List of Abbreviations

ix

Introduction

1

Scope of Practice

3

EVIDENCE-BASED PRACTICE

5

I

DEFINITION AND IMPLICATIONS

5

A

Definition

5

B

Implications for Practice

5

C

Advantages of Evidence-Based Practice

5

II

THE PROCESS OF EVIDENCE-BASED PRACTICE

6

III

EVIDENCE-BASED GUIDELINE IMPLEMENTATION

8

RADIATION ONCOLOGY NURSING PRACTICE AND EDUCATION

11

I

THE CLINICAL PRACTICUM

11

A

Course Description

11

B

Course Objectives

12

C

Clinical Activities

13

D

Evaluation

13

II

THE PRACTICE OF RADIATION ONCOLOGY

17

A

Principles of Radiation Therapy

17

B

Radiobiology

19

C

Dose Prescription, Treatment Planning, and Simulation

22

D

Purpose of Radiation Therapy

24

E

Tissue Tolerance Dose

24

F

Factors Related to Radiation-Induced Injury of Normal Tissue

24

G

Considerations for Radiation Therapy

25

H

Radioresponsiveness of Normal Tissue

25

I

Side Effects

26

III

RADIATION PROTECTION AND SAFETY

29

A

Importance of Knowing Specific Information

29

B

Purpose of Radiation Protection Regulations

29

C

Sources of Radiation Exposure

29

D

Major Organizations Involved in Radiation Protection Guidelines and Standards

31

E

Major Agencies in the United States and Canada that have Regulatory Authority

32

F

Radionuclide Factors that Determine the Type and Amount of Radiation Protection Practices

34

G

Principles of Radiation Protection

36

H

Radiation Monitoring Devices

37

I

Recognition of Radiation-Restricted Areas

39

J

Special Radiation Protection Considerations and Issues

39

K

Nursing Education in Radiation Protection

42

L

Related Web Sites

43

IV

GENERAL SYMPTOM MANAGEMENT

45

A

General Patient and Family Education

45

B

Fatigue

53

C

Skin Reactions

62

D

Pain

66

E

Distress/Coping

68

F

Sexual Dysfunction

75

G

Nutritional Issues

80

V

SITE-SPECIFIC MANAGEMENT

95

A

Brain and Central Nervous System

95

B

Head and Neck

122

C

Breast

145

D

Thoracic

162

E

Gastrointestinal/Abdomen

174

F

Bladder

185

G

Male Pelvis/Prostate

197

H

Female Pelvis

209

I

Bone Metastases

219

VI

DISEASE-SPECIFIC MANAGEMENT

227

A

Sarcomas

227

B

Lymphoma

232

C

Benign Conditions

238

VII

ONCOLOGIC EMERGENCIES

247

VIII

MODALITY-SPECIFIC MANAGEMENT

257

A

External Beam (Teletherapy)

257

B

Low Dose Rate and High Dose Rate Brachytherapy

262

C

Intraoperative Radiation Therapy

271

D

Stereotactic Radiosurgery

274

E

Hyperthermia

281

F

Total Body Irradiation and Hematopoietic Stem Cell Transplantation

283

G

Total Lymphoid Irradiation

295

H

Total Skin Irradiation

298

I

Photodynamic Therapy

299

J

Proton Beam Radiation Therapy

305

IX

SPECIAL POPULATIONS

311

A

Pediatric Radiation Oncology

311

B

Geriatric Radiation Oncology

321

C

Radiation Therapy for People with Special Needs

329

X

CHEMICAL MODIFIERS OF CANCER TREATMENT

349

A

Radioprotectors

349

B

Radiosensitizers and Concurrent Chemotherapy and Biotherapy

354

C

Radioimmunotherapy and Radiopharmaceuticals

360

XI

GENERAL RADIATION ONCOLOGY ISSUES

373

A

Survivorship

373

B

Palliative Care

376

C

Cancer Clinical Trials

379

D

Nursing Management in Radiation Oncology

385

XII

ACCREDITATION AND QUALITY IMPROVEMENT

395

A

The Joint Commission

395

B

American College of Radiology

404

XIII

RADIATION ONCOLOGY RESOURCES

407

A

Oncology Nursing Society

407

B

Additional Online Radiation Resources

408

C

American Society for Radiation Oncology

410

D

National Comprehensive Cancer Network

413

E

National Cancer Institute

413

Index

415