a patient’s guide

East

an

d N

ort

h H

ertf

ord

shir

eN

HS

Tru

st

Ch

emo

rad

ioth

erap

yto

th

e h

ead

, nec

k,

mo

uth

an

d t

hro

atPa

tient

Info

rmat

ion

Serie

s PI

24

2

Patie

nt L

abel

Co

nta

cts

My

onco

logi

st is

: ...

......

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olog

ist’s

sec

reta

ry t

el n

o: ..

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......

......

.

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nt V

erno

n H

ospi

tal:

.....

......

......

......

....0

20 3

826

2020

Can

cer

clin

ic n

urse

s: .

......

......

......

......

......

..02

0 38

26 2

186

Mac

mill

an s

peci

alis

t nu

rse

(key

wor

ker)

: Aud

rey

Scot

t

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......

......

......

......

......

...02

0 38

26 2

089

/ 077

68 2

3752

2 Ra

diot

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py s

uppo

rt n

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s: ..

......

......

......

.078

25 0

2549

9

Spee

ch &

Lan

guag

e Th

erap

y (S

ALT

) dep

artm

ent:

tel n

o: .

......

......

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0192

3 84

4457

Die

tetic

dep

artm

ent:

tel n

o: .

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.....

020

3826

212

9

24 h

ou

r A

cute

On

colo

gy

Serv

ice

Mo

un

t V

ern

on

Can

cer

Cen

tre:

078

25 0

2885

5

3

Ch

emo

rad

ioth

erap

y to

th

e h

ead

, nec

k,

mo

uth

an

d t

hro

atC

on

ten

tsC

onta

cts

2In

trod

uctio

n 4

Wha

t is

che

mor

adio

ther

apy?

4

Wha

t ha

ppen

s be

fore

I st

art

my

trea

tmen

t?

5

Wha

t ha

ppen

s at

my

plan

ning

app

oint

men

t?

6

Wha

t w

ill h

appe

n du

ring

my

trea

tmen

t?

8

How

are

the

tre

atm

ents

com

bine

d?

8

Clin

ical

tria

ls

8

Wha

t si

de-e

ffec

ts a

m I

likel

y to

hav

e fr

om m

y ch

emot

hera

py?

9

Wha

t si

de-e

ffec

ts a

m I

likel

y to

hav

e fr

om m

y ra

diot

hera

py?

10

If yo

u no

rmal

ly p

ay f

or N

HS

pres

crip

tions

11

How

sho

uld

I loo

k af

ter

my

skin

? 15

How

sho

uld

I loo

k af

ter

my

mou

th?

16

How

will

my

tast

e be

aff

ecte

d?

17

Wha

t ca

n I e

at o

r dr

ink?

17

How

will

my

mou

th f

eel?

18

Will

I lo

se m

y ha

ir?

19

Wha

t sh

ould

I do

if I

need

to

visi

t th

e de

ntis

t?

19

Can

I ha

ve d

entu

res

or im

plan

ts?

20

Wha

t w

ill h

appe

n if

I sm

oke?

20

Will

I lo

se m

y vo

ice?

21

Wha

t if

I hav

e a

lary

ngec

tom

y?

21

Wha

t ca

n I d

o to

hel

p m

ysel

f?

22

How

will

I fe

el o

nce

my

trea

tmen

t ha

s fi n

ishe

d?

22

Whe

re c

an I

get

help

? 23

Will

I ne

ed t

o ha

ve p

hysi

othe

rapy

?

25

Wha

t is

lym

phoe

dem

a?

25

Whe

n w

ill I

see

the

onco

logi

st a

fter

my

trea

tmen

t ha

s fi n

ishe

d?

26

How

can

I ge

t to

hos

pita

l?

26

Am

I en

title

d to

fi na

nce

help

? 28

Use

ful n

atio

nal i

nfor

mat

ion

29

Oth

er h

elp

and

supp

ort

30

Con

sent

31

Iden

tifi c

atio

n 31

Preg

nanc

y/fa

ther

ing

a ch

ild

314In

tro

du

ctio

nYo

ur o

ncol

ogis

t1 ha

s re

com

men

ded

that

you

r ca

ncer

sho

uld

be t

reat

ed w

ith a

cou

rse

of c

hem

orad

ioth

erap

y at

Mou

nt

Vern

on C

ance

r C

entr

e (M

VC

C).

This

leafl

et

is a

sim

ple

guid

e to

che

mor

adio

ther

apy.

We

hope

it w

ill a

nsw

er s

ome

of y

our

ques

tions

.

If yo

u ha

ve f

urth

er q

uest

ions

bef

ore,

dur

ing

or a

fter

you

r tr

eatm

ent,

ple

ase

cont

act

one

of y

our

heal

th c

are

team

. th

e co

ntac

t te

leph

one

num

bers

are

on

page

2 o

f th

is le

afl e

t.

Dur

ing

your

che

mor

adio

ther

apy

ther

e w

ill b

e a

team

of

onco

logi

sts,

spe

cial

ist

nurs

es, d

ietit

ians

, spe

ech

and

lang

uage

th

erap

ists

(SA

LT),

radi

ogra

pher

s an

d ot

her

hosp

ital s

taff

ca

ring

for

you.

You

coul

d be

see

n by

bot

h m

ale

and/

or f

emal

e ra

diog

raph

ers

whe

n yo

u ha

ve y

our

radi

othe

rapy

pla

nnin

g an

d tr

eatm

ent.

Wh

at is

ch

emo

rad

ioth

erap

y?C

hem

orad

ioth

erap

y is

the

com

bine

d us

e of

che

mot

hera

py

and

radi

othe

rapy

.

Che

mot

hera

py is

the

tre

atm

ent

of c

ance

r w

ith d

rugs

.

Radi

othe

rapy

is t

he t

reat

men

t of

can

cer

with

rad

iatio

n us

ing

x-ra

ys. Y

ou w

ill n

ot f

eel t

he r

adio

ther

apy

whe

n yo

u ha

ve y

our

trea

tmen

t. It

is li

ke h

avin

g a

norm

al x

-ray

.

By c

ombi

ning

the

se t

reat

men

ts, t

he c

hem

othe

rapy

mak

es t

he

radi

othe

rapy

mor

e ef

fect

ive.

Ther

e ar

e tw

o ty

pes

of r

adio

ther

apy

give

n to

pat

ient

s w

ith

head

and

nec

k ca

ncer

s: c

onve

ntio

nal r

adio

ther

apy

and

inte

nsity

-mod

ulat

ed r

adia

tion

ther

apy

(IMRT

).

1 In

thi

s le

afl e

t th

e te

rm ‘o

ncol

ogis

t’ w

ill r

efer

bot

h to

you

r ca

ncer

spe

cial

ist

and

any

doct

ors

wor

king

with

in h

is/h

er t

eam

5

Your

onc

olog

ist

will

dec

ide

the

mos

t su

itabl

e ty

pe o

f ra

diot

hera

py f

or y

ou.

Both

of

thes

e ty

pes

of r

adio

ther

apy

are

care

fully

pla

nned

an

d sh

aped

to

mat

ch t

he p

art

of y

ou t

hat

need

s tr

eatm

ent.

Th

is h

elps

to

redu

ce a

ny s

ide

effe

cts

you

may

get

.

Wh

at h

app

ens

bef

ore

I st

art

my

trea

tmen

t?Be

fore

you

r tr

eatm

ent

begi

ns y

our

onco

logi

st w

ill s

ee y

ou

to e

xpla

in y

our

trea

tmen

t pl

an.

If yo

u ar

e ha

ving

tre

atm

ent

to y

our

mou

th, y

ou w

ill h

ave

a de

ntal

ass

essm

ent

to s

ee if

you

nee

d an

y de

ntal

tre

atm

ent

or

som

e te

eth

rem

oved

. Tee

th a

re r

emov

ed b

efor

e tr

eatm

ent

to

prev

ent

or r

educ

e th

e ris

k of

den

tal p

robl

ems

and

infe

ctio

ns

afte

r yo

ur t

reat

men

t ha

s fi n

ishe

d.

The

num

ber

of t

eeth

to

be r

emov

ed w

ill d

epen

d on

the

co

nditi

on o

f yo

ur t

eeth

. If

they

are

in a

poo

r co

nditi

on, s

ome

or a

ll te

eth

may

nee

d to

be

rem

oved

. Tee

th t

hat

are

heav

ily

fi lle

d or

cro

wne

d m

ay a

lso

need

to

be r

emov

ed.

Your

onc

olog

ist

will

dis

cuss

thi

s w

ith y

ou a

nd a

rran

ge t

his

befo

re y

our

radi

othe

rapy

pla

nnin

g.

Befo

re y

ou c

an h

ave

chem

orad

ioth

erap

y yo

u w

ill n

eed

som

e bl

ood

test

s. If

you

req

uire

an

addi

tiona

l kid

ney

func

tion

test

, yo

u w

ill h

ave

an in

ject

ion

follo

wed

by

a bl

ood

test

tw

o an

d th

ree

hour

s la

ter.

