Saint John Regional Hospital – Oncology Services Cancer Services – Who we are and what we do Horizon’s Oncology Program is a comprehensive provincial service that provides systemic therapy, radiation therapy as well as supportive care and follow-up care to patients diagnosed with cancer. Systemic Therapy or Chemotherapy (chemo) is the use of one or more drugs to kill cancer cells. Chemotherapy may be used alone or used combined with other treatments such as surgery or radiation therapy. Radiation Therapy is the controlled use of a radiation beam to destroy a cancerous tumour. Radiation Therapy destroys cells either directly or by interfering with cell reproduction. Radiation Therapy may be used by itself or combined with other treatment modalities. The Horizon Health Network Oncology Program Radiation Treatment Program is based out of the Saint John Regional Hospital. The Oncology Program is actively involved in clinical trials which ensure that patients receive treatment according to nationally accepted protocols and by means of the latest equipment and techniques. The New Brunswick Stem Cell Transplantation program is based out of the Saint John Regional Hospital and offers services to patients from throughout the province. History of the Oncology Program Saint John Regional Hospital (SJRH) Site Your Cancer Care Team Therapies Patient Experience Oncology services have been provided to New Brunswick residents from Saint John facilities for over one hundred (100) years. In 1901, the installation of an x-ray machine for treatment purposes marked the beginning of radiotherapy treatment. Between the years 1931-1936, the Saint John General Hospital formed a multidisciplinary cancer clinic which saw 89 patients and administered 534 treatments. By 1955, the hospital employed two physicians who had received specialist training in radiotherapy, one medical physicist and one radiation therapist. These individuals comprised the Department of Radiotherapy. During this time, researchers discovered that nitrogen mustard, used as a chemical weapon during World War II, possessed therapeutic properties in the treatment for certain types of cancer. Over time new drugs were developed and in 1960 chemotherapy was administered to select patients by the Radiation Oncology physicians at the Saint John General Hospital. Chemotherapy as an accepted treatment modality, expanded quickly while the medical management of patients receiving these drugs became increasingly complex. In 1979, the hospital attracted the services of a physician who had received specialized training in chemotherapy. The expertise provided by this physician allowed the department of Radiation Oncology to treat many new patients. Over the next 10 years the number of chemotherapy treatments administered to patients tripled in number. The outpatient chemotherapy unit became an integral component of patient care that the Radiation Oncology Department changed its name to Department of Oncology. In 2003-2004 the 53,000 oncology treatments delivered represent a 1000% increase from the 534 treatments in 1936. Acknowledgement of this milestone has come recently in the form of new concept for oncology services. The introduction of program management provides for the co-ordination of the various services involved in oncology care. Co-operative and collaborative strategic planning allows for the highest quality patient care to be provided in a rapidly changing environment. In 2007 the division of radiation oncology continued the path of providing leading edge treatment delivery by establishing the first IMRT (Intensity Modulated Radiation Therapy) program in the Province of New Brunswick. IMRT delivery techniques use several small beams of computer controlled radiation therapy along with IGRT (Image guided Radiation Therapy) resulting in the ability to sculpt radiation doses tightly around the area treated while minimizing doses to normal tissues. The centre has treated over 1000 patients with IMRT/IGRT; sites currently treated with IMRT include prostate, head and neck, brain, and other sites. In 2010 the centre added two new linear accelerators which improved IGRT imaging quality by providing On Board KV imaging (OBI); this resulted in the ability take higher definition 2D images and 3D Cone beam CT images. Additional enhancements include the ability to reduce treatment times required for IMRT/IGRT treatments by using VMAT (Volumetric Arc Therapy) techniques. The year 2010 also saw the advent of the New Brunswick Stem Cell Transplantation Program for the Province of New Brunswick. In 2012 the centre established the first Stereotactic Radiosurgery (SRS)/Stereotactic Radiation Therapy (SRT) program in New Brunswick, prior to this patients were referred out of the Province for this service. To date over 50 patients have received SRS/SRT in the Saint John Department of Oncology. Oncology services have realized tremendous growth and development over the last one hundred (100) years. Always recognized as a centre of excellence for the diagnosis and treatment of malignant disease, Horizon’s Oncology program is acknowledged as a comprehensive service that includes medical oncology, radiation oncology, haematological oncology, stem cell transplantation and clinical trials. Horizon Health Network leads the way in bringing innovation and efficiencies to deliver sustainable, affordable, safe and quality health-care services to residents of New Brunswick, northern Nova Scotia and Prince Edward Island with a collaborative team approach to offer services in English