Nursing education for breast cancer patients undergoing radiotherapy

Radiotherapy (RT) is the use of high-energy rays to irradiate tumors to destroy the DNA of tumor cells, inhibit the metabolism and growth of cancer cells, and cause cancer cells to be destroyed and die, thereby achieving the purpose of making cancer cells lose their reproductive ability and clearing cancer cells. Radiotherapy, as a local treatment method, mainly includes preventive, radical, and palliative treatments. Radiotherapy can be used at different stages of breast cancer, including patients before, during, and after breast cancer surgery, as well as patients with metastasis to distant organs.

Applicable population for breast cancer radiotherapy:

(1) After breast-conserving surgery.

(2) Bone metastasis: Bone metastasis can be effectively controlled by radiotherapy to key areas on the basis of effective drugs.

(3) After mastectomy, one of the following conditions occurs: a. The diameter of the breast tumor exceeds 5 cm. b. There is metastasis to the axillary lymph nodes.

(4) If there is axillary lymph node metastasis or the primary tumor is >5 cm and has been treated with chemotherapy/targeted therapy before surgery (neoadjuvant therapy), postoperative radiotherapy is required even if the axillary lymph nodes are negative after surgery.

(5) Brain metastasis: Most brain metastases need to be well controlled through medication, radiotherapy and surgery.

(6) Local recurrence: After surgery, the tumor reappears in the breast, chest wall, or lymph nodes.

Before radiotherapy:

(1) Before radiotherapy, we need to understand that radiotherapy is not only an auxiliary treatment, but also an important means of tumor treatment. Radiotherapy can be used alone or in combination with surgery or chemotherapy, so you don’t need to be nervous or afraid. Please reduce your anxiety and fear and actively cooperate with the treatment.

(2) Unhealed wounds must wait until they are healed before radiotherapy. Wounds with scabs can be treated with radiotherapy at the same time. (Please consult the attending physician for specific circumstances)

(3) Follow the doctor's instructions to complete various examinations: routine blood tests, liver and kidney function, routine coagulation tests, tumor markers, CT, electrocardiogram, etc.

(4) Radiotherapy process (after admission, complete various examinations to confirm that radiotherapy is possible → determine the purpose of treatment, determine the radiation source → simulate positioning under CT, some patients need to make a fixation device and body contour (such as a body frame, head frame) → outline the target area, determine the tumor volume and required dose → design a treatment plan, design the irradiation field, calculate and select the best plan → determine the treatment plan → simulate the implementation of the treatment plan → start the first radiotherapy positioning, take verification films, and ensure the best treatment plan) Please be patient during the admission.

Instructions during radiotherapy:

(1) After positioning, please keep the marking line clear and the skin in the irradiation field clean. If the marking color becomes lighter, the attending physician should repaint it and it is not allowed to be painted by yourself until the end of radiotherapy.

(2) Precautions for entering the treatment room: remove metal objects and do not move your body position at will after positioning. If you feel uncomfortable, you can raise your hand to ensure the accuracy of the radiotherapy effect.

(3) Check blood count at least once a week, correct anemia and other symptoms promptly based on the blood test results, give a high-protein, high-vitamin diet, and if there is an infection, it must be controlled before radiotherapy.

(4) Swelling and functional impairment of the affected limb: Please perform limb functional exercises according to the functional exercise plan to increase muscle tone, promote venous lymphatic return, and reduce the occurrence of edema. Avoid measuring blood pressure, drawing blood, injecting, and lifting heavy objects on the affected arm to prevent injury; raise the affected upper limb to relieve edema.

(5) Improve nutrition: It is advisable to eat a light diet that is high in calories, protein, and rich in vitamins. Patients should drink plenty of water, 2000 to 4000 ml per day, which is conducive to promoting the excretion of toxins.

(6) Grading and care of radiation-induced skin damage.

According to the RTOG acute radiation injury grading standard, skin reactions caused by radiotherapy can be divided into the following grades:

There is no change to the level 0 skin.

Grade I: Mild erythema, itching, and mild dryness reaction.

Grade II: Scattered erythema, moist reaction in skin folds, or moderate edema.

Grade III: Confluent moist desquamation and pitting edema outside skin folds.

Grade IV: Ulcers, bleeding, and necrosis occur on the skin.

During the entire radiotherapy process, regardless of the level, you must wear cotton, soft, loose clothing; you cannot wear a bra, and you should open your chest when convenient to keep the area under your breasts and armpits clean and dry; you can shower during the treatment cycle, but the skin in the irradiation field can only be rinsed with warm water. Alkaline soaps and irritating cosmetics are prohibited. Keep the skin in the irradiation field clean and dry. It is forbidden to apply hot or cold compresses to the skin in the irradiation field, and do not apply adhesive tape; avoid direct sunlight.

Level I injury care: Most patients only need general skin care measures, do not scratch to avoid injury, such as moisturizing with hydrophilic lotion, but no other special treatments are needed. Low- and medium-efficiency topical hormones can effectively control itching.

Care for grade II injuries: Topical medications can be used according to doctor's orders to reduce inflammation and promote healing. The skin in the irradiated area should be fully exposed and should not be covered or bandaged to avoid trauma and infection.

Care for grade III and IV injuries: Symptomatic treatment can be used to prevent infection. Patients with severe pain can take analgesics as prescribed by the doctor and receive professional wound treatment under the guidance of medical staff. Radiotherapy can be stopped if necessary according to the patient's skin condition.

(7) Avoid scratching. It is strictly forbidden to tear the epidermis with your hands or use external medications without authorization. If necessary, inform the doctor in charge immediately.

Discharge instructions after radiotherapy:

(1) The skin in the irradiated area still needs to be protected for at least 1 month, because radiation ulcers may still occur in the irradiated area many years later. Therefore, you should always pay attention to the protection of the skin in the irradiated area, avoid friction and strong physical and chemical stimulation, and wait for the skin lines to fade naturally. Do not rub hard or use detergent to clean.

(2) Develop good eating and living habits, pay attention to scientific and reasonable nutrition, combine work and rest, lead a regular life, strengthen personal hygiene, and prevent colds.

(3) Keep the environment clean and quiet, maintain an optimistic mood, and ensure adequate sleep.

(4) Strengthen functional exercises of the affected limb, at least 1 to 2 times a day.

(5) Avoid pregnancy within 2-3 years.

(6) Have regular outpatient checkups and monthly self-examinations of the healthy breast, and seek medical attention promptly if any abnormalities are found.