Thes

e w

ill n

eed

to b

e do

ne a

t M

ount

Ver

non

Hos

pita

l. Yo

u m

ay n

eed

addi

tiona

l blo

od t

ests

dur

ing

the

cour

se o

f ch

emor

adio

ther

apy.

If y

ou

are

dia

bet

ic, a

nd t

akin

g M

etfo

rmin

ple

ase

call

020

3826

262

2 as

soo

n as

pos

sibl

e. W

e m

ay n

eed

to

arra

nge

for

you

to h

ave

a bl

ood

test

prio

r to

you

r pl

anni

ng a

ppoi

ntm

ent.

6Wh

at h

app

ens

at m

y p

lan

nin

g a

pp

oin

tmen

t?A

ll pa

tient

s ha

ving

rad

ioth

erap

y to

the

hea

d, m

outh

or

thro

at

will

nee

d to

hav

e a

spec

ial m

ask

calle

d an

‘im

mob

ilisa

tion

shel

l’ m

ade.

Thi

s sh

ell i

s m

ade

spec

ially

for

you

. It

will

hol

d yo

u in

the

cor

rect

pos

ition

whi

le y

ou a

re ly

ing

fl at.

It w

ill h

elp

you

to k

eep

still

, and

hel

p en

sure

you

r tr

eatm

ent

is a

ccur

ate.

The

radi

ogra

pher

s w

ill s

how

you

an

imm

obili

satio

n sh

ell a

nd

expl

ain

how

you

rs w

ill b

e m

ade.

The

re is

a v

ideo

tha

t yo

u ca

n w

atch

on

the

Lynd

a Ja

ckso

n M

acm

illan

Cen

tre

(LJM

C)

web

site

. Ple

ase

see

page

24

for

deta

ils.

You

will

be

aske

d to

tak

e of

f yo

ur c

loth

es f

rom

abo

veyo

ur w

aist

. We

will

mai

ntai

n yo

ur d

igni

ty a

t al

l tim

es.

Aft

er y

our

shel

l is

mad

e, y

ou w

ill h

ave

a co

mpu

teris

ed

tom

ogra

phy

scan

(CT)

whi

le y

ou a

re w

earin

g it.

You

may

ne

ed a

n in

ject

ion

of a

spe

cial

dye

dur

ing

this

sca

n. T

his

will

be

expl

aine

d to

you

if it

is n

eede

d.

Whi

le y

ou a

re h

avin

g yo

ur s

can

you

will

be

alon

e in

the

roo

m

for

20-2

5 m

inut

es. D

urin

g th

is t

ime

you

are

wat

ched

thr

ough

a

win

dow

. The

rad

iogr

aphe

rs w

ill t

ell y

ou h

ow y

ou c

an le

t th

em k

now

if y

ou h

ave

any

prob

lem

s. Y

ou w

ill n

ot h

ave

any

radi

othe

rapy

dur

ing

your

pla

nnin

g ap

poin

tmen

t.

You

may

hav

e so

me

pen

mar

ks d

raw

n on

you

r sk

in. D

on’t

w

orry

if t

hese

fad

e or

was

h of

f. W

ith y

our

perm

issi

on, t

he

radi

ogra

pher

s w

ill m

ake

a tin

y pe

rman

ent

mar

k on

you

r ch

est

(tat

too)

. Thi

s is

ver

y sm

all a

nd is

don

e by

pin

pric

king

the

ski

n w

ith s

ome

spec

ial d

ye. T

he p

erm

anen

t do

t is

impo

rtan

t as

it

enab

les

accu

rate

pos

ition

ing

and

trea

tmen

t de

liver

y ea

ch d

ay.

7

Your

pla

nnin

g ap

poin

tmen

t m

ay t

ake

betw

een

one

to t

hree

ho

urs,

so

expe

ct t

o be

at

the

hosp

ital f

or m

ost

of t

he m

orni

ng

or a

fter

noon

on

that

day

. You

r ra

diot

hera

py w

ill u

sual

ly s

tart

ab

out

two

to t

hree

wee

ks a

fter

you

r pl

anni

ng a

ppoi

ntm

ent.

Th

is a

llow

s tim

e fo

r yo

ur o

ncol

ogis

t an

d pl

anni

ng p

hysi

cist

to

calc

ulat

e yo

ur t

reat

men

t do

ses.

Befo

re s

tart

ing

your

rad

ioth

erap

y yo

u w

ill h

ave

an

appo

intm

ent

at M

ount

Ver

non

Can

cer

Cen

tre

with

the

he

ad a

nd n

eck

spec

ialis

t nu

rse.

It is

ver

y im

po

rtan

t th

at

you

atte

nd t

his

appo

intm

ent

so t

hat

you

can

be g

iven

the

m

outh

was

h to

use

dur

ing

your

rad

ioth

erap

y. T

his

sess

ion

is

also

a c

hanc

e to

ask

abo

ut y

our

trea

tmen

t, y

our

care

and

any

ot

her

ques

tions

you

hav

e.

Man

y pe

ople

fi nd

it h

elpf

ul t

o at

tend

the

Hea

d an

d N

eck

Can

cer

Supp

ort

Gro

up b

efor

e st

artin

g th

eir

trea

tmen

t. T

his

is

a ch

ance

to

mee

t pe

ople

who

hav

e ha

d si

mila

r tr

eatm

ents

and

ca

n sh

are

usef

ul in

form

atio

n an

d ad

vice

(see

pag

e 23

).

Your

key

wor

ker

durin

g tr

eatm

ent

is

____

____

____

____

____

____

____

____

__

Your

tre

atm

ent

will

last

:

____

____

____

____

____

____

____

____

__

8Wh

at w

ill h

app

en d

uri

ng

my

trea

tmen

t?O

n yo

ur fi

rst

day,

the

rad

ioth

erap

y m

ay t

ake

up t

o 30

min

utes

. A

fter

tha

t yo

ur r

adio

ther

apy

appo

intm

ent

norm

ally

last

s fo

r ab

out

10-3

0 m

inut

es. T

he r

adio

grap

hers

will

get

you

in t

he

corr

ect

posi

tion;

it t

hen

take

s ab

out

10-2

0 m

inut

es f

or y

our

trea

tmen

t to

be

give

n. Y

ou w

ill b

e al

one

in t

he r

oom

dur

ing

that

tim

e, b

ut t

he r

adio

grap

hers

can

see

you

all

the

time

by

usin

g cl

osed

circ

uit

tele

visi

on. T

hey

will

tel

l you

how

you

can

le

t th

em k

now

if y

ou h

ave

any

prob

lem

s w

hile

you

are

hav

ing

the

trea

tmen

t.

The

num

ber

of t

reat

men

ts y

ou h

ave

depe

nds

on a

few

fa

ctor

s w

hich

the

onc

olog

ist

will

dis

cuss

with

you

.

Ho

w a

re t

he

trea

tmen

ts c

om

bin

ed?

Radi

othe

rapy

is g

iven

as

an o

ut-p

atie

nt, e

ach

day

of t

he w

eek

from

Mon

day

to F

riday

for

six

wee

ks.

If yo

u ar

e re

ceiv

ing

cisp

latin

che

mot

hera

py it

is g

iven

to

you

as a

n in

patie

nt f

or o

ne d

ay d

urin

g sp

ecifi

c w

eeks

of

your

ra

diot

hera

py. Y

ou w

ill b

e st

ayin

g as

an

inpa

tient

at

MV

CC

on

eac

h oc

casi

on f

or o

ne n

ight

.

If yo

u ar

e re

ceiv

ing

carb

opla

tin c

hem

othe

rapy

it is

giv

en a

s a

day

case

in t

he C

hem

o Su

ite f

or 1

-2 h

ours

.

Clin

ical

tri

als

If yo

ur t

reat

men

t is

par

t of

a c

linic

al t

rial y

our

trea

tmen

t m

ay d

iffer

, you

r he

alth

care

tea

m w

ill d

iscu

ss t

his

with

you

. Th

is m

ay c

onsi

st o

f a

7 w

eek

radi

othe

rapy

sch

edul

e w

ith

chem

othe

rapy

giv

en o

n w

eeks

1, 4

and

7.

9

Wh

at s

ide-

effe

cts

am I

likel

y to

hav

e fr

om

m

y ch

emo

ther

apy?

The

deta

ils o

f th

e ch

emot

hera

py d

rug

you

will

be

havi

ng,

alon

g w

ith it

s sp

ecifi

c si

de-e

ffec

ts, w

ill b

e di

scus

sed

with

yo

u at

you

r cl

inic

vis

it.

Befo

re e

ach

chem

othe

rapy

you

will

usu

ally

hav

e a

bloo

d te

st. T

his

is a

rou

tine

chec

k as

the

se d

rugs

aff

ect

bloo

d ce

lls,

part

icul

arly

the

‘whi

te c

ells

’ whi

ch p

rote

ct o

ur b

odie

s fr

om

infe

ctio

n. If

the

num

ber

of b

lood

cel

ls b

ecom

es t

oo lo

w, y

our

chem

othe

rapy

may

nee

d to

be

dela

yed

for

up t

o a

wee

k, t

o al

low

the

blo

od c

ells

to

reco

ver.