and French. It operates 12 hospitals and more than 100 medical facilities, clinics and offices providing medical services ranging from acute care to community based health services. With 1,000 physicians, an annual budget of approximately $1 billion and approximately 12,400 employees, Horizon Health Network’s strategic vision focuses on research, innovation, education and health and wellness. Horizon received accreditation status from Accreditation Canada in 2010 and 2013.Horizon is a designated campus of the Dalhousie University Post Graduate Medical Education Program, is affiliated with Memorial University School of Medical Education, as well as the Saint John School of Radiation Therapy, and has an active Research Services Division. The Department of Oncology, located at the Saint John Regional Hospital (SJRH) in Saint John, New Brunswick, with outpatient services offered on Floor Level 1 and inpatient services on Level 5. Level 1 (Outpatient Services) Specific patient/family areas include: The main reception desk Chemotherapy Room (outpatient chemotherapy is also given on 5A South) Outpatient/Follow-Up clinic Outpatient/Follow-Up Clinic waiting area Daffodil Lounge Patient Resource Centre Patient/family quiet room Oncology garden Radiation planning and simulation Radiation therapy treatment Radiation Therapy Patient/Family Waiting Area Brachytherapy treatment Main Reception Desk As you enter the Department of Oncology you will find the main reception desk to your right. The receptionist will check you in for your initial appointment and help direct you to the location of your appointment. Remember; most oncology appointments require you to register in the main lobby of the hospital prior to coming to the Department of Oncology. Chemotherapy Room The chemotherapy room is located directly across the hall from our reception desk and overlooks the oncology garden. Outpatient chemotherapy may also be given on 5A South (5th floor) in room 15. Staff will inform you if you are to receive your treatment on Level 1 or 5. Outpatient/Follow-Up Clinic The outpatient clinics are located at the front of the Department of Oncology. You will be asked to sit in a general waiting area while you wait for your appointment and called to this area at your designated time; this helps us ensure we provide privacy for our patients at each visit. This area is used for both initial visits to your oncologist and for post-treatment follow-up visits for checkups. Daffodil Lounge Patient Resource Centre The Daffodil Lounge is located inside the outpatient clinic waiting area and has a wide variety of resource materials including books, videos, pamphlets and CD’s that patients/family members may read on the premises or sign out. A computer with internet access as well as a telephone with a direct link to the Canadian Cancer Society can also be found in the Daffodil Lounge. Both patients and family members may use these resources. The Oncology Garden The oncology garden is located in a central courtyard and can be viewed from the chemotherapy room or accessed through a door off the front hallway leading to the radiation therapy treatment area. This area is graciously provided to the patients and their families by the Regional Hospital Brighten Group. Radiation Planning and Simulation This area is located near the centre of the Department of Oncology and consists of CT simulation, and treatment planning rooms. All radiation therapy patients will visit the CT simulation area prior to the start of their therapy to begin the planning process. Radiation Therapy Treatment This area is located just beyond the planning and simulation areas and includes four radiation therapy treatment rooms, which house radiation therapy treatment units of various energies and features. Level 5 (Inpatient Services) The Saint John Regional Hospital’s inpatient oncology unit (5A South), Clinical Trials Department and Hostel Unit (5B South) are located on the 5th level of the Saint John Regional Hospital. 5A South The 5A South area is a 21 bed radiation/medical/hematology oncology unit. The unit also has an outpatient treatment room which accommodate ‘overflow’ patients from the chemo room of the Level 1 Department of Oncology. 5A South is shaped like a horseshoe with patient rooms on the either side and the nursing station/reception desk at the head of the horseshoe. There are 21 inpatient beds on 5A South, 5 semi-private rooms and 7 private rooms. While the unit tries to accommodate patient requests as much as possible, private rooms are used primarily for patients whose medical condition require this type of accommodation (i.e. protective isolation). There are two outpatient rooms on 5A South- Room15 and Room 17. Room 15 is an outpatient chemotherapy room while Room 17 is the Stem Cell Transplantation clinic. Patients who access the outpatient rooms may receive chemotherapy, blood or blood products, have procedures such as bone marrow aspirations completed, and/or convalesce following procedures done in diagnostic imaging (i.e. post PICC line insertion, post thoracentesis, etc). Specific patient/family areas on 5A South include: Nursing Station/Reception Patient Lounge Patient/Family Resource Room Inpatient Rooms Outpatient Treatment Rooms Kitchen The kitchen has a blender, toaster, microwave and stove for patient and family use. There are two fridges in the kitchen. Patients are encouraged to bring in home cooking/favourite snacks and store them in the unit refrigerator. 