changes in the skin over the area that has been treated. The skin may:
 

• feel tight and uncomfortable
• become pink or red
• become dry and flaky
• itch

 
Your skin reaction may be worse and develop earlier if you are also having chemotherapy.
 
Your skin will be monitored by your radiographers during radiotherapy and you will be given advice on skincare. You will also be seen once a week in a radiotherapy clinic by your oncologist, the nurse specialist or specialist radiographer who will examine your skin and advise on any creams if necessary. 
 
Skin care  
 
We recommend that you take special care of your skin during and up to six weeks after your radiotherapy as the reaction may continue after treatment has finished. 
 

• Keep the area cool. Wear loose, preferably cotton clothing that does not rub the skin and will allow air to circulate. 
• Do not expose the treated area to the sun.
• Whilst in the sun the treated area should be covered completely or a high protective factor sun cream (25 or above) should be applied. Do not use a sunbed as this could make the reaction worse.
• Do not soak the area in the bath or under a long hot shower. You may wash your skin in the treated area using a simple, unperfumed soap, applied gently with your hands and rinse well with warm water. Avoid using flannels or sponges. Pat the area dry with a soft towel or let the skin dry naturally. 
• Do not use talcum powder, bubble baths, bath salts, shower gels or body lotions on the treated area as they tend to be highly perfumed and can dry or irritate the skin. You may be given a moisturising cream to soothe the skin, from the radiographers or nurses, or your oncologist may prescribe a cream if needed.

Tiredness and Fatigue 
 
Radiotherapy can sometimes make you feel very tired especially towards the end of your course of treatment and for a number of weeks after. It may be a while before you feel able to do some of your usual activities. You should rest as much as you need to although gentle exercise may help. Fatigue is something nearly everyone with cancer feels. It affects people differently and it is important to tell the health care team if you are feeling more tired than usual. There are some physical causes, such as anaemia that are readily treatable. 
 
Please ask for a booklet on fatigue at the Information Centre in NCCT which will give you tips to help with this. 
 
Breathlessness

Your treatment may make you feel more breathless than usual.  There are lots of things you can do to make yourself feel better. For example:

• Plan ahead. Be realistic about what you can do. Concentrate on the things that are important to you.
• You may be able to sit down for some tasks, such as preparing food.
• Avoid bending and stretching.

Cough

You may get a cough, or if you already have one, radiotherapy may make it worse. It is also normal to cough up a lot of sputum.  Please advise your CHART radiographer, oncologist or nurse specialist if:

• You cough up sputum which is coloured or blood stained as you may have an infection that requires medication
• Your cough stops you from sleeping

Swallowing and eating problems

Radiotherapy to your chest can cause internal inflammation and may make it difficult or sore when you swallow. It can also feel as if there is a “lump” in your throat. You may have a feeling of indigestion or heartburn. Please tell your radiographer, oncologist or the nurse specialist as they may be able to offer you some medication to help or arrange for you to see a dietician. You may not feel much like eating, but it is important to try.

Try these tips:

• If your throat is dry, it may help to drink more liquids. Carry a small bottle of water with you to sip.
• Eat little and often.
• Eat a bit of what you fancy!
• Try soft or runny foods such as milk puddings, pasteurised yoghurts, soft cheese and mashed foods. Soups and meal replacements (e.g. Complan) are also good.
• If you have a food processor, try puréed food.
• You can make soft food more nourishing by adding things like butter, cooked eggs, cream, sauces, gravy, mashed or minced meat or fish.
• Take tepid food and drinks
• Avoid highly spiced foods
• Don’t eat jars of baby food - they aren't suitable for adults.
• If you're too tired to cook, try a ready made meal, cold food or ask someone else to cook for you.
• If you are also having chemotherapy there may be some foods you should avoid. Your chemotherapy doctor or nurse will tell you more about this. 

 
How else can I help myself during treatment? 
 

• Don’t try to lose weight.
• Try not to smoke. It can make your side effects worse. Please ask if you need help with stopping smoking.
• Tell us if you are worried about your side effects, if you feel unwell or if you have any problems or questions about your treatment.  

Your progress 
 
You will be seen by a member of your specialist team once a week during your treatment. This will be an opportunity to discuss any concerns or problems you may have.

You may experience some breathlessness or a cough about 6-12 weeks after your treatment is completed. This may be due to the radiotherapy, which can occasionally cause an inflammatory reaction in your lung. This is called pneumonitis. It can be treated with steroids although it usually resolves itself over a period of a few weeks. Your oncologist or the nurse specialist will check this for you at a follow up appointment. 
 
Your emotions 
 
It is important to make time for yourself. Emotions associated with the reactions to a diagnosis of cancer may come to the surface at various stages during your treatment.
 
Don’t worry if you feel low, this is normal. If you need to talk to someone, please ask, we are here to help. We have a wide range of support services within the department, such as the Roy Castle Lung Cancer Nurse, the Palliative Care Team, dietician and social worker.
 
A Clinical Psychology service is also available at NCCT on referral from your oncologist.  
 
Sex 
 
Having radiotherapy for lung cancer will have no long-term effect on your sex life. However when you are tired or have worries about your cancer, your sex drive can be affected. This is personal to each individual and may be an aspect of your life about which you have concerns. You may have questions you wish to ask. Please talk to your radiographer, oncologist or the nurse specialist if you would like to talk about these issues confidentially.
 
There is more information available on this subject in the Information Centre at NCCT. 
 
Pregnancy 
 
It is very important that you or your partner are not and do not become pregnant whilst undergoing radiotherapy. Please inform a member of staff immediately if you think you may be pregnant.

When your radiotherapy has finished
 
The side effects of radiotherapy can continue for several weeks after treatment has finished.
 
Continue with your skincare routine until any changes return to normal.
 
You will be seen by the CHART radiographer at NCCT ten days after you have finished your radiotherapy treatment. After this, you will be seen in a follow up clinic at your referring hospital 2-6 weeks after finishing treatment.

You will get a letter giving you a date and time for your appointment. 
 
If you are worried about your side effects after your treatment has finished, please contact the CHART Radiographer or your specialist lung cancer nurse at your referring hospital for further advice. 
 
 
Useful contact telephone numbers: 
 
CHART Radiographer, NCCT
(0191) 256 3636
 
Northern Centre for Cancer Treatment Information Centre
(0191) 256 3596 / 256 3597
 
Opening hours

Monday to Friday from 10am to 4pm  
 
 
CancerBACUP  020 7613 2121 / freephone 0808 800 1234

Macmillan Cancer Relief  020 7840 7840