The majority of people with breast cancer will undergo surgery in combination with radiotherapy to decrease the risk of local recurrence. Clinical practice guidelines recommend:13, 39
- radiotherapy after complete local excision, as it significantly reduces the risk of local recurrence in the breast and the need for further surgery
- postmastectomy radiotherapy for women at high risk of local or regional relapse.
Conventional adjuvant whole breast radiotherapy is typically delivered over a period of five weeks using a standard dose of two Gray (Gy) per treatment episode (fraction) in 25 fractions to a total dose of 50 Gy.40 Hypofractionated whole breast radiotherapy involves fewer fractions; however each fraction contains a larger daily dose of radiation than the conventional two Gy per fraction. Compared to conventional radiotherapy regimens, the duration of a hypofractionated radiation treatment course is shorter by several days or weeks, as fewer fractions are required. A hypofractionated regimen may be more convenient for patients and less-resource intensive than a conventionally fractionated regimen. It is recommended that hypofractionated radiotherapy can be offered as a suitable alternative to conventionally fractionated radiotherapy for women:41
- aged 50 years and over
- with pathological stage T1-2, N0, M0
- with low or intermediate histologic grade breast cancer
- who have undergone breast conserving surgery
- with clear surgical margins.
A substantial body of evidence reports that women receiving multimodal therapy for breast cancer will often experience fatigue.42 Skin reactions range from a mild erythema to dry desquamation or moist desquamation over the area of treatment and usually resolve within two weeks of completion of treatment. Late effects in the months or years after radiotherapy include tight skin and lymphoedema (if the axilla is irradiated).13
Fundamentals of radiotherapy for cancer. EdCaN supporting module
Discuss the common side effects for a person undergoing radiation therapy for breast cancer.
Prepare a skin care education plan to prevent skin reactions for women undergoing radiotherapy for cancer.
Libby's story 6: radiotherapy
Describe how you would assess and diagnose Libby's radiation skin reaction.
Describe the nursing interventions to manage Libby's radiation skin reactions.
Access the systematic review Exercise for women receiving adjuvant therapy for breast cancer.42 Discuss how you could use the findings of the systematic review, in the resource below, in Libby's care.