5B South (Hostel Unit) Located on 5BS, the Hostel unit provides a home away from home environment for out of town patients requiring medical treatment or investigations available only at the Saint John Regional Hospital. You may not ‘book yourself’ into the Hostel. Patients are admitted to the Hostel by their attending physician. The Hostel unit is a non-nursing unit; therefore, you must be independent in your care (family members cannot stay in the Hostel with you) and be able to take your own medications to be eligible to stay in the Hostel. Please be advised that smoking is permitted only in designated outdoor areas. Liquor is not permitted in the hospital. Meals Patients on the Hostel unit receive meal vouchers which can be redeemed at the hospital cafeteria or coffee shop on Level 2. What to wear Bring comfortable and casual clothing to wear while staying in the Hostel unit. TV There is a TV lounge on the unit. If you prefer you may have a television connected in your room for a fee. Mail/Telephone/Internet Mail service is available daily. There is a telephone available at your bedside that can be connected and charged to your home phone number if you wish. If you do not wish to connect your room phone, there are payphones available for your use. In addition, incoming calls (limited use) can be taken for you at the main desk (preferably after 6 pm). Wireless internet is available upon request. Laundry Room There are a washer and dryer as well as an iron/ironing board available for patient use. Lockers It is recommended that you do not bring valuables with you to the hospital. There are lockers available if you need to secure your wallet or purse. It is your responsibility to bring a lock for the locker. What to bring with you to the Hostel Facial tissues Deodorant/soap/shampoo (unscented) Brush/comb Blow dryer Electric razor Toothpaste/toothbrush Denture care items Comforter and soft pillow Pyjamas/housecoat Loose fitting comfortable clothes Footwear with non slip soles All medications you are currently taking Proof of drug insurance Health card Bottled water Laundry soap/fabric softener (unscented) Address book Clock/clock radio Please note that the Saint John Regional Hospital has a ‘No Scent’ policy in effect. DO NOT BRING the following items: Perfumes, colognes, after shave Scented deodorants, hairsprays Room air fresheners Charlotte County Hospital (CCH) Site The Charlotte County Oncology Outreach Unit is a treatment and resource centre for patients and families of patients who have been diagnosed with cancer. This Unit is part of the Horizon Health Network Oncology Program and is a sister unit to the chemotherapy outpatient treatment area(s) of the Saint John Regional Hospital, and therefore embraces the same values, standards of care and philosophy of care that Horizon stands for. The Outreach Unit permits patients from St. Stephen and surrounding areas to have their chemotherapy treatments, blood products, line care and routine blood work done in their home community thus eliminating the need for them to travel to Saint John. The Oncology Outreach unit at Charlotte County Hospital is staffed by a fulltime registered nurse. This nurse acts as the main resource person for cancer care in the Charlotte County area. In addition to the previously mentioned clinical duties, some of the things the staff here can assist you with include: Answer questions you/your family may have about your illness, medications, treatments or procedures Coordinate appointments, services and relay information between you/your family and team members at the SJRH site Assist with your physical, emotional, spiritual and nutritional needs Make referrals to support agencies/groups as necessary Your First Visit The Saint John Department of Oncology houses a Medical Oncology Centre, a Radiation Oncology Centre and a Stem Cell Transplantation program with both inpatient and outpatient services. The following is a brief example of what you may expect on your first visit to the Oncology Department in Saint John. Outpatient Visit For your first visit to the Saint John Department of Oncology, please bring the following items: Your NB Medicare card A list of all your medications, including over- the-counter medication, vitamins, minerals, herbal supplements Name, address and phone number of your pharmacy or drug store Group and policy numbers for your drug insurance plan Eyeglasses and hearing aid if you use them A family member or friend Please bring a family member or friend to your first appointment. Many people feel anxious at their first visit and find it helpful to have someone with them. There will be a lot of information given to you. A family member or friend can help you remember what was discussed. Admission to Hospital You will be notified by our admitting clerk by telephone of your admission date and what time to come to the hospital. Return Visits If you are coming in for chemotherapy or radiation therapy, the amount of time you spend at the Saint John Department of Oncology will vary depending on the treatment you are receiving. The room where chemotherapy is given has limited space. It would be appreciated if only one family member or friend accompanied you while you are having this treatment. On return visits to the Saint John Department of Oncology, please bring: Your NB Medicare card All the medicines you will need for the day A list of questions you want to ask staff Hearing aid and eyeglasses if you use them Lunch or snacks, if you are diabetic or have special diet needs Horizon Health Network believes in a multidisciplinary, team approach to your cancer