If you decide to take part in the study you will be assessed by your cancer specialist who will check that you are eligible and will ask you about your pain. In particular, they may ask:
• Where your pain is
• Whether the pain is there all the time or if it comes and goes
• Whether anything makes the pain better or worse
• How it changes throughout the course of the day
• What the pain is like (sharp, jagging, dull)
• How bad it is out of 10 (if 10 is the worst pain imaginable)
• What painkillers you are on and how much they help you
Changes to Medication
The specialist may make some changes to your painkillers to help to stabilise your pain as much as possible. If your pain remains at a score of 4 or more out of 10, despite the changes to your medicines, you may be eligible to take part in the trial.
If you have not had a recent CAT scan of your chest and abdomen this will be organised for you. If you have had a previous reaction to the dye used for these scans please make sure you tell your doctor. You will have another CAT scan 9 weeks after the start of your radiotherapy. We will then be able to compare these scans to look for any changes which may be due to the radiotherapy.
You will be asked to sign a consent form to say that you have read and understood the information given to you about the trial and that you are happy to go ahead. You are able to change your mind about taking part in the trial at any point, even after you have signed the consent form and you will not be asked to give a reason. Deciding not to take part in the trial would not affect your routine care and you would still be able to receive radiotherapy for your pain out-with the trial, under the care of your cancer specialist.
Radiotherapy Planning Scan
You will receive an appointment to come to your local radiotherapy department for a ‘radiotherapy planning scan’. This is similar to the CAT scan which you will have recently had, but no dye will be used. At this appointment, you will be asked to show the doctors and radiographers where your pain is worst. Sticky markers will be put on these areas and your scan will be done with these in place. These markers are a great help to your doctor in planning your radiotherapy, because they are visible on the scan and allows us to see exactly where your pain is coming from. The scan takes about 10 minutes to complete. Once your scan is done the radiographers will put some very small marks on your chest wall with dye, which are painless. These marks are permanent and are known as radiotherapy tattoos. They help us to make sure that you are in the same position each time you come for your treatment, which helps to make sure the radiotherapy is delivered accurately.
After your planning scan, your doctor and radiotherapy department will work together to come up with the best plan for you and the areas of pain that you have. Once the team are happy with your plan they will contact the Clinical Trials Department who will then enter your details into the computer and find out which radiotherapy dose you are to receive. Your radiotherapy department will then be able to tell you the dates of your treatment.
Before you begin your radiotherapy, your cancer specialist will re-assess your pain to ensure that radiotherapy is still the right treatment for you. They will also make a note of all your medications, in particular they will look at the doses of your painkillers and how much ‘breakthrough’ pain relief you are using in a 24 hour period. At this visit you will also be asked to complete some questionnaires about your pain and quality of life. Your doctor will also perform some routine blood tests on you and ask you about any existing medical problems or symptoms that you have.
On the first day of your radiotherapy the doctors and radiographers will make sure that they are happy with everything before they deliver your treatment. This appointment may therefore take a little bit longer than the rest of your treatments, which will usually be less than 10 minutes.
If you have any problems or notice any side effects throughout the course of your radiotherapy please let the radiographers know. They may ask one of the radiotherapy nurses or doctors to come and see you.
On the final day of your radiotherapy your pain and any side effects will be assessed and the doses of painkillers that you are on will be noted. When you have completed your treatment you will be followed up by the trial team looking after you at regular points. You will be asked to come back to clinic 5 weeks after the start of your radiotherapy and again at 9 weeks after the start of the radiotherapy. During these visits your doctor will monitor your progress and will check for any side effects. You will have some routine blood checks at these visits and will be asked to complete some questionnaires about your quality of life and about any pain that you have. There will be a final visit where your doctor will ask you to complete some questionnaires only. To see the schedule of visits click here.