Whi

le y

ou a

re r

ecei

ving

che

mot

hera

py, i

f yo

u fe

el p

ain

or

stin

ging

at

the

cann

ula

site

, tel

l the

nur

se s

trai

ght

away

. If

at a

ny t

ime

durin

g yo

ur c

hem

orad

ioth

erap

y yo

u de

velo

p a

feve

r or

bec

ome

unw

ell,

cont

act

the

war

d or

you

r sp

ecia

list

nurs

e im

med

iate

ly (s

ee p

age

2).

Bef

ore

sta

rtin

g t

reat

men

t, p

leas

e re

ad ‘A

pat

ien

t’s

gu

ide

to c

hem

oth

erap

y at

Mo

un

t V

ern

on

Can

cer

Cen

tre’

, av

aila

ble

from

the

LJM

C.

10

Wh

at s

ide-

effe

cts

am I

likel

y to

hav

e fr

om

my

rad

ioth

erap

y?Ra

diot

hera

py k

ills

canc

er c

ells

, but

can

als

o da

mag

e so

me

norm

al c

ells

cau

sing

sid

e-ef

fect

s. T

he s

ide-

effe

cts

you

may

ha

ve w

ill d

epen

d on

whi

ch p

art

of y

our

head

, nec

k, m

outh

or

thr

oat

is b

eing

tre

ated

.

Plea

se r

emem

ber

not

ever

yone

will

hav

e ev

ery

side

eff

ect.

The

mos

t co

mm

on s

ide-

effe

cts

are

liste

d in

the

tab

les

on

page

s 12

-14.

Thes

e si

de-e

ffec

ts d

evel

op g

radu

ally

ove

r th

e co

urse

of

the

trea

tmen

ts a

nd f

or t

he t

wo

wee

ks f

ollo

win

g tr

eatm

ent.

A

fter

thi

s m

ost

will

gra

dual

ly r

educ

e ov

er t

he n

ext

6-12

w

eeks

. But

som

e ch

ange

s m

ay n

ever

go

(may

be

perm

anen

t).

Thes

e w

ill b

e di

scus

sed

in m

ore

deta

il by

you

r on

colo

gist

or

spec

ialis

t nu

rse.

Dur

ing

your

tre

atm

ent,

you

will

be

revi

ewed

wee

kly

by

your

onc

olog

ist,

nur

se, d

ietit

ian

and

som

etim

es a

SA

LT.

At

thes

e ap

poin

tmen

ts y

ou w

ill b

e gi

ven

med

icin

es a

nd a

dvic

e to

hel

p yo

u co

pe w

ith s

ide-

effe

cts.

11

The

day

for

your

rev

iew

clin

ic is

:

____

____

____

____

____

____

____

____

Plea

se b

ring

a lis

t of

any

med

icin

es y

ou n

eed

so t

hat

a ne

w p

resc

riptio

n ca

n be

giv

en. T

ry t

o pl

an a

head

so

tha

t yo

u do

not

run

out

of

med

icin

es. Y

ou c

an le

ave

your

pr

escr

iptio

n at

Pha

rmac

y an

d co

llect

the

nex

t da

y. T

his

help

s to

avo

id lo

ng w

aits

at

Phar

mac

y.

You

will

nee

d to

hav

e a

bloo

d te

st e

very

wee

k du

ring

radi

othe

rapy

.

Ever

yone

rea

cts

and

resp

onds

diff

eren

tly t

o tr

eatm

ent.

Yo

ur h

ealth

car

e te

am w

ill a

dvis

e yo

u ab

out

wha

t yo

u sh

ould

ex

pect

. The

fol

low

ing

page

s gi

ve s

ome

tips

to h

elp

you

man

age

your

sid

e-ef

fect

s.

If y

ou

no

rmal

ly p

ay f

or

NH

S p

resc

rip

tio

ns

Peop

le u

nder

goin

g tr

eatm

ent

for

canc

er d

o no

t ha

ve t

o pa

y N

HS

pres

crip

tion

char

ges

if th

ey h

ave

a va

lid m

edic

al e

xem

ptio

n ce

rtifi

cate

. To

get

an e

xem

ptio

n ce

rtifi

cate

, ask

you

r G

P fo

r an

appl

icat

ion

form

.

12

Sym

pto

mW

hen

will

it

occ

ur?

Ho

w t

o m

anag

e it

?W

hen

will

it

get

bet

ter?

Red/

sore

ul

cera

ted

skin

on

nec

k, f

ace,

up

per

ches

t an

d sh

ould

er(s

ee p

age

15)

Redn

ess

- ar

ound

w

eek

2-3

Ulc

erat

ed/

sore

-

arou

nd

wee

k 4

onw

ards

plea

se d

iscu

ss

the

use

of

crea

ms

with

you

r he

alth

car

e te

am

el

ectr

ic s

have

on

ly

av

oid

perf

umes

, m

ake-

up, t

alcs

et

c

dr

essi

ngs

daily

w

hen

skin

is

ulce

rate

d

Mos

t re

actio

ns

will

hav

e he

aled

by

abou

t 2

wee

ks

afte

r fi n

ishi

ng

trea

tmen

t.

Any

red

ness

or

dark

enin

g of

th

e sk

in w

ill g

et

bett

er o

ver

the

next

8-

12 w

eeks

.

Ulc

erat

ed

mou

th/t

hroa

t/lip

s(s

ee p

age

16)

Abo

ut

wee

k 3

use

your

m

outh

was

h as

pr

escr

ibed

regu

lar

pain

kille

rs

Slow

ly s

ettle

s ov

er

6-10

wee

ks

afte

r fi n

ishi

ng

trea

tmen

t.

Pain

ful

swal

low

ing

(see

pag

e 16

)

Abo

ut

wee

k 2-

3

av

oid

citr

us/s

picy

/sa

lty f

ood

soft

tex

ture

foo

d

us

e re

gula

r pa

inki

llers

revi

ew b

y di

etiti

an

re

view

by

SALT

poss

ible

PEG

tu

be s

uppo

rt

Aft

er fi

nish

ing

trea

tmen

t,

swal

low

ing

impr

oves

and

tu

be f

eedi

ng

is n

ot n

eede

d.

Regu

lar

revi

ew

by d

ietit

ian

and

SALT

are

ne

cess

ary.

Thi

s w

ill a

lso

depe

nd

on w

hat

your

sw

allo

win

g fu

nctio

n w

as

like

befo

re

radi

othe

rapy

.

If yo

u ar

e ha

ving

diffi

cul

ties

with

any

of

the

follo

win

g sy

mpt

oms

plea

se t

ell y

our

head

and

nec

k sp

ecia

list

nurs

e. N

ot e

very

one

will

ha

ve e

very

sid

e ef

fect

.

13

Sym

pto

mW

hen

will

it

occ

ur?

Ho

w t

o m

anag

e it

?W

hen

will

it g

et

bet

ter?

Tast

e ch

ange

(see

pag

e 17

)Fo

r so

me,

ar

ound

w

eek

2 on

war

ds

regu

lar

mou

th

was

h

us

e of

her

bs,

hone

y, s

auce

s to

fl a

vour

foo

ds

Ther

e m

ay b

e so

me

impr

ovem

ents

in

tast

e, a

few

wee

ks

to a

few

mon

ths

afte

r fi n

ishi

ng

trea

tmen

t.

How

ever

for

som

e pa

tient

s th

eir

tast

e ch

ange

s m

ay n

ever

go

aw

ay (t

hey

will

be

per

man

ent)

.

Exce

ss

prod

uctio

n of

muc

us

(thi

ck s

aliv

a)(s

ee p

age

18)

Abo

ut

wee

k 3

regu

lar

mou

th

care

drin

k pl

enty

of

fl uid

s

ne

bulis

ed s

alin

e 6-

8 tim

es a

day

8-12

wee

ks a

fter

fi n

ishi

ng t

reat

men

t.So

me

patie

nts

may

ha

ve c

hang

es t

o th

eir

saliv

a fo

r go

od

(per

man

ently

), ie

. stic

ky o

r th

icke

r sa

liva.

Cha

nge

in

voic

e(s

ee p

age

21)

Wee

k 3-

4

re

view

by

SALT

avoi

d st

rain

ing

to s

peak

depe

nds

on

loca

tion

of

tum

our

8-12

wee

ks a

fter

fi n

ishi

ng t

reat

men

t.So

me

chan

ges

take

man

y m

onth

s to

set

tle. S

ome

stay

for

goo

d (p

erm

anen

t).

Tris

mus

(res

tric

ted

mou

th

open

ing)

Wee

k 3-

4Th

is d

epen

ds o

n w

here

you

r ca

ncer

is

. You

will

be

give

n sp

ecifi

c m

outh

ex

erci

ses

by

your

SA

LT.

