Hostname: page-component-848d4c4894-jbqgn Total loading time: 0 Render date: 2024-06-30T01:32:46.289Z Has data issue: false hasContentIssue false
  • English
  • Français

Management of breast cancer: an overview for therapeutic radiographers

Published online by Cambridge University Press:  10 February 2020

Gillian McKittrick ,
Paul Shepherd Open the ORCID record for Paul Shepherd [Opens in a new window]  and
Terri Gilleece
Gillian McKittrick
Affiliation:
Western Health and Social Care Trust, North West Cancer Centre, Altnagelvin Area Hospital, Londonderry, County LondonderryBT47 6SB, UK
Paul Shepherd*
Affiliation:
Ulster University, School of Health Sciences, Jordanstown Campus, Newtownabbey, County DownBT37 0QB, UK
Terri Gilleece
Affiliation:
Ulster University, School of Health Sciences, Jordanstown Campus, Newtownabbey, County DownBT37 0QB, UK
*
Author for correspondence: Paul Shepherd, Ulster University, School of Health Sciences, Jordanstown Campus, Newtownabbey, County DownBT37 0QB, UK. E-mail: PH.Shepherd@ulster.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

The management of breast cancer patients from diagnosis to treatment and beyond can be variable depending on factors including tumour extent and location, histology, genetics, health and wellbeing of the patient as well as personal patient preferences. The therapeutic radiographer’s role is not only vital to ensure safe and accurate radiotherapy delivery but also crucially, as the regular patient interface, they must be fully empowered to engage effectively with all aspects of the patient care pathway. They must be knowledgeable and up to date with evidence-based practices relating to the patient experience including surgery, chemotherapy, endocrine therapy and radiotherapy.

Aim:

The aim of this paper is to outline the breast cancer management pathway, highlighting the potential side effects that occur as a result of breast radiotherapy treatment and concomitant treatment in order to inform therapeutic radiographers and best practice.

Discussion:

The treatment pathway for breast cancer patients varies greatly depending on a wide range of factors and is very much individualised for each patient. Each treatment modality has its advantages and disadvantages, and all come with a number of side effects that can affect a patient’s daily living. Toxicities can arise during radiotherapy treatment or months after treatment, and education regarding the management of these is essential for effective patient care. Many technological advances in radiotherapy treatment techniques and regimes have the potential to decrease radiation-induced side effects. Despite attempts to standardise clinical guidelines on the use of topical agents and dressings, historical opinions and ideas are still evident in clinical practice. The use of grading systems in radiotherapy tends to only record patients’ physical symptoms and not their holistic wellbeing and emotional needs.

Conclusion:

Therapeutic radiographers must ensure that they remain equipped with the skills and knowledge to correctly manage and/or signpost services effectively. This overall outline of the management of patients with breast cancer is designed to help therapeutic radiographers reflect on the current practices and to inspire them, where evidence dictates, to seize opportunities, to explore improvement and to enhance best practice.