care. Throughout the course of your cancer journey, various team members may be consulted to contribute to your care. An illustration of the many disciplines that make up the cancer care team can be found below. Nurses The oncology nurses employed at our centre are specially trained to provide care and support to cancer patients and their families. They will assess how you are doing throughout treatment and will help you cope with the changes you may experience. They will explain the possible side effects you may experience and describe how you can manage them. They will also provide support and counseling to you and your family. The oncology nurses you will meet are committed to providing you and your family with quality, compassionate nursing care. Oncologists An oncologist is a physician who specializes in the treatment of cancer. A radiation oncologist is a medical specialist with expertise in the diagnosis and care of patients with malignant disease. These physicians recommend, prescribe and supervise the use of therapeutic radiation in the treatment of cancer. A medical oncologist is a medical specialist with expertise in the diagnosis and care of patients with malignant disease. These physicians are cancer specialists who work with patients requiring cancer drugs such as chemotherapy (also called systemic therapy) or hormone therapy to treat their cancer. Pharmacists The care of those with cancer often includes drug therapy, and this part of care involves the hospital pharmacy. The oncology pharmacist is a pharmacist who specializes in drug therapy for oncology. This person is part of the cancer care team with the role of optimizing drug therapy for our oncology patients. This includes being a resource for drug information for both team members and for patients. Radiation Therapists The radiation therapist is a health professional who is a vital part of the cancer treatment team. Radiation therapists work together with radiation oncologists, medical physicists, and medical dosimetrists to deliver daily treatments. They are skilled in the use of ‘state of the art’ equipment and administer the prescribed treatment with care, compassion and respect. Radiation therapists go through a four-year university and hospital-based educational program following high school. They take a special examination and are certified by the Canadian Association of Medical Radiation Technologists. All provinces require radiation therapists to be licensed. Dosimetrists Dosimetrists carefully calculate the dose of radiation to make sure the tumour gets enough radiation. Using computers, they work to develop a number of treatment plans that can best destroy the tumour while sparing normal tissue. Since treatment plans are often very complex, dosimetrists work with the radiation oncologist and the medical physicist to choose the treatment plan that is right for you. Many dosimetrists start as radiation therapists and then, with very intensive training, become dosimetrists. Therapeutic Physics The responsibility of the Physics Team is to ensure the accuracy and the safe delivery of radiation treatments to oncology patients. They oversee the work of the dosimetrist and help ensure that complex treatments are properly tailored for each patient. Medical physicists are responsible for developing and directing quality control programs for equipment and procedures. The Physics Team staff provides services in many areas of activity; in the Department of Oncology these include radiation beam dosimetry, quality assurance, treatment planning, dose computation, maintenance and repair of all equipment, and radiation protection of the staff, the patients and the public. Dietitian A registered dietitian from the Department of Nutrition and Food Services is available to provide individual nutrition counseling to patients and their families. Cancer and/or its treatment can affect a person’s nutritional health. A healthy diet is especially important for cancer patients for maintaining strength, immune function (to help fight infection), and increasing tolerance to cancer treatments. Requests to see the dietitian can be made through your doctor, nurse, or radiation therapist. Administrative/Clerical Support Members role include greeting patients and registering them for their appointments and treatments as well as organizing and preparing your medical charts and documents to prepare and support the physician and other members of your health-care team. They also manage and book appointments and consults for patients visiting the clinic as well as other duties. Social Workers Oncology social workers are available to assist patients cope with the physical and psychological challenges of the diagnosis and treatment of cancer as well as helping family members understand and adapt to the changes in their lives. In addition, oncology social workers can answer questions which may arise regarding finances, insurance, employment, and discharge planning issues such as home care. The needs and concerns of you and your family are important. Please speak with your doctor, nurse or radiation therapist if you would like to meet with the oncology social workers. Spiritual and Religious Care Life is a journey of meaning and purpose, which are central to our existence. The journey of life is physical, mental and spiritual. Sometimes this journey can be difficult, for example hospitalization. The Spiritual and Religious Care department is here to let you know that none of us need to walk alone. By sharing the journey with others, we are more able to face