This

can

be

a lo

ng

term

pro

blem

. It

is im

port

ant

to d

o re

gula

r m

outh

exe

rcis

es t

o im

prov

e an

d ke

ep

your

abi

lity

to o

pen

your

mou

th. T

hese

ex

erci

ses

are

a lif

etim

e ac

tivity

.

14Sym

pto

mW

hen

will

it

occ

ur?

Ho

w t

o m

anag

e it

?W

hen

will

it

get

bet

ter?

Extr

eme

tired

ness

(see

pag

e 23

)

Wee

k 4-

5

fo

llow

nut

ritio

n pl

an f

rom

di

etiti

an

pl

an r

est

perio

ds

durin

g th

e da

y.

Try

to d

o so

me

gent

le e

xerc

ise

(sho

rt w

alks

) w

hen

you

feel

ab

le t

o

8-12

wee

ks

afte

r fi n

ishi

ng

trea

tmen

t.Tr

y ge

ntle

non

-st

renu

ous

daily

ex

erci

se, g

radu

ally

in

crea

sing

ov

er t

he n

ext

few

mon

ths,

e.

g. w

alki

ng,

swim

min

g. It

may

ta

ke u

p to

12

mon

ths

to f

ully

re

cove

r.

Hai

r lo

ss(s

ee p

age

19)

Wee

k 5

Faci

al h

air

loss

Hai

r at

sid

e/ba

ck o

f he

ad

Elec

tric

Sha

ve. Y

ou

may

fi nd

you

do

not

need

to

shav

e af

ter

a fe

w w

eeks

.Te

mpo

rary

- k

eep

hair

long

er t

o hi

de

if po

ssib

le.

Usu

ally

re-

grow

s w

ithin

3 m

onth

s.

Hai

r m

ay n

ot

grow

bac

k in

th

e ar

ea t

hat

has

been

tre

ated

.

Dry

mou

th(s

ee p

age

16)

Usu

ally

as

soon

as

radi

othe

rapy

ha

s fi n

ishe

d

Wat

er s

pray

.C

arry

a b

ottle

of

wat

er.

Man

y sa

liva

repl

acem

ent

prod

ucts

are

av

aila

ble

(you

r nu

rse

will

hel

p to

fi nd

the

be

st o

ne f

or y

ou).

Som

e pa

tient

s w

ill h

ave

som

e dr

ynes

s fo

r up

to

2 ye

ars

afte

r fi n

ishi

ng

trea

tmen

t.

For

othe

rs t

his

may

sta

y fo

r go

od

(be

perm

anen

t).

Lym

phoe

dem

a(f

acia

l and

ne

ck s

wel

ling)

(see

pag

e 25

)

Som

etim

es

this

can

occ

ur

tow

ards

th

e en

d of

tr

eatm

ent.

U

sual

ly

occu

rs 8

-12

wee

ks a

fter

fi n

ishi

ng

trea

tmen

t

You

will

be

show

n ho

w t

o m

assa

ge

the

area

by

a ly

mph

oede

ma

nurs

e.So

met

imes

you

may

ne

ed a

cou

rse

of

mas

sage

tre

atm

ent.

This

usu

ally

get

s be

tter

bet

wee

n 6-

12 m

onth

s af

ter

your

tre

atm

ent

has

fi nis

hed.

You

may

nee

d to

ca

rry

on d

oing

se

lf m

assa

ge f

or

long

er t

han

12

mon

ths.

15

Ho

w s

ho

uld

I lo

ok

afte

r m

y sk

in?

Your

ski

n m

ay b

ecom

e re

d an

d itc

hy d

urin

g yo

ur r

adio

ther

apy.

Yo

u sh

ould

fol

low

thi

s ad

vice

to

help

you

cop

e w

ith a

ny s

kin

chan

ges:

was

h th

e tr

eate

d ar

ea v

ery

gent

ly u

sing

tep

id w

ater

(war

m

but

not

hot)

and

a m

ild u

nper

fum

ed s

oap.

Pa

t yo

ur s

kin

dry,

usi

ng a

sof

t to

wel

do n

ot u

se m

ake-

up, c

ream

s, p

erfu

mes

, lot

ions

or

afte

rsha

ve in

the

are

a be

ing

trea

ted

try

to le

t th

e ar

ea b

eing

tre

ated

get

as

muc

h ai

r as

pos

sibl

e.

Avo

id w

earin

g tig

ht c

olla

rs

us

e a

moi

stur

iser

. Do

not

put

anyt

hing

els

e on

you

r sk

in in

th

e tr

eate

d ar

ea u

nles

s yo

ur o

ncol

ogis

t ha

s re

com

men

ded

it. If

you

are

in a

ny d

oubt

, ask

you

r he

alth

car

e te

am

ther

e m

ay b

e a

time

in y

our

trea

tmen

t w

hen

your

ski

n be

com

es u

lcer

ated

and

sor

e. If

thi

s ha

ppen

s yo

u w

ill n

eed

dres

sing

s w

hich

will

be

give

n to

you

by

your

hea

d an

d ne

ck

spec

ialis

t nu

rse

your

ski

n w

ill h

eal a

bout

tw

o w

eeks

aft

er y

ou h

ave

fi nis

hed

your

tre

atm

ent.

The

red

ness

will

fad

e ov

er t

he n

ext

few

w

eeks

. Dis

tric

t nu

rse

supp

ort

can

be a

rran

ged

for

afte

r yo

ur

trea

tmen

t, t

o he

lp y

ou w

ith t

he d

ress

ings

men

wis

hing

to

shav

e sh

ould

tak

e ex

tra

care

. Onc

e th

e sk

in

beco

mes

pin

k or

dar

ker

tone

d yo

u sh

ould

sto

p sh

avin

g.

You

will

fi nd

tha

t yo

ur b

eard

sto

ps g

row

ing

at t

his

stag

e

do

not

exp

ose

the

trea

ted

area

to

stro

ng s

unlig

ht b

oth

durin

g an

d af

ter

your

rad

ioth

erap

y. T

his

is b

ecau

se y

our

skin

will

be

mor

e ea

sily

sun

burn

t an

d w

ill t

ake

long

er

to h

eal

in t

he s

umm

er, w

e re

com

men

d th

at y

ou w

ear

a w

ide

brim

med

sun

hat

to

shad

e yo

u fr

om s

tron

g su

nlig

ht

in

the

fut

ure

you

mus

t al

way

s pr

otec

t th

is a

rea

from

the

su

n an

d us

e a

high

fac

tor

sun

crea

m

16

Ho

w s

ho

uld

I lo

ok

afte

r m

y m

ou

th?

you

will

be

give

n ‘T

ello

dont

’ mou

thw

ash

whi

ch w

ill lo

osen

m

ucus

and

ref

resh

you

r m

outh

. You

can

use

thi

s as

oft

en

as y

ou n

eed

if yo

ur m

outh

is b

eing

tre

ated

you

may

als

o be

giv

en

‘Cap

hoso

l’ m

outh

was

h. T

his

will

hel

p to

pre

vent

ulc

ers

from

dev

elop

ing.

It m

ust

be

used

fou

r tim

es a

day

fr

om t

he fi

rst

day

of r

adio

ther

apy.

If y

our

mou

th s

tart

s to

ulc

erat

e yo

ur o

ncol

ogis

t or

nur

se w

ill a

dvis

e yo

u to

in

crea

se u

p to

eig

ht t

imes

a d

ay. A

fter

rin

sing

you

mus

t no

t ea

t or

drin

k fo

r 15

min

utes

brus

h yo

ur t

eeth

with

a s

oft

toot

hbru

sh a

fter

foo

d.

You

may

fi nd

thi

s ge

ts m

ore

diffi

cul

t af

ter

a nu

mbe

r of

tr

eatm

ents

. If

so, s

top

brus

hing

you

r te

eth

and

use

mou

thw

ashe

s

do

not

use

mou

thw

ashe

s w

hich

con

tain

alc

ohol

brus

h de

ntur

es a

fter

foo

d an

d so

ak t

hem

ove

rnig

ht

in d

entu

re c

lean

ing

solu

tion

if po

ssib

le d

o no

t us

e de

ntur

e ad

hesi

ve

use

your

pai

nkill

ers

as t

his

will

mak

e yo

ur m

outh

fee

l mor

e co

mfo

rtab

le. T

hey

wor

k be

tter

if y

ou t

ake

them

reg

ular

ly.

The

spec

ialis

t nu

rse

will

giv

e yo

u ad

vice

and

sup

port

(see

pa

ge 2

2)

av

oid

hot

spic

y fo

ods,

citr

us a

nd t

omat

o ba

sed

food

s.

Als

o av

oid

dry

food

s (m

oist

foo

ds a

re e

asie

r to

man

age)

do n

ot d

rink

any

alco

hol.