Keywords

breast cancermanagement of radiotherapy toxicitiesradiotherapytherapeutic radiographer
Type
Educational Note
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 1 , March 2021 , pp. 99 - 107
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Sibbering, M, Courtney, C A. Management of breast cancer: basic principles. Surgery 2015; 34 (1): 25–31.Google Scholar
Queens University N. Ireland Cancer Registry (NICR). Release of the cancer incidence and survival statistics for Northern Ireland 2013–2017. Available from https://www.qub.ac.uk/nicr. Accessed on 29th November 2019.Google Scholar
Senkus, E, Kyriakides, S, Penault-Llorca, F et al. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up. Ann Oncol 2013; 24 (6): vi8–vi23.Google ScholarPubMed
Cardoso, F, Harbeck, N, Fallowfield, L, Kyriakides, S, Senkus, E. Locally recurrent or metastatic breast cancer; ESMO clinical practice guidelines for diagnosis, treatment and follow up. Ann Oncol 2012; 23 (7): vi 11–vi 19.Google ScholarPubMed
NHS Breast Screening Programme and Association of Breast Surgery. An audit of screen – detected breast cancers for the year of screening April 2013 to March 2014. Available from: http://associationofbreastsurgery.org.uk/media/1109/nhs-bsp-abs-audit-2014-15.pdf. Accessed on 29th November 2019.Google Scholar
Willett, A M, Michell, M J, Lee, M J R. Best practice diagnostic guidelines for patients presenting with breast symptoms. Breakthrough Breast Cancer 2010. Available from: https://www.evidence.nhs.uk/document?id=2013590&returnUrl=search%3Fq%3Dhc11%26sp%3Don&q=hc11. Accessed 29th November 2019.Google Scholar
Newman, LA. Advances in Breast Cancer Management, 2nd edition. USA: Springer, 2008.Google Scholar
Vaidya, J S, Joseph, D. Breast Cancer. Abington Oxford UK: Health Press Online Resource, 2014.Google ScholarPubMed
Jacobs, L N, Finlayson, C A. Early Diagnosis and Treatment of Breast Cancer. Philadelphia: Saunders Elsevier, 2010.Google ScholarPubMed
Viani, G A, Stefano, E J, Afonso, S L et al. Breast conserving surgery with or without radiotherapy in women with ductal carcinoma in situ: a meta – analysis of randomised trials. Radiat Oncol 2007; 2: 28–39.CrossRefGoogle ScholarPubMed
Wolmark, N, Wang, J, Mamounas, E, Bryant, J, Fisher, B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Nat Cancer Inst Monogr 2001; 30: 96–102.CrossRefGoogle Scholar
Van der Hage, J A, Van de Velde, C J, Julien, J P, Tubiana-Hulin, M, Vandervelden, C, Duchateau, L. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trail 10902. J Clin Oncol 2001; 19 (22): 4224–4237.CrossRefGoogle Scholar
Mauri, D, Pavlidis, N, Ioannidis, J P A. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Nat Cancer Inst 2005; 97 (3): 188–194.CrossRefGoogle ScholarPubMed
Henderson, I C. Breast Cancer: Fundamentals of Evidence-Based Disease Management. New York: Oxford University Press, 2015.CrossRefGoogle Scholar
Early Breast Cancer Trialists Collaborative Group. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomized trials. Lancet 2011; 378 (9804): 1707–1716.CrossRefGoogle Scholar
National Institute for Health and care Excellence. Early and locally advanced breast cancer: diagnosis and treatment clinical guideline. Published February 2009. Available from http://nice.org.uk/guidance/cg80. Accessed 29th November 2019.Google Scholar
Standardisation of Breast Radiotherapy Trialists Group. The UK Standardisation of Breast Radiotherapy (START) Trail B of radiotherapy hypo fractionation for treatment of early breast cancer: a randomised trial. Lancet 2008; 29 (371): 1098–1107.Google Scholar
McAlinden, L, Mullan, A, Shepherd, P. An evaluation of the skincare management of patients receiving radiotherapy for breast cancer. J Radiother Pract 2019. page 1 of 5. doi: 10.1017/S1460396919000724 Google Scholar
Sharp, L, Johansson, H, Landin, Y, Moegelin, I M, Bergenmar, M. Frequency and severity of skin reactions in patients with breast cancer undergoing adjuvant radiotherapy, the usefulness of two assessment instruments – a pilot study. Eur J Cancer 2011; 47: 2665–2672.CrossRefGoogle ScholarPubMed
McQuestion, M. Evidence based skin care management in radiation therapy. Semin Oncol Nurs 2006; 22 (3): 163–173.CrossRefGoogle ScholarPubMed
O’Donovan, A, Colemen, M, Harris, R, Herst, P. Prophylaxis and management of acute radiation induced skin toxicity: a survey of practice across Europe and USA. Eur J Cancer Care 2015; 24: 425–435.CrossRefGoogle ScholarPubMed
Ryan, JL. Ionizing radiation: the good, the bad and the ugly. J Investig Dermatol 2012; 132: 985–993.CrossRefGoogle ScholarPubMed