the future to find a place for healing and growth. Care is available to you and your family to support your spiritual wellbeing while in hospital. We can help you find resources that will help nurture your spiritual health. Literature is also available. The Spiritual and Religious Care team consists of professionally trained chaplains from the Anglican, Baptist, Roman Catholic and United Churches. You may ask one of the staff to have one of our team members paged. Volunteers The Department of Oncology is pleased to have a committed volunteer presence in both the inpatient and outpatient areas of the program. On 5A South, volunteers familiarize new patients and their families to the Oncology Unit. They offer emotional support to patients and families and join in activities such as cards, games, reading and music. In the outpatient clinic, volunteers serve refreshments and offer companionship to patients coming for treatment. Physical Therapists Physical therapists use therapeutic exercises to ensure that your body functions properly while you are undergoing treatment. These exercises are used to help manage side effects, alleviate pain and keep you healthy. Dentists A patient may be referred to a dentist if they are receiving radiation for oral or head and neck cancers. They may recommend that you have preventive dental work prior to radiation. They will also help you manage oral complications of cancer therapy, such as dry mouth. A dental hygienist may also perform these services under the supervision of a dentist. Radiation Therapy Radiation Therapy is the controlled use of a radiation beam to destroy or inhibit the growth of a cancerous tumour. Radiation therapy destroys cells either directly or by interfering with cell reproduction. Radiation Therapy may be used by itself or in combination with other treatment modalities. For more information on the types of techniques used, please see the sidebar. The Saint John Department of Oncology uses state of the art equipment and treatment planning software. Through the use of the latest treatment protocols and activities in clinical trials, patients are ensured access to leading edge treatments. The GE Optima CT Simulator: A large bore dedicated Oncology CT scanner used for high-precision treatment planning. The Varian- Trilogy: A dual energy linear accelerator with 6 and10 MV photons, a wide range of electrons, a 120 multi leaf collimator, On board KV imager with 2D and 3D imaging capability (OBI). This unit is also equipped with advanced features such as stereotactic radio-surgery (SRS), RapidArc IMRT, and gated treatment delivery. This treatment unit is used to treat many different treatment sites. The Varian- iX: A dual energy linear accelerator with 6 and 10 MV photons, a wide range of electrons, a 120 multi leaf collimator, rapid arc, On board KV imager with 2D and 3D imaging capability (OBI). This treatment unit is used to treat many different treatment sites. The Varian- Edge: A dual energy linear accelerator with 6 MV and 10 MV photons, an HD 120 multi leaf collimator system with advanced stereotactic radio-surgery (SRS), rapid arc IMRT, and gated treatment delivery features. This treatment unit is used to treat many different treatment sites and will be available soon. (Scheduled to go live in 2015) Radiation Therapy Techniques: The Radiation Therapy Program at the Saint John Regional Hospital utilizes a variety of treatment techniques to offer the best care to our patients. Some of the techniques used are: 3D Conformal Radiation Therapy: Multiple beams of radiation with customized planning and shielding to create a personalized treatment plan for each patient. A well established and evidence-based form of treatment, this is often the standard of care for non-complex cases or those without nearby sensitive body parts. Intensity Modulated Radiation Therapy (IMRT): A newer standard of care for many treatment sites for our patients. This techniques utilized fields with dynamic shielding that further customizes the radiation dose within the patient. This is more useful in cases where a cancer is close to sensitive structures or when we need to treat to higher doses. Volumetric Modulated Arc Therapy (VMAT): A further advanced form of IMRT, this technique utilizes beams of radiation that stay on as the machine moves around the patient. The shielding inside the machine moves and changes as the beam moves around the patient, painting a highly conformal dose of radiation to the targeted areas. This technique is generally able to be delivered in less time as compared to IMRT techniques, but is more complicated from a planning perspective. Electron Beam Therapy: Electron therapy is a form of Radiation Therapy that uses electrons (tiny charged particles) as the treatment beam. Since these particles have mass, compared to photons of energy, they are able to deliver a radiation dose to superficial parts of the patient’s body. Common uses of this technique include: scars, skin cancer, and keloids. Stereotatic Radiation (SRS/SRT) There are two types of Stereotactic treatments offered at the Department of Oncology. They are similar but have some differences in duration and planning. Your oncologist and treatment team will review your specific case with you but both are outlined below. Stereotactic Radiosurgery (SRS) What is Stereotactic Radiosurgery? Stereotactic Radiosurgery is a form of radiation treatment, it is a non-surgical and minimally invasive procedure. It is the precise delivery of a single dose of radiation to a small target, while sparing