Plea

se s

peak

with

a m

embe

r of

yo

ur h

ealth

car

e te

am if

you

fee

l thi

s w

ill b

e di

ffi c

ult

do n

ot s

mok

e. If

thi

s is

a p

robl

em p

leas

e di

scus

s it

with

a

mem

ber

of y

our

heal

th c

are

team

smok

ing

durin

g tr

eatm

ent

will

mak

e yo

ur s

ide-

effe

cts

wor

se, a

nd m

ake

your

rec

over

y tim

e lo

nger

. Sm

okin

g w

ill

also

red

uce

the

effe

ct o

f yo

ur t

reat

men

t on

you

r ca

ncer

(s

ee p

age

20)

17

if yo

u ha

ve b

een

told

to

do ja

w o

peni

ng e

xerc

ises

, it

is

impo

rtan

t yo

u do

the

se. I

f th

is b

ecom

es p

ainf

ul p

leas

e as

k th

e SA

LT f

or a

dvic

e. T

hese

exe

rcis

es w

ill h

elp

to p

reve

nt

futu

re p

robl

ems

with

mou

th o

peni

ng

Ho

w w

ill m

y ta

ste

be

affe

cted

?Yo

ur s

ense

of

tast

e w

ill c

hang

e. P

leas

e se

e th

e LJ

MC

fac

tshe

et

‘Man

agin

g ta

ste

chan

ges’

(see

pag

e 25

). It

may

impr

ove

afte

r yo

ur r

adio

ther

apy

has

fi nis

hed

but

this

may

tak

e se

vera

l m

onth

s. F

or s

ome

patie

nts

thes

e ch

ange

s in

tas

te m

ay n

ever

re

turn

to

how

you

wer

e be

fore

sta

rtin

g tr

eatm

ent.

Wh

at c

an I

eat

or

dri

nk?

It is

impo

rtan

t th

at y

ou a

re w

ell n

ouris

hed

and

do n

ot lo

se

wei

ght

durin

g yo

ur t

reat

men

t. Y

our

trea

tmen

t m

ask

is fi

tted

cl

osel

y. W

eigh

t lo

ss c

an c

ause

the

mas

k to

bec

ome

loos

e an

d m

ay m

ean

that

you

r tr

eatm

ent

need

s to

be

repl

anne

d. T

his

can

caus

e a

dela

y in

you

r tr

eatm

ent.

The

diet

itian

will

tal

k to

you

abo

ut w

ays

to k

eep

your

wei

ght

the

sam

e to

hel

p av

oid

any

dela

ys in

tre

atm

ent.

If y

ou h

ave

a fe

edin

g tu

be, t

he d

ietit

ian

will

adv

ise

you

on h

ow m

uch

pres

crip

tion

feed

and

fl ui

ds y

ou w

ill n

eed.

Fol

low

ing

thei

r in

stru

ctio

ns w

ill h

elp

you

not

to lo

se w

eigh

t.

You

may

hav

e di

ffi c

ulty

che

win

g an

d sw

allo

win

g yo

ur f

ood

beca

use

of t

he p

ain.

A S

ALT

will

be

able

to

offe

r ad

vice

on

cons

iste

ncie

s an

d te

xtur

es o

f fo

od. S

ee t

he L

JMC

fac

tshe

et o

n ‘C

hew

ing

and

swal

low

ing

prob

lem

s’ (s

ee p

age

25).

It is

ver

y im

port

ant

that

you

con

tinue

to

swal

low

dur

ing

the

trea

tmen

t an

d th

e re

cove

ry p

erio

d, e

ven

if it

is o

nly

smal

l sip

s of

tep

id w

ater

or

milk

. Thi

s ke

eps

your

abi

lity

to s

wal

low

, and

he

lps

with

the

reh

abili

tatio

n of

you

r sp

eech

and

sw

allo

win

g.

Plea

se t

alk

to a

SA

LT f

or f

urth

er a

dvic

e, if

you

are

con

cern

ed

or h

avin

g pr

oble

ms.

18

In s

ome

circ

umst

ance

s yo

u m

ay b

e ad

vise

d no

t to

tak

e an

ythi

ng b

y m

outh

and

be

depe

nden

t on

tub

e fe

edin

g.

Your

tea

m w

ill d

iscu

ss t

his

with

you

.

Ho

w w

ill m

y m

ou

th f

eel?

This

dep

ends

on

how

muc

h of

you

r m

outh

is r

ecei

ving

ra

diot

hera

py.

Whe

n yo

u ar

e ab

out

half

way

thr

ough

you

r tr

eatm

ent

you

will

beg

in t

o pr

oduc

e th

ick

muc

us a

nd s

aliv

a. T

here

are

no

med

icin

es a

vaila

ble

to s

top

this

sid

e-ef

fect

hap

peni

ng. S

ome

peop

le m

ay a

lso

feel

sic

k (n

ause

ous)

due

to

the

thic

k m

ucus

. So

met

imes

pat

ient

s fi n

d th

at r

insi

ng t

heir

mou

th c

an h

elp

prev

ent

the

muc

us b

uild

ing

up a

nd r

educ

e so

me

of t

hese

si

de e

ffec

ts.

Spra

ying

wat

er (f

rom

a w

ater

spr

ay b

ottle

) can

hel

p to

lo

osen

the

muc

us. W

hen

you

have

exc

ess

saliv

a or

muc

us

you

may

nee

d to

rin

se y

our

mou

th f

requ

ently

(i.e

. eve

ry

10-1

5 m

inut

es).

Neb

ulis

ed s

alin

e (s

alt

wat

er) o

r st

eam

inha

latio

ns c

an h

elp

to

clea

r th

is m

ucus

and

mak

e yo

u fe

el b

ette

r. Yo

ur h

ealth

car

e te

am m

ay le

nd y

ou a

neb

ulis

er m

achi

ne if

one

is a

vaila

ble.

Pl

ease

ret

urn

it as

soo

n as

you

no

long

er n

eed

it. W

e do

not

al

way

s ha

ve a

neb

ulis

er m

achi

ne a

vaila

ble.

Som

etim

es w

e m

ay

need

to

advi

se y

ou t

o bu

y on

e.

The

radi

othe

rapy

can

aff

ect

the

saliv

ary

glan

ds if

the

y ar

e in

th

e ar

ea b

eing

tre

ated

. If

your

mou

th b

ecom

es d

ry, y

ou m

ay

fi nd

regu

lar

sips

of

wat

er h

elpf

ul.

Do

not

drin

k al

coho

l dur

ing

this

tim

e as

it w

ill in

crea

se t

he

dryn

ess

in y

our

mou

th, a

nd it

will

als

o be

pai

nful

to

swal

low

. M

any

patie

nts

will

alw

ays

have

som

e dr

ynes

s in

the

ir m

outh

. H

owev

er s

ome

patie

nts

fi nd

this

gra

dual

ly g

ets

bett

er f

or u

p to

tw

o ye

ars

afte

r th

ey fi

nish

ed t

heir

trea

tmen

t.

19

Will

I lo

se m

y h

air?

Som

e of

the

hai

r on

you

r fa

ce m

ay s

top

grow

ing.

Thi

s w

ill

depe

nd o

n th

e ex

act

area

you

are

hav

ing

trea

ted.

For

som

e pe

ople

thi

s ha

ir m

ay n

ot g

row

bac

k (m

ay b

e pe

rman

ent)

.

Som

e pe

ople

may

lose

hai

r at

the

bac

k or

sid

e of

the

ir he

ad.

This

hai

r us

ually

sta

rts

to g

row

bac

k a

few

mon

ths

afte

r fi n

ishi

ng t

reat

men

t.

Your

onc

olog

ist

will

tel

l you

whe

ther

you

will

lose

any

hai

r, an

d if

it is

like

ly t

o re

grow

aft

er t

he t

reat

men

t ha

s fi n

ishe

d.

This

will

dep

end

on t

he d

ose

of r

adia

tion

you

will

rec

eive

.

Wh

at s

ho

uld

I d

o if

I n

eed

to

vis

it t

he

den

tist

?A

fter

you

r ra

diot

hera

py, y

ou m

ay b

e m

ore

pron

e to

too

th

deca

y. It

is v

ery

impo

rtan

t to

tel

l you

r de

ntis

t ab

out

your

ra

diot

hera

py, a

nd a

ny o

ther

tre

atm

ent

you

have

had

.

Onc

e yo

ur t

reat

men

t is

fi ni

shed

, it

is im

port

ant

to b

rush

you

r te

eth

thre

e tim

es a

day

aft

er m

eals

with

a fl

uorid

e to

othp

aste

. A

fl uo

ride

gum

tra

y m

ay b

e us

ed, y

ou c

an g

et t

his

from

you

r de

ntis

t/hy

gien

ist.

You

are

stro

ngly

adv

ised

to

see

your

den

tist

and

oral

hyg

ieni

st

ever

y th

ree

to s

ix m

onth

s. In

the

fut

ure

if yo

u ne

ed a

ny

dent

al w

ork

to t

he t

reat

ed ja

w a

rea,

the

bon

e m

ay n

ot h

eal

prop

erly

and

thi

s m

ay c

ause

oth

er p

robl

ems.

For

thi

s re

ason

it

is im

port

ant

that

you

ask

you

r on

colo

gist

bef

ore

havi

ng a

ny

dent

al t

reat

men

t to

thi

s ar

ea.

