The Radiation Treatment Journey

Prof Fogarty heads up a radiation multidisciplinary team. Radiation nurses with a specific interest in skin cancer, radiation therapists also with a specific interest in skin cancer and specific training for that, and radiation physicists who will help to design the radiation fields and the appropriate filtration needed. All combine their skills to maximize your experience from all angles. All have a specialized role, all are important and you will meet them on your journey.

Your radiation journey begins with having a consultation with Prof Fogarty. A referral from a doctor is needed. GPs can refer. A new patient appointment can be made by ringing the relevant department listed above and asking for an appointment with Professor Fogarty.

The initial consultation

The initial consultation is where you and Prof Fogarty get to know each other. This can take up to an hour. Having a support person with you is a good idea. You and Prof Fogarty will have a conversation from which he will construct a history of your illness. He might perform a physical examination. He may make some temporary marks on your skin that will be removed before you leave the department. He will discuss with you what radiation treatment is all about. You and your support person will have ample time to ask questions. 

If in his experience radiation is indicated, he will then fill out some paperwork which will involve a consent form. He will go through the rationale, or reason for treatment, the process, side effects and costs. It is important to understand this information so that you and your support person can make an informed decision whether to go ahead or not. The treatment consent form needs to be signed to go ahead.

Planning

If radiation is indicated, you will then be introduced to the radiation planners.  Planning is about aiming the radiation to where it must go on and in your body. Planning is not scheduling. Scheduling is when you have the radiation. The planning staff also will advise on this. They will record the marks that Prof Fogarty has made with photos and templates. They may involve the physicist.  They then remove the temporary marks.  Planning can take up to an hour. Usually, we begin planning on the same day as your initial consultation.

The planners may ask you to come back on another day for a computed tomographic (CT) scan. This scan is for planning and not for a diagnosis. No contrast, either by mouth or vein, is needed. You can go home after the scan. We then do a lot of work on the scan. Prof Fogarty contours different volumes on the scan. He will prescribe radiation to the volumes that include tumour. He will identify normal tissue volumes that need to be avoided. He will approve the plan when there is enough dose going to tumour volumes to control the tumour but the dose to the normal structures is low enough to avoid long term side effects. During planning, you will also meet our nurses and administration people.  

On-treatment reviews

The next step is treatment. Prof Fogarty will supervise the treatment and review you regularly during the treatment to make sure the exact amount of radiation is delivered to achieve the best outcomes. During this time, short term side effects may arise eg redness and flakiness of skin, tiredness, etc. The doctor may prescribe medication for any side effects if needed. The nurses will see you regularly and advise on skincare. The nurses will weigh you regularly during treatment. This is because the normal cells within the high dose treatment volume need to repair between the fractions, and they will only repair if they are well nourished. 

Post treatment follow up

There will be a medical follow up a month or two following the treatments and then care will once again be continued by the original skin care doctor who, with the radiation oncologist, forms the skin cancer multidisciplinary team. Medical follow up will examine for lingering treatment effects, disease recurrence, or new cancers. Sometimes follow up is conducted by Prof Fogarty for a longer period. Long term side effects Also known as light effects looked for in these longer follow up periods. These are rare especially if adequate fractionation has been used.