Bárbara Dias and João Marques - Radiotherapists at the Champalimaud Clinical Centre
Bárbara Dias and João Marques are Radiation Therapists at the Champalimaud Clinical Centre and they have kindly agreed to tell us about their work and the developments of the last five years in one of the key areas of the Champalimaud Centre.
Bárbara Dias and João Marques are Radiation Therapists at the Champalimaud Clinical Centre. They have both been with us since the Centre opened, when they were one-third of a six-person Radiation Therapy team. Five years later, their department has doubled in size and they have kindly agreed to tell us about their work and the developments of the last five years in one of the key areas of the Champalimaud Centre.
What exactly is a Radiation Therapist?
João: A radiation therapist is a health professional that administers radiation treatment. We have many different aspects to our job, but basically, we are involved from the beginning to the end of the radiotherapeutic process: we work from the simulation/planning CT, to the planning of the treatment and, finally, to the radiation treatment itself. For this reason, we work closely with the doctors, nurses, physicists, dosimetrists – everybody who is responsible for the health and care of the patient.
Can you tell us about the treatment itself, and the equipment you use?
Bárbara: All of the equipment we use basically does the same thing, from the patient’s point of view. But the radiation treatment is much less invasive than other treatments. It doesn’t burn, which lots of patients worry about. In fact, the patients don’t feel anything during treatment. There is nothing to see for the patient, they don’t smell or hear anything at all.
J: The important thing is for the patient to be in the same position that they are during the simulation, to allow us to administer the treatment accurately. It really helps if the patients are calm and relaxed, because if they are tense and nervous, they tend to move around and it’s more difficult to be precise.
B: And we have really good protocols that allow us to spend more time on each patient, both in terms of planning and actually during the treatment itself, meaning that we can really decrease and control most of the side effects.
Talk us through the usual process with a patient.
B: It’s always a little different for every patient, but usually, the patient has a consultation with one of the radio-oncology doctors and if the doctor thinks that radiation therapy may be appropriate, the patient will have a planning exam, usually a CT scan or a MRI or a PET-CT, or all three. We call this the Simulation, because it is pre-treatment. Then, the patient goes home because we will use the images to start working on the plan to delimit the structures of interest (target and organs). After this, using a planning system, the physicists and ourselves plan the distribution of the dose, and the physicist verifies the treatment to guarantee its safety and efficacy.
J: It’s an interesting part of our job – that we are with the patient from the first contact, at the simulation stage, right through the treatment and sometimes for many years later, for monitoring and follow-up tests. It means we build really strong relationships with the patients.
What has changed over the last five years?
B: Of course, the technology has moved on, and the equipment we use has become more precise, more efficient. But the biggest change has been in ourselves, I think! I started here at 22, and it was my first real job. But, because we were here from the beginning, I think we have grown with the technology. The most important thing is that we have grown to have the confidence to say “I’m not happy with this image; let’s do it again” and that comes from the trust that the doctors have in us.
J: That’s true. We have created a really great relationship with the doctors, the physicists and the therapists over the last five years, and that allows us to trust each other completely. On top of that, as the equipment has become more complex, our planning has also needed to become more precise and more efficient. Our processes have improved a lot, providing a higher quality of treatment. Besides having the most up-to-date technology, more important is our capacity to help our patients, which we think has improved a lot over the years.
What do you anticipate for the future in radiation therapy?
B: That is very difficult to say - every day here there is something new. Colleagues that have been working in our field for much longer than us say that the last five years have been the most exciting, and that seems to be continuing as new techniques and equipment are developed.
How do you keep on top of these innovations?
J: We go to meetings, workshops; we read all of the articles and literature available. Some of us are also teaching, so we have to do research on new techniques. And we receive visitors from all over the world who come here to exchange ideas with us, where we can show them our ways of doing things and they can let us know if they do things differently. But it’s important to constantly want to learn more and adapt our knowledge.
B: In university, you learn the basics, and when new machines emerge, this training that you have received means that you know what that machine does, but you need to learn how to use it. So, we have training and practice on these new machines, and it’s great for us that we are given this time to learn and improve.
What’s the best part of being a Radiation Therapist?
B: When we receive a patient, we see them regularly for at least a month. You can build really good relationships in that time.
J: For that month, we are part of the patient’s life. We are here for treatment, but we are also here to talk and to listen. Patients have lots of questions about their illnesses and treatment, but they also like to talk about other things: their families, the last Benfica game or whatever.
B: We try to be there if the patient wants to forget about their condition for a little while. Patients are always leaving messages for us saying things like “tell the curly haired one (they don’t always remember my name, but that’s fine!) that my granddaughter passed her school tests” because they don’t see us just as part of the medical team, sometimes they treat you like part of the family. Some of these people have been sick for a long time, and their days are filled with thoughts of cancer and medicine and treatment; we try to provide a release for that. And there is a medical reason behind that too; if you notice that somebody who is normally very talkative is suddenly quiet, for example, this can be a sign that something needs to be looked at in their treatment.
J: Of course, the most rewarding part of the job is when you have a patient who you have treated and they come back one, two, three years later for check-ups and they thank you and tell you that they feel healthy. Sometimes they call in just to say hello, or wish you Merry Christmas and that’s very cool.
What would you say to any patient that is about to receive radiation therapy, and maybe is a little nervous about it?
B: Just don’t panic. Try to be as calm as you can be. We always tell the patients that it won’t hurt beforehand, but they don’t believe us! And then when they have finished, you can see that they were expecting it to be much more uncomfortable than it really is.
J: I would tell them to have confidence in us. Lots of patients come with information from the internet, or some experience that a friend of a friend told them about - and it’s really important to be informed - but every patient is different and the treatment experience is different for everyone.
B: That’s true. There is no standard treatment, so the patient will be more relaxed and the results will be better if they trust us. The whole process is more difficult for everybody if the patient is stressed or anxious, and it is part of our job to try to reduce these negative ideas, but it helps if the patient comes with a good frame of mind.
J: Often a patient will say ‘thank you’ at the end of the treatment and that is really nice, but I always tell them that they are also responsible for the treatment going well.
B: That’s right, I tell my patients that they are not just here for treatment, but they are actually part of the treatment team.