Aft

er y

our

trea

tmen

t ha

s fi n

ishe

d yo

ur o

ncol

ogis

t w

ill b

e pl

ease

d to

ans

wer

any

que

ries

from

you

r de

ntis

t. P

leas

e gi

ve

your

den

tist

your

onc

olog

ist’s

sec

reta

ry’s

phon

e nu

mbe

r (s

ee

page

2).

20

Can

I h

ave

den

ture

s o

r im

pla

nts

?Yo

u m

ay n

ot b

e ab

le t

o w

ear

dent

ures

for

a f

ew m

onth

s af

ter

trea

tmen

t. T

his

will

dep

end

on h

ow m

uch

of y

our

mou

th is

tr

eate

d. U

sual

ly n

ew d

entu

res

shou

ld n

ot b

e m

ade

until

six

m

onth

s af

ter

your

tre

atm

ent.

Thi

s is

to

allo

w t

ime

for

your

gu

ms

to h

eal a

nd f

or a

ny c

hang

es in

you

r m

outh

to

sett

le.

Den

tal i

mpl

ants

are

not

sui

tabl

e fo

r al

l pat

ient

s. Y

ou w

ill n

eed

an a

sses

smen

t by

a h

ead

and

neck

(max

illof

acia

l) su

rgeo

n to

fi n

d ou

t if

impl

ants

are

sui

tabl

e fo

r yo

u.

Wh

at w

ill h

app

en if

I sm

oke

?Yo

ur o

ncol

ogis

t or

spe

cial

ist

nurs

e w

ill d

iscu

ss t

his

with

you

. W

e re

com

men

d th

at y

ou s

top

sm

okin

g co

mpl

etel

y. T

his

is

beca

use

smok

ing

incr

ease

s th

e ul

cera

tion

and

pain

.

Your

onc

olog

ist

will

dis

cuss

thi

s w

ith y

ou a

nd w

ill r

ecom

men

d th

at y

ou g

ive

up s

mok

ing

both

dur

ing

trea

tmen

t an

d af

terw

ards

.

Giv

ing

up s

mok

ing

will

ens

ure

you

give

you

rsel

f th

e be

st

chan

ce t

o re

cove

r fr

om c

ance

r. Th

is is

bec

ause

nic

otin

e in

ci

gare

ttes

cau

ses

the

bloo

d ve

ssel

s to

shr

ink

(vas

ocon

stric

tion)

an

d th

is m

ay m

ake

your

tre

atm

ent

less

eff

ectiv

e.

Mak

e ev

ery

effo

rt n

ot t

o re

-sta

rt s

mok

ing

afte

r yo

ur t

reat

men

t ha

s fi n

ishe

d. If

you

do

smok

e th

ere

may

be

an in

crea

sed

risk

of s

ome

long

ter

m s

ide

effe

cts.

If y

ou w

ant

mor

e in

form

atio

n,

plea

se a

sk y

our

onco

logi

st o

r nu

rse.

If y

ou

sm

oke

yo

ur

can

cer

is m

ore

like

ly t

o r

etu

rn.

Nic

otin

e re

plac

emen

t tr

eatm

ents

are

ava

ilabl

e on

pre

scrip

tion.

Yo

ur o

ncol

ogis

t or

GP

will

be

able

to

pres

crib

e th

em f

or

you.

Ple

ase

ask

at t

he L

JMC

for

leafl

ets

to

help

you

giv

e up

sm

okin

g. Y

ou c

an a

lso

cont

act

the

NH

S sm

okin

g he

lplin

e (s

ee

page

29)

.

21

Will

I lo

se m

y vo

ice?

If yo

u ar

e ha

ving

rad

ioth

erap

y to

you

r th

roat

, it

is li

kely

tha

t yo

ur v

oice

will

get

hoa

rse.

You

may

als

o lo

se y

our

voic

e co

mpl

etel

y at

som

e st

age.

Bec

ause

of

this

it is

bes

t to

:

rest

you

r vo

ice

as m

uch

as p

ossi

ble

durin

g yo

ur t

reat

men

t

do

n’t

stra

in t

o m

ake

it lo

uder

whe

n it

is q

uiet

do

n’t

over

-tal

k w

hen

it se

ems

stro

nger

Aft

er y

our

trea

tmen

t ha

s fi n

ishe

d, it

may

be

a fe

w w

eeks

be

fore

you

r vo

ice

star

ts t

o re

cove

r. It

may

rem

ain

husk

y fo

r so

me

time.

The

SA

LT w

ill b

e ab

le t

o of

fer

advi

ce a

nd s

uppo

rt.

Wh

at if

I h

ave

a la

ryn

gec

tom

y?If

you

have

had

a la

ryng

ecto

my

and

are

usin

g a

spea

king

val

ve

you

will

not

be

able

to

wea

r yo

ur b

ase

plat

e du

ring

trea

tmen

t.

This

is b

ecau

se it

will

irrit

ate

the

skin

aro

und

your

sto

ma.

We

advi

se y

ou t

o w

ear

a st

oma

butt

on a

nd a

spe

cial

bib

.

You

will

nee

d to

neb

ulis

e re

gula

rly (s

ix t

o ei

ght

times

per

day

) to

kee

p yo

ur s

ecre

tions

loos

e an

d ea

sy t

o cl

ear.

It is

impo

rtan

t yo

u al

way

s w

ear

the

spec

ial b

ib p

rovi

ded

to

help

kee

p yo

ur s

ecre

tion

moi

st a

nd a

irway

cle

ar. Y

ou m

ay a

lso

fi nd

it ea

sier

to

use

suct

ion

to c

lear

you

r se

cret

ions

.

Your

hea

d an

d ne

ck s

peci

alis

t nu

rses

will

sho

w y

ou h

ow

to d

o th

is.

22

Wh

at c

an I

do

to

hel

p m

ysel

f?

yo

u w

ill b

e gi

ven

med

icin

es t

o he

lp m

anag

e so

me

of y

our

side

eff

ects

. The

se w

ill in

clud

e pa

inki

llers

to

help

you

fe

el c

omfo

rtab

le w

hile

eat

ing

and

drin

king

. It

is u

sual

for

pa

tient

s to

be

on s

tron

g pa

inki

llers

by

the

end

of t

reat

men

t an

d fo

r so

me

wee

ks a

fter

tre

atm

ent

whi

le t

he t

issu

es h

eal.

Your

hea

lth c

are

team

will

dis

cuss

how

to

take

pai

nkill

ers

regu

larly

so

that

the

y ar

e m

ost

effe

ctiv

e, h

elpi

ng t

o ke

ep

any

pain

und

er c

ontr

ol. P

leas

e us

e yo

ur p

aink

iller

s as

ad

vise

d an

d te

ll on

e of

you

r he

alth

car

e te

am if

you

are

ha

ving

any

sid

e ef

fect

s fr

om t

hem

. The

se s

ide

effe

cts

can

be m

anag

ed s

o th

at y

ou s

tay

com

fort

able

and

abl

e to

car

ry

on w

ith d

aily

act

iviti

es

at

ten

d t

he

wee

kly

Mo

nd

ay r

evie

w c

linic

dur

ing

your

tr

eatm

ent.

You

will

be

seen

by

the

onco

logi

st, s

peci

alis

t nu

rse,

die

titia

n an

d SA

LT. T

his

may

mea

n yo

u ar

e in

the

cl

inic

for

a f

ew h

ours

follo

w y

our

nutr

ition

pla

n fr

om t

he d

ietit

ian.

If y

ou n

eed

mor

e ad

vice

ple

ase

ask

it is

ver

y im

port

ant

that

you

fol

low

the

adv

ice

for

look

ing

afte

r yo

ur m

outh

. Reg

ular

mou

th c

are

will

hel

p w

ith y

our

com

fort

and

the

pre

vent

ion

of in

fect

ion

if yo

u ha

ve a

ny c

once

rns

or q

uest

ions

tal

k to

you

r he

alth

ca

re t

eam

Ho

w w

ill I

feel

on

ce m

y tr

eatm

ent

has

fi n

ish

ed?

With

in 8

-12

wee

ks o

f fi n

ishi

ng y

our

radi

othe

rapy

, mos

t of

you

r si

de-e

ffec

ts w

ill h

ave

sett

led.

Som

e w

ill c

arry

on

to im

prov

e ov

er m

any

mon

ths,

but

som

e ch

ange

s m

ay s

tay.

You

may

hav

e on

goin

g di

ffi c

ulty

che

win

g an

d sw

allo

win

g yo

ur

food

. If

this

hap

pens

a S

ALT

will

giv

e yo

u ad

vice

on

cons

iste

ncy

and

text

ures

of

food

. The

y w

ill s

ugge

st s

wal

low

ing

tech

niqu

es

whi

ch m

ay b

e ea

sier

for

you

. The

die

titia

n w

ill a

dvis

e yo

u ab

out

wha

t fo

ods

to e

at s

o th

at y

ou g

et t

he r

ight

nut

ritio

n to

he

lp y

ou r

ecov

er f

rom

you

r tr

eatm

ent.