the normal surrounding healthy tissue. Who can have this procedure? This is a specialized type of treatment for patients with small brain tumours that may be deep within the brain, or in hard to reach areas. These tumours can be either benign or malignant. What will happen on the treatment day? You will be given special diet instructions prior to the morning of your procedure. You will come to the Oncology Department to meet with your treatment team. The neurosurgeon will attach a head frame using local freezing. You will wear this head frame throughout the day and for the procedure. You will have a special CT scan in the Oncology Department. After the scan you will be made comfortable and allowed to relax for several hours. During this time the team will be working on your treatment plan and will be checking with you regularly. When the plan is ready, you will be escorted to the treatment room. The Radiation Therapists will explain what to expect throughout the treatment. You will not feel anything during the treatment, similar to having an x-ray, but the machine will make noise as it delivers your treatment. The treatment can take 20-60 minutes depending on your plan. After your treatment, the head frame will be removed by the neurosurgeon. You will be required to remain in the department for a short period of time following the removal (approximately an hour). You will be given special instructions to follow for the next 3-7 days. Tips for the Treatment Day You should bring someone with you for this procedure. They will be responsible for driving you home and can be with you throughout the day. Expect to be in the Oncology Department for 10-12 hours. You can bring books, puzzles, a portable DVD player or laptop (Wi-Fi is not currently available), snacks, etc. to help you pass the time. Wear comfortable clothing. You can wear your contacts, but probably will not be able to wear your eyeglasses because of the head frame. You will be provided a small private room to spend the day in. It has space for two people with a private washroom. Medication will be given to you if you develop any symptoms like pain, nausea or a headache while you are waiting for treatment. You will be given medication before your treatment to prevent nausea and swelling around the tumour. What is the head frame? The head frame is a metal ring used to keep your head in the same position while you are having your scan and throughout your treatment. It will be held in place with two pins in the front of your head and two pins in the back. You can expect to feel some pressure but it should not be painful. Who will I encounter during this treatment? Radiation Oncologist – They will prescribe this treatment and are responsible for your care. Neurosurgeon – They will be responsible for the placement of the head frame and will work closely with your oncologist throughout this procedure. Medical Physicists – They will prepare your treatment plan alongside your oncologist. Nurses – They will be monitoring you throughout the day, ensuring you are as comfortable as possible. Radiation Therapists – You will be seeing them throughout the day. They are involved in the planning, preparation and delivery of your treatment. How will I feel after my treatment? Some early side effects that may occur can include: fatigue, skin irritation, swelling at the pin sites, and nausea. When the head frame is removed it is not uncommon to experience a mild headache, or slight bleeding from the pin sites. Please advise your treatment team if you are experiencing any side effects after your treatment and they will look after you while you are at the hospital. You may be given special instructions to follow once you are home. Side effects are typically gone within a few weeks. You will be contacted by the nursing staff the following morning. You will be given an appointment to see your radiation oncologist 2 weeks after the procedure. Stereotactic Radiotherapy (SRT) What is Stereotactic Radiotherapy? Stereotactic Radiotherapy is a form of radiation treatment given over several days using a face mask system. Who can have this procedure? This is a specialized type of treatment for patients with small brain tumours that may be deep within the brain, or in hard to reach areas. These tumours can be either benign or malignant. What will happen on the planning day? Before your first treatment, you will come to the Oncology Department to have a special face mask made. It will take about one hour to complete, and then you will have a CT scan in the Oncology Department. After the scan you will be able to go home. You will be called with an appointment time for your first treatment. What will happen on the treatment day? The Radiation Therapists will explain what to expect throughout the treatment and position you with your face mask. You will not feel anything during the treatment, similar to having an x-ray, but the machine will make a buzzing noise as it delivers your treatment. Daily treatments can take 20-40 minutes depending on your plan. You will be given a schedule of your appointments. What is the face mask system? The face mask is a custom mask that is attached to a frame on the treatment table and holds your head in place for your treatments. Who will I encounter during this treatment? Radiation Oncologist – They will prescribe this treatment and are responsible for your care. Medical Physicists – They will prepare your treatment plan alongside your oncologist. Nurses – They will be monitoring you during the course of your treatments. Radiation