Radiotherapy far from home: how do you organise several weeks of treatment in Morocco?

The steps of external beam radiotherapy

The radiotherapy consultation

The radiation oncologist reviews the file: pathology report, imaging, operative reports, the decision of the multidisciplinary team meeting and treatments already received. They explain the goal of treatment, to cure, to reduce the risk of recurrence or to relieve a symptom, the number of sessions planned and the expected side effects. Previous radiotherapy to the same area must always be reported, with the report of that treatment.

The planning scan

A CT scan, called a simulation or planning scan, is carried out in the exact treatment position. Depending on the area, immobilisation devices help the patient keep the same position at each session, for example a moulded mask for the head and neck. Small marks may be drawn or tattooed on the skin.

Calculating the treatment plan

On the images, the team outlines the area to be treated and the organs to be protected, and then calculates how the dose will be distributed. This step, carried out without the patient, generally takes several days. It determines the precision and safety of the treatment.

The sessions

The patient is positioned exactly as for the scan. The irradiation itself lasts only a few minutes; with positioning and imaging checks, a session usually takes less than half an hour. The session is painless. A follow-up consultation with the radiation oncologist takes place regularly during treatment.

How long does treatment last?

The number of sessions varies greatly with the indication: from one to a few sessions for some symptom treatments or some stereotactic radiotherapy, to several weeks of daily sessions for many cancers. For some cancers, shorter schedules, with fewer sessions at a higher dose, are now validated. The radiation oncologist sets the schedule; for a patient coming from abroad, it helps to ask at the first consultation for the total planned length, preparation included.

When radiotherapy is combined with chemotherapy given at the same time, or completed by brachytherapy, for example in cervical cancer, the schedule must coordinate the different teams.

Organising the stay

• Accommodation should be close to the treatment centre, as journeys are daily and fatigue increases over the weeks.
• A companion is often invaluable, especially towards the end of treatment or in the event of troublesome side effects.
• Weekends without sessions are generally not long enough to go home between two weeks of treatment.
• A margin of a few days at the end of treatment makes it possible to manage acute effects before the return journey.
• The budget includes the treatment, but also accommodation, meals, transport and the companion’s stay.

Side effects and how they are managed

Effects depend mainly on the area treated and the dose. Fatigue is common. The skin in the treated area may redden. Radiotherapy to the head and neck can cause inflammation of the mouth and difficulty swallowing, requiring nutritional support; pelvic radiotherapy can cause bowel or urinary problems. The team gives advice on skin care, diet and mouth hygiene, and treats symptoms. A dental problem may need to be dealt with before irradiation of the mouth area.

Why avoid interruptions?

For several cancers, extending the overall treatment time because of unplanned interruptions can reduce tumour control. Returning home early, a problem with accommodation or funding that runs out during treatment are avoidable causes of interruption. They are prevented by a clear plan before departure.

After radiotherapy

Some effects peak in the days after the last session, then gradually subside. The patient leaves with an end-of-treatment report that specifies the area treated, the dose and the dates: this document is essential for any future treatment. The schedule of follow-up consultations and tests is given to the doctor caring for the patient in their country.

Frequently asked questions