Bostock, S. Improving management of radiotherapy – induced skin reactions: a radiographer’s perspective. Wounds UK 2016; 12 (3): 39–45.Google Scholar
Feight, D, Baney, T, Bruce, S, Mcquestion, M. Putting evidence into practice: evidence based interventions for radiation dermatitis. Clin J Oncol Nurs 2011; 15 (5): 481–492.CrossRefGoogle Scholar
Freedman, G M, Li, T, Nicolaou, N, Chen, Y, Ma, C C, Anderson, P R. Breast intensity- modulated radiation therapy reduces time spent with acute dermatitis for women of all breast sizes during radiation. Int J Radiat Oncol Biol Phys 2009; 74: 689–694.CrossRefGoogle ScholarPubMed
Pignol, J P, Oilvotto, I, Rakovitch, E et al. A multicentre randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 2008; 26: 2085–2092.CrossRefGoogle Scholar
Hymes, S R, Strom, EA, Fife, C. Radiation dermatitis: clinical presentation pathophysiology, and treatment. J Am Acad Dermatol 2006; 54 (1): 28–46.CrossRefGoogle ScholarPubMed
Fisher, J, Scott, C, Stevens, R et al. Randomised phase III study comparing best supportive care to biafine as a prophylactic agent for radiation induced skin toxicity for women undergoing breast irradiation: radiation therapy oncology group (RTOG) 97-13. Int J Radiat Oncol Biol Phys 2000; 48: 1307–1310.CrossRefGoogle Scholar
Graham, P, Browne, L, Capp, A et al. Randomised paired comparison of no string barrier film versus sorbolene cream (10% glycerine) skin care during postmastectomy irradiation. Int J Radiat Oncol Biol Phys 2004; 58: 241–246.CrossRefGoogle Scholar
Paterson, D B, Poonam, P, Bennett, NC et al. Randomised intra-patient controlled trial of mepilex lite dressings versus aqueous cream in managing radiation induced skin reactions post mastectomy. Cancer Sci Therap 2012; 4: 347–356.Google Scholar
Trotti, A, Byhardt, R, Stetz, J et al. Common toxicity criteria: version 2.0. An improved reference for grading the acute effects of cancer treatment; impact on radiotherapy. Int J Radiat Oncol Biol Phys 2000; 47 (1): 13–47.CrossRefGoogle ScholarPubMed
Schnur, J B, Love, B, Scheckner, BL, Green, S, Wernicke, AG, Montgomery, GH. A systematic review of patient rated measures of radiodermatitis in breast cancer radiotherapy. Am J Clin Oncol 2011; 34 (5): 529–536.CrossRefGoogle ScholarPubMed
Cox, J, Stetz, J, Pajak, T F. Toxicity criteria of the radiation therapy oncology group (RTOG) and the European organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31 (5): 1341–1346.CrossRefGoogle Scholar
Momm, F, Bartelt, S, Haigis, K, Grobe-Sender, A, Witucki, G. Spectrophotometric skin measurements correlate with EORTC/RTOG Common toxicity criteria. Strahlenther Onkol 2005; 181: 392–395.CrossRefGoogle ScholarPubMed
Huang, C J, Hou, M F, Luo, K H et al. RTOG, CTCAE and WHO criteria for acute radiation dermatitis correlate with cutaneous blood flow measurements. Breast 2015; 24: 230–236.CrossRefGoogle ScholarPubMed
Schnur, J, Ouellette, S C, DiLorenzo, T A, Green, S, Montgomery, G H. A qualitative analysis of acute skin toxicity among breast cancer radiotherapy patients. Psychooncology 2011; 20: 260–268.CrossRefGoogle ScholarPubMed
Neben-Wittich, M A, Atherton, P J, Schwartz, D J et al. Comparison of provider – assessed and patient reported outcome measures of acute skin toxicity during a phase III trial of mometasone cream versus placebo (N06C4). Int J Radiat Oncol Biol Phys 2010; 81: 397–402.CrossRefGoogle Scholar
Ryan, J L, Bole, C, Hickok, J T et al. Post Treatment skin reactions reported by cancer patients differ by race, not by treatment or expectations. Br J Cancer 2007; 97: 14–21.CrossRefGoogle ScholarPubMed
Maddocks-Jennings, W, Wilkinson, J M, Shillington, D. Novel approaches to radiotherapy induced skin reactions: a literature review. Complement Ther Clin Pract 2005; 11: 224–231.CrossRefGoogle ScholarPubMed
Harris, R, Probst, H, Beardmore, C et al. Radiotherapy skin care: a survey of practice in the UK. Radiography 2012; 18 (1): 21–27.CrossRefGoogle Scholar
Kumar, S, Juresic, E, Barton, M, Shafiq, J. Management of skin toxicity during radiation therapy: a review of the evidence. J Med Imag Radiat Oncol 2010; 54: 264–279.CrossRefGoogle Scholar
Swamy, U, Ashamalla, H, Guirguis, A. A nationwide survey of radiation oncologist’s management practices of radiation induced skin reaction (RISK). J Radiother Pract 2009; 8: 195–205.CrossRefGoogle Scholar
Society and College of radiographer (SCoR) Practice guideline Document: Skin care advice for patients undergoing radical external beam megavoltage radiotherapy. 2015 Available from: https://www.sor.org/learning/document-library/skin-care-advice-patients-undergoing-radical-external-beam-megavoltage-radiotherapy-0. Accessed 29th November 2019.Google Scholar