Therapists – You will be seeing them on each treatment day. They are involved in the planning, preparation and delivery of your treatment. How will I feel after my treatment? Some early side effects that may occur can include: fatigue, skin irritation, nausea, and mild headache. Please advise your treatment team if you are experiencing any side effects during the course of your treatments. Brachytherapy Brachytherapy is a form of radiotherapy where a radiation source is placed inside or next to the area requiring treatment. Brachytherapy is commonly used as a treatment for cervical, prostate, breast, and skin cancer and can also be used to treat tumours in many other body sites. Every patient is assessed by a multidisciplinary team to decide which treatment option is best for you. Brachytherapy can be used alone or in combination with other therapies such as surgery, External Beam Radiotherapy (EBRT) and chemotherapy. Brachytherapy differs from EBRT because it involves the precise placement of short-range radiation-sources (radioisotopes) directly at the site of the cancerous tumour. These are enclosed in a protective capsule or wire which allows the radiation to treat the surrounding tissue. A key feature of brachytherapy is that the irradiation only affects a very localized area around the radiation sources. Exposure to healthy tissues further away from the sources is therefore reduced. These characteristics of brachytherapy allow the tumour to be treated with very high doses of localized radiation, while sparing the surrounding healthy tissues. Brachytherapy procedures consist of fewer visits to the radiotherapy clinic compared to EBRT, and the treatment is often performed on an outpatient basis. This makes treatment accessible and convenient for many patients. Services offered under the Brachytherapy program at Horizon Health Network include: Gold Seeds/Visicoil fiducial implants for prostate localization, Cervix Brachytherapy, Vaginal vault Brachytherapy and Brachytherapy for Skin Cancers. Clinical Trials A clinical trial is a research study done to answer questions about new drugs, medical devices or new ways of using known treatments. All clinical trials collect important information to determine if new drugs or treatments are safe and effective. Oncology clinical trials are research studies conducted to test new treatments for patients with cancer. These treatments may include new drugs (chemotherapy), new approaches to radiotherapy and/or new combinations of treatments. The goal of these clinical trials is to find better ways to treat cancer and to improve the quality of life and outcomes for patients living with cancer. Why are clinical trials important? Clinical trials contribute to new knowledge and progress against cancer. Progress made through clinical trials means many people treated for cancer are now living longer. Clinical trials ensure that cancer treatments are safe and effective. Clinical trials have helped us develop new anti-cancer drugs with fewer side effects that may work more quickly. Clinical trials provide a way for cancer patients to access the latest forms of treatment. What is it like to be on a clinical trial? In a clinical trial, you will receive treatment and will be followed carefully to see how the treatment works. If you participate in a clinical trial you will get your treatment in the same location that the standard treatment is given. Your treatment team will include doctors, nurses, social workers and other health-care professionals. You will also have a clinical trials nurse who will help you understand the study and support you in your treatment. This nurse will also work with you and your doctor to set up tests or examinations. If you are enrolled in a clinical trial, you may need to have more blood tests and x-rays that you normally would if you were receiving standard treatment. Your progress will be followed closely. Many studies require that we continue to follow your progress after completion of treatment. For more information about clinical trials available to cancer patients, contact a clinical trials nurse. Medical Oncology The subspecialty of Medical Oncology, also commonly known as systemic therapy, is the treatment of cancer using drugs. The medical oncologist is a member of the team and is specialized in the assessment and prescription of systemic therapy for cancer. This includes developing a treatment plan, prescribing the treatment and managing acute and long term side effects. The medical oncologist works collaboratively with surgical specialists, and radiation oncologists to determine what the best course of treatment will be and to discuss the options with the patients and their families. The administration of systemic therapy involves a large team to ensure its correct delivery, safety and appropriate management of side effects. Patients are then followed up to ensure that they have obtained the maximum quality and quantity of life and successfully transitioned back into their normal life. The treatment prescribed by medical oncology may be given orally, through an intravenous, under the skin or more rarely into the abdominal cavity and even the cerebral spinal fluid. Treatments for systemic therapy can be subdivided into different categories: Hormone treatment – (prostate/breast cancer for example) in which the goal is to block the cancer cells from receiving the hormones that are needed for growth. Chemotherapy drugs – which work by damaging DNA in cells to destroy cancer cells. Immune modulators – drugs which work by up