Nursing Section
Procedures of Particle Beam Radiation Therapy

First Visit

• Patients should please get a referral from their primary care physician.
• The patient will receive an explanation from the doctor at HIBMC about whether particle beam radiation therapy is appropriate for his/her condition and what can be expected based on the medical information you bring to us.
• The patient's physical condition will be examined to see if he/she can meet the requirements for therapy. Depending on the patient, various treatment conditions may be required such as lying on the stomach, fasting, etc.
• Pre-treatment may be necessary, depending on the location of the illness. If the patient has a chronic condition such as diabetes or high blood pressure, he/she needs to consult his/her primary care physician before treatment to find out how to control his/her medical condition during radiation therapy.
• Some patients may be wary about the treatment because it is an advanced medical technology. We ask that the patient sort out the questions in advance so that we can use our treatment time efficiently.
• If the patient is hesitant about the treatment, it is important that he/she go back and talk it over thoroughly with the primary care physician and his/her family rather than making a hasty decision.
• If the patient has difficulty understanding the doctor's explanation or he/she has any concerns, it is advised to not hesitate to consult the nurse in charge. (Photo: Outpatient consultation)
• If the patient is accepted for the treatment, we will consult him/her about the date to start treatment preparations.

Return to the Center

• The patient's therapy goal is verified with the doctor. He/she explains the condition of the illness and the objective of the therapy, including whether the treatment will be a definitive cure of cancer or only an alleviation of the present condition.
• The doctor gives a description of the therapy and the side effects anticipated at this state.
• Preparations for the therapy begin. We set up a schedule ranging from examination to completion of therapy (a clinical path) - checkup, treatment, examination and nursing. (Photo: An explanation of clinical path by the doctor)
• The patient's goal is to be able to complete the entire therapy schedule as planned. Therefore, cooperation from the patient is indispensable.
• After the explanation from the doctor, guidance is given by the nurse and the radiation technologist.

1. The nurse will explain precautions in receiving the therapy and what the patient can do proactively for himself/herself. (Photo: Path explanation by nurse)
2. As for the therapy schedule, as a general rule, treatments are administered on weekdays, but depending on the equipment maintenance schedule, they may also be done on Saturday.
3. How the patient should spend the time during therapy period: Get plenty of sleep and nutrients and be careful not to catch a cold.
4. Health management: If the patient has any pre-existing chronic conditions, he/she should let the nurse know about them.
5. If the patient experiences pain or nausea, we will work with the patient to find a way to alleviate these symptoms
6. Anxiety can be a hindrance to treatment. If the patient feels anxious, thisishould be freely communicated to us.
7. For those who receive the therapy on an outpatient basis, we give precautionary explanations about how to commute to HIBMC and what do to at home.
8. The nurse will give explanations as to when the anticipated side effects are most apt to happen, what to do to prevent them, and how to ease the symptoms. These include:
   Prostate …..Preventing inflammation of rectal mucous membrane, procedure to empty bladder, etc.
   Head and neck …..Care of oral cavity, lockjaw, etc.
   Prevention of dermatitis (skin irritation) ….. Preventive care, etc.

CT and MRI Simulation

The basic images will be taken to prescribe the therapy.

Therapy Planning and Conference

• The therapy planning is carried out for the patient based on the images obtained from the simulation images that show the tumor location, size, and its relationship to surrounding organs.
• The planning is meticulously performed to have maximum kill of the tumor while keeping collateral damage to the vital organs at a minimum.
• The plan prescribed individually for each patient is reviewed by doctors, radiation technologists, medical physicists, and nurses in the conferences. They exchange opinions as to whether the plan is right for the treatment goal and will garner the anticipated effect, whether all efforts are being made to minimize side effects, and if there are any problems pertinent to nursing care, etc. After all these points are discussed, the medical team reaches a consensus on the final irradiation exposure dose, number of fractions, the direction of the therapy, etc.
  (Photo: Conferences to discuss therapy)

Informed Consent

• While being shown the images for the prescribed therapy plan, the patient receives an explanation of the therapy goal, specific irradiation methods, and anticipated side effects.
• In radiation therapy, there are two types of side effects: ones that appear during treatment to up to three months after the start of the therapy (an acute-phase reaction), and others that begin after three months (a late-phase reaction).
• With appropriate care, the former will recede after a while, but the latter are difficult to heal, and can become a hindrance in the patient's daily life. Efforts are made in the therapy plan to minimize the side effects, but when they are unavoidable, it is important for the patient to fully understand the explanations of these possibilities before receiving the radiation therapy.

Rehearsal

• The patient will receive an information session regarding the therapy, and his/her positioning will be confirmed so that the planned therapy can be carried out precisely.
• We make every effort to make the patient comfortable during the course of the therapy. If there is any pain, the patient is urged to communicate with us.
• It is necessary to take measures to control conditions such as pain and nausea before the therapy starts. The patient is advised to consult with the doctors and nurses regarding medication use to alleviate these symptoms.

Therapy

• We support the patient so that he/she can receive the therapy most safely and comfortably.
• If the patient has fever, feels fatigue, is unable to eat, or has swelling, he/she should tell the nurse about it without fail.
• If for some unavoidable reason, the patient has become unable to receive the therapy, he/she should let us know in advance.
• If the patient has any symptoms during the course of the therapy, he/she should not fail to inform us.

Completion of Therapy and Informed Consent

• The doctor will give the patient an explanation about the therapy conducted, what to expect, anticipated side effects, and post-therapy examinations and tests.
• A personalized medical file, "the Patient Chart," will be given to the patient. It has a summary of treatment and post-treatment plans. (Photo: Patient Chart)
• The nurse is present at this time. If there is something that the patient does not understand, he/she should ask the nurse immediately.
• The nurse will give an explanation of the care that needs to be continued after the therapy, the actual methods, and how to cope if there is an abnormality, etc.
• There are individual differences in experiencing dermatitis (skin irritation) and stomatitis (mouth ulcer), but the symptoms peak at around one month after the therapy, and with appropriate care, they should get better in about two months.
• If there is a nutritional deficient, or if the patient has pre-existing chronic conditions such as diabetes, the healing may be delayed. It is very important to keep the chronic medical conditions under control.
• An explanation will be given to the patient regarding how to detect early the side effects that could occur more than three months after the therapy. The patient is also informed of how to contact HIBMC for a consultation, and where the consultation takes place.

Patient Follow-up

• After receiving particle beam radiation therapy, it is important for the patient to visit the primary hospital to receive regular check-ups for follow-up in order to detect relapse or metastasis at an early stage and to confirm any side effects.
• After receiving the regular check-up examination at the primary hospital after the particle beam radiation therapy, the patient sends the results of the regular check-up and "the Patient Chart" to the HIBMC Patient Follow-up Support Team.
• We offer advice on care methods and consultations for various concerns regarding particle beam radiation therapy.

　●Patient Follow-up Support Team