23

Mos

t pa

tient

s fe

el t

ired

and

leth

argi

c at

som

e st

age

durin

g an

d af

ter

thei

r ra

diot

hera

py. T

his

is t

o be

exp

ecte

d. F

or s

ome

patie

nts

this

can

last

man

y m

onth

s or

eve

n ye

ars.

Try

to

pace

yo

urse

lf an

d no

t do

too

muc

h. S

ome

gent

le e

xerc

ise

can

help

w

ith t

iredn

ess.

See

the

LJM

C f

acts

heet

‘Liv

ing

with

tire

dnes

s (f

atig

ue)’

(see

pag

e 25

).

It is

unw

ise

to b

ecom

e su

nbur

nt o

n an

y pa

rt o

f yo

ur b

ody.

Tr

y no

t to

exp

ose

the

trea

ted

area

to

the

sun

at a

ny t

ime.

Yo

u w

ill n

eed

to a

pply

a h

igh

prot

ectiv

e fa

ctor

sun

cre

am t

o th

e tr

eate

d ar

ea f

or t

he fi

rst

year

aft

er y

our

trea

tmen

t if

you

cann

ot k

eep

it co

vere

d w

hen

you

are

in t

he s

un.

Plea

se a

sk y

our

onco

logi

st o

r sp

ecia

list

nurs

e fo

r ad

vice

on

how

to

deal

with

long

-ter

m s

ympt

oms.

Wh

ere

can

I g

et h

elp

?O

ften

peo

ple

who

hav

e ha

d ca

ncer

say

tha

t du

ring

thei

r ill

ness

th

ey h

ave

a ra

nge

of e

mot

ions

, exp

ecte

d an

d un

expe

cted

. M

any

peop

le fi

nd it

a s

tres

sful

, anx

ious

and

con

fusi

ng t

ime,

fo

r th

emse

lves

and

the

ir fa

mily

and

frie

nds.

So

me

patie

nts

fi nd

it he

lpfu

l to

mee

t an

d di

scus

s th

eir

expe

rienc

es w

ith o

ther

pat

ient

s w

ho h

ave

been

thr

ough

si

mila

r tr

eatm

ent.

If y

ou w

ould

like

us

to a

rran

ge f

or y

ou

to m

eet

anot

her

patie

nt p

leas

e sp

eak

to a

mem

ber

of y

our

heal

th c

are

team

.

Furt

her

supp

ort/

info

rmat

ion

avai

labl

e:

the

Hea

d a

nd

Nec

k C

ance

r Su

pp

ort

Gro

up

mee

ts o

n th

e se

cond

Tue

sday

of

each

mon

th a

t 4p

m a

t th

e Po

st

Gra

duat

e C

entr

e at

Mou

nt V

erno

n H

ospi

tal.

You

do n

ot

need

to

book

, jus

t tu

rn u

p. It

off

ers

a ch

ance

for

pat

ient

s an

d ca

rers

to

shar

e th

eir

expe

rienc

es, d

iscu

ss c

once

rns

and

get

prac

tical

adv

ice.

A h

ead

and

neck

spe

cial

ist

nurs

e is

al

way

s at

thi

s gr

oup

24

go t

o w

ww

.ljm

c.or

g an

d fo

llow

the

link

s to

info

rmat

ion

for

patie

nts

with

can

cer

to t

he h

ead,

nec

k, m

outh

or

thro

at

w

ebsi

te: M

ovin

g on

fro

m H

ead

and

Nec

k C

ance

rFa

cebo

ok p

age:

Mov

ing

on f

rom

Hea

d an

d N

eck

Can

cer.

Thes

e ha

ve b

een

deve

lope

d by

our

pat

ient

sup

port

gro

up

to h

elp

info

rm a

nd s

uppo

rt y

ou

‘M

ovi

ng

on

fro

m H

ead

an

d N

eck

Can

cer’

is a

tw

o da

y se

lf-he

lp w

orks

hop

for

patie

nts

and

care

rs. W

e re

com

men

d th

at a

ll ou

r pa

tient

s at

tend

. Car

ers

are

also

wel

com

e. Y

ou

will

be

give

n im

port

ant

info

rmat

ion

abou

t liv

ing

wel

l aft

er

head

and

nec

k ca

ncer

tre

atm

ent

and

how

to

cope

with

any

si

de-e

ffec

ts. P

leas

e ca

ll th

e he

ad a

nd n

eck

nurs

es o

n 02

0 38

26 2

089

for

mor

e in

form

atio

n ab

out

this

wor

ksho

p

H

ead

an

d N

eck

Can

cer

‘Wh

at c

an I

tell

You

’ vid

eos.

Th

is is

a s

erie

s of

sho

rt v

ideo

s de

velo

ped

by t

he h

ead

and

neck

pat

ient

gro

up a

t M

ount

Ver

non

Can

cer

Cen

tre.

The

y gi

ve a

n in

sigh

t in

to s

ome

conc

erns

you

may

hav

e be

fore

, du

ring

and

afte

r tr

eatm

ent.

Go

to w

ww

.ljm

c.or

g an

d fo

llow

the

link

s to

info

rmat

ion

for

patie

nts

with

can

cer

to

the

head

, nec

k, m

outh

or

thro

atSo

me

patie

nts

fi nd

it ha

rder

to

mak

e de

cisi

ons

or t

o fa

ce u

p to

thi

ngs.

Som

e fe

el o

verw

helm

ed a

nd a

re u

nabl

e to

foc

us

on p

ositi

ve a

spec

ts in

the

ir liv

es. I

f yo

u ha

ve d

iffi c

ulty

mak

ing

sens

e of

you

r fe

elin

gs o

r ca

n re

late

to

any

of t

hese

fee

lings

, yo

u m

ay fi

nd it

hel

pful

to

talk

to

a tr

aine

d he

alth

pro

fess

iona

l. Yo

u ca

n be

ref

erre

d fo

r co

unse

lling

if y

ou f

eel t

his

wou

ld b

e he

lpfu

l.

The

LJM

C p

rovi

des

supp

ort

and

info

rmat

ion.

It o

ffer

s a

rang

e of

ser

vice

s in

clud

ing

coun

selli

ng, c

ompl

emen

tary

the

rapi

es,

rela

xatio

n se

ssio

ns a

nd b

enefi

ts

advi

ce. T

here

are

mor

e de

tails

ab

out

the

LJM

C o

n th

e ba

ck o

f th

is le

afl e

t.

The

LJM

C a

lso

prod

uces

a s

erie

s of

fac

tshe

ets

on a

var

iety

of

topi

cs in

clud

ing

side

-eff

ects

of

radi

othe

rapy

.

25

List

ed b

elow

are

som

e of

the

titl

es w

hich

you

may

fi nd

hel

pful

:

Alc

ohol

issu

es

C

hew

ing

and

swal

low

ing

prob

lem

s

Li

ving

with

tire

dnes

s (f

atig

ue)

Loss

of

appe

tite

Man

agin

g ta

ste

chan

ges

LJM

C a

lso

has

a ra

nge

of le

afl e

ts f

rom

oth

er o

rgan

isat

ions

, and

ca

n gi

ve y

ou a

dvic

e ab

out

furt

her

info

rmat

ion.

Plea

se d

rop

in t

o th

e LJ

MC

for

a c

opy

of a

ny o

f th

ese

or

dow

nloa

d th

em f

rom

the

LJM

C w

ebsi

te: w

ww

.ljm

c.or

g.

Will

I n

eed

to

hav

e p

hys

ioth

erap

y?

We

advi

se p

atie

nts

who

hav

e ha

d su

rger

y an

d/or

rad

ioth

erap

y to

att

end

for

phys

ioth

erap

y. Y

ou w

ill b

e gi

ven

inst

ruct

ions

on

exe

rcis

es t

o im

prov

e ne

ck a

nd s

houl

der

mov

emen

t.

Your

doc

tors

, spe

cial

ist

nurs

e or

SA

LT w

ill r

efer

you

to

the

phys

ioth

erap

ist.

Wh

at is

lym

ph

oed

ema?

Whe

n yo

ur in

itial

sid

e-ef

fect

s of

tre

atm

ent

have

eas

ed, y

ou

may

not

ice

swel

ling

arou

nd t

he n

eck

area

or

unde

r th

e ch

in.

This

hap

pens

bec

ause

the

fl ui

d fr

om t

he h

ead

and

neck

are

a m

ay n

ot b

e ab

le t

o dr

ain

away

fro

m t

he t

issu

es in

tha

t ar

ea.

This

is a

n ef

fect

of

surg

ery

and/

or r

adio

ther

apy.

It is

cal

led

lym

phoe

dem

a. It

may

hap

pen

6-12

wee

ks a

fter

fi ni

shin

g ra

diot

hera

py.

If th

is h

appe

ns t

o yo

u pl

ease

tel

l you

r on

colo

gist

or

nurs

e.