Fowble, B, Yom, S S, Yuen, F, Arron, S. Skin Care in Radiation Oncology: A Practical Guide. Switzerland: Springer International Publishing, 2016.CrossRefGoogle Scholar
Macmillan, M S, Wells, M, Macbride, S, Rabb, G M, Munro, A, Macdougall, H. Randomised comparison of dry dressings versus hydrogel in management of radiation induced moist desquamation. Int J Radiat Oncol Biol Phys 2007; 68: 864–872.CrossRefGoogle Scholar
Diggleman, K V, Zytkovicz, A E, Tuaine, J M, Bennett, N C, Kelly, L E, Herst, P M. Mepilex lite dressings for the management of radiation induced erythema: a systematic inpatient controlled trial. Br J Radiol 2010; 83: 971–978.CrossRefGoogle Scholar
Herst, P M, Bennett, N C, Sutherland, A E, Peszynski, R I, Paterson, D B, Jasperse, M L. Prophylactic use of meptiel film prevents radiation induced moist desquamation in an intra-patient randomised controlled clinical trial of 78 breast cancer patients. Radiother Oncol 2014; 110: 137–143.CrossRefGoogle Scholar
Manir, K S, Bhadra, K, Kumar, G, Manna, A, Patra, N B, Sarkar, S K. Fatigue in breast cancer patients on adjuvant treatment; course and prevalence. Indian J Palliat Care 2012; 18: (2): 109–116.CrossRefGoogle ScholarPubMed
Greenberg, D, Sawicka, J, Eisenthal, S, Ross, D. Fatigue syndrome due to localised radiation. J Pain Symptom Manage 1992; 7: 38–45.CrossRefGoogle Scholar
Wratten, C, Kilmurray, J, Nash, S et al. Fatigue during breast radiotherapy and its relationship to biological factors. Int J Radiat Oncol Biol Phys 2004; 59(1): 160–167.CrossRefGoogle ScholarPubMed
Lee, T S, Kilbreath, S L, Refshauge, K M et al. Quality of life of women treated with radiotherapy for breast cancer. Support Care Cancer 2008; 16 (4): 399–405.CrossRefGoogle ScholarPubMed
White, J, Joiner, M C. Radiation Toxicity: A Practical Guide. New York: Springer, 2006.Google Scholar
Mock, V, Hassey-Dow, K, Meares, C, Grimm, P M, Dienemann, J A, Haisfield-Wolfe, M E. Effects of exercise on fatigue, physical functioning and emotional distress during radiation therapy for breast cancer. Oncol Nurses Forum 1997; 24: 991–999.Google ScholarPubMed
Lipsett, A, Barrett, S, Haruna, F, Mustian, K, O’Donovan, A. The impact of exercise during adjuvant radiotherapy for breast cancer on fatigue and quality of life: a systematic review and meta-analysis. Breast 2017; 32: 144–155.CrossRefGoogle ScholarPubMed
McNally, F, Shepherd, P H, Flood, T. A review of the impact of exercise on treatment-related fatigue among patients receiving adjuvant radiotherapy for breast cancer. J Radiother Pract 2019; 18: 295–300.CrossRefGoogle Scholar
Macmillan Cancer Support. A Practical Guide to Understanding Cancer; Understanding Breast Cancer in Women, 11th edition, 2016.Google Scholar
Amir, E, Seruga, B, Niraula, S, Carlsson, L, Ocana, A. Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta – analysis. J Nat Cancer Inst 2011; 103 (17): 1299–1309.CrossRefGoogle ScholarPubMed
Heisig, S R, Shedden-Mora, M C, Von Blanckenburg, P et al. What do women with breast cancer expect from their treatment? Correlates of negative treatment expectations about endocrine therapy. Psycho-oncology 2016; 25: 1485–1492.CrossRefGoogle ScholarPubMed
Barsky, A J, Saintford, R, Rogers, M P, Borus, J F. Nonspecific medication side effects and the nocebo phenomenon. J Am Med Assoc 2002; 287: 622–627.CrossRefGoogle ScholarPubMed
Van Oers, H M, Schlebusch, L. Anxiety and the patient with breast cancer: a review of current research and practice. South African Family Pract 2013; 55 (6): 525–529.CrossRefGoogle Scholar
Halkett, G K B, Kristjanson, L J, Lobb, E A. ‘If we get too close to your bones they’ll go brittle’: women’s initial fears about radiotherapy for early breast cancer. Psychooncology 2008; 17: 877–884.CrossRefGoogle ScholarPubMed
Lanigan, S W, Joannides, T. Pulsed dye laser treatment of telangiectasia after radiotherapy for carcinoma of the breast. Br J Dermatol 2003; 148: 77–79.CrossRefGoogle ScholarPubMed
Fehlauer, F, Tribius, S, Holler, U et al. Long term radiation sequelae after breast conserving therapy in women with early stage breast cancer: an observational study using the LENT-SOMA scoring system. Int J Radiat Oncol Biol Phys 2003; 55 (3): 651–658.CrossRefGoogle ScholarPubMed
Taylor, M E, Perez, C A, Halverson, K J et al. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys 1995; 31 (4): 753–764.CrossRefGoogle ScholarPubMed