regulating the immune system to attack the cancer cells using their own immune system. Targeted therapy – drugs which work by specifically targeting pathways within the cell that have given it its cancerous properties. Systemic therapy may be given on its own or be combined with radiation either before, at the same time as, or following radiation. Treatments can take different amounts of time depending upon the tumour characteristics, aim of treatment and tolerance by the patient of the systemic treatment. Systemic therapy may be given to cure the cancer or to prevent the cancer from returning. Sometimes however, this may not be possible and then the goal of treatment is focused on trying to shrink the disease to improve the patient’s quality and quantity of life. The medical oncology team is extensive and dedicated to working with you to help manage your side effects and to provide whatever support is needed. When the patient is first seen by the medical oncology team they may experience: Perform a complete history and physical Reviewing test results to date Ordering further investigations if indicated Coordinating with other members of interdisciplinary team either during the appointment or to be arranged shortly thereafter Discussing with the patient and family members/care provider options for treatment to enable them to choose which one is best suited to their own situation. The Saint John Regional Hospital medical oncology systemic therapy clinic in the Department of Oncology is a state of the art treatment clinic that offers outpatient/inpatient treatment. Over 90% of chemotherapy is administered in the outpatient setting on Floor Level 1 or Level 5. If required for treatment, management of disease or side effects, 5A South is the inpatient floor. The Saint John Regional Hospital Department of Oncology has access to full imaging capabilities with CT, MRI, PET imaging as well as the Stem Cell Transplant Program. The pathology department and laboratory medicine is well-equipped to handle and support the needs of its patients. Patient Resources Library and Patient Information The Saint John Regional Hospital Oncology Department has a comprehensive directory of resources for patients to access in the main waiting area. Here you can find patient information booklets, information about local programs, and a computer with internet access. Parking Oncology Parking at the Saint John Regional Hospital: There are a limited number of parking spaces reserved for Oncology patients; these parking spaces are located in the public parking lot near the pedway. These spaces are intended for oncology outpatients who come in for an appointment or treatment; these are not meant for patients who are parking their car while staying as an in-patient or guest in the Hostel. Oncology inpatients and Hostel patients can apply for special rates but must park in regular public parking spots. Note: General Oncology (non-reserved) patient parking will be honoured at any Horizon Health Network facility. Applying for a general public parking pass: This type of pass is available for any patient, requires no deposit and is transferrable to any Horizon facility. This type of parking pass includes access to all non-reserved public parking spaces. Websites for Cancer Information Please note: Inclusion in this list does not imply endorsement by the Horizon Health Network. The websites listed below are provided for information only and are not intended to replace medical advice. Many of these sites originate from outside Canada and, may contain information about therapies, screening methods, etc. which may differ from those offered at the Horizon’s Cancer Centre. If you have any questions about your cancer treatment, please ask your doctor, nurse or radiation therapist. General Information on Health https://www.nlm.nih.gov/ U.S. National Library of Medicine. Select ‘Medline Plus’ to find information for patients on cancer and other health related topics. You can search the Medline database (PUBMED) Oncology Specific Information https://www2.gnb.ca/content/gnb/en/departments/health/NewBrunswickCancerNetwork.html The NBCN’s goal is to reduce the incidence, morbidity, and mortality of cancer among New Brunswickers through the planning, delivery, and evaluation of sustainable cancer services. The NBCN is responsible for ensuring a provincial, evidence-based, approach to the delivery of cancer programs and services for all elements of cancer care. These include prevention, screening, treatment, follow-up, palliative care, education and research. http://www.cancer.ca/en/?region=nb The Canadian Cancer Society is a national, community-based organization of volunteers whose mission is the eradication of cancer and the enhancement of the quality of life of people living with cancer. https://www.facebook.com/nbbcnorg/ The NB Breast Cancer Support Network (NBBCN) exists to support people affected by breast cancer and to provide hope through education, public awareness and partnering with others. http://www.newbrunswick.canadiancancertrials.ca/ New Brunswick Cancer Trials – This site was created by the Canadian Partnership Against Cancer and its partners to help you learn about clinical trials for cancer. Contact Us Charlotte County Oncology – 506-465-4444 Fredericton Oncology – 506-452-5400 Miramichi Oncology – 506-623-3000 Moncton Oncology – 506-857-5111 Perth Andover Oncology – 506-273-7100 Saint John Regional Oncology – 506-648-6884 St. Joseph’s Oncology – 506-632-5555 Sussex Oncology – 506-432-3100 Upper River Valley – 506-375-5900