They

will

arr

ange

for

you

to

be s

een

by a

lym

phoe

dem

a th

erap

ist

who

will

use

spe

cial

mas

sage

tec

hniq

ues

to im

prov

e th

e ci

rcul

atio

n of

fl ui

d in

the

se a

reas

. Thi

s w

ill u

sual

ly s

ettle

ov

er t

ime.

26

Wh

en w

ill I

see

the

on

colo

gis

t af

ter

my

trea

tmen

t h

as fi

nis

hed

?Yo

u w

ill b

e se

en w

eekl

y fo

r ab

out

six

to e

ight

wee

ks a

fter

yo

ur t

reat

men

t ha

s fi n

ishe

d. T

his

will

dep

end

on t

he t

ype

of

trea

tmen

t an

d th

e si

de e

ffec

ts y

ou h

ave.

You

r sp

ecia

list

nurs

e or

rad

iogr

aphe

r w

ill a

dvis

e yo

u w

hen

you

will

be

seen

.

As

soon

as

your

sid

e-ef

fect

s ha

ve s

ettle

d yo

u w

ill b

e re

ferr

ed

back

to

your

orig

inal

hos

pita

l or

clin

ic t

o se

e yo

ur o

ncol

ogis

t,

surg

eon,

SA

LT, d

ietit

ian

and

nurs

e.

To s

tart

with

you

will

be

seen

the

re e

very

fou

r to

six

wee

ks.

As

time

pass

es t

hese

app

oint

men

ts w

ill b

e le

ss f

requ

ent

i.e.

ever

y tw

o to

six

mon

ths.

The

rea

son

for

thes

e ap

poin

tmen

ts

is t

o ch

eck

that

you

r si

de-e

ffec

ts h

ave

sett

led

and

that

you

r ca

ncer

is n

ot r

etur

ning

.

You

shou

ld b

e co

ntac

ted

with

a d

ate

for

the

fi rst

of

thes

e ap

poin

tmen

ts w

ithin

tw

o w

eeks

of

your

last

app

oint

men

t at

M

ount

Ver

non.

If y

ou h

ave

not

hear

d fr

om u

s, p

leas

e co

ntac

t yo

ur c

onsu

ltant

’s se

cret

ary

(see

pag

e 2)

.

Ho

w c

an I

get

to

ho

spit

al?

If po

ssib

le p

atie

nts

shou

ld p

rovi

de t

heir

own

tran

spor

t to

ho

spita

l. Th

is m

ay m

ean

that

you

sta

rt y

our

trea

tmen

t so

oner

an

d th

at y

ou w

ill n

ot h

ave

long

wai

ts f

or y

our

tran

spor

t to

tak

e yo

u ba

ck h

ome.

You

mig

ht li

ke t

o ha

ve a

frie

nd o

r re

lativ

e co

me

with

you

.

If yo

u pr

ovid

e yo

ur o

wn

tran

spor

t, y

ou c

an g

et h

elp

with

you

r tr

avel

cos

ts (b

us, t

rain

or

car

mile

age)

if y

ou a

re g

ettin

g an

y of

th

e fo

llow

ing

bene

fi ts:

Inco

me

Supp

ort

Inco

me-

base

d Jo

bsee

ker’s

Allo

wan

ce

In

com

e-ba

sed

Empl

oym

ent

and

Supp

ort

Allo

wan

ce

U

nive

rsal

cre

dit

27

the

Gua

rant

ee C

redi

t pa

rt o

f Pe

nsio

n C

redi

t

or

if y

ou h

ave

an H

C2

or H

C3

cert

ifi ca

te.

If yo

u ar

e el

igib

le, t

he P

atie

nt A

ffai

rs D

epar

tmen

t w

ill p

ay

your

tra

velli

ng e

xpen

ses.

The

y w

ill a

lso

prov

ide

you

with

a

toke

n fo

r th

e ca

r pa

rk. Y

ou w

ill n

eed

to b

ring

proo

f th

at y

ou

rece

ive

one

of t

he b

enefi

ts,

you

r tr

avel

rec

eipt

s an

d yo

ur

appo

intm

ent

lett

er. P

atie

nt A

ffai

rs is

loca

ted

at t

he m

ain

hosp

ital r

ecep

tion

near

the

res

taur

ant

and

is o

pen

Mon

day

- Fr

iday

, 8.3

0am

- 4

.30p

m.

Dep

artm

ent

of W

ork

and

Pens

ions

(DW

P) r

ules

sta

te t

hat

we

cann

ot r

efun

d ta

xi f

ares

. You

r he

ad a

nd n

eck

nurs

e ca

n ap

ply

for

a M

acm

illan

gra

nt w

hich

can

be

used

tow

ards

tra

vel c

osts

. Th

is is

mea

ns t

este

d.

If yo

u ar

e on

a lo

w in

com

e, o

r tr

avel

ling

long

dis

tanc

es b

ut

not

gett

ing

any

of t

he a

bove

ben

efi t

s, y

ou m

ay s

till b

e ab

le

to g

et s

ome

help

. Get

the

HC

1 cl

aim

for

m f

rom

you

r lo

cal

DW

P of

fi ce

or P

atie

nt A

ffai

rs D

epar

tmen

t. T

his

gran

t is

mea

ns

test

ed.

If yo

u ar

e un

able

to

prov

ide

your

ow

n tr

ansp

ort,

hos

pita

l tr

ansp

ort

can

be r

eque

sted

but

48

hour

s no

tice

is r

equi

red.

Pl

ease

spe

ak t

o a

mem

ber

of y

our

heal

th c

are

team

if y

ou

need

tra

nspo

rt. I

f yo

u w

ish

to c

ance

l you

r tr

ansp

ort,

ple

ase

give

as

muc

h no

tice

as p

ossi

ble.

If yo

u ha

ve a

mor

ning

rad

ioth

erap

y ap

poin

tmen

t yo

u w

ould

ne

ed t

o be

rea

dy f

or p

ick

up f

rom

7.0

0 am

onw

ards

. If

you

have

an

afte

rnoo

n ap

poin

tmen

t yo

u ne

ed t

o be

ava

ilabl

e fr

om

12.0

0pm

onw

ards

. We

cann

ot g

ive

an e

xact

pic

k up

tim

e.

28

Am

I en

titl

ed t

o fi

nan

ce h

elp

?If

you

wor

k, it

is a

dvis

able

to

info

rm y

our

empl

oyer

tha

t yo

u m

ay n

eed

up t

o si

x to

nin

e m

onth

s of

f w

ork.

We

know

tha

t th

is w

ill im

pact

upo

n yo

ur h

ouse

hold

inco

me,

an

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you

to c

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he b

enefi

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advi

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at

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LJM

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ee b

ack

cove

r). A

dvic

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als

o av

aila

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on b

enefi

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for

care

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site

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Use

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Let’

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with

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Jack

son

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to p

atie

nts

and

thei

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mili

es a

nd is

lo

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Sui

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taff

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Peop

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Mou

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LJM

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incl

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a ra

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31

Co

nse

nt

It is

a le

gal r

equi

rem

ent

to h

ave

a si

gned

con

sent

for

m

from

you

bef

ore

the

star

t of

you

r tr

eatm

ent.

If yo

u ha

ve a

lread

y be

en g

iven

one

of

thes

e fo

rms,

ple

ase

brin

g th

e co

mpl

eted

for

m w

ith y

ou w

hen

you

com

e fo

r yo

ur fi

rst

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intm

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If yo

u ha

ve n

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een

give

n a

form

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s w

ill b

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with

yo

u at

you

r fi r

st a

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Iden

tifi

cati

on

Plea

se n

ote

that

it is

a le

gal r

equi

rem

ent

for

the

staf

f to

che

ck

your

nam

e an

d de

tails

aga

inst

you

r tr

eatm

ent

shee

t ev

ery

time

you

atte

nd.

Preg

nan

cy/f

ath

erin

g a

ch

ildFe

mal

e pa

tient

s m

ust

not

be p

regn

ant

or b

ecom

e pr

egna

nt

and

mal

e pa

tient

s m

ust

not

fath

er a

chi

ld d

urin

g a

cour

se o

f ra

diot

hera

py o

r fo

r so

me

mon

ths

afte

rwar

ds. P

leas

e d

iscu

ss

this

wit

h y

ou

r ca

nce

r sp

ecia

list.

If yo

u th

ink

ther

e is

a c

hanc

e, h

owev

er s

mal

l, of

you

or

your

pa

rtne

r be

ing

preg

nant

dur

ing

trea

tmen

t, it

is e

xtre

mel

y im

port

ant

that

you

dis

cuss

thi

s w

ith y

our

onco

logi

st,

radi

ogra

pher

or

nurs

e as

soo

n as

pos

sibl

e.

Fem

ale

patie

nts

will

be

aske

d to

con

fi rm

the

ir pr

egna

ncy

stat

us

prio

r to

rad

ioth

erap

y. T

his

appl

ies

to a

ll w

omen

bet

wee

n th

e ag

es o

f 12

- 5

5 ye

ars.

Thi

s is

a le

gal r

equi

rem

ent.

This

pub

licat

ion

has

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Info

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m M

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