Radiotherapy is also often the last stage of specific oncology care and marks the patient's entry into the monitoring phase. The "patient in active care" becomes a "person in remission." At this point of transition, the patient is "suddenly" removed from oncology care facilities for several weeks and returns to their living environment with varying degrees of success. However, this experience is a new ordeal in the face of challenges such as managing side effects that continue, worsen or become chronic, fatigue and acceptance of a body weakened by the disease, possible specific or non-specific treatments to be continued at home, fear of recurrence and other unstable emotions, adopting a new lifestyle, returning to work, and misinformation.

At this crucial point in their journey, we also find that the early side effects of radiotherapy take several weeks to resolve or even reach their peak after the patient has left active care. This effect is currently being exacerbated by the shortening of the total duration of radiotherapy and the increase in doses per session (hypo-fractionation). Patients may find themselves unable to cope with the consequences of these prolonged effects or may consult other non-expert medical or paramedical resources (general practitioners, emergency services, medical oncologists, organ specialists, alternative medicine practitioners, chiropractors, etc.). Quality of life is therefore threatened at the end of "active" cancer care. The recognition, standardized assessment, and management of these side effects require ongoing access to radiation therapy professionals.

It is therefore important to involve the radiation oncologist in post-treatment follow-up.  

The CFB also offers psychological support to patients in remission. If any of your patients are experiencing depression or anxiety, please encourage them to get in touch with us.

Radiotherapy is used in more than 50% of cancer patients for curative or palliative purposes. Due to the necessary irradiation of healthy tissue around the tumor, patients may experience two types of side effects. These vary depending on the location and volume irradiated, the dose delivered, the individual sensitivity of the patient, and their age. They appear in the irradiated area and their probability and severity are proportional to the dose administered. Advances in radiation techniques have made them less common.

There are two types:

• Early effects, which are very common and expected, occur during radiotherapy and up to 3-6 months afterwards, depending on the definition. They are generally temporary and heal without any lasting effects. However, they can be painful or uncomfortable and may sometimes require medical treatment or even hospitalization. The most common are fatigue, radiodermatitis (inflamed or even ulcerated skin), and oral, digestive, or gynecological mucositis.
• Late effects occur more than 6 months after the end of treatment in a minority of patients (10-15%) and can lead to sequelae mediated by tissue fibrosis. They can be of several types depending on the area treated:
• Loss of skin elasticity and/or edema;
• Pain in the treated area and inflammation of the mucous membranes;
• Rosacea, which appears 18 months to two years after the end of radiation therapy. This is known as telangiectasia. These are small dilated superficial blood vessels. This rosacea-like appearance is more pronounced when the irradiated area is exposed to the sun;
• Loss of saliva (known as hyposialia or asialia) following ENT radiation.
• Permanent hair loss;
• Fragility of the genital mucosa, increased vaginal dryness, fibrosis, or vaginal narrowing;
• The risk of secondary cancer caused by radiotherapy is extremely low in adults but may be a legitimate cause for concern.

Leur prise en charge est bien détaillée dans le chapitre Description and Management of Radiotherapy-Induced Long-Term Effects(Vogin G) de l’ouvrage Survivorship Care for Cancer Patients (pp.257-285), ISBN: 978-3-030